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DOI: 10.1177/088610999701200407
1997 12: 471Affilia
Carolyn S. Carter
Alcoholic Women
Ladies Don't: A Historical Perspective on Attitudes Toward
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471
Ladies Don’t:
A Historical Perspective
on Attitudes Toward
Alcoholic Women
Carolyn S. Carter
Stigmatic and sex-biased attitudes toward contemporary alcoholic
women can be traced back to the 1800s. Reinforced by Western culture,
these attitudes are oppressive in that they exacerbate women’s shame,
diminish their self-esteem, and undermine their recovery. This article
discusses the trends and historical events that have shaped societal
attitudes toward alcoholic women and the effects of social workers’
attitudes on policy formulation and professional behavior toward
clients who are alcoholic women.
Alcoholism was once considered a problem for men, but an
estimated 3.9 million, or about one third of all alcohol-abusing
or alcohol-dependent persons, are women (National Institute
on Alcohol Abuse and Alcoholism [NIAAA], 1995). Although
societal attitudes toward alcoholic men have become more
enlightened since the 19th century, attitudes toward alcoholic
women have not changed substantially (Blume, 1991).
Throughout Western history, alcoholic women have been subjected
to more restrictions than alcoholic men and have been
AFFILIA, Vol. 12 No 4, Wmter 1997 471-485
@ 1997 Sage Pubhcabons, Inc.
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472
punished more harshly for defying codes against drinking
(Sandmaier, 1992). As a result, alcoholic women confront many
of the same negative attitudes today as did their counterparts
of the 1800s.
By adopting a historical perspective, this article documents
that stigmatic and sex-biased attitudes toward alcoholic women
have not only persisted over time, but have oppressed women.
It discusses the impact of certain national trends, events, and
issues on the shaping of alcohol-related societal attitudes and
the adverse effects of these attitudes on alcoholic women.
Because social workers are influenced by the cultural context
(Berlin, 1993; Meyer, 1993) and are subject to the same negative
attitudes toward alcoholic women as is the general population,
this article explores the effects of their attitudes on the helping
relationship and the formulation of social policy It demonstrates
how sex-biased attitudes of clinicians (including attitudes
that infantilize or devalue females) can reinforce negative
stereotypes of alcoholic women. It also explains why some of
the male-oriented alcoholism interventions that practitioners
commonly use are harmful to women and the ways that child
welfare policies can inadvertently discriminate against alcoholic
women. Stigmatic attitudes of clinicians are presented as
barriers to the appropriate diagnosis of women as alcoholics
and as deterrents to women entering alcoholism treatment
facilities. Specific ways in which practitioners’ sex-biased and
stigmatic attitudes can increase the shame of alcoholic women,
diminish alcoholic women’s self-esteem, and undermine their
sobriety are examined.
Sex-biased attitudes refer to attitudes that discriminate
against women on the basis of sex-role stereotypes and generalizations
(Barker, 1987), including those that set double standards
and/or attempt to protect women. Stigmatic attitudes are
those that attach degrading or dishonorable meanings to the
behavior and reputation of alcoholic women.
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473
ALCOHOL-RELATED ATTITUDES
The 1800s
Societal attitudes are
inextricably linked to the historical context.
Examples are the manner in which gender-role expectations
(expectations of &dquo;ladies&dquo;) affected alcohol consumption
during the 1880s and the disparate legal sanctions that were
imposed on women who drank to excess.
The term lady was redefined in the 1880s to include not only
upper-class women, but other women who managed their
households, depended on men for economic support, accepted
subordinate positions in their homes, and developed feminine
traits (Abramovitz, 1992; Hymowitz & Weissman, 1978). In
return for ladylike behavior, women were afforded the favor
and protection of men.
Whereas the definition of lady was expanded, attitudes toward
women’s drinking behavior were not. Women’s use of
alcohol was restricted to culinary and medicinal purposes,
although upper-class ladies were permitted to drink alcohol in
small amounts at their homes or private gatherings. Women
who drank publicly or became drunk were considered sexually
indiscreet and irresponsible mothers (Barrows, 1910; Morell,
1993; Riis, 1890/1970).
The legal repercussions faced by alcoholic women were also
sex biased and stigmatic. Chronically drunk or alcoholic
women could be committed to insane asylums, lose their children,
or be subject to involuntary hysterectomies (Hymowitz &
Weissman, 1978; Sparks, 1897).
The 1900s
During the 1920s, women beganto drink openly. Their behavior
was influenced by the economic independence created during
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474
World War I, the right to vote, and the relaxed sexual mores
associated with Freudian philosophy. Women protested patriarchal
attitudes by drinking in public places, accelerating their
drinking behavior, and wearing shorter dresses (Hymowitz &
Weissman, 1978). Despite their protests and behavior, societal
attitudes toward women who drank publicly remained linked
to promiscuity and parental neglect.
There were also strong social forces that discouraged drinking
by women in the early 1920s and 1930s, partly because of
sex biases and stigmatization. Three such forces were Prohibition,
the Great Depression of the 1930s, and the Temperance
movement, led by the Women’s Christian Temperance Union
(Bordin, 1986; Lender & Martin, 1982). Although both women
and men could be arrested for drinking during Prohibition and
the Temperance movement, drinking by women remained
linked to sexual misconduct and the absence of femininity
(Hymowitz & Weissman, 1978; Sandmaier, 1992). The avoidance
of stigmatic attitudes was a major incentive for some
women to abstain from drinking.
The Great Depression drastically reduced employment opportunities
for women and forced many female employees out
of the labor market. In returning to their unpaid labor in the
home, these women experienced diminished autonomy and a
resurgence of traditional values and attitudes. Both in response
to sex-role stereotyping and to evade stigmatic attitudes, many
women stopped drinking and others tended to drink less
openly (Sandmaier, 1992).
Between 1940 and 1945, millions of women were employed
for the first time to replacemen who were fightingin World War
II. When the war ended, women, including widows and single
female heads of households, were coerced out of the labor
market because they now had men to take care of them
(Coleman, 1995). Women resisted these sex-biased expectations,
partly by increasing their consumption of alcohol
(Hymowitz & Weissman, 1978).
Federal studies of alcoholism were also sex biased in that
they focused primarily on middle-class White men, were genat
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475
erally conducted in male-oriented work settings, and used
male-dominant or all-male samples. The studies, which gained
popularity during the 1950s, virtually ignored women and did
little to offset pejorative societal attitudes toward alcoholic
women.
Although the Comprehensive Alcohol Abuse and Alcoholism
Prevention, Treatment and Rehabilitation Act of 1970
(Pub. L. No. 94-371) paid special attention to the needs of
alcoholic women, sex-biased research and treatment persisted
(Raymond, 1991; Vannicelli, 1984). As of 1978, only 17 of the 578
treatment programs funded by the NIAAA were designed specifically
for women (Request for Proposal, 1978).
The combination of the women’s movement and expanded
advertising for alcohol had a unique effect on attitudes toward
alcoholic women in the 1960s and 1970s. For the first time, the
liquor industry was permitted to show women in advertisements
for alcohol (Jacobson, Atkins, & Hacker, 1983). However,
whereas commercials consistently portrayed women as liberated,
free-spirited individuals with a growing desire for alcoholic
beverages (Jacobson et al., 1983; Morrissey,1986), societal
attitudes continued to be oppressive. For example, women
were offered half-price drinks on ladies’ nights but risked having
their personal or professional reputations viewed disparagingly
if they drank to excess or could not contain themselves.
These attitudes were sex biased because they advocated double
standards for men and women and were stigmatic in that
degrading meanings were attached to the characters of women
on the basis of drinking patterns.
Women’s roles continue to be based primarily on sexual,
reproductive, and child-rearing functions (Walther & Young,
1992). Examples abound both in women’s personal and professional
lives. For instance, a man who becomes drunk may be
considered the life of the party, whereas a woman who drinks
excessively is usually viewed in a more pejorative manner (as
&dquo;loose&dquo;). Male recovering alcoholics are often commended,
whereas female recovering alcoholics are blamed for their previous
lifestyles (van Wormer, 1995).
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476
In the corporate world, where the alcohol-related entertainment
of clients is a common practice, women are generally
castigated if they fail to drink like ladies. Male employees in
need of alcoholism treatment are frequentlyreferred for service,
whereas female employees are generally ignored (LukinaWiersma,
1990). Women, more so than men, are not charged by
police officers with alcohol-related vehicular offenses, and
judges sometimes ignore symptoms of alcoholism in women
when sentences are rendered. Even when women acknowledge
that they have alcohol-related legal difficulties, they are sometimes
referred to relatives, rather than for treatment. The failure
of criminal justice personnel to charge or appropriately refer
alcoholic women is sex biased because the purpose is to shield
women from criminal records or a diagnostic label of alcoholism
(Sandmaier, 1992). In turn, women are protected from the
consequences of their behaviors.
Sex biases are also evident among researchers. Studies that
use predominantly male samples and generalize the findings
to females are still being conducted (Davis & Srinivasan, 1994).
Policies and practices related to women are sometimes based
on the results, disregarding gender differences. For example,
because current alcoholism treatment programs are based on
the needs of male subjects, child care services are rarely provided.
The lack of reliable child care then becomes a major
barrier to alcoholic women entering treatment (Sandmaier,
1992).
Despite supportive legislation, protest movements, and efforts
to glamorize female drinkers, contemporary women face
many of the same attitudes as did their predecessors of the
1800s. Society still regulates women’s drinking behavior, and
alcoholic women remain the targets of unyielding stigmatic and
sex-biased societal attitudes (Blume, 1991). Practitioners are
influenced by these attitudes and, as is discussed in the next
section, the attitudes of clinicians can compromise the helping
relationship in a variety of ways.
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477
EFFECTS ON CLIENT-WORKER RELATIONSHIPS
Three important aspects of the relationships of social workers
and their clients are trust, authenticity, and empathy (Hepworth
& Larsen, 1993). Social workers have the additional
responsibility of affirming clients’ strengths and respecting
their uniqueness, problem-solving skills, and right to selfdetermination.
Stigmatic and sex-biased attitudes can undermine
each of these values and practices and increase the shame
and diminish the self-esteem and recovery efforts of alcoholic
women.
Sex-Biased Attitudes
Sex-biased attitudes of clinicians can lower the self-esteem of
alcoholic women clients because they stereotype women and
disaffirm women’s value as individuals or adults. One way that
clinicians demonstrate sex-biased attitudes is by perpetuating
male-oriented alcoholism interventions; for example, by facilitating
mixed-sex therapy groups to the exclusion of women’s
groups. Studies have found that women are reluctant to discuss
sexual issues in mixed-sex groups (Reed, 1987; Sandmaier,
1992) and that 30% to 75% of alcoholic women were sexually
assaulted as children (Root, 1989). Women also find it difficult
to discuss more recent sexual assaults, gynecological problems,
or lesbian issues in mixed-sex groups (Blume, 1991).
Using strategies that ignore alcoholic women’s fragile selfesteem
is also sex biased. Confrontation, for example, is a
common tool that is used during the early stages of treatment
to penetrate the denial of alcoholic clients (van Wormer, 1995).
Because of their low self-esteem, confrontation can be extremely
threatening to alcoholic women (Zankowski, 1987) and
may be contraindicated during the early stages of therapy.
Clinicians in in-patient settings may reflect sex-biased attitudes
when they coerce alcoholic women to participate in eveat
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ning or weekend mixed-sex activities or assume that women
who do not participate are being resistant. Zankowski (1987)
found that women often fail to participate in these activities
because they feel inadequate and outnumbered by men. Clinicians
sometimes overlook spatial and boundary issues, such as
men outnumbering women 3 to 1 in alcoholism treatment
settings (NIAAA & National Institute on Drug Abuse, 1990).
Requiring women to participate in evening and weekend
activities without the opportunity to plan more appropriate
ones and assuming that women are resistant to treatment recommendations
are sex-biased notions because the needs of
male clients are being projected onto female clients. According
to Reed (1987) and Sandmaier (1992), most alcoholism programs
were designed for men, and the strategies are seldom
flexible enough to accommodate the needs of women. Therefore,
these programs ignore important issues, such as women’s
lack of health insurance and the inordinate number of losses
experienced by alcoholic women (of husbands, families of origin,
and jobs).
Clinicians likewise demonstrate sex biases in the examples
just presented by ignoring the significance of child care issues
to the recovery needs of alcoholic women. The lack of reliable
child care is one of the primary reasons that mothers drop out
of treatment and, as was previously noted, is a serious impediment
to women entering treatment. Denying women the privilege
of visiting with their children reinforces their shame and
beliefs about being unfit mothers (Zankowski, 1987). It is also
plausible that when treatment activities occur on weekends,
mothers may feel torn between their recovery and visiting their
children.
Relieving mothers who are alcoholic of child custody rights,
a related issue, severely challenges their self-esteem. A subject
in Sandmaier’s (1992) nationwide study of alcoholic women
stated that when she lost custody of her children, she lost all
hope and contemplated suicide. Routinely removing children
from the homes of alcoholic mothers or otherwise criminalizing
the drinking behavior of women is sex biased in at least two
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479
ways. First, similar actions are not taken with men. Second,
these actions are often based on the belief that women who
drink excessively can no longer satisfactorily perform traditional
feminine tasks, such as caring for their children (Sandmaier,
1992). Increasing family preservation services to alcoholic
women would seem a more appropriate intervention.
An examination of the educational policies related to fetal
alcohol syndrome reveals sex biases as well (Gustavsson, 1991).
In an effort to protect children, some child welfare workers
inadvertentlyadvise pregnantalcoholic women to avoid drinking
because of the risks to their unborn children without emphasizing
the ill effects on the women’s own bodies (Gustavsson,
1991). Although unintentional, the message devalues
women and is life threatening in that the effects of alcoholism
are progressive and ultimately lead to death (NIAAA & National
Institute on Drug Abuse, 1990).
Clinicians’ sex-biased attitudes can also lead to genderdifferentiated
therapeutic expectations of alcoholic women.
Broverman’s (1970) classic study of clinical behavior indicated
that the therapeutic expectation for female clients was submissive,
childlike, excitable, dependent behavior. If alcoholic
women are perceived by clinicians to be immature adults who
are unable to negotiate their environment or interact as equals,
these women may not be expectedto assume the assertive roles
that are expected of men in practice situations.
When practitioners hold gender-differentiated therapeutic
expectations, clinical relationships and ultimately the recovery
of alcoholic women are jeopardized in a variety of ways. First,
in lieu of learning to assert themselves, women are taught to
disregard their rightto self-determination and respond in ways
that are not authentic. The right to self-determination and
authenticity are hallmarks of effective helping relationships.
Second, women are also encouraged to avoid conflict and risktaking
behavior. When female alcoholic clients are unable to
resolve conflicts easily, they tend to drop out of treatment,
rather than engage in problemsolving (Sandmaier, 1992). These
findings suggest that the sex-biased attitudes of clinicians can
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undermine recovery by diminishing authenticityand, byextension,
trust and ultimately lead to the premature departure of
alcoholic women from treatment.
Stigmatic Attitudes
The stigmatic attitudes of clinicians can lower the self-esteem
of alcoholic women, exacerbate their shame, and indirectly
undermine their recovery. The tendency of alcoholic women
who have been sexually abused to denigrate themselves is often
exacerbated when the women are told, for example, that girls
desire or fantasize about sexual experiences with their father
figures (Root, 1989). Clinicians’ messages concerning girls’
childhood sexual fantasies can be especially shame producing
or esteem lowering to alcoholic women, who attribute their
abuse to having been seductive or promiscuous as children.
Questions such as, &dquo;Why do you think your father molested
you but not your sisters?&dquo; can cause alcoholic women to blame
themselves. Failing to inform women that they were victims
(and their assailants, perpetrators) when they themselves question
their role in childhood sexual abuse may reinforce their
shame. Blaming and other shame-producing messages can undermine
sobriety because alcoholic women frequently use alcohol
to suppress their feelings of shame (Hurley 1991).
Clinicians also stigmatize alcoholic females byconveying the
message that alcoholic women are sicker than alcoholic men
(Sandmaier, 1992). This message portrays women as more
needy, manipulative, deceptive, and difficult to work with than
men (Zankowski, 1987). Despite the insufficient number of
treatment facilities for alcoholic women nationwide, this argument
was used by the staff in Zankowski’s studyof hospitalized
alcoholic clients to justify the lower number of clients in the
women’s unit of the facility.
Althoughsome practitioners view alcoholic women as sicker
than alcoholic men, clinicians are more reluctant to assign
alcohol-related diagnoses to women (Rhodes & Johnson, 1994).
That clinicians believe they must protect women from a diagat
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481
nosis of alcoholism may reflect their moralistic perception of
alcoholic women. If it does, and women sense this attitude of
clinicians, the already fragile self-esteem of alcoholic women
may be further diminished.
Social workers who maintain stigmatic attitudes toward alcoholic
women can adversely affect their clients’ recovery and
self-esteem in other ways. When clinicians demean alcoholic
women, according to Bersak (1990), it causes the women to
respond in an alienating, defensive, and anger-producing manner.
Individuals with whom alcoholic women subsequently
interact tend to reciprocate, and negative transactions further
decrease the women’s self-esteem.
On occasion, social workers may direct stigmatic attitudes
toward alcoholic women because of their own issues, rather
than in response to the clients with whom they are working.
One issue is unresolved shame about parents who were alcoholic.
A studyof 60 social work students (Marsh, 1988) reported
that 59% had close family members who were alcoholics. Similar
to other adult children of alcoholics, social workers who are
adult children of alcoholics may have internalized the pejorative
societal attitudes that were directed toward their parents
and may harbor shame that they project onto their alcoholic
women clients. The extent to which clinicians have not resolved
their own shame-related issues may limit their ability to help
their clients who are alcoholic (Russell, Gil, Coyne, & Woody,
1993).
There are other consequences of stigmatizing alcoholic
women. To avert stigmatic attitudes, such as the ones that were
just described, some women become hidden alcoholics and
drink alone in the privacy of their homes. In spite of the fact
that women are more likely than men to seek mental health
treatment (Conte, Plutchik, Picard, Galanter, & Jacoby, 1991;
Hurley, 1991), alcoholic women tend to conceal their drinking
to avoid being stigmatized. Concealment, in turn, allows their
alcohol-related problems to progress, so that women are at
more advanced stages of alcoholism when they report for treatat
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ment. In addition, the death rate of female alcoholics is 50% to
100% higher than that of male alcoholics (NIAAA, 1990).
IMPLICATIONS FOR SOCIAL WORK
Stigmatic and sex-biased attitudes are oppressive to alcoholic
women and can adversely affect their relationships with helping
professionals. Therefore, social workers have an ethical
responsibility to confront these problems. Because work with
women requires attention to both policy and practice issues
(Hagen & Davis, 1992), effective approaches to improving social
workers’ attitudes toward alcoholic women should take
into account clinical tasks, education, and advocacy
First, clinicians need to address the esteem issues of alcoholic
women by developing rapport early on, allowing the women
to experience success, and rewarding even their smallest
achievements (Zankowski, 1987). Alcoholic women experience
low self-esteem with greater frequency than do alcoholic men
(Levin, 1995) and are more likely to drink to relieve their
feelings of worthlessness. Second, clinical interventions must
focus on the emotional effects on women of losing the custody
of their children. Increased suicide rates and depression have
been correlated with alcoholic women losing such rights to
custody (Sandmaier, 1992).
Third, it is essential for educational programs to emphasize
the unique needs of alcoholic women. At a minimum, effective
educational modules should address depression, insomnia, nutritional
issues, and other physiological conditions that can
camouflage the alcohol-related problems of women. Sensitizing
clinicians to the grave consequences of alcoholism may
increase their empathy and ensure that they make appropriate
alcohol-related diagnoses and referrals.
Fourth, social workers must propose policies on fetal alcohol
syndrome that are sensitive to women as well as to their unborn
fetuses. In an effort to protect children and unborn fetuses,
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483
family preservation policies sometimes criminalize the drinking
behavior of alcoholic women (Bernard, 1992).
Fifth, because women are often abandoned by their husbands
and families of origin and hence are deprived of social
and economic supports, it is critical for social workers to help
women to become activists in their work settings by confronting
pay inequities and harassment, for instance. Possible benefits
of workplace activism are personal, interpersonal, and political
empowerment (Almeleh, Soifer, Gottlieb, & Gutierrez,
1993), all of which are esteem building and crucial to the recovery
of alcoholic women.
Sixth, because concealment of alcoholism can be life threatening,
creative outreach programs that motivate hidden alcoholic
women to seek professional help are essential. Obtaining
familial support and advocating for child and medical care
policies for women could greatly enhance the quality of casefinding
efforts.
Finally, social workers must resist the tendency to support
patriarchal practices and policies (Dinerman, 1992) and advocate
on behalf of alcoholic women. Gender-sensitive programs
would not only affirm the worth of alcoholic women but give
attention to problems such as limited detoxification facilities,
homelessness, victimization, and the absence of support systems
among alcoholic women.
REFERENCES
Abramovitz, M. (1992). Poor women in a bind: Social reproduction without
social supports. Affilia, 7, 23-43.
Almeleh, N., Soifer, S., Gottlieb, N., & Gutierrez, L. (1993). Women’s achievement
and empowerment through the workplace. Affilia, 8, 26-39.
Barker, R. L. (1987). Social work dictionary. Silver Spring, MD: National Association
of Social Workers Press.
Barrows, I. C. (1910). The reformatory treatment of women in the United
States. In C. Richmond (Ed.), Penal and reformatoryinstitutions (pp.129-167).
New York: Russell Sage.
Berlin, S. (1993). Informingpractice decisions. New York: Macmillan.
Bernard, L. D. (1992). The dark side of family preservation. Affilia, 2,156-158.
at LUND UNIVERSITY LIBRARIES on November 14, 2011aff.sagepub.comDownloaded from
484
Bersak, C. (1990). Enhancing self-esteem as a strategy for treating female
alcoholics. Alcoholism Treatment Quarterly, 7,105-111.
Blume, S. B. (1991). Women, alcohol and drugs. In N. S. Miller (Ed.), Comprehensive
handbook of drugs and alcohol addiction (pp. 147-177). New York:
Marcel Dekker.
Bordin, R. (1986). Frances Willard: A biography. ChapelHill: UniversityofNorth
Carolina Press.
Broverman, I. (1970). Sex role stereotypes and clinical judgements of mental
health. Journal ofConsulting and Clinical Psychology, 34,1-7.
Coleman, P. (1995). Rosie the riveter. New York: Crown.
Conte, H., Plutchik, R., Picard, S., Galanter, M., & Jacoby, J. (1991). Sex
differences in personality traits and coping styles of hospitalized alcoholics.
Journal ofStudies on Alcohol, 52, 26-32.
Davis, L. V, & Srinivasan, M. (1994). Feminist research within a battered
women’sshelter. In E. Sherman & W. J. Reid (Eds.), Qualitative research in
social work (pp. 347-357). New York: Columbia University Press.
Dinerman, M. (1992). Is everything women’swork? Affilia, 7,77-93.
Gustavsson, N. S. (1991). Pregnant chemically dependent women: The new
criminals. Affilia, 6, 61-73.
Hagen, J., & Davis, L. V (1992). Working with women: Building a policy and
practice agenda. Social Work, 37, 495-502.
Hepworth, D., & Larsen,J. A. (1993). Direct social work practice: Theoryand skills.
Pacific Grove, CA: Brooks/Cole.
Hurley, D. L. (1991). Women, alcohol and incest: An analytical review. Journal
ofStudies on Alcohol, 52, 253-268.
Hymowitz, C., & Weissman, M. (1978). A history ofwomen in America. New
York: Bantam.
Jacobson, M., Atkins, R., & Hacker, G. (1983). The booze merchants. Washington,
DC: Center for Science in the Public Interest.
Lender, M. E., & Martin,J. K. (1982). Drinkingin America. New York: Free Press.
Levin, D. J. (1995). Introduction to alcoholism counseling: A bio-psycho-social
approach. New York: Taylor & Francis.
Lukina-Wiersma, M. E. (1990). Employee assistance programs. In R. C. Engs
(Ed.), Women: Alcohol and other drugs (pp. 79-84). Dubuque, IA:
Kendall/Hunt.
Marsh, S. R. (1988). Antecedents to choice of a helping career: Social work vs.
business majors. Smith College Studies in Social Work, 58, 85-100.
Meyer, C. H. (1993). Assessment in social work practice. New York: Columbia
University Press.
Morell, C. (1993). Intentionally childless women: Another view of women’s
development. Affilia, 8, 300-316.
Morrissey, E. R. (1986). Contradictions inhering in liberal feminist ideology:
Promotion and control of women’s drinking. Contemporary Drug Problems,
13, 65-88.
National Institute on Alcohol Abuse and Alcoholism (NIAAA). (1990).Alcohol
Alert (Report No. 10 PH 290). Washington, DC: U.S. Government Printing
Office.
at LUND UNIVERSITY LIBRARIES on November 14, 2011aff.sagepub.comDownloaded from
485
National Institute on Alcohol Abuse and Alcoholism (NIAAA). (1995). National
Longevity Alcoholism Epidemiological Survey. Washington, DC: U.S.
Government Printing Office.
National Institute on Alcohol Abuse and Alcoholism (NIAAA) & National
Institute on DrugAbuse. (1990). Highlights from the 1989 drugand alcoholism
treatment unit survey. Washington, DC: U.S. Government Printing Office.
Raymond, C. (1991). Recognition of the gender differences in mental health
illness and its treatment prompts a call for more health research of problems
specific to women. Chronicle of Higher Education, 37(9), A10.
Reed, B. G. (1987). Developing women-sensitive drug dependence treatment
services. Why so difficult? Journal of Psychoactive Drugs, 19,151-164.
Request for proposal/treatmentservices foralcohol abusingyouthand alcohol abusing
women: Information bulletin. (1978). Harrisburg: Pennsylvania Governor’s
Office on DrugAbuse and Alcohol Abuse.
Rhodes, R., & Johnson, A. D. (1994). Women and alcoholism: A psychosocial
approach. Affilia, 9,145-156.
Riis,J. A. (1970). How the other half lives : Studies among the tenements of New York.
New York: Dover. (Original work published 1890)
Root, M. P. (1989). Treatment failures: The role of victimization in women’s
addictive failures. American Journal ofOrthopsychiatry, 59, 542-549.
Russell, R., Gil, P., Coyne, A., & Woody, J. (1993). Dysfunction in the family of
origin of MSW and other graduate students. Journal ofSocial Work Education,
29,121-129.
Sandmaier, M. (1992). The invisible alcoholics: Women and alcohol. Blue Ridge
Summit, PA: Tab Books.
Sparks, A. (1897). Alcoholism in women. Medico-Legal Journal,15,219.
van Wormer, K. (1995). Alcoholism treatment: A social work perspective. Chicago:
Nelson Hall.
Vannicelli, M. (1984). Treatment outcome of alcoholic women: The state of the
art in relation to sex bias and expectancy effects. In S. Wilsnack &
L. Beckman (Eds.), Alcohol problems in women (pp. 369-412). New York:
Guilford.
Walther, V, & Young, A. T. (1992). Costs and benefits of reproductive technologies.
Affilia, 7,111-122.
Zankowski, G. L. (1987). Responsive programming: Meeting the needs of
chemically dependent women. Alcoholism Treatment Quarterly, 4, 53-66.
Carolyn S. Carter, D.S.W., is an assistant professor at the School of Social
Work, Arizona State University, Tempe, Arizona.
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