She has been hiding her drinking, but doesn't know how much longer she can fool the people around her. She is ignoring the kids and feels guilty, seems like all of the time now. She is terrified that her ex-husband will find out that she's drinking so much and get the judge to take the children away from her. Maybe he should—I'm a lousy mother anyway." Someone told her about a clinic where she could get sober. "Would it work for me? Can I afford it? Who will take care of my kids?"

The first place women go to get help is their primary care provider. Here, screening for substance abuse is uncommon, so substance abusing women go unrecognized. When these practitioners do discover their client's substance abuse they often are judgmental. This especially is true if the woman seeking help is pregnant or has young children. The provider has to decide whose rights to consider, the mothers or her children's. Most commonly the rights of the women are secondary. This can lead to loss of custody of her children, her unborn baby, and to prosecution for her. A woman will avoid this punitive environment often putting herself, her baby, and her other children at further risk.

Substance abuse is rising among young women and this has brought new challenges to the treatment community. Most treatment models are based on experience with men, and do not work well for women. Research has shown that women have better treatment outcomes if their treatment is based on a family model of care that includes gender-specific treatment. Therapeutic modalities shown to be effective for women include group therapy, treatment separated from males, and the use of female therapists Comprehensive services that include the needs of children like day hospitalization for their mother, residential treatment, and prevention services for them also seem promising.

Federal legislation in recent years has spawned the growth of women's services within existing treatment venues and the development of a significant number of new program. The-treatment community in California for example, has used these legislative initiatives to develop a continuum of programs that extend from prevention to residential treatment. The rapid development of women's programs has not permitted systematic evaluation of treatment effectiveness. This is a unique opportunity for the research and treatment communities. Researchers have the chance to study treatment through all stages of its development and implementation. CBOs that treat women may be more receptive to research since their organizations are relatively new, often based on scientific theory, and less entrenched than those providers with a longer treatment tradition. The development of evidence-based treatment for women is an opportunity to set a research agenda that is bidirectional, collaborative, and creates partnerships between researchers and providers.

SOURCES: Abcott (1994); Brindis et al. (1997); Brindis and Theidon (1997); Garcia (1993); Grella (1996); Kaufman (1996); Light et al. (1996); Mallouh (1996); Naegle (1968); Pokomi and Stanga (1996); Ripple and Luthar (1996); Samsioe and Abreg (1996); Streissguth (1993).