Mary Coleman, a psychotherapist who specializes in addiction and recovery, talks about the unique challenges women face with addiction and treatment.
Rosemary Cope: Welcome to this edition of the Vanderbilt Health and Wellness Wellcast. I am Rosemary Cope with Work/Life Connections. Our guest today is Mary Coleman, who is a marriage and family therapist in private practice in Nashville. Mary is a graduate of Antioch University in Los Angeles and has a specialty in addiction and recovery. She is also an adjunct professor at Tennessee State University and is completing a book about first year in recovery. Addiction is an equal-opportunity disease that doesn't single out race, religion, or gender, yet, for some women, the female substance abuse stigma can be so strong that it keeps them from seeking help. In a world where much of the research on addiction is focused on men, it is more important than ever for women to have the courage to receive the treatment they need without shame and judgment. Mary, men and women often take different routes to substance abuse and addiction. What are some of the unique risk factors that women face?
Mary Coleman: Well, thank you for having me, Rosemary.
Rosemary Cope: Absolutely.
Mary Coleman: And I wanted to just touch on something you said, that it wasn't until the '90s that people even began to study the effects of alcoholism and addiction on women, and there was a lot of information missing that could have been very helpful and directed toward treatment. So, women have a higher sort of "at risk." There is a larger percentage of sexual abuse in alcoholics and addicts. They have now done research that hormones play a significant part, particularly estrogen, in a proclivity toward addiction, and women have different pain receptors. They have a lower tolerance to pain, which has fueled the opioid addiction. But once in addiction, some of the differences are really important. It takes much less for women than men for whatever substance they are abusing, and so, the impact is greater. They are higher faster. They are drunker quicker, which has led to more overdoses, more trips to the hospital. They ... We also metabolize alcohol and drugs differently than men do and it takes less for us to get to that point, as I just said. Women also do what's known as "telescoping," which is they go from use to abuse to addiction much more quickly than men do, and so, while there are more men addicts, women go much quicker into addiction, which is significant.
Rosemary Cope: Absolutely, because I'm thinking, for women who are just ... I'm just having a glass of wine. Then, I'm having another glass. And now I've killed half the bottle and I don't realize that I am fast-tracking myself to a place that I might never have intended to go. So, yeah, I'm thinking that one stereotype of an intoxicated man is that, well, he's the life of the party, and that, for a woman, she's seen as a hot mess, which seems very unfair to me. And how has this double standard affected a woman's ability to seek treatment?
Mary Coleman: I think women begin to internalize some of the messages. Unfortunately, in society, we still have that "good girl/bad girl" mentality. You would think we had made a lot more progression. There are ... Women still receive such mixed messages of how they are supposed to be, accomplish it all, look nice and smell nice at the same time. So, there are a great deal of pressures on women. So, you have this notion ... And first of all, let me say no one likes to be around someone who is completely out of control. It is uncomfortable. But when women are in that position, there is a certain sense of danger or endangerment that makes people even more uncomfortable, and by the time women are bottoming out, they are stigmatized, they are traumatized, and they are demoralized, and a lot of times, they don't have even the inkling, the beginnings of self-esteem to think they are worth getting help or that treatment could actually work for them. So ... And there are some physical, logistical things. Women are caretakers. They are taking care of children, families, and maternal.
Rosemary Cope: How will I get treatment when I have so many other things to do?
Mary Coleman: Exactly, when I have these demands, when I have financial limitations. So, it's just hard for women.
Rosemary Cope: Absolutely. And I'm thinking about removing that female substance abuse stigma requires removing shame and removing guilt about that ... from the addiction equation, and that I have to do all these other things first and I don't come first ever.
Mary Coleman: Ever.
Rosemary Cope: So, how does a woman come to feeling empowered enough to do all of that? How does she move to that? Huge question, though.
Mary Coleman: Huge question. Huge question. And I wish we could remove the shame and guilt. I think society needs to do a better job at education and empowering younger girls and giving them this notion that they don't have to take care of everything and accomplish everything. So, education is a huge piece, changing our attitudes, recognizing that this is a disease. When my clients come to me in the beginning of their bottoming-out period, recognizing that they have a problem, which is a whole journey unto itself, I try to help them understand that they have a disease. They are not the disease. They are not broken. They are not broken for life. And, you know, I think you mentioned shame and this toxic shame. Brené Brown says that shame is the swampland of the soul, but she also says that one of the most successful combatants is the simple phrase "Me Too," and I think women need to know that there are other women like them, and that no matter what has happened to them, what they have had to do, there are other women in treatment that are there who have gone before them and who understand.
Rosemary Cope: Yes. So, with that in mind and seeking treatment, can you tell our listeners briefly where are some places that they might reach out here in the Middle Tennessee area? What are some local resources?
Mary Coleman: Cumberland Heights, I hear amazing things about. I am still getting familiar with some of the local treatment centers. I've heard good things about Addiction Centers of America. Local AA meetings.
Rosemary Cope: Right or Smart Recovery.
Mary Coleman: Smart Recovery, absolutely. Smart Recovery is really developing a lot of groundwork and has had a great deal of success because the 12 steps and the spiritual aspect of it don't work for everybody.
Rosemary Cope: Sure.
Mary Coleman: But there are meetings all over Nashville and Middle Tennessee. It is a hub of recovery.
Rosemary Cope: Excellent. Thank you so much. That was a great place for us to begin to start thinking about if I know somebody or I am somebody who has questions about this, I am not alone and there are places for me to actually receive the help that I need.
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