Gender Matters:

Changing the World with Our Work

Dan Griffin, MA Minneapolis, MN & Twyla P. Wilson, LCSW, ACSW Durham, NC

This is Water

In conjunction with Dr. Stephanie Covington & Rick Dauer

Evolving Treatment Approaches

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Gender-Responsive Treatment
Creating an environment through: site selection staff selection program development content and material that reflects an understanding of the realities of the lives of women/girls, of boys/men and addresses and responds to their strengths and challenges.
Source: Covington, S.S., & Bloom, B.E. (2006). Gender-responsive treatment and services in correctional settings. In E. Leeder (Ed.), Inside and out: Women, prison, and therapy . Binghamton, NY: Haworth.

Guiding Principles
Gender: Acknowledge that gender makes a difference. Environment: Create an environment based on safety, respect, and dignity.

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Guiding Principles

(cont.)

Guiding Principles (cont.)

Socioeconomic status: Provide women and men with opportunities to improve their socioeconomic conditions. Community: Establish a system of comprehensive and collaborative community services.
(Bloom, Owen, Covington 2003)

Relationships: Develop policies, practices, and programs that are relational and promote healthy connections to children, family, significant others, and the community. Services: Address substance use disorders, trauma, and mental health issues through comprehensive, integrated, and culturally relevant services.

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Statistics
The following statistics illustrate how pervasive interpersonal violence is in the lives of women and girls. A woman is battered every 15-18 seconds (United Nations Commission on the Status of Women, 2000). Approximately 1.5 million women are raped or physically assaulted by an intimate partner each year in the US. Women under 24 years of age suffer the highest rates of rape (NOW, 2010). There is one sexual assault every about every two minutes. (FBI CIUS, 2008).
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Statistics
1 in 6 women will be sexually assaulted in her lifetime, with college age women 4 times more likely to be sexually assaulted (RAINN, 2007). More than half of rapes occur before age 18 and 22% occur before age 12 (CDC, 2009b). 1 in 5 girls and 1 in 10 boys are sexually victimized before adulthood (Nat (Nat l Center for Missing and Exploited Children, 2008). In homes where DV occurs, children are seriously abused or neglected at a rate that is 1,500% higher than the national average for the general population (Children (Children s Defense Fund Ohio, 2009).
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Statistics
1/3 of women in state prison and 1/4 in jails said they had been raped (BJS, 1999). Women in prison reported childhood abuse at a rate almost twice that of men; abuse of women as adults was eight times higher than the rate for men (Messina et. al., 2001). Between 23-37% of female offenders reported that they had been physical or sexually abused before the age of 18 (BJS, 1999).

Violence Against Women

Violence against women is so pervasive that the United Nations has addressed and defined violence against women as any act of gender-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivations of liberty, whether occurring in public or private life. life.
(United Nations General Assembly, 1993).

Sexual Assault Graph

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Bureau of Justice Statistics

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Sexual Assault Graph

Women Womens Issues: An International Perspective

Shame and Stigma Physical and Sexual Abuse Relationship Issues

fear of losing children fear of losing a partner needing partners permission to obtain treatment

Bureau of Justice Statistics

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Women Womens Issues: An International Perspective

Treatment Issues lack of services for women not understanding treatment long waiting lists lack of childcare services Systemic Issues lack of financial resources lack of clean/sober housing poorly coordinated services
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Moral Challenges
19th century - slavery 20th century - totalitarianism 21st century brutality against women and girls
(NY Times 9/23/09)

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Theoretical Foundation
The theories related to gender and substance use disorders (and any other relevant treatment services) that create the framework of thought for program development. This is the knowledge base that creates the foundation upon which the program is developed.

