Only in five people in treatment is a woman: how to eliminate gender-related barriers to access to addiction services
In substance use disorders, gender differences appear to be multifactorial, with internal factors related to the reward system, and external factors such as the expectations and gender roles of society. In consequence, addiction services should be sensitive to the needs of all people, including men, women and other gender identities – Image: Shutterstock
By Paula Lozano Garbaccio – The use of psychoactive substances affects men and women differently. Only one in five women access specialized addiction services, and when they do, they find interventions grounded in an androcentric perspective that fails to meet their specific needs as women. The question therefore arises as to what solutions could be implemented to eliminate gender-related barriers in these services.
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Raising awareness of inequalities in drug use
The reasons for drug use, its effects and the development of dependence differ according to gender. There is, for example, the so-called “telescopic bias”, whereby women progress more quickly to pathological use; women also experience more intense craving and a higher risk of relapse, leading to a poorer prognosis.
In addition, women face a double stigma – linked on the one hand to substance use and, on the other, to assigned gender roles that may lead them to feel inadequate with regard to what social norms consider to be expected from them – mothers, caretakers and managers of the home – and not from men.
These factors can give rise to feelings of guilt and/or shame, or even lead them to hide their use for fear of social sanction, which ultimately only makes it more difficult for them to seek support.
Another barrier identified is the coexistence of different clinical and social problems. Various studies have highlighted the complex relationship between pathological drug use among women and gender-based violence. Women who experience violence seem more likely to develop an addiction, while substance use appears to increase the risk of suffering violence while reducing their ability to react to the situation and seek help. This suggests that both elements are mutually reinforcing and influence each other.
Despite the differences described above, therapeutic approaches are generally designed from an androcentric perspective and treatment settings are heavily masculinized, making it difficult for women to access and adhere to treatment. Consequently, an essential measure to adopt in specialized services would be first to take these inequalities into account, and then to develop and adapt intervention programmes.
Eliminating barriers
Integrating a gender perspective into health resources requires measures capable of taking into account the particularities and problems associated with the lived and living experiences of men, women and other gender identities, going way beyond the androcentric, supposedly ‘neutral’ approach. In the field of addictions, it is a priority to introduce this perspective, as it means taking into account the motivations for substance use, its effects and consequences, and removing the obstacles to treatment.
Women with an addiction are less likely to have access to treatment. It is estimated that out of every five people in treatment, only one is a woman. While women are a minority in treatment services, there are even fewer people from the LGBTI+ community and other gender identities.
Women looking to enter treatment services face more barriers, such as greater stigma, more family responsibilities, more severe addictions and more complex needs than men, due to the invisibilisation of their problems, which leads to them becoming more chronic and severe. Research suggests that interventions are likely to be better when exclusive approaches are proposed.
It has now been established that gender-segregated spaces are essential for addressing certain issues. Women’s support groups, for example, are a key element in relapse prevention. Among the issues that can be addressed in these groups are: the sex/gender system and associated stereotypes and roles; self-esteem (including that associated to the gender with which one identifies); family pressures; emotional relationships; lack of respect for gender roles; and, most importantly, the development of support tools and networks for women.
Inclusive therapeutic approaches
The issues affecting women who use drugs are manifold and complex. It is therefore necessary to design and implement programmes capable of offering a holistic approach, sensitive to their specific needs and those of other gender identities.
Available data shows the high incidence of the co-occurrence of gender-based violence and post-traumatic stress disorder. An obvious difficulty in this respect is the lack of specific staff training in the association between violence and addiction, and the fact that addiction treatment is seldom trauma-informed.
It should also be noted that, as a general rule, addiction services do not have unified programmes for systematically dealing with both issues. The result is that women experiencing both problems have to go to different facilities, with no possibility of being followed-up as part of a single integrated intervention, which hampers their adherence to treatment, can make situations chronic and even lead to professional interventions based on polarized approaches, which may significantly and negatively impact women’s adherence to care services.
Ultimately, we propose using Najavits’ Seeking Safety approach as a strategic measure. This approach tackles these issues comprehensively and has shown promising results in terms of effectiveness and efficiency. In this way, it is possible to address the traumatic experiences associated with drug use as well as the complex relationships that may co-exist.
Call to action and practical implications
In summary, several implications can be suggested. The first is the need to assess any history of violence among women who use drugs when they go to specialized services. The second point is the importance of developing integrative protocols in order to carry out interventions that are more in-depth and not limited to the sole issue of drug use. One well-established programme is the Seeking Safety approach. We also recommend implementing treatments that are sensitive to the needs and circumstances of each gender. Let’s ask ourselves the question: should people be adapted to treatment or should treatment be adapted to each person?