Drug treatment: explaining the gender paradox.

There is something of a gender paradox in drug user treatment. Research consistently indicates that women possess "risk factors" associated with drug use relapse, yet women are no more likely, and possibly less likely, to relapse to drug use. Efforts to explain this paradox involve a longitudinal study of 330 women and men participating in outpatient drug-user treatment associated with the evaluation of the Los Angeles Target Cities Project funded by the Center for Substance Abuse Treatment. The findings offer no support for the drug severity and social support hypotheses, but some support for the treatment engagement hypothesis. Specifically, women participate more frequently in group counseling which, in turn, lowers their rate of relapse in spite of having more "risk factors." Further analyses indicate that the greater participation of women in group counseling does not stem from child-custody or other gender differences in the reasons for entering treatment, nor does it result from the enhanced services associated with the Target Cities Project. Rather, the differences in treatment engagement for women and men may result from gender norms concerning help-seeking, personal independence, strength, and control. The treatment and policy implications of these findings and recommendations for further research are discussed.