++
Identify prevalence and diagnostic issues of substance-use disorders that are relevant to women.
Compare and contrast the pharmacotherapy of substance-use disorders with an emphasis on transgender and gender non-binary.
Describe complications in treating substance abuse in pregnancy and lactation.
Discuss the complications of dual diagnosis substance abuse in women, transgender, and gender non-binary patients.
++
Note: With terminology constantly evolving, both inclusive and specific gender and culture terms are used interchangeably when appropriate. Editors and authors have the best intentions of being respectful and inclusive of all individuals.
++
All SUDs should be treated with a holistic approach that addresses social, environmental, psychological, and medical factors. The Substance Abuse and Mental Health Service Administration (SAMHSA) recovery model is a holistic, person-centered approach to mental health care that is based on two main tenets: (1) It is possible to recover from a mental health condition—for example, eliminating or reducing symptoms, reducing the impact the SUD has on one's life, maintaining sobriety, etc. (2) The most effective recovery is patient-directed, giving autonomy to the individual. Other important components include recognizing there are many pathways to recovery that recovery should be supported by peers, allies, and social networks, and that recovery is culturally based and influenced by an individual's values, traditions, and beliefs playing a role. The recovery model differs from the medical model, which aims to identify a physiological cause or causes of a mental illness and the focus is often on the use of medications for treatment.
++
Stigma prevents people from getting necessary, lifesaving care for mental health conditions, including SUDS.1 The language used with patients, other health care professionals, and in notes matters—when we adapt the language for discussing SUDs, it can, in turn, change the way we think about SUDs. See Table 32-1 for guiding language.
++++
A SUD indicates a physical and/or psychological dependence on a substance. SUDs can be diagnosed using DSM-5 criteria related to the following, with more criteria indicating higher severity: using larger amounts over longer periods of time than intended, difficulty decreasing or stopping use, spending substantial time and energy to obtain the substance, physical cravings, psychological cravings, recurrent use in hazardous situations, recurrent use resulting in failure to fulfill obligations at work, home or school, reduction in social, occupational or recreational activities due to use of substance, continued use despite knowledge that the substance is making physical or psychological problems ...