The Caribbean society is generally considered to be a predominantly male-dominated one, even though the women, usually being single parents, are left to bear and take care of the children, many a time even being the household breadwinners.
In this regional scenario of gender inequality, socio-economic and health issues affecting women are usually accorded back-burner status and given less priority in the region’s strategy for development. This is reflected by an absence of statistics on drug use and its effect on female mental health. Up to the latter half of the 20th century, attention was only being paid to the the use and abuse of illicit drugs in male members of the Caribbean society. In more recent times, more attention is being paid to the situation with respect to women.
The US National Survey on Drug Use and Health found that 11.5 per cent of males ages 12 and older had a substance abuse or dependence problem, compared with 6.4 per cent of females. Despite the smaller number, women tend to face tougher challenges. According to the Substance Abuse and Mental Health Services Administration (SAMHSA) 2014, scientists have discovered special issues related to hormones, menstrual cycle, fertility, pregnancy, breastfeeding, and menopause that impact women who use illicit drugs or overuse medication. Additionally, women have described distinctive reasons for using drugs, which include controlling weight, fighting exhaustion, coping with pain, and self-medicating mental health problems.
In the National Comorbidity Study, a nationally representative population study in the United States, about 41-65 per cent of participants with any lifetime substance abuse disorder also had a lifetime history of at least one mental health disorder (Kessler et al., 1996). Comorbidity, which is also referred to as “dual-diagnosis” or “co-occurring”, describes two or more disorders or illnesses occurring in the same person. In this instance, it would be a substance addiction alongside one or multiple mental health disorders.
SAMHSA regularly publishes studies exploring different causes, effects, and treatment options related to dual diagnosis and have indicated that more men than women are diagnosed with co-occurring disorders, but the percentage of females living with a dual diagnosis has increased in recent years. Between 1995 and 2001, the proportion of women admitted into dual diagnosis treatment programmes increased from 28 to 44 per cent.
Unfortunately, there are no specific statistics on the extent of the addiction problem in the adult female population in Barbados or the Caribbean. Neither has there been research done on dual diagnosis. Since 2015, the clinical team at Marina House has come across five clients that have been admitted with dual diagnosis.
An interview conducted with a client admitted to the Marina House Drug Rehabilitation Facility provided us with some insight into how Caribbean women might be impacted by dual diagnosis.
This particular client’s primary drug of choice is marijuana and her secondary choice is cocaine. The client identified her first experience with drugs at the age of 15 when she started off with marijuana and alcohol and then she was introduced to cocaine. Eight years later, at the age of 23, she was diagnosed with bipolar disorder and then at 25, she was diagnosed with Borderline Personality Disorder. These two mental health disorders were diagnosed by the Psychiatric Hospital in Barbados where the client went to seek treatment. The client feels that her drug use did not affect her mental health disorders, due to the fact that the diagnosis was made eight and ten years after she started using the drugs. The client describes her moods to be heightened, especially while on marijuana but doesn’t see a change while on cocaine. The client indicates that she has no need to go back to drugs and has become more cognizant of her mood changes and behaviour patterns since she has been undergoing treatment.
At Marina House, the client not only receives treatment for her addiction but she also receives education about dual diagnosis through the Substance Abuse Foundation Inc. Marina House seeks to address and treat similar cases with utmost care. Within the next three years, Marina House plans to gather and use statistics to contribute to research in this field which is specific to women in Barbados and the Caribbean.
Source: U.S. Substance Abuse and Mental Health Services Administration Office of Applied Studies. Results from the 2008 National Survey on Drug Use and Health: National Findings (Department of Health and Human Services, 2008).
Kessler, R.C., Nelson, C.B., McGonagle, K.A., Edlund, M.J., Frank, R.G., & Leaf, P.J. (1996). The epidemiology of co-occurring addictive and mental disorders: Implications for prevention and service utilization. American Journal of Orthopsychiatry, 66, 17- 31