Women face a unique set of mental health concerns. And due to societal pressures, they may also encounter barriers to treatment. For example, some women feel unsafe or uncomfortable around men. Because of this, it can be hard for them to start recovery in a mixed-gender environment. In order to accommodate this demographic, some facilities offer women-only rehab programs.
Gender-specific rehab is a protected space. Surrounded by people who share some part of your experience, you can build deep connections with your cohort. In this context, many women feel more comfortable sharing thoughts and feelings they wouldn’t discuss elsewhere.
For some women, these programs are the best possible way to begin healing. However, they’re not always the right fit. And gender itself isn’t a simple thing.
There’s an important distinction between gender and biological sex.1 The term “sex” usually refers to a person’s biology—or at least, observations about their biology. “A person typically has their sex assigned at birth based on physiological characteristics, including their genitalia and chromosome composition.”
Gender, however, is far more complex. In fact, gender is sometimes considered a “social construct,”2 related to, but not identical to, sex. It encompasses a set of social norms, roles, and expectations assigned to people who present in traditionally feminine or masculine ways.
In the U.S., for example, many people assume that it’s feminine to wear makeup to work, and masculine to wear a suit. As time goes on, these norms are starting to shift. However, a person’s assigned and/or affirmed gender continues to impact their mental health and access to medical care.
In some cases, gender norms can be incredibly affirming. Some women feel empowered by wearing high heels every day—and that’s wonderful! But these norms are often enforced too strictly, without consideration for the wants and needs of individual people.
This harsh rigidity can harm people of all genders. That includes women, men, intersex people, nonbinary people, a-gender people, and everyone else. It’s all too common for patients to feel like they’ve been forced into roles that feel inauthentic, or excluded from spaces where they might belong.
For women, in particular, gender can have a direct impact on health. Women face disproportionate levels of interpersonal violence, including domestic violence3 and sexual assault.4 The World Health Organization (WHO) recognizes that “gender inequality and discrimination faced by women and girls puts their health and well-being at risk.”5 That risk is not only physical; it also impacts women’s mental health. And substance use disorders are a mental health issue.
Historically, research has shown that women have lower rates of substance misuse than men.6 But the gap is narrowing. According to research conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), 7.2 million women had substance use disorders in 2019.7 Of those women, 4.6 million also had a mental illness.
As with any statistic, these numbers only reflect reported cases. Because of the inherent gender bias in medicine,8 there may be many more cases. Women are routinely misdiagnosed or underdiagnosed with a host of conditions, from fibromyalgia to heart disease. Regardless of their prevalence, women experience a unique set of issues related to substance use disorders.
After first using illicit substances, women may be more vulnerable to addiction.9 Some data suggests that “women tend to progress more rapidly than men from initial experience” to developing serious substance use disorders. More research is needed on the subject, but experts wonder whether this is due to a difference in neurochemistry or social norms.
Women may also develop substance use disorders as a result of medical treatment for other conditions. As the opioid epidemic10 continues, this is a growing concern for patients who take prescription painkillers. “Women are more likely to have chronic pain, be prescribed prescription pain relievers, be given higher doses, and use them for longer time periods than men. Women may become dependent on prescription pain relievers more quickly than men.”
This trend is especially concerning because of the relationship between addiction and chronic pain. Nearly ⅓ of people with chronic pain may also have substance use disorders.11
Chronic physical pain is just one of many conditions related to substance misuse. Other co-occurring disorders may also lead to addiction.12 “People with mental illness are more likely to experience a substance use disorder than those not affected by a mental illness.
Co-occurring disorders are just what they sound like—multiple diagnoses that are experienced by one patient. Most often, this term refers to mental health conditions. And women in recovery13 may be at a higher risk for developing these concerns. Data shows that “women are more prone to depression, anxiety, and eating disorders than men. Almost 2x as many women experience depression as men.”
These numbers may partly be related to women’s high risk of experiencing interpersonal violence. According to experts, “Women who have gone through abuse or other trauma14 have a higher risk of developing a mental health condition.”
Women are at an increased risk of many types of interpersonal violence, including sexual assault. Statistics show that 20% of women in the U.S. have have experienced rape. For women in recovery from substance use disorders,13 that number is estimated to be more than 70%.
