Book Excerpt
Healing the Wounded Self – A Trauma-Focused 12 Step Journey for Women
By Chaplain Deb
The Big Book of Alcoholics Anonymous and the Twelve Steps are iconic resources that have helped millions of individuals. While the Big Book reflects the language, knowledge and culture of another era, the beauty of the AA program is that it has stood the test of time – many of the insights and adages are as relevant today as they were at program inception. Still, we now know that addiction manifests very differently in women than in men. With this knowledge and the availability of additional resources, women can enhance and adapt the AA and recovery philosophies to our unique bodies, minds and spirits. Because of our complexity and our traumas, we can now choose to go deeper.
Different Bodies. Different Minds. Different Emotions. Different Spirits... means Different Work. Deeper Work.
In this journal book, I address the gender difference and present an approach that encompasses the physical, mental, emotional and spiritual components of the disease of addiction in women. As we address the parts of the whole, as well as ‘the whole,’ our healing will be profound and expansive.
This trauma-focused approach is designed to be used in conjunction with the Twelve Steps from a female gendered lens and will speak more clearly to those of us who have experienced trauma. (It is important to note that clinical studies since the early 2000s cite high correlations between Post Traumatic Stress Disorder (PTSD) and Substance Use Disorder (SUD) – whether the substance is alcohol, cocaine, opiates, marijuana... any drug.) So, the work may be beneficial to users of all substances.
The Physical, Mental, Emotional and Spiritual Aspects of Women and Addiction
Recovery from addiction has four components: physical, mental, emotional and spiritual. As stated, we will address these components both individually and as part of the whole. We can think of this as the four-legged stool of recovery foundation. If one of the legs is not as strong as the others or is missing some key stability, the stool will topple over. Adjustment and repair would then be needed.
Our goals are to establish a firm foundation in recovery, to create a design for living that fits our uniqueness, and to heal the root trauma of our disease.
The Physical Component:
The physical differences between males and females in addiction involve metabolism, hormones, and body composition, causing women to generally reach higher intoxication levels faster and experience faster addiction progression. Women also face higher risks for organ damage, cravings, and relapse due to the influence of hormones.
Because addiction manifests in the body, then part of our healing must also focus on the body. As women in recovery, we must be intentional about taking care of our bodies as an essential part of sobriety. In addition to physical fitness and exercise, our diets and sleep routines need attention.
The Mental Component:
Women use substances to cope with negative emotions, stress and trauma. In fact, nine out of ten women suffered from primary trauma, including sexual abuse, emotional abuse and neglect, and physical abuse and neglect. Women are more likely to suffer from co-occurring mental health conditions such as depression, anxiety, Post Traumatic Stress Disorder (PTSD), and eating disorders. Women face higher social stigma which can lead to increased shame and in turn, higher rates of mental health issues. More likely to have alcoholic parents, relatives and dysfunctional families, women are also more likely to encounter obstacles in recovery per caregiving roles, gender expectations, and socioeconomic hardships.
Research out of the Yale School of Medicine cites that women who suffered major stressors in early childhood, such as abuse or neglect are especially vulnerable to developing alcohol use disorder. “The prefrontal cortex and the amygdala are key brain regions that interact with the experience of childhood adversity, childhood trauma and stress,” says Sherry McKee PhD, professor of psychiatry at Yale School of Medicine. These experiences lead to the internalization of anxiety and depression, which then lead to alcohol use. “Data suggest that this is a common pathway for alcohol use disorder in women.”
What stands out most is the statistic on trauma: 90% of women with substance abuse have experienced primary trauma. Now, we know that almost every single individual on this planet experiences some form of trauma in her life. But not everyone experiences Trauma with a big T, meaning violent sexual and interpersonal assault, and/or traumatic grief.
Of the total U.S. and Canadian population, 50.5%, or 195 million, are female. Roughly 14% of women have a substance abuse disorder. That equals 27 million women. If we apply the 90% statistic on primary trauma, that means 24.3 million women in the US and Canada have experienced trauma and potentially suffer from PTSD.
How exactly does PTSD manifest in the brain? The impact of trauma on the brain is multifaceted. The research indicates that there are three distinct areas in the brain that are injured with trauma: the amygdala (the area responsible for re-experiencing and the symptoms of hypervigilance), the hippocampus (the area responsible for verbally based autobiographical memory) and the prefrontal cortex (the area dealing with emotions and impulses).
This information is of note because it gives us a very practical clue as to how to heal:
- by engaging our brain’s ability to reorganize itself by forming new connections and pathways – also known as neuroplasticity,
- by building a new narrative of the traumatic experience, and
- by reframing and retraining our emotional responses to situations.
The Emotional Component
Emotional differences between males and females in addiction are significant – not only from a gender perspective but also based on societal pressures and cultural dynamics. Women in addiction use substances to cope with emotional pain such as anxiety, depression, and trauma, and women are more likely to relapse due to emotional stress.
The Spiritual Component:
Before we even discuss the differences between females and males in spirituality, let’s define the term ‘spirituality.’ While religion can be defined as institutional, external and related to religious principles, spirituality tends to have a more internal, individual character.
Spirituality can be seen as one’s personal authenticity, completeness, and sense of meaning and purpose of life. Spirituality can encompass the cultivation of a bond with a higher being or other force beyond human existence and knowledge. A spiritual life perspective can foster the will to help others for the benefit of humanity.
Frankly, there’s just not a lot of clinical research concerning differences in spirituality between traumatized males and females. The research I have found cites that women have a greater propensity for forgiving others. However, other study findings cite that females have a higher level of negative spiritual coping skills to begin with. xii Hopefully, we will expand our clinical research on gender-based spirituality and addiction in the future.
Clinical research with respect to the physical, mental, emotional and spiritual differences of women in addiction solidifies the need for gender-specific treatment and therapeutic modalities.
Different Bodies. Different Minds. Different Emotions. Different Spirits... means Different Reflection. Deeper Work. Different pathways to Healing.