The State of the Art on Gender and Addiction

Women face discrimination and violence, as well as fewer economic and educational opportunities compared to men. These inequalities are even greater when combined with other characteristics such as being a migrant or belonging to an ethnic minority – Photo by Pâmela Lima on Unsplash

This handbook/study examines the intricate relationship between gender and drugs in contemporary society, highlighting persistent inequalities rooted in multiple factors. Through feminist and gender perspectives, it analyses how hierarchical structures, especially those based on gender, influence individual experiences with drugs. Emphasis is placed on how gender expectations and social inequalities affect concerned people’s use of drugs, as well as their treatment. Through detailed analyses, including surveys and an exhaustive literature review of the last 12 years in Spain. Two professional experiences of note are also presented. One on group intervention with women and the other on a practical tool for gender mainstreaming in addiction treatment. The manual concludes with a number of considerations and recommendations.

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Sex and gender

Gender and sex are two related but distinct concepts. Sex refers to the biological differences between men and women, while gender refers to the social and cultural constructs assigned to each sex, including roles, norms and stereotypes which, in turn, may influence access to resources and decision-making.

Historically, women have been placed in a subordinate position, based on a biological rationale, which resulted in structural inequalities. Women face discrimination and violence, as well as fewer economic and educational opportunities compared to men. These inequalities are even greater when combined with other characteristics such as being a migrant or belonging to an ethnic minority.

The gender perspective was developed as a tool designed to analyze and understand these inequalities. Its origins go back to the ethnographic research of the 1930s, but it has evolved and can now be applied in a variety of areas, including research on psychoactive drugs. This perspective seeks to unpack how gender constructs affect men and women in various contexts and how these constructs can perpetuate inequalities.

Nuria Romo was a pioneer in the application of the gender perspective in substance use research through a study (2001) on the use of synthetic drugs among women in discotheques and other nightspots. A few years later, the same author laid the foundations for the application of a gender perspective in the field of drugs, which is worth mentioning because of its relevance:

“Applying the gender perspective to the field of drug use studies involves questioning epidemiological models based on sex differences and addressing the situation of women based on the very contexts in which they use and abuse certain psychoactive substances. Here, gender is a methodological perspective, a way of knowing the social reality that allows us to understand difference”. (Romo, 2005).

Some data on substance use according to sex

The manual provides a broad overview of trends in the use of various substances in Spain, with special emphasis on gender differences. This overview is carried out by analyzing the data published in the main Spanish surveys on substance use, including those carried out on a regular basis by the National Plan on Drugs (PNsD) ESTUDES and EDADES, from which the following general observations are made:

• Alcohol: there is an emerging trend among young women, particularly those aged 14-18, to consume more alcohol than men. This is reflected not only in terms of overall alcohol use, but also in binge drinking episodes. However, in the general population (15-64 years), men still exceed women in drinking.
• Tobacco: the trend in daily consumption has decreased for both genders, but men still tend to smoke more than women in the general population.
• Vapers: men tend to consume more e-cigarettes than women, regardless of age.
• Sedative-hypnotics: these drugs are consumed more by women than men, especially among young women. But it is the only substance where women’s use is higher than men’s at all ages.
• Cannabis: although traditionally used more by men, young women are beginning to use more than men in certain age groups.
• Cocaine, ecstasy, amphetamines: these substances are predominantly used by men.
• Opioid analgesics: there is an emerging trend where women in the general population (15-64 years) use more than men, although in the young population the opposite is true.

Knowledge generation on gender and addiction in the last decade

The manual mainly deals with research on gender and drug dependence in Spain, highlighting that in the last decade the country has been at the forefront in this field. Although the author acknowledges that this is a personal perception based on his experience and not a formal statement. Over the last 12 years, 107 Spanish-language publications focusing on Spain and related to gender and drugs have been identified. In these publications, such keywords as gender”, “women”, “drugs”, “addictions”, “masculinities” and “gender violence” are used in various combinations.