This is likely because sexual assault increases the risk of substance abuse.15 Addiction may develop in an attempt to “ameliorate post-assault distress,” as survivors try to self-medicate the symptoms of post-traumatic stress disorder (PTSD).
Survivors are often isolated by the stigma of sexual violence.16 Women who have been raped “are frequently condemned and socially excluded” when they seek help. Without adequate social support or medical attention, substance use may feel like the best way to treat mental health symptoms.
Like sexual trauma, substance use disorders are extremely stigmatized.17 Researchers believe this is a greater issue for women than people of other genders. This may be the “result of their traditional societal roles as gatekeepers, mothers, caregivers, and often the central organizing factor in their family units.”
Stigma prevents women with substance use disorders from receiving support,18 but it also affects self-image. Results from one study “suggest that ‘proneness to shame’ (conceptually similar to self-stigma) was higher among women who use drugs than among men who use drugs.” This self-stigma can be a barrier to treatment,19 because it causes a perceived “need for secrecy” about both substance use and the recovery process.
When women seek recovery from some types of substance misuse,9 they may experience “more severe withdrawal than men.” This is not universally true; it depends on which substance the patient was using, and the severity of their addiction. For example, men healing from alcohol abuse usually have more severe withdrawal symptoms than women.
Women and men also exhibit different levels of susceptibility to relapse. One study found that although there was a “lack of gender differences in alcohol relapse rates,20 women appear less likely to experience relapse to substance use, relative to men.” However, women with relationship problems were more vulnerable to relapse.
Because of these concerns, marriage is a risk factor for relapse among women20 in recovery. If you’re already in a relationship when you begin healing, it can be helpful to take some space and focus on your own mental health. And if not, you may benefit from attending rehab in a protected environment, like a gender-specific program. Even if you’re attracted to people of your own gender, this experience may set the tone for a more sustainable recovery.
In any type of affinity group, people come together with a common understanding of each other’s identities. This is true for book clubs, knitting circles, and hiking meetups. It’s also true for gender-specific rehab.
Surrounded by people with a shared experience of gender, many patients report feeling safe. These cohorts provide women with substance use disorders21 “more freedom to talk about difficult topics such as abuse and relationship issues and to focus on themselves rather than on the men in the group.”
According to Dr. Campbell Leaper, a professor of Psychology at the University of California, Santa Cruz, “‘Men tend to be more talkative than women,22 but particularly when they’re interacting in mixed-gender settings.’” He explains that this may be “a result of men traditionally being socialized to dominate.” Because of this dynamic, women sometimes struggle to voice their opinions in mixed-gender settings. The issue may be less apparent in women-only groups, including treatment programs.
By removing these stressors, women can put more energy into their own recovery, and less into navigating the dynamics of a mixed-gender group. And women who are attracted to men may face fewer distractions during treatment. These factors can greatly benefit some patients, but they are not universally necessary.
Although available data “supports same-sex groups as being more beneficial than mix-gender groups for women,” experts note that more research is needed. Many published studies on the subject fall short in their efforts to compare women’s rehab to mixed-gender treatment.21
While many women feel safer among other women, some prefer a different dynamic. If you struggle to trust people of your own gender, then this type of treatment might not be the right fit. Gender is just one aspect of identity.
Different rehab centers define “gender” in different ways. And, unfortunately, some women’s-only rehab programs may not be accepting of trans women, gender non-conforming women, and others with non-cis identities. If you’re concerned about finding LGBTQ+ affirming care, it’s absolutely vital that you talk to the admissions team before enrolling in any program. Ideally, rehab should be a place where you feel supported, safe, and ready to begin healing.
In any residential rehab experience, it’s important to focus on your own personal healing journey. And no matter who makes up your cohort, that journey will be complex, sometimes painful, and unique to you. When you’re ready to choose a program, it’s important to prioritize your needs. What would make you feel safe? What would make you feel supported? What feels right?
For some patients, women’s-only rehab is the best way to begin healing. That’s certainly not true for everyone. But in the process of making that decision, you can learn a lot about yourself. And that, too, is an important part of recovery.
If you’re interested in attending a gender-specific program, you can learn more about rehabs with specialized programs for women here.