1. Texas COSIG Project Gender Differences in Substance Use Severity and Psychopathology in Clients with Co-Occurring Disorders 5 th Annual COSIG Grantee Meeting May 2008

2. Texas COSIG Project Key Components  Substance abuse treatment counselor training on COD and the use of diagnostic and assessment instruments to improve identification of comorbidity and monitor client progress  A voucher system that provides recovery and social support services to enhance the treatment process ($1800 per client)

3. Voucher Service Categories  Child Care  Housing Support  Transportation  Food Assistance  Education Support  Employment Assistance  Clothing  Medical Care  Prescriptions  Peer Mentoring

4. Gender Differences  Prior to this study, research related to gender differences in clients with COD was limited to severely mentally ill populations  Studies indicated that women were more likely to have children, had a greater history of victimization and associated traumatic stress, more medical problems, and may be more willing or able to identify relationship and psychiatric problems, whereas men tend to have higher levels of legal involvement

5. Gender Differences  The current study examines gender differences in a sample of clients with COD entering addiction treatment that includes both severe and non-severe psychiatric disorders  The purpose of the study is to determine if gender characteristics in this sample, containing a wider array of psychiatric disorders, are similar to those found in previous studies of SMI populations

6. Study Sample  The sample consisted of 213 clients entering addiction treatment who subsequently qualified for the Texas COSIG program  The sample was recruited between March 2005 and January 2006 from six state-funded addiction treatment programs participating in the COSIG project  The total sample was 60% males, 53% Hispanic, 41% White, and 7% Black

7. Data and Analyses  Males (n = 127) and females (n = 86) were compared on demographic variables, MINI psychiatric diagnoses, substance use characteristics, psychiatric severity, voucher service utilization, and treatment characteristics  Psychiatric severity measures include the Brief Symptom Inventory (client report) and the Brief Derogatis Psychiatric Rating Scale (clinician rating)  Demographic, substance use, voucher service, and treatment data were obtained from BHIPS, the Texas administrative data system

8. Client Demographics  Women were more likely to have children (38% vs. 24%), be living in a group or institutional setting (28% vs. 6%), and had higher levels of legal involvement (33% vs. 18%)  Men were older (40.6 vs. 33.5 years) and had higher homelessness rates (24% vs. 12%)  The groups did not differ in race/ethnicity, education, age, marital status, employment, or past year substance-related arrests

9. MINI Diagnostic Impressions

10. Psychiatric Symptom Severity  On the Brief Symptom Inventory, men reported greater severity on the phobic anxiety, paranoia, and psychoticism scales  Clinicians rated men as having more severe symptoms on the paranoid ideation and psychoticism scales of the Brief Derogatis Psychiatric Rating Scale

11. ASI Problems Days

12. Primary Substance of Abuse*

13. Substance Use Patterns  Women reported higher levels of daily substance use during the past 6 months (74% vs. 52%)  A greater percentage of women reported polysubstance use (51% vs. 37%)  Men reported greater years of substance use (21 vs. 12); however, no group differences were found in age of first use

14. Substance Abuse Treatment History

15. Discharge Characteristics  Men were more likely to receive detox services relative to women (47% vs. 28%)  Men received more types of voucher recovery support services (3.2 vs. 2.4)  No gender differences were found in length of stay, treatment completion, or abstinence rates at termination from treatment

16. Voucher Service Utilization

17. Conclusions  Consistent with previous findings in the SMI population, the current study revealed that women were more likely to have children, had higher rates of posttraumatic stress disorder, displayed higher medical problems, and reported more psychosocial problems relative to men  Contrary to past results, women in this sample were more likely to be legally involved compared to men and reported comparable substance related arrests during the past year

18. Conclusions  Also contrary to past results, men in this sample displayed greater severity on psychiatric measures and received a wider array of ancillary services, yet reported less social and psychological problem days at admission to treatment  Conversely, females presented relatively greater substance use severity but reported higher levels of psychosocial distress and less problems related to substance use

19. Conclusions  These findings suggest that a differential pattern of awareness may exist regarding the effects of psychiatric and substance use severity on life functioning, with males more readily admitting to problems related to substance use and females more open to acknowledging the effects of social and psychiatric problems  The possible presence of differential gender effects on client reporting has significant clinical implications for the assessment process and highlights the importance of using a variety of measures and informant sources to corroborate the client’s problem presentation

20. Conclusions  Further, gender differences in problem awareness may also indicate the need for treatment programming and interventions tailored toward increasing recognition of the broader and interactive effects of substance use and psychiatric problems on social functioning

21. Article Reference Mangrum L. F., Spence R. T., & Steinley-Bumgarner, M. D. (2006). Gender differences in substance abuse treatment clients with co-occurring psychiatric and substance use disorders. Brief Treatment and Crisis Intervention, 6(3), 255-267. Mangrum L. F., Spence R. T., & Steinley-Bumgarner, M. D. (2006). Gender differences in substance abuse treatment clients with co-occurring psychiatric and substance use disorders. Brief Treatment and Crisis Intervention, 6(3), 255-267.