WCH’s substance-use service keeps patients closer to home
Women’s challenges can differ from men’s, making traditional treatment plans less effective
From the time she had her first drink at age 27, Tracy became hooked on alcohol.
“I always wanted more,” she says. “I wasn’t drinking socially; I didn’t drink normally.”
Like many women with substanceabuse issues, Tracy — who doesn’t want her last name and hometown made public — drank to deal with a lack of self-confidence.
“I didn’t feel comfortable in my own skin,” she says.
That first drink was in 1989 and by 2010 she was also hooked on oxycodone, which she had never been prescribed, but got from a friend.
“I had no pain to be taking those prescription drugs,” she says. “So it was truly for emotional pain.”
While men with alcohol- and drugabuse issues have traditionally outnumbered women, that gender gap is closing. Alcohol is “by far” the most common and serious addiction for both sexes, says Dr. Meldon Kahan, medical director of the Substance Use Service at Women’s College Hospital. Meanwhile, opiate-use disorders are on the rise among both men and women, he says.
Women with substance-abuse issues often face different challenges from men, according to Kahan.
“There’s a lot of stigma attached to addiction, especially for women,” he says. “They don’t want to admit they have an addiction, because they face serious consequences in terms of child custody and disapproval of their family and so on.” That’s where Kahan’s program comes in. The service — which ultimately helped Tracy get clean — combines anti-craving medications with counselling, and can be accessed via a simple referral from a family doctor. This can make it easier for women to find success in treatment, particularly because it allows them to remain in their own communities with their families.
The hospital-based outpatient addiction service “is not common at all,” Kahan says.
“Our goal is not to keep patients in a long-term treatment program, but to get them back to their primary-care doctor whenever feasible.”
While the program is open to both men and women, it does address many of the challenges that women with addictions face.
Women tend to develop health consequences from addiction faster than men, according to a report from the B.C. Centre of Excellence for Women’s Health. For example, women are more likely than men to develop cirrhosis of the liver after consuming lower levels of alcohol over a shorter period of time.
The B.C. report also found as many as two-thirds of women with a substance-abuse problem suffer from a mental-health issue, and a “large proportion” are victims of domestic violence, childhood abuse, sexual assault and rape. Women can struggle with group therapy, often part of traditional treatment programs, because they don’t want to speak to men about their experiences with violence and trauma, Kahan says.
Women also often have child care and family responsibilities, which not only make it harder for them to attend treatment, but add to the social stigma that can prevent them from seeking help in the first place, he says.
Kate Hardy, project manager of a two-year project aimed at spreading an access-to-addiction-medicine-services model across Ontario, says the “well-known model” for treating addiction involves removing patients from their communities for extended periods.
“This is very disruptive to people’s lives, and it can also be incredibly expensive,” Hardy says. “So what we’ve
tried to do is to bring treatment right into people’s communities, making them available in hospital where they can access services in under seven days.”
Under the program Hardy manages — called META:PHI, or Mentoring, Education and Clinical Tools for Addiction: Primary Care-Hospital Integration — WCH is mentoring seven hospitals across the province as they set up substance abuse treatment services, with variations tailored to each facility.
“The main goal of this project is to spread best practices for providing care to people who are struggling with problematic substance use,” Hardy says.
These rapid-access clinics are created by reorganizing existing resources at each hospital, Hardy says, so the changes don’t come with big price tags, and they can partner with existing programs within the community.
As with WCH, the ultimate goal is to integrate care by addiction physicians, counsellors and primary-care providers, and provide patients with rapid access to that care.
And that timeliness is key, Hardy says. “Often women need to access treatment right away in order to keep their lives on track.” Tracy can attest to that. After five attempts to get clean, she ended up at a women-only detox facility in Toronto in June 2014.
Hardy happened to be visiting that day.
“I’d been through treatments where it’s just been, ‘Yeah, you’re another statistic, you’re another drunk, you’re another addict.’ But this was a different feeling of help,” Tracy says of speaking to Hardy. “I felt that I was being listened to and that she really cared.”
Tracy called Hardy the day they’d met and Hardy arrived at the detox centre in less than an hour. She brought Tracy to the hospital (she had put her in the rapid-access cohort of the study), and Tracy saw Kahan almost immediately.
She was put on anti-craving medication and given counselling, which continued even after she went back to her home community outside the city. She commuted in by train.
“We’ve had a lot of patients report that it’s very important to them to access care in community hospitals or with their family doctor, rather than going to what are known to be addiction treatment programs,” Hardy says. Patients “enjoy the setting, they find it comfortable and relaxed and not intimidating in the way that a lot of more specialty programs have tended to feel.”
June will mark two years since Tracy’s been clean, and she still sees the team at WCH once a month. She’s gone through tough times since arriving at the program, including the death of her mother.
“And that’s how I knew this would stick,” Tracy says. “There wasn’t any craving for any escape. That was it for me, that told me, ‘You’re going to be OK.’”