Women are far less likely than men to access treatment for addiction, and women who do seek care are far more medically compromised by the time they enter rehab than their male counterparts. Addiction psychiatrist Kristen Schmidt, MD, talks with host William C. Moyers about factors that influence the progression and treatment of substance use disorder among women. The doctor’s advice for women in active addiction? Substance use disorder is a disease, and you are worthy of care and healing. Read the transcript below, listen and subscribe on iTunes, Google Play or watch on YouTube. 0:00:15 William Moyers Hello and welcome to Let's Talk, a series of podcasts produced by the Hazelden Betty Ford Foundation on the issues that matter to us, the issues that we know matter to you, too. Substance use prevention, research, treatment of addiction, recovery management, advocacy, and education. I'm your host, William Moyers, and today, we're joined by my colleague Dr. Kristen Schmidt. An Addiction Psychiatrist for Hazelden Betty Ford based in Minnesota. Welcome, Dr. Schmidt. 0:00:45 Dr. Kristen Schmidt Thank you. 0:00:46 William Moyers And today we're talking about women in addiction and women in recovery. Why do we need to differentiate between women and everybody else in treatment? 0:00:55 Dr. Kristen Schmidt Well because there is a difference [chuckles] between women and men. And we know that biologically, there is a difference in terms of substance use and relapse. We know that psychologically, environmentally, there's a difference between women and men. And the outcomes can be different if, you know, we don't take those things into account. 0:01:23 William Moyers What makes women particularly vulnerable to substances, legal or illegal? 0:01:28 Dr. Kristen Schmidt First we'll I guess we'll touch on the biological— 0:01:31 William Moyers Yes. 0:01:31 Dr. Kristen Schmidt —Component. So, females have the hormone estrogen versus males. And what we know is that estrogen has been found to increase both animal and actual human females in studies—increase the intake and consumption of substances. So, we've seen actually female rats will start to increase their alcohol intake compared to male rats. When the concentration of alcohol is increased. We know that the males start to titrate off their alcohol use whereas the females will continue to use. We also know that in terms of women who enter treatment, they tend to have more severe addiction when they enter treatment. They actually are more medically compromised specifically because of their bodies. So women have less of the enzyme used to break down alcohol than men do. 0:02:35 William Moyers The metabolism issue. 0:02:36 Dr. Kristen Schmidt Right! The metabolism issue! So women—my female patients their lab values often times are much worse than my male patients. Despite the fact that their much younger. And I always talk with my patients about that. And I let them know that there is a phenomena we refer to in research as telescoping. Where women their bodies just can't take the substances to the same degree that males can. And so it's so important that once they're in treatment that they really understand that medical difference. And that they—they try and stop. 0:03:16 William Moyers So physiology certainly has a huge factor as you said. What about external factors that women then internalize? 0:03:23 Dr. Kristen Schmidt Right. So, we know environmentally that women tend to be relational substance users. So, being in a relationship where the male partner is using substances is so much harder for women to stop using substances as a result. There was one study that showed that 50 percent of heroin users, female heroin users, the first time they ever injected was from a male partner. This is compared to 90 percent of males saying that a friend of theirs first injected them. So, I've had patients tell me, my female patients who have actually woken up and they've had a needle in their arm from their partner. And they weren't even aware that that had happened. So, there's always that environmental relational concern. And then women are caretakers. So, often times they have children and that influences their ability to access treatment. Because often times they can't take their children with them and they don't know what to do in terms of their kids if they wanna get treatment. They did a recent study on methamphetamine use and they found that one of the reasons women used methamphetamine, reported using, was actually so they could go to work, take care of their kids, clean the house, and they really wanted that extra energy as a component of their use. 0:04:57 William Moyers What about sexual abuse and the role that it plays in the substance use disorder in women? 0:05:02 Dr. Kristen Schmidt Yeah. So we know that they did a study looking at female sex workers who were in Canada and they found that 75 percent of those females who had suffered abuse before age 18 went on in six months to start injecting substances. So, abuse plays a huge role. We know that females who have PTSD are five times more likely to become substance users. Than women who haven't had some kind of serious trauma in their lives. 0:05:41 William Moyers So we you and I did another podcast on trauma-informed care— 0:05:46 Dr. Kristen Schmidt Mmm-hmm. 0:05:47 William Moyers That our listeners and our viewers can tune into. But trauma certainly plays a huge force and is a factor in what happens to women under the influence, correct? 