Women, Dependency and Work

By Dr Michael McCann MB BCh MA DIH MD MFOM, occupational health expert and speaker at  iCAAD London 2019; Europe’s leading conference on Behavioural, mental and Emotional Health. 

Women are more susceptible to intoxication and dependency and addiction-like behaviour is more rapid in women.

This is because women generally having a higher fat to muscle ratio than men. Muscle has a higher water content than fat and this absorbs some of the ingested water-soluble alcohol, so for a given amount of alcohol women will achieve a higher blood alcohol concentration. 

Women are more susceptible to the toxic effects of alcohol e.g. they are more prone to liver disease and brain damage. These harmful health complications for women occur after a lower consumption and with a shorter drinking history compared to men i.e. the harmful effects occur more rapidly and more severely in women compared to men. ( NIAAA 2004) 

The reason for their greater risk of liver damage is because they have a smaller blood volume and as already mentioned a smaller muscle mass than men, that absorb the alcohol. 

Drinking during pregnancy of course risks the health of the baby and not only is Fetal Alcohol syndrome a serious risk for those who drink at very high levels but lower levels of consumption place the baby at risk of Foetal Alcohol Spectrum Disorders.  

There is of course the added complication that female alcoholics may also be misusing other drugs including benzodiazepines or prescription drugs.

Psychological Impact of Addiction. 

Alcohol dependent women have higher rates of depression and anxiety and this is four times more common than in the normal population. Mostly this disorder of mood is directly linked to the drinking and its impact on the person’s life. Such psychological disturbance is therefore to be seen more as a consequence of the addiction and it resolves with effective therapy for the addiction. Women experience more shame and are more reluctant to talk about their drinking. If they have children, a female alcoholic may feel ashamed of being labelled as a bad parent. 

Several studies also show elevated levels of eating disorders in women who suffer from addiction. Shame and low self-esteem are feelings often suppressed by alcohol and drugs initially but eventually the drinking only makes the shame worse. There are similarities between the two behaviours with a loss of control, craving, and conditioned response to external cues. 

A history of trauma is not uncommon in adult female alcoholics and they are often victims of rape or assault and emotional and physical abuse. This could be associated with the workplace either as a cause or an effect. It has been shown that sexual harassment and assault is likely to be directly associated with the perpetrator being intoxicated. This could be work related.

Self – harm attempts are frequent among women with addictive disease. Most at 

risk are women in the 20 to 29 age group. 

Women in treatment are often living with a partner who is also misusing alcohol or drugs. They are also often divorced or separated. There are therefore often fewer support systems and less family support for a female alcoholic after treatment. 

These particular co-occurring problems need specific focus in treatment. 

Treatment 

Identification and Screening 

Women of all ages report more medical and mental health problems with substance abuse than men and they have higher rates of co-ocurring medical and mental health problems. It should also be noted that they often present to their GP with problems other than alcohol or substance misuse. It is essential therefore that alcohol and other substance misuse screening in primary care should be systematic so that the problem is not missed. ( D’Amico et al 2005) 

Treatment Specifics 

46% of addiction treatment facilities provide specialised services for women. 

These other comorbid problems need to be addressed during the treatment process for substance dependence otherwise there is a greater risk of relapse.  

Women only treatment programmes can address needs that are specific and common to women. There is very good evidence pointing to the success of gender specific groups.  Components of specific programmes for women are identified as helpful in gender specific groups combined with more personal counselling. Research suggests that women specific treatment programmes are more effective in engaging subgroups of women with more complex problems than mixed gender groups particularly those who are pregnant, trauma affected or if they have co-morbid psychiatric disturbances. ( SAMHSA 2009) 

Treatment needs to be supportive and to be non-confrontational; it should aim to raise awareness and facilitate insight. Helping the person to see themselves as ill rather than a moral delinquent can alleviate shame; nonetheless the realities of the full impact of addiction need to be acknowledged and faced. Specific group therapy sessions for women at Castle Craig allow them to address the issues that they have in common. We also try to match a female with a female counsellor where there is a history of abuse or trauma.  Coexisting depression and physical health complications need to be addressed during treatment.  

At Castle Craig there are two women’s groups a week in the first stage of care where women can speak of their gender specific issues and they like these groups very much. A lot of women benefit from Extended care because of the high level of comorbidity – complex issues – so we also have a women ‘s separate unit where they have a special track and women’s only groups each day. At the same time the programme can address other common problems for women such as PTSD groups, assertiveness training groups for women and eating disorders.  We know and the evidence is showing that addressing these additional complex issues in a gender specific environment can enhance outcomes for a subgroup of women.

(ref: Dr Margaret Anne McCann, CEO Castle Craig) 

Women, Dependency and Work

The problems women face with alcohol at work is highlighted in research on performance in simulated driving. This shows that motor coordination, speed and capacity of information processing in both genders were significantly affected by a challenge dose of alcohol but women displayed a more significant impairment than men on all the behaviour tests. This was likely due to reported higher levels of subjective intoxication than men. (ref. Miler MA, Weaver J and Fillmore, MT ‘Gender differences in alcohol impairment of simulated driving performance and driving skills. (2009) 44. Alcohol and Alcoholism 586-593.

What is noted by this research is that women seemed more conscious of their reduced performance, which suggests that women were also more honest with their perception of decreased performance. This would fit with my experience in the workplace. Women were more honest in acknowledging their problem than men. This makes them more likely to seek help if there was a safe and caring support programme available for dependency. In my experience with the right supportive treatment they would likely be more successful with the treatment.  Women would therefore benefit greatly from the Corporate “Caring approach to Dependency” in an Alcohol and Drug Policy.

ABOUT THE AUTHOR

Dr Michael McCann MB BCh MA DIH MD MFOM is a Member of the Faculty of Occupational Medicine, and received a Doctorate in Medicine for his work on alcohol problems in the workplace. His latest book, “Alcohol, Drugs and Employment”, is designed to be a reference book for health professionals as well as management and human resources to assist them in dealing with the often-challenging cases of substance abuse which they may be faced with.  Dr McCann will be speaking at iCAAD London 2019; Europe’s leading conference on Behavioural, mental and Emotional Health. https://www.icaad.com/icaad-london-2019