Posted December 3, 2015 in Roundtable Discussion
by Anne Fletcher
I knew little about the work of Stephanie Covington, PhD, LCSW until just recently when helping a young woman find residential treatment for a substance use disorder and co-occurring mental health problems, including trauma. I came across a unique facility, called A Woman’s Way (scroll down to find the women’s program) that bases its treatment on Dr. Covington’s materials, which piqued my interest and led to this interview with a pioneer in the field of women’s issues, addiction, trauma, and recovery.
A Look at Dr. Covington’s Career
Back in the 1970s, when Dr. Covington began her work in this area as a social worker and psychologist, the general consensus was that all “alcoholics are the same,” an attitude that persists all too often today. Ahead of her time, she recognized the need for and advocated for specialized substance use disorder treatment for women.
William L. White, an addiction and recovery historian, pointed out in a 2014 interview with Dr. Covington that she faced an uphill battle from the outset because “the majority of addiction treatment staff were male, the research community was predominately male, administrators were predominantly male, and the clients were predominantly male.”
Dr. Covington’s initial interest was spurred by her own recovery from an alcohol use disorder – it inspired her to want to help other women to not only stop using alcohol and drugs, which she’s said in some ways is “the easiest part,” but to change their lives in a broader way. She recognized the need to help newly sober women develop and expand their inner lives (thoughts feelings, beliefs, and values) along with their outer lives (their behavior and relationships.)
As her career progressed, she identified the role that trauma played for many addicted women, particularly in the criminal justice system. Over the course of the past 35 years, Dr. Covington has developed multiple programs and manuals that have been tested in studies published in peer-reviewed journals and are used in residential and outpatient addiction treatment programs as well as correctional settings.
Q: When I look through the list of the many research papers on your work, it’s obvious that your approaches have a solid foundation and are evidence-based. Why didn’t they jump out at me when visiting treatment facilities and reviewing “what works” in my research for two books on addiction and recovery?
Not a single rehab or client mentioned her approaches when writing Inside Rehab, despite the fact that Dr. Covington’s two main programs – Helping Women Recover and Beyond Trauma – are presented favorably at the National Registry of Evidence-Based Programs and Practices or NREPP.
Dr. Covington: It’s interesting, isn’t it? I think it’s been difficult for the field to focus on women; they’d rather use materials that they can employ for women and men. I do a lot of public speaking and when I talk about gender, people act like, “Didn’t we resolve that years ago?” Then I go into all the reasons why we didn’t – for instance, women have different developmental and trauma issues, they experience more stigma and shame than men around addiction – and they still don’t get it. When I suggest that they try some of my approaches with men, they say they wouldn’t consider it, that the men would be humiliated. So then I ask them, “So why do you give women material written for men?”
That’s when they start to get it. When providers try gender-specific groups, they’re amazed at how much better both women and men respond.
Q: Speaking of things written for men, don’t some women object to the 12 steps for that reason, because they have a male orientation? Isn’t that why you wrote a book (and accompanying workbook) called A Woman’s Way Through the Twelve Steps?
Dr. Covington: Yes. All the language in AA materials is male-based and archaic. For some women, especially well-educated ones, it seems simplistic and reductionist. What really motivated me to write A Woman’s Way Through the Twelve Steps was working with women in my own clinical practice at the time. I saw a lot of women struggling with the 12 steps.
As managed care was taking over and clamping down on treatment funding, I wondered, “How do you take something [AA] that’s free and readily available in most communities and make it more accessible for women?” I began talking to Hazelden Publishing about it, and they wanted a re-written big book for women. I told them, “No way,” but that I was interested in writing a book that involved talking to a diverse group of women and finding out how AA works for them.
That became A Woman’s Way Through the Twelve Steps. The stories of women in the book show how women interpret the steps their own way and share how that works for them. I receive letters from women saying they hated meetings until they read the book, and then they could “get it.”
It should be noted that Dr. Covington has also co-authored a Helping Men Recover resource, the first gender-responsive, trauma-informed intervention for men. It addresses addictive disorders and trauma, but also deals with violence that men may have perpetrated on others.
Q: In articles I’ve read by you and about you, I am pleased to see that you are spreading the word that addiction and trauma don’t have to be treated sequentially. Can you say more about that?
Dr. Covington: It used to be believed that addiction had to be treated before one could deal with trauma – the rule of thumb was that you had to be sober for a year before you could work on your trauma. But we now know that trauma work can begin in early treatment and recovery.
Many women who are labeled “treatment failures” are actually trauma victims who return to drugs and alcohol because their trauma was not addressed. By integrating trauma and addiction treatment, the risk of trauma-based relapse can be lowered.
Q: Do your approaches/studies always involve the 12 steps?
Dr. Covington: No – all of the treatment programs I’ve developed have to do with aspects of trauma and/or addiction, but the 12 steps are optional. For instance, a curriculum might say, “If you’re in 12-step program, you can introduce step X and Y here.” The approaches in “Helping Women Recover” and “Beyond Trauma” are designed to help women develop effective coping skills, build healthy relationships, and develop a strong support network. Women learn cognitive- behavioral skills, do mindfulness meditation, engage in experiential therapies (such as visualization, art therapy, and movement), and are educated about the different forms of trauma, typical reactions to abuse, and how a history of victimization interacts with substance use.
A trauma-informed treatment environment is important, too – one of empowerment, not one that’s punitive, shaming, or intrusive.
Q: I see on the NREPP website that Helping Women Recover has been implemented in more than 2,200 community-based programs. If a woman doesn’t have access to a facility that uses your approaches, which is the case more often than not, but wants to access them, what do you suggest? I’d also like to know if your programs can be done in individual format, with a private therapist, or is it always done in groups?
Dr. Covington: “Helping Women Recover” and “Beyond Trauma” are often offered hand-in-hand and have been delivered in residential and outpatient substance abuse treatment settings, mental health clinics, and domestic violence shelters, as well as in criminal justice settings. But individuals can purchase the workbooks individually. They can probably do about 85 percent of the work without being in a group.
In addition, A Woman’s Way Through the 12 Steps book and workbook can also be done on their own. Typically, the programs are offered in group settings and, although some women may be initially hesitant to share, the bonding that eventually comes about can be very healing. Each manual is designed to be self-instruction for seasoned counselors with group experience.
However, the materials can be adapted for work with an individual therapist. We also offer training across the country and onsite.
What is often missing is many settings is clinical supervision of any kind, but particularly trauma-informed supervision. This is an important element when working with people who have a history of trauma.
Q: How can your materials be accessed and purchased?
Dr. Covington:There are two websites.
The www.stephaniecovington.com website, which describes and offers the women, girls, trauma and addiction materials. (Many of them are at Amazon, Hazelden Publications, The Change Companies, and other online places.)
The other place is the Center for Gender and Justice website that links to the criminal justice publications and bookstore