Theoretical Foundations

Relational Theory & Female Psychological Development Addiction Theory Trauma Theory

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Prison Study
(NIDA Funded)

Drug Court Study

(NIDA Funded)

Randomized control group Gender-responsive vs. Therapeutic Community Significant differences

Greater reduction of drug use More likely to complete treatment Remained longer in aftercare Less recidivism (re-incarcerated) at 12 months
(p ! .05)"
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Four sites in San Diego County Randomized control group Preliminary results
Less substance use Fewer sanctions Longer in treatment Judge notices differences
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Addiction: A Holistic Health Model

Physiological
Emotional

Upward Spiral
Transformation

Social Spiritual Environmental Political

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Addiction (constriction)

Recovery (expansion)

Definition of Recovery
The definition of recovery has shifted from a focus on what is deleted from one ones life (alcohol and other drugs, arrests for criminal acts, hospitalizations) to what is added to one ones life (the achievement of health and happiness).
(Miller & Kurtz, 2005)

Relational-Cultural Theory
Connection and development Disconnection Sociocultural disconnection Privilege and domination

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Relational-Cultural Theory
Alcohol and other drugs can be used: To maintain a relationship To fill in the void of whats missing in a relationship To self-medicate the pain of abuse in relationships
(Covington & Surrey, 1997)

Definition of Trauma
The diagnostic manual (DSM V) used by mental health providers defines trauma as: exposure to actual or threatened death, serious injury or sexual violation. violation.
(American Psychiatric Assoc. [APA] DSM-5)

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Definition of Trauma (cont.)

The exposure must result from one or more of the following scenarios in which the individual: directly experiences the traumatic event; witnesses the traumatic event in person;
(American Psychiatric Assoc. [APA] DSM-5)

Definition of Trauma (cont.)

The exposure must result from one or more of the following scenarios in which the individual: learns that the traumatic event occurred to a close family member or close friend; experiences first-hand repeated or extreme exposure to aversive details of the traumatic event (not through media, pictures, television or movies unless work-related).
(American Psychiatric Assoc. [APA] DSM-5)
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Definition of Trauma (cont.)

The disturbance, regardless of its trigger, causes significant distress or impairment in the individual individuals: social interactions, capacity to work, or other important areas of functioning.
(It is not the physiological result of another medical condition, medication, drugs or alcohol.)
(American Psychiatric Assoc. [APA] DSM-5)
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Definition of Trauma
Trauma occurs when an external threat overwhelms a person persons internal and external positive coping skills.
(Van der Kolk, B. 1989)

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Potential Trauma Sources Two Kinds of Suffering

Natural Created

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Types of Abuse
Sexual abuse Physical abuse Emotional abuse Domestic violence Witnessing abuse/violence Self-inflicted violence Military sexual assault (MST) Stigmatization
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Trauma

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Trauma-informed Services
Trauma-informed services:
Take the trauma into account. Avoid triggering trauma reactions and/or traumatizing the individual. Adjust the behavior of counselors, other staff and the organization to support the individuals coping capacity. Allow survivors to manage their trauma symptoms successfully so that they are able to access, retain and benefit from the services.
(Harris & Fallot)
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ACE Study
(Adverse Childhood Experiences) Before age 18:
Recurrent and severe emotional abuse Recurrent and severe physical abuse Contact sexual abuse Physical neglect Emotional neglect

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ACE Study
(Adverse Childhood Experiences) Growing up in a household with:
An alcoholic or drug-user A member being imprisoned A mentally ill, chronically depressed, or institutionalized member The mother being treated violently Both biological parents not being present
(N=17,00)
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ACE Study
(Adverse Childhood Experiences) Results ACEs still have a profound effect 50 years later, although now transformed from psychosocial experience into organic disease, social malfunction, and mental illness. Smoking Alcoholism Injection of illegal drugs Obesity
(Felitti, V.J.: Origins of Addictive Behavior: Evidence from the ACE Study. 2003 Oct:52(8): 547-59. German. PMID: 14619682 (PubMed-indexed for MEDLINE).
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ACE Study
(continued)

Childhood Traumatic Events

Largest Effect-Mental Health

Women 50% more likely than men to have a score of 5 or more.

980% increase in odds if exposure to 7 CTEs

(Messina & Grella, 2005)

(Felitti & Anda, 2010)

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ACE Study
If a male child has six or more yes yes answers, his risk of becoming an IV drug user increases by 4,600% compared to a boy with a score of zero.

