Best Practices: Treatment and Rehabilitation for Women with Substance Use Problems

8.0 Treatment Principles and Values

8.1 Treatment Principles and Values: Key Expert Perspectives

Key experts identified 13 basic treatment principles and values which underlie the effective treatment of women with substance use problems. These principles and values address structural, organizational and philosophical elements of treatment.

Table 8: Overall Principles and Values of Treatment: Key Expert Perspectives

Treatment Principles and Values	Key Expert Quotes
Treatment for women should be based on choice (a "menu" of choices and a variety of options).	Offer a variety, extensive menu.
Treatment should support a harm reduction approach.	Lapsing is to be expected and can be explored. Use addiction management approach--don't have to adopt abstinence model.
Treatment should address all aspects of a woman's life.	Look at the person's whole being, not just the addiction. Use a holistic approach.
Treatment should address practical needs (housing, transportation, child care and job training).	Address issues around parenting ... , job training ..., provide child care.
Treatment should support connections between women.	Help make connections with other women, other mothers. Empowering women to help them support each other.
Treatment should be gender specific (i.e. completely gender specific or gender-specific component of a co-ed program).	Do specific women's programming. Do women-focussed, gender-specific programming.
Treatment should be supportive, egalitarian and non-hierarchical.	Groups of women receiving help from female treatment providers, working and growing together in an atmosphere of equality.
Treatment should support the empowerment of women.	Trust and respect women's ways of knowing and being in the world--honour clients' power with, rather than power over--women are the experts.
Treatment should be respectful and staff should empathize with and support the dignity of clients.	Empathy for clients--not shaming or condescending.
Treatment should be client driven and based on individual client needs.	Good treatment providers help clients achieve what they are seeking and then support. Women directed. Involving her in the planning and goals builds self-esteem, counteracts the depression.
Treatment should facilitate the education and awareness of clients.	Provide literature, women need to read. Hope and information, important in early treatment.
Treatment should be based on client strengths, not deficits.	Real valuing of client strengths/strength-based approach.
Treatment should incorporate a woman-centred approach.	Feminist approach (e.g. awareness of women's social conditions, experience of inequality, victimization, embedded in a background of women's experiences).

8.2 Treatment Values and Philosophy: Literature Review

It was difficult to differentiate treatment principles from a discussion of issues such as treatment structure, approaches or methods in the literature. However, many of the principles identified by key experts (e.g. empowerment and harm reduction approaches) are supported by the literature review.

Finkelstein noted that most "models of care (for pregnant and parenting women) have been developed without thought given to the underlying conceptual or philosophical framework and service intent" (Finkelstein, 1993:1286). Given the concern with developing new service models for pregnant and parenting women with substance abuse problems (and their children), she suggested that "a first step in the development of such models would be to agree on certain guiding principles as a foundation" (Finkelstein, 1993:1286). She identified seven principles (see below) related to the focus and organization of treatment. Although they are discussed in relation to pregnant and parenting women, most of the principles apply to all women requiring treatment.

Principles of Treatment (Organization and Focus of Treatment)

• Treatment should be family focussed. This principle reflects the understanding that substance misuse affects family functioning. It also recognizes and respects cultural diversity and the importance many cultures place on the stability of the family unit. A family model works to ensuring the needs of all its members.
• Treatment should promote competency building and empowerment. Finkelstein described this approach as focussing on identifying and building on strengths rather than deficits and women being supported to define their own needs and priorities.
• Treatment should be community-based. Finkelstein noted that programs should be based in local communities and responsive to the cultural communities they serve.
• Treatment should be multi-disciplinary, comprehensive, coordinated and work toward achieving a collaborative model. Finkelstein identified the importance of providing a range of services (e.g. mental health, prenatal care, education and support, nutritional and vocational services). This requires the coordination of a variety of professionals.
• Treatment should address practical, non-treatment needs. This includes a focus on issues such as health, child care, housing and employment as well as mental health issues.
• Treatment should be individually tailored and long-term (depending on the needs of the woman).
• Treatment should include different levels of service intensity and a continuum of care.
  

According to Schliebner (1994), gender sensitivity is the most important underlying principle of treatment. Gender-sensitive treatment comprises:

• an understanding of the social, gender and economic barriers to treatment for women;
• an understanding that the physiological development of addiction is different for women than for men;
• treatment that addresses specific women's needs;

Covington (1998a) also stressed the valuing of relationships as an underlying principle of treatment. Relational theory emphasizes the importance of relationships to women. True connections are mutual, empathic, creative, energy-releasing, empowering and essential for fostering women's growth. Effective services for women need to be based on relational theory, be gender specific, consider life experiences and incorporate a holistic theory of addictions and a theory of trauma.

Creamer and McMurtrie (1998), in a study of special needs of pregnant and parenting women in recovery, described several underlying principles/values:

• an empowerment and strength-based approach;
• a client-directed approach;
• a harm reduction model;
• comprehensiveness of care.
  

Key expert opinions and the literature identify the empowerment principle as fundamental to best practice. The empowerment approach is composed of the following elements (Kasl, 1995):

• based on love, not fear;
• holistic approach to problem;
• works toward transformation;
• embodies choice;
• accepts complexity;
• is flexible;
• is creative;
• does not label or judge;
• respects women's wisdom;
• involves community effort.
  

While many specific components of the empowerment model are associated with best practice, there is a lack of empirical research which assesses treatment outcomes based on this approach.