PROBLEM SOLVING COURTS
JAMI VIGIL, J.
Problem solving courts (PSCs) are collaborative court programs that promote rehabilitation and reduced recidivism through non-adversarial and therapeutically guided court responses aimed at addressing complex problems such as substance abuse, domestic and family violence, mental health issues, and truancy. Prior articles in this series have addressed best practice recommendations relating to individualized court responses;1 medication-assisted treatment;2 prescription drug misuse;3 and team member roles, responsibilities, and ethics.4 This final installment addresses best practice recommendations for gender-responsive treatment, emphasizing treatment options for women.
For team members (including judicial officers) new to PSCs, it may seem unusual to focus on substance use, treatment considerations, and needs for women. After all, national research shows that men are more likely than women to use almost all types of illicit drugs, are more likely to become involved in a PSC program, and are more likely to succumb to an overdose death.5 However, national drug court evidence-based best practices, strongly recommended by the National Drug Court Institute (NDCI) and the National Institute on Drug Abuse (NIDA), support incorporating gender-responsive treatment in all PSC programs to improve effectiveness and outcomes for women.
Women’s Unique Treatment Needs
To begin the discussion of gender-responsive treatment, it is important to note that all individuals should receive the most effective treatment approach possible. Nothing in this article is meant to diminish the treatment needs of any PSC participant, male or female. However, when it comes to substance use, women and men are not the same: they begin substance use for different reasons, use drugs differently, and respond to drugs differently.6 Moreover, substance use disorders appear or manifest differently between the sexes. Ultimately, it may be more difficult for members of one sex to quit a particular drug in comparison with members of the other sex.8
Gender differences exist for a variety of reasons, including biological factors.9 Research indicates that sex hormones and metabolism greatly influence a person’s sensitivity to a particular drug, and as a result males and females respond differently to different drugs.10 For instance, males are more sensitive to a marijuana-induced high than women, whereas women are often more susceptible to the effects of stimulants like cocaine and methamphetamine.11 Women who use these stimulants (especially methamphetamine) are more likely than men to experience co-occurring depression.12 Research also indicates that women will likely experience greater hallucinatory effects associated with MDMA (ecstasy) use than men, but are also more likely to experience depression after use.13
Social and environmental factors can also greatly impact substance use and treatment needs. Many treatment-relevant circumstances affect women at higher rates than men, necessitating more specialized treatment services.14 To name a few, women as a group are more likely than males to:
■ be victims of trauma (both physical and sexual, as a child, adult, or both);
■ experience co-occurring disorders, including mental health and substance abuse;
■ seek out and engage in mental health treatment; and
■ be caregivers for children.15
Research has shown that for women, more so than men, primary triggers for substance use susceptibility and relapse are (1) abusive relationships, (2) depression, and (3) not living with or caring for one’s own children.16 These factors can dramatically alter a person’s susceptibility to substance use and ability to complete treatment successfully.
Any discussion of gender-responsive treatment for PSC programs would be incomplete without mention of pregnancy and how it impacts substance use and treatment needs. When assessing the treatment needs of pregnant women, it is important to take into account the potentially harmful effects that alcohol, drugs, tobacco, and prescription medications can have not only on expectant mothers but also on the developing fetus.17 Prenatal use of some drugs, such as nicotine or prescription pain medicine, can increase the risk of stillbirth, and opioids may cause neonatal abstinence syndrome in which babies are born drug dependent and may suffer seizures, respiratory and feeding complications, birth defects, and even death.18 Even medication-assisted treatment can harm the baby.
This is a lot to consider for a PSC treatment team. Evidence-based treatment recommendations for women and pregnant...