0:05:58 Dr. Kristen Schmidt Oh absolutely. And actually what we find is you know women are under the influence tend to actually contract things like HIV and Hepatitis as well as other sexually transmitted diseases. Adverse pregnancy outcomes because of substance use. And often times what happens is the female will still take the gender role of using after her partner. So she becomes then the recipient of these possible transmissible diseases. 0:06:33 William Moyers So let's talk about what happens when a woman comes into treatment— 0:06:39 Dr. Kristen Schmidt Mmm-hmm. 0:06:39 William Moyers That's Hazelden Betty Ford. How do we tailor treatment to fit the needs specifically of women? 0:06:48 Dr. Kristen Schmidt So, one of the things that we do is we really advocate for self-efficacy. So, self-efficacy I simply define as the ability for a woman to articulate what she wants. And not only articulate it, but have faith that it will actually happen. They've looked at Harvard there's a woman called Shelly Greenfield she's done a lot of work on women's recovery group. And what she found is that if you have manuals and you have therapies that are tailored specifically to women's issues—so things like, you know, child care— 0:07:26 William Moyers Mmm-hmm. 0:07:26 Dr. Kristen Schmidt Things like self-esteem. Things like body image which is huge for my female patients. Eating disorders, things like that. If you are mindful of those issues, women tend to do much better. And they tend to do much better if there are what we call affiliative statements. So, people being supportive in the groups of one another. And really building up that sense of self-esteem. Which is already lacking in substance users but in our females even more so. 0:07:59 William Moyers And yet we talked about—earlier we talked about outcomes and the challenge that Hazelden Betty Ford and that you as an Addiction Psychiatrist have in trying to help women have the same kind of outcome as a man as it relates to treatment. Can you talk about that a little bit? 0:08:16 Dr. Kristen Schmidt Yeah. So, what we know is that for every two men that enters treatment, there's only one woman that enters treatment. So, improving access in terms of, you know, the child care component, the relational component, those are all going to impact outcomes. What we need is we need more access for females to improve outcomes. We need to be supporting them economically. Women tend to not make as much money as men. Their education is less. So there's a financial disparity there. And so women tend to not have the same level of insurance. Which also affects treatment outcome. So all of this disparity and chaos essentially leads women away from the doors of our treatment centers. So what we need to do is really strategize and find more ways to open those doors. 0:09:18 William Moyers So recovery management for women—when I mean treatment is certainly a tough challenge for anybody but as I've always said, the treatment is the easy part in the scheme of things. It's what happens after we leave treatment that is so vital. And recovery management as we now call it is—is important, that we manage our recoveries. What would you—what would be your counsel to women who might be listening today in terms of how they manage their recoveries once they leave treatment? 0:09:48 Dr. Kristen Schmidt I think it's really important that women find a group that they feel comfortable with. We know that outcomes improve when they have a peer support network that they feel really strong about. We know that they do better when there is an anchoring care provider actually. So— 0:10:07 William Moyers What does that mean, an anchoring care provider? 0:10:09 Dr. Kristen Schmidt Yeah. So if they are with a therapist and they see that therapist while they're in residential, let's say, and then it's time for them to step down care to an outpatient experience. If they're able to stay connected with a care provider longitudinally, it dramatically increases their ability to stay sober. Because you're really just taking that negative component— 0:10:35 William Moyers Mmm-hmm. 0:10:35 Dr. Kristen Schmidt —Of the relational piece that added to their use and you're kind of flipping it and making it a part of their recovery. Rather than their substance use. 0:10:44 William Moyers Hmm. There're gonna be women who have tuned in today either listened to this podcast or to watch you and me here, and they're gonna tune in because they're struggling. What would be your counsel for a woman who might be at home today with two small children or a mom who is responsible for keeping that household intact or has got an elderly parent living with them—what would you be your counsel to a woman who's struggling today and has and is tuned in to hear you share? 0:11:15 Dr. Kristen Schmidt Yeah. My counsel would be that they're worth their own recovery. And that they need to take the time for themselves. To treat their substance use disorder. Because some of the people they care about the most, right, are being impacted by their substance use. So that grandmother, their children, we know that specifically young girls are watching their moms. And women who have mothers who tend to smoke will then start smoking. So, the kids are watching. And really it's just it's worth it for that woman to get help for herself. She will end up helping others as a result. But she is worth it just on her own. 0:12:09 William Moyers She is worth it just on her own. Dr. Kristen Schmidt, thank you for bringing us your professional expertise today and that message of hope and help and healing to women and families who might be tuning in today. I'm your host, William Moyers, and on behalf of our Executive Producer Lisa Stangl we wanna thank you for joining us for another edition of Let's Talk, a series of Podcasts on the issues that matter to women, to men, to families, that matter to all of us. We'll see you again.