A systematic review of gender-responsive and integrated substance use disorder treatment programs for women with co-occurring disorders

ABSTRACT

Background: Integrated and gender-responsive interventions, designed to target co-occurring substance use and psychiatric disorders in women, may be effective in addressing gender-specific challenges.

Objectives: This systematic review aims to identify integrated gender-responsive substance use disorder treatments for women, summarize evaluations of these treatments, and address gaps in the literature.

Methods: We searched PsycINFO, PubMed, and MEDLINE on September 24, 2021, and March 10, 2022. Included articles were randomized-controlled trials, secondary analyses of naturalistic studies, or open-label studies of integrated and gender-responsive treatments from any year that assessed both substance use and mental health/trauma outcomes.

Results: We identified N = 24 studies (participants = 3,396; 100% women) examining Seeking Safety, Helping Women Recover and Beyond Trauma, A Woman’s Path to Recovery, Modified Trauma Recovery and Empowerment Model (TREM), Breaking the Cycle, VOICES, Understanding and Overcoming Substance Misuse, Women’s Recovery Group, Female Specific Cognitive Behavioral Therapy, and Moment by Moment in Women’s Recovery. Across treatments there were significant improvements over time; Seeking Safety, Helping Women Recover, and TREM were associated with significantly better substance use and mental health outcomes relative to the comparison groups.

Conclusions: Integrated gender-responsive treatments are a promising approach to treating women with co-occurring substance use and mental health concerns, and broad clinical implementation stands to benefit women. However, there remains a lack of studies evaluating substance use treatments in women with severe mental illness (e.g., psychotic-spectrum disorders) who differ in their needs and capacity.

KEYWORDS:

• Women
• comorbid disorders
• substance use disorders
• treatment outcomes
• barriers
• gender-responsive

Disclosure statement

No potential conflict of interest was reported by the author(s).

Disclosures

Dr George reports consulting fees from Frutarom, Marshall University, and Sanford Burnham Prebys (SBP), and expert legal testimony related to substance use disorder treatment in the past 3 years, as well as advisory board income from the Yale University Tobacco Control Regulatory Sciences (TCORS), the Office of the United States Surgeon General, the Canadian Center for Substance Use and Addictions (CCSA) and in his role as Deputy Editor, Neuropsychopharmacology (NPP). Dr Potenza has the following financial disclosures. He has consulted for and advised Opiant Pharmaceuticals, Idorsia Pharmaceuticals, AXA, Game Day Data, and the Addiction Policy Forum; has been involved in a patent application with Yale University and Novartis; has received research support from the Mohegan Sun Casino, the Connecticut Council on Problem Gambling, and the National Center for Responsible Gaming; has participated in surveys, mailings, or telephone consultations related to drug addiction, impulse control disorders, or other health topics; and has consulted for law offices and gambling entities on issues related to impulse control or addictive disorders. All other authors report no conflicts of interest with respect to the content of this manuscript.

Data Availability Statement

Data sharing is not applicable to this article as no new data were created or analyzed in this study.

Additional information

Funding

The preparation of this review was supported by grants from NIDA (R21-DA-043949, to Dr George), the Astrid H. Flaska Funds from Scotiabank/CAMH Foundation (to Dr George) and the Centre for Complex Interventions at CAMH (David J. Castle, Director). The funding agencies did not have input into the content of the manuscript, and the views in the manuscript may not reflect those of the funding agencies.