Trinity College Dublin: Perceived fear of losing children major barrier to women accessing addiction treatment

A new report from Trinity College has found that there is an urgent need for the expansion of gender-sensitive drug and alcohol treatment approaches that support the needs of women. A dominant theme in the report found that the perceived fear of losing children is a major barrier to women accessing treatment for drug and alcohol addiction.

The ‘Supporting Women To Access Appropriate Treatment (SWAAT) Study’ was launched by Minister Frank Feighan, Minister of State with responsibility for Public Health, Well-Being and National Drugs Strategy.

The number of women reporting drug and alcohol use in Ireland is rising but research tells us that women are less likely than men to attend drug and alcohol treatment services.

The aim of the Trinity study was to gain an insight into the experience of women with drug and alcohol treatment needs in the greater Dublin areas of Ballyfermot and Tallaght. Researchers noted that literature focussing on women accessing treatment remains relatively scant, particularly around their rationale for not attending treatment; this study aims to address this knowledge gap.

There are gender differences in the way that men and women experience substance use initiation, addiction progression, substance use consequences, treatment access and treatment outcomes. While accessing substance use treatment can be difficult for both men and women, women consistently under-present to substance use treatment services.

It is estimated that less than 10% of American women aged between 18-44 years receive treatment services when needed. In Ireland, most people who use drugs are treated in the community and only three in ten people accessing services for substance use are female. It is likely that the small number of women receiving substance use treatment is related to sociocultural factors hindering women from accessing treatment. These factors can include stigma, economic disadvantage, maternal responsibilities, low-levels of family support and the inability of services to respond to their complex needs.

Furthermore, specific groups of women who use drugs such as mothers, those who experience trauma, domestic violence, those with comorbid mental health difficulties and women who engage in the sex trade report particular difficulties in accessing substance use treatment services.

SUMMARY OF FINDINGS
Prior exposure to traumatic early and later life events was associated with
progression into problematic patterns of drug use.

Women in the study typically described a childhood marked by poverty,
bereavement and family adversity.

Notwithstanding their challenges with alcohol and/or other drug use, women
participating in this study expressed a strong desire to access recovery services.

Lack of access to childcare services was cited as the most significant barrier to
accessing treatment.

Key stakeholders discussed the ongoing sexual exploitation and control of women
in these communities.

Services were disjointed and did not work together as effectively as they could.
The perceived fear of losing children as a barrier to treatment for the women was
a dominant theme in the key stakeholder’s narratives.

Women did not have adequate access to the necessary support services (domestic
violence, mental health, primary care).

A high number of key stakeholders noted how the responsibility of childcare most
often rested with the mothers.

Key stakeholders highlight the constant loop that women with co-occurring
mental health issues and drug use found themselves in when seeking help.

The need to build competencies around addiction in non-addiction service staff
was a key theme in the stakeholder interviews.

Peer-led support was seen as particularly successful when attempting to engage women.


WHAT MIGHT BE DONE DIFFERENTLY TO BETTER SUPPORT WOMEN ACCESSING TREATMENT
The following are the report’s recommendations based on the international evidence base and the study’s findings. The recommendations are intended to inform broader policy and practice at a local and national level:

1: Develop an adequate trauma-informed response for women who use drugs

2: Establish gender-transformative, integrated treatment and support

services for women who use drugs

3: Establish a working group between Ballyfermot and Tallaght Local Drug

and Alcohol Task Forces and the child and family agency (Tulsa)

4: Develop pathways for women to sustain recovery

5: Expand pathways to education and training for women

6: Support women to rebuild and sustain healthy family relationships



Dr Jo-Hanna Ivers, Assistant Professor in Addiction, School of Medicine, Trinity College, said:

While both men and women who use drugs experience stigma the experience is gendered due to drug dependence challenging social and cultural expectations of women as nurturers, mothers, daughters, sisters, and caregivers. Women who use drugs report significantly higher levels of stigma than men. Fear of stigmatising experiences is one of the most reported factors hindering women who use drugs from accessing substance use treatment.

Participants spoke about several necessary changes to ensure women who use drugs access treatment, for example; an increase in residential treatment centres with onsite childcare facilities; lowering the threshold of domestic violence refuge for women who use drugs and alcohol, and