- Fredrik Spak, Associate Professor and specialist in general psychiatry and social medicine, Göteborg University, Sweden
- Lotten Sunna, Parliamentary candidate for the Feminist Initiative and Managing Director of Ulfshyttan Treatment Center
Fredrik Spak, MD, PhD began by reviewing some of the health goals in Sweden which include offering lifestyle advice rather than medication; physical activity; reduce/stop smoking tobacco; recognize and give advice on risky drinking and substance use.
The top ten foremost causes of lost DALYs (Disability Adjusted Life Years) account for 60% of all mortality and morbidity, reduced length of life and reduced quality of life in one single measure.
The figures are lower for the world than for Europe, mainly due to income. When people have a lot of income they can afford to buy alcohol and drugs; if you have little income money is mostly focused on housing and food.
There are very large differences between men and women with regard to addiction. Dr. Spak questioned the relevance of the groups identified by research as “high-risk”, specifically why are women identified as a high-risk group when it comes to alcohol. If you were to select a group that should not drink, it is men. Many more men drink alcohol which results in significant negative health and social problems.
The elderly are identified as a high-risk group, but overall few people have severe problems when they are elderly. There has been an increase in drinking among the elderly in rich countries (e.g. Sweden) but not for drugs. It was noted that in the United States, prescription drug abuse is an increasing problem among the elderly, but this group is not the primary problem group.
Specifically, men, and young men, cause many more social problems than any other identified high-risk group when it comes to substance use.
Dr. Spak presented gender differences in Sweden related to alcohol use, showing that many more men (slightly twice the rate) consume alcohol than women.
The number of false-positives increases when prevalence goes down. Hospitalizations are going up in number for women but it still remains much lower for men.
In Sweden, the death rate for men is still 3.5 times greater than women.
When comparing genders and crime, about 90% of murders are committed by men; half of both male and female offenders are under the influence of alcohol at the time. Men are responsible for more cases of assault than women and more are intoxicated at the time.
The data on assaults are incomplete as only about one fifth of all attacks are reported. Both men and women underreport these crimes. While attacks against women are in the home, most attacks on men are in the street and alcohol-related. And sexual violence is much more common in men than previously thought.
The prevalence of Driving While Intoxicated (DWI) has increased among women by a dramatic percentage increase, but men are still accountable for far more DWI incidents. The reporting of findings can be misleading.
It has been asked if Swedish alcohol policy has “normalized” men’s drinking. While it was thought that female drinking was similar to men, female drinking has been described as more problematic for women than for men due to higher vulnerability and for individual psychological reasons. After an emphasis was placed on problems of female drinking problems, the focus on male drinking was de-emphasized.
Dr. Spak asked if drinking is worse for women. It is known that women reach higher blood alcohol concentration (BAC) quicker than men and that fetal injury by alcohol is an important problem. In some cases women’s bodies are more easily damaged by alcohol but men also drink faster and in some cases cause more damaged (e.g. heart disease).
Dr. Spak asked if we are willing to advise men not to drink. One study showed that many more female patients were advised to stop drinking than men, even though they had similar alcohol use patterns.
With regard to illegal drugs and gender differences, Dr. Spak indicated that it is about the same. In Sweden, women suspected or prosecuted for drug offenses has remained steady at 15% since mid-1970s. The percentage of women hospitalized for drug abuse has been relatively stable. Women’s drug-related deaths have declined from 30% before 2000s to a little above 20% in 2000s.
Dr. Spak summarized that overall, gender differences are commented upon from the view point of women’s use. But substance use is greater and the problems from that use are much larger for men than women concerning morbidity, mortality and criminality.
This is the only area of the addiction field where women are over-represented in Sweden is in treatment. But this fact can be reformulated as men are under-represented in treatment.
Lotten Sunna explained that there are many unanswered questions today regarding gender, addiction and treatment. In general, the knowledge is scattered. People draw conclusions they want from research. Women often hide addiction. If they are older and have children, they are afraid of losing their children. When they ask for treatment, they want to get it quickly and preferably at home rather than in residential settings. Social workers have confirmed that it is easier to refer men to residential treatment while for women there is a need that they be home.
Some of the questions relevant to gender that must be asked include:
– What signifies how women develop addiction?
– What are typical symptoms of women’s abuse?
– In what way does addiction in women differ from that in men?
– How are women addicts identified today?
– What motivates/deters women (and men) to seek treatment?
– Are women and men offered the same treatment options?
– What resources are used on women/men in addiction treatment?
– Do women in treatment need to be treated by women? How does the gender of the service provider affect the treatment situation?
Once we have the knowledge, we need to educate and inform. We need to understand the role of alcohol and drugs in creating and sustaining gender stereotypes Today, when we speak to educators and social workers, there is no information shared about gender.
Gender-specific knowledge can be a useful tool to provide perspective in all areas of treatment.
To break free from addiction requires a change in lifestyle, to live a different life away from alcohol and drugs. To do that is to question your identity and create a new one. Both men and women have strong ideas about their gender identity.
– What do men/women need in treatment?
– What incentives do women/men need in treatment?
– To stay in a relationship of power, control and emotional dependency is a trigger for relapse. To be independent is a must, and how do women get there?
– What support is needed in treatment?
Once we have knowledge about how men and women develop addiction and how best to treat them, the education component comes next. Then we must apply that knowledge to help those in need without gender stereotypes.