TAILORING YOUR ADULT DRUG COURT TO THE GENDERS

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TAILORING YOUR ADULT

DRUG COURT

TO THE GENDERS

Presenter: Sandi Metcalf, MS

Director, 20th _{Circuit Court, Juvenile Services Division}

Michigan Association for Drug Court Professionals March 11 & 12, 2014

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GENDER PATTERNS OF DRUG USE

• _{According to the National Household Survey on Drug Abuse and the} Monitoring the Future studies

Men use illicit drugs at a higher rate than females (8.5% to 4.5%)

Men report higher rates of cocaine use (.95 versus .5%), alcohol use (58% to 45%), binge drinking (23% to 8%) and heavy drinking (8.7% to 2.1%)

• _{Same patterns observed in marijuana use}_{(Office of Applied Studies report)}

• _{Females more frequently die from antidepressant abuse. Psychotropic} drugs are prescribed more often for females than males and thus,

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GENDER, DRUGS AND CRIME

• _{In the past two decades, arrests of female drug users has more than} tripled

• _{Drug use and abuse are greater among female arrestees than male} arrestees

• _{Female drug users are more likely to be arrested for nonviolent crimes} (prostitution, possession and petty larceny); have little to no history of high level drug trafficking.

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GENDER, DRUGS AND CRIME

• _{Men and women differ in their illegal activities that support their drug} use

Men dominate drug selling and street crimes; women restrict their activities to a few property crimes like “boosting” or shoplifting and “hustling” or prostitution.

Female drug dealing has increased, significantly, over the past decade but they are subordinate to male drug dealers.

The majority of female prisoners are serving time for drug offenses, property crimes, larceny-theft and fraud. (Arrestee Drug Abuse

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GENDER, DRUGS/ALCOHOL AND

HEALTH

• _{Data show that a significant portion of property crime offenders test positive}

for drugs, indicating a potential for sizeable chemical dependency problems among all female offenders

• _{In prison, higher HIV positive rate for females which may be directly linked to}

their drug abuse. Women in jail report higher intravenous drug use that men.

• _{Other health related problems include STDs, gynecological problems,}

tuberculosis, circulatory problems, hypertension, diabetes, pregnancy, prenatal and postpartum issues; and sexual and physical victimization

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GENDER, DRUGS/ALCOHOL AND

HEALTH

• _{Psychotropic and other medications = prescribed more often to} women

Medications have estrogenic effects

Majority of medications are tested on white males, NOT females

Medications may be metabolized at different rates

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GENDER, DRUGS/ALCOHOL AND

HEALTH

• _{Approximately 32% clients in treatment facilities are female}

• _{Females using psychotropic drugs are significantly more likely to} develop dependence

• _{Females have unique treatment needs}

• _{Female-only programs improve outcomes; accommodate lesbian,} HIV + pop

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GENDER, DRUGS/ALCOHOL AND

HEALTH

Females and the impact of alcohol

• _{Females can drink for shorter periods of time and consume lesser} amounts but become dependent on alcohol, faster

• _{Speed of Progression (alcoholism): Earlier onset; one way to measure} may be identified as increased frequency of black-outs

• _{Genetics determine females are more apt to be alcoholic than males} if mother is alcoholic versus father an alcoholic

• _{Vulnerability to alcoholism or chemical dependency is strongly “event} driven”, i.e. driven by relationships

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GENDER, DRUGS/ALCOHOL AND

HEALTH

•

Female alcoholism is not diagnosed as rapidly as male

alcoholism; females report as being “depressed” rather than

alcohol or drug dependent

•

Thus, they enter treatment later than males when they are

deeper into the disease

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GENDER, DRUGS/ALCOHOL AND

HEALTH

• _{Suffer from liver disease and other associated diseases after using less} alcohol for shorter period of time; faster progression of the disease

Liver more sensitive to toxic effect of chronic alcohol intake

Develop liver disease (cirrhosis/hepatitis) after comparatively shorter periods and less intense drinking than males

Achieve higher concentrations in blood after drinking same amount

Level of alcohol dehydrogenase (enzyme assoc. w/ metabolism of alcohol) is lower in females

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GENDER, DRUGS/ALCOHOL AND

HEALTH

• _{Greater vulnerability to cerebral atrophy and other brain-related} conditions

• _{Significant difference between amounts of gray and white matter in} brain among drinking and non-drinking females

• _{Increased risk of breast cancer}

• _{Infertility, early menopause and osteoporosis}

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GENDER, DRUGS/ALCOHOL AND

HEALTH

• _{Significant higher rates of impairment}

• _{Depleted physical and mental health condition with shorter duration} of lifetime drinking and lower lifetime dose

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GENDER DIFFERENCE IN BRAIN

HARDWIRING

• _{The brain develops from the bottom to the top, and from the inside, out.}

• _{Starts with the brain stem, moves up to develop emotional brain and moves}

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GENDER DIFFERENCE IN BRAIN

HARDWIRING

• _{Female brains function through a relational imperative – increased amounts}

of brain chemicals; e.g. oxytocin, vasopressin

• _{Males brains function through a performance imperative; tasking} • _{Female brains reason inductively (intuitively); males deductively}