Adverse Childhood Experiences

Underlie Alcoholism

People with an ACE score of 4 or more are over 5 times more likely to struggle with alcoholism than people with an ACE score of 0.

(Felitti & Anda, 2010)

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Source: Ann Jennings, Ph.D.

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Adverse Childhood Experiences

(www.ACEStooHigh.com) (www.cdc.gov/ace)

Women in Prison
Childhood Traumatic Events Largest Effect-Mental Health

980% increase in odds if exposed to 7 CTE CTEs

(Messina

& Grella, 2005)

R. Fallot, Ph.D.

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Three Critical and Interrelated Issues

Substance Use Disorders

Level of Burden
Burden Burden is defined as the total number of problem conditions:

Mental Health Trauma

Use of alcohol and/or other drugs Homeless Co-occurring mental health problem Significant health disorder HIV/AIDS Cognitive impairment History of childhood or adult abuse
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Vivian Brown, Ph.D.

Mental Illness

SUDs

A Repetitive Cycle of Risk

Incarceration Homelessness

HIV/ AIDS

Other Health Problems

Substance Abuse

Violence and Trauma

Trauma
Source: Vivian Brown, Ph.D.

Mental Health Problems

Homelessness
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Roger Fallot, Ph.D.

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What does the prevalence data tell us?

Many people with trauma histories have overlapping problems with mental health, substance use disorders, physical health and are victims or perpetrators of crime. Victims of trauma are found across all systems of care.
(Source: NASMHPD 2008)

Therefore Therefore

We need to exercise universal precautions.

(Source: NASMHPD 2008)

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Copyright 2013, Covington, Griffin, and Dauer

Emerging Paradigm Values-Based Services

Gender-responsive Trauma-informed Culturally competent Recovery-oriented

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Rules
Always be in Control Don Dont Cry Don Dont ask for help Don Dont show emotion Be a sexual superman Don Dont show weakness Integrity Responsibility Be a provider

Recovery
Show vulnerability Ask for help Admit powerlessness Let go of control Be responsible Be of service Express emotion Humility Sobriety

We have to learn how to walk through the messages of gender but only if we can see them them only if we can see the Water

Dan Griffin, GRE INC.

How have your ideas of being a man changed since getting into recovery?

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Men Mens Integrated Treatment

Evolving Treatment Approaches

Covington, Griffin, & Dauer 2013

Covington, Griffin, & Dauer 2013

Gender-Responsive Treatment
Creating an environment through:
site selection staff selection program development content and material

What Whats Been Missing?

Impact of male socialization on recovery Relational needs of men Abuse and trauma (experienced and perpetrated)

that reflects an understanding of the realities of women/men and girls/boys, and addresses and responds to their strengths and challenges.
Source: Covington, S.S., & Bloom, B.E. (2006). Gender-responsive treatment and services in correctional settings. In E. Leeder (Ed.), Inside and out: Women, prison, and therapy . Binghamton, NY: Haworth.

Covington, Griffin, & Dauer 2013

Covington, Griffin, & Dauer 2013

Copyright 2013, Covington, Griffin, and Dauer

The Theory of Men Mens Psychosocial Development

Men are not the problem how men have been socialized is the problem Homophobia, devaluation of women, violence, detached fathering, and emotional illiteracy Power, privilege, and pain

Gender and Trauma

A gender-informed framework A fundamental belief that trauma is pervasive in men mens lives and there are gender differences in:
How men experience trauma How men respond to trauma How men exhibit the symptoms of traumabased disorders How men heal from trauma

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THERE IS

Is There Another Way to View Men Mens Trauma?

NO
GENDER NEUTRAL
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Men, Violence & Trauma

75 percent of student suspensions, expulsions, grade failures, special-education referrals, school-violence casualties, and all other assaults are for boys 75 percent of teenage suicides are boys 70 percent of all suicides are boys/men 80 percent of the homeless are boys/men
(Lyme et al., 2006)

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Men, Violence & Trauma

(cont.)
80 percent of homicide victims are men 93 percent of prison inmates are men 99 percent of executed prisoners are men (in the last decade, 700 men and 10 women) Men are two to five times more likely to develop a substance-use disorder
(Lyme et al., 2006)

Male Violence Affects Womens Lives Approximately 1.5 million women and 870,000 men are raped or physically assaulted by an intimate partner each year in the United States. One in every four women will experience domestic violence in her lifetime. Eightyfive percent of domestic violence victims are women. Most cases are never reported to the police. (National Coalition Against
Domestic Violence, 2009)
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Ending Men Mens Violence We will not end the cycle of boys boys childhood trauma and men mens violence until we treat men with compassion as well as accountability.
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Core Principles of Trauma-Informed Care

Safety: Ensuring physical and emotional safety Trustworthiness: Maximizing trustworthiness, making tasks clear, and maintaining appropriate boundaries Choice: Prioritizing consumer choice and control Collaboration: Maximizing collaboration and sharing of power with consumers Empowerment: Prioritizing consumer empowerment and skill-building
(Fallot & Harris, 2006)

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Relational Cultural Theory and Men

We are a traumatized field, Working with traumatized clients, Sending them to a traumatized recovery community.

Dr. Stephen Bergman

* Self in Relation vs. Individuated Self * Male relational dread * Agents of disconnection * Power dynamics

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Male Relational Dread

Characteristics of Healthy Relationship? Intimacy Honesty Vulnerability Compromise Trust Sharing Emotions
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Trauma and CBT (CBT (CBTs Just Alright With Me, Oh

yeah)

Not very effective as the predominant approach Pre-frontal cortex goes offline offline Trauma resides in the body as much as in the mind How many men in the system have trauma related TBI?
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there is no clinical evidence pointing to the therapeutic efficacy of confrontation, and there is ample clinical evidence that this approach results in poor outcomes and can even cause harm (Miller & White, 2007). This is particularly relevant in treatment of offenders. Although there may be a need for increased accountability and consequences associated with inappropriate behavior, there is no evidence that a highly confrontational model is more effective than a strengths-based approach
- Helping Men Recover, Chapter 1, 2011

Trauma-Informed Responses & Criminal Justice Interventions

Trauma-Informed

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Criminal Justice
Structure Consistency Predictability Accountability Punitive Behavioral Correction Directive Reactive Restriction Deterrence Fear Hierarchy Rigid
Copyright 2012 Griffin

Structure Consistency Predictability Safety Therapeutic Healing and Growth Collaborative Responsive Exploration Empowerment Trust Mutuality Flexible

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Eight Points of Agreement

1. While progress has been made in the understanding of trauma, there remains a myth that trauma is not a major issue for males. 2. Trauma is a significant issue for males with substance and/or process addictive disorders. 3. Males are biologically and culturally influenced to minimize or deny traumatic life experiences.

Eight Points of Agreement

4. Addiction treatment has been negatively influenced by cultural myths about males. 5. Males are often assumed to be the perpetrator, which has negatively influenced our concepts of trauma and models for treatment, and often results in the re-traumatization of men in addiction treatment. 6. Male trauma must be assessed and treated throughout the continuum of addiction services.

Eight Points of Agreement

7. Male-responsive services will improve addiction treatment outcomes. 8. Effective treatment of male trauma will help to interrupt cycles of violence, abuse, neglect, and addiction.

And Now Now.

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Contact Information
Twyla P. Wilson, LCSW, ACSW
112 Swift Avenue Durham, NC 27705 (919) 801-9087 twyla.lcsw@gmail.com therapists.psychologytoday.com Dan Griffin, MA Griffin Recovery Enterprises, Inc. Phone: 612-701-5842 dan@dangriffin.com www.dangriffin.com Facebook: www.facebook.com/TwelveStepsforMen
Stephanie S. Covington, PhD, LCSW (858) 454-8528 (858) 454-8598 FAX sc@stephaniecovington.com www.centerforgenderandjustice.org

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