Of these 107 publications, 64 have been selected for further analysis. Some publications, especially manuals and papers focusing on Latin America, were excluded, not because of their relevance or lack thereof, but because they did not fit the specific purpose of this paper and/or to avoid information overload.

The main sources for the search of information were scientific platforms such as Google Scholar and specific repositories on gender and drugs, including one developed by Patricia Martínez Redondo and the digital library of the National Plan on Drugs dedicated to gender and drugs. Once the publications have been collated, they have been classified according to different themes in order to facilitate their analysis.

Table 1. Classification of the bibliography in thematic areas and their percentages

Professional practice in working with women

Based on professional experiences, this section provides a more practical approach to gender and drugs. The aim is to provide tools and knowledge that are useful for professionals who interact on a daily basis with people who use psychoactive substances, paying special attention to the needs and challenges arising from gender differences. Two different professional experiences are addressed:

• Addiction treatment for women: based on years of experience working with women, this chapter offers valuable insights and recommendations for effectively serving this population.

Women experiencing addiction are generally more stigmatized than men. Traditional treatment programmes, predominantly designed from a male perspective, often fail to address the specific needs of women, which makes them almost invisible and excludes them from the health care system. To improve treatment effectiveness, it is critical to mainstream a gender-sensitive approach, as this is the only way to adequately address the characteristics and needs of women. Women-only therapy groups offer a safe environment wherein women can deal more openly with their experiences and emotions. There are a number of issues that are crucial to address in these groups, including self-esteem, motherhood, sexuality, relationships and addiction, and gender-based violence. Integrating these groups into the care system is essential for the recovery and empowerment of women with substance use disorders.

• Evaluation instrument: presentation of a tool designed to measure how effectively the gender perspective is integrated into addiction programmes and services.

The Catalan Federation of Drug Addiction and the General Sub-directorate of Drug Addiction of the Government of Catalonia, with the subsequent support of the Catalan Institute for Women, designed a tool to measure the degree of gender mainstreaming in the addiction care network programmes and services. Tests of this tool have produced interesting results. It should be noted that the various services concerned have made efforts towards gender mainstreaming despite a lack of specific training – although all have shown a willingness to receive it. Women with drug dependence have been perceived as more stigmatized, and a demand for specific spaces dedicated to addressing gender and drugs issues has been identified. The Catalan Federation has also positively valued the fact that the test/study had raided awareness of the importance of gender mainstreaming.

Final considerations and recommendations

The relevance of integrating a gender perspective in the treatment of drug use has been highlighted. This perspective stresses how gender inequality and social exclusion compound women’s vulnerability to drug use and violence. Research suggests an imperative need to address substance addiction through the lens of gender inequalities, both in the areas of prevention and treatment, and in other specific areas such as incarceration and prostitution.

Final Recommendations

• Mainstream a gender perspective into all drug policies with a view to addressing the gender differences in drug use, risk factors and consequences of problematic use, with particular attention to women’s experiences.
• Promote more research on gender and drugs to understand the specific experiences and needs of men and women, with an emphasis on areas such as harm reduction, prevention and masculinities.
• Design strategies that directly address women’s specific issues, including gender-based violence and women’s household duties and responsibilities at work.
• Promote women’s participation in all stages of the design, implementation and evaluation of addiction policies and programmes.

The review showed significant developments in knowledge on gender and drugs, nonetheless some areas still require particular attention. It is essential to continue these efforts to ensure an equitable and effective approach to substance use and addiction intervention, grounded in a gender-sensitive perspective.

Author’s note: For more information and to review the bibliography, please download the original document (Spanish)

Carlos Molina-Sánchez holds a degree in Political Science and Sociology from the Universidad Nacional de Educación a Distancia (UNED) and a Master’s degree in Sociology Applied to Social Problems from the Universidad Complutense de Madrid (UCM). He has spent most of his professional career as a researcher specializing in gender, substance addiction and poverty. He has led and participated in a number of research projects on social exclusion based on a gender perspective at the Atenea Foundation. He has also contributed to the literature on drugs and addictions, women’s empowerment and inequalities.