effectiveness. There are large gaps in our knowledge of these areas, much of which is attributable to methodological difficulties.

Women

The health consequences of drug abuse can be more serious for women than for men, in spite of the fact that fewer women abuse drugs. Women can contract HIV through injection drug use or prostitution to purchase drugs. Maternal drug use can result in transmitting the disease to their fetus, premature delivery with serious complications, and impairments in parenting. Yet research has documented more barriers to treatment entry for female than for male alcoholics (Weisner and Schmidt, 1992; Schmidt and Weisner, 1995). Some of the obstacles for women are the cost of treatment, the possible loss of custody of their children, and the lack of child care (Beckman, 1994). Similar barriers to treatment may be operating for male drug abusers, but the extent of the problem is unknown.

A recent study of more than 12,000 clients in treatment found that women tended to drop out of treatment at higher rates than men (Mammo and Weinbaum, 1993). It is possible that women have difficulty making child care arrangements, fear retribution, or feel uncomfortable talking about their problems when being treated in programs that are predominantly male. Some programs, in an attempt to overcome these barriers, have experimented with women-only groups and with on-site facilities for child care.

Studies have also shown that women with drug abuse disorders typically have more psychiatric disorders (including depression and anxiety) than males (Blume, 1992). Many drug-dependent women have been sexually abused as children, suffer from posttraumatic stress disorder, and have significant problems forming healthy relationships with males (SAMHSA, 1994b). Abusive relationships with drug-abusing males are common, sometimes characterized by situations in which the male exerts control by providing drugs. These complex issues indicate that psychiatric assessment and treatment constitute a particularly important aspect of drug abuse treatment for women. Few studies have been done to examine the effect of integrating psychiatric treatment into the ongoing services of programs that treat drug-abusing women.

In spite of those problems, research shows that when women remain in treatment, they benefit just as much as men do (Sanchez-Craig et al., 1989; Ball and Ross, 1991; Finnegan, 1991). Methadone maintenance programs for pregnant women are the best studied, but outcomes in many other settings indicate that women benefit at least as much as men from the range of treatments that are currently available (Hubbard et al., 1989;



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