• _{Motivations are different; males do things because it makes sense to them;}

females are motivated by relationships

• _{Female has larger Hippocampus; 11% more emotional sensors}

• _{Female brain has larger Corpus Callosum – information processing} • _{Verbal/language parts differ between the genders}

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GENDER DIFFERENCE IN BRAIN

HARDWIRING

• _{Amygdala: Part of limbic system involved in emotional processing;} larger in males – makes males more aggressively responsive

• _{Female brains are wired for less risk taking}

• _{Female brains are more prone to worry (Anterior Cingulate Cortex} larger)

• _{Male brains are visual}

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GENDER DIFFERENCE IN BRAIN

HARDWIRING

• _{Prefrontal Cortex: Executive functioning part of the brain}

• _{Different parts of the brain mature at varying rates during adolescence. This}

image indicates an average decrease in gray matter volumes between ages 5 and 20, thanks to the pruning of neural connections.

• _{Areas that mediate “executive functioning” mature later than areas responsible}

for basic functions.

• _{Chemical messenger, dopamine, increases}

capacity to learn in response to reward;

Dopamine inputs into prefrontal cortex grow dramatically during adolescence

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GENDER DIFFERENCE IN BRAIN

HARDWIRING

• _{Medial Prefrontal Cortex(mPFC): Less active during adolescence than} adulthood

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GENDER DIFFERENCE IN BRAIN

HARDWIRING

• _{mPFC: Mediates decision-making; creates associations between} context, locations, events, and corresponding adaptive responses, particularly emotional responses; interacts with the lateral prefrontal cortex to form perceptions, understanding of others and self, etc.

• _{Hyper-sensitive yet quiet during adolescence}

• _{Makes adolescents more prone to risk taking, especially with friends} • _{Studies reveal adolescents have a reduced capability to read the}

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HOW DOES THIS RELATE TO DRUG

COURTS?

• _{Research = Females have been under-represented and therefore, programs}

are not always designed to adequately address their needs

• _{Understanding gender differences results in improved outcomes}

• _{Example: Men’s and women’s entry and exit from drug abuse differs}

Entry related more to relationships with men

Exit of drug careers for women are often because of family more than men and are centered more on personal and emotional aspects of drug related

experiences; men center around external and financial experiences.

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ACTIVITY

Question:

• _{Currently, what do you do in your drug court to address the different} needs of women and men in your drug court?

OR

• _{Identify one thing you would like to do in your drug court to address} the needs of women and men differently

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TAILORING YOUR DRUG COURT TO

ADDRESS GENDER ISSUES

• _{Establish separate drug court programs for genders to prevent females}

focusing on males

• _{Make certain there is a solid mental health component}

• _{Focus on activities for males to assist them in processing information and}

sharing thoughts

• _{Hire staff who are relational for females}

• _{Allow input from participants to determine what will work for them}

• _{Individualize} _{the treatment approach for participants; avoid the “one size fits}

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TAILORING YOUR DRUG COURT TO

ADDRESS GENDER ISSUES

• _{Resist isolation or rejection of females; the worst thing - destroys the ego and}

resiliency

• _{Consider child care, transportation, work schedules}

• _{Rules needs to be clear with understanding of consequences}

• _{Make the environment “female-friendly”; women tend to form “families” or}

relationships within the program; actively promote a sense of the group as “family”

• _{Modify confrontation tone – Harsh confrontational style is inappropriate;}

confrontation begets confrontation (W. Miller); leads to aggressive, avoidant behavior; empathic staff responses = participative behavior

Teach females how to confront in an effective, assertive manner; do not allow aggressive body language just short of violence in treatment

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TAILORING YOUR DRUG COURT TO

• _{Handling denial – Two approaches:}

12 Step – Denial seen as a symptom of the disease with person blocking or refusing to accept the reality; studies show females’ self esteem

plummets during this time and therefore, maximum, relational support is critical

Therapeutic approach – Women are not seen as denying their addiction and its consequences but rather, she has compelling attachment to it (numbing her depression, memories of trauma, etc.) Help her to seek to understand the attachment, e.g. What is she getting out of it? Why is it so compelling? How does this attachment effect her individually? Basically, explore issues of attachment, grief and loss (Use confrontation only with

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TAILORING YOUR DRUG COURT TO

• _{Address the trauma - Use caution; do not push this issue but rather, provide}

opportunities for these issues to be addressed

During screening and assessment – wait to ask questions about trauma until more of a relationship has been established, especially if the interviewer is male.

Typically, issues of trauma need to be addressed during treatment

Need to provide opportunities for them to establish a vision without the trauma/abuse

• _{Address retention rate by trying to remove barriers, e.g. child care, etc.}

• _Show _{honor and respect for participants; females especially respond to this} • _{Aftercare – Develop support groups early and continue post treatment;}

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REMEMBER…

Maya Angelou’s Quote:

“

I’ve learned

that people will forget what you said, people

will forget what you did, but people will

never forget

how you

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THANK YOU!