Academic journal article Indian Journal of Psychiatry

Interventions in Individuals with Specific Needs

Academic journal article Indian Journal of Psychiatry

Interventions in Individuals with Specific Needs

Article excerpt

Byline: Piyali. Mandal, Anju. Dhawan

With the growing understanding of substance use problems among special populations like women, gender minority groups, as well as in the geriatric population, there is a drive to develop sensitive interventions catering to their unique needs. This chapter is a short review of psycho-social interventions targeted towards these individuals with specific needs.

Introduction

Traditionally, substance use has been seen as a phenomenon among adult males. Until recently, addiction research and services suffered a scarcity of intervention and outcome related data for women or sexual minorities like LGBT, extreme age groups and other minorities. These groups often pose unique treatment challenges due to the obvious differences in the interplay of various bio-psychosocial factors relating to substance use. However, with the emergence of evidence on increasing substance use among women, sexual minority groups, decrease in the age of initiation of substance use and problematic substance use among older adults, the specific treatment needs of these groups are being assessed and interventions are being planned during the recent three decades. Apart from the pharmacological treatment for substance use, these population groups in question often benefit from psycho-social interventions. Many of these interventions are developed taking into consideration the theoretical underpinnings and epidemiological evidence related to bio-psychosocial factors associated with substance use among these populations. In this chapter, the psycho-social interventions developed or modified so far for these special population groups for substance use problems would be discussed.

Women

With the emergence of understanding of gender difference in substance abuse, there has been a drive for developing gender-sensitive interventions/programmes for substance use problem among women and sexual minorities. Certain psychosocial antecedents have been found more likely to be associated with substance use by women. These include comorbid psychiatric disorders[1], significantly more physical and sexual abuse and domestic violence, victimization,[2],[3] and deficits in social support.[4] Nearly half of the women treatment-seekers in tertiary addiction treatment centres or community clinics in India also report similar psychosocial issues for initiation of substance use.[5],[6],[7] Treatment seeking and retention are usually poor among women all over the world including India.[5],[6] Studies indicate that women face various systemic, structural, social and individual barriers in treatment seeking and retention in treatment for substance abuse.[8] These include lack of appropriate gender responsive treatment models, lack of services for pregnant women; rigid programme schedules, lack of safety at treatment centres; inadequately trained staff for handling gender sensitive issues; fear of losing custody of children; lack of childcare outside of treatment. disadvantaged life circumstances; stigma, shame and guilt; lack of support from family; decreased perception of need for treatment are few of the socio- cultural and personal barriers reported in the literature.[9]

A gender sensitive intervention ideally should systematically integrate the gender dimension into every step of the process, from defining the problem, to identifying potential solutions, in the methodology and approach to implementing the intervention.[10],[11]

The theoretical underpinnings for gender-sensitive interventions developed for women take into account the addiction theory, women's psychological development, the trauma theory and the factors associated with substance use among women discussed earlier.[10],[11],[12],[13],[14] Apart from the emotional, psychological, spiritual component, the addiction theory takes into account the environmental and socio-political dimensions into the disease model of addiction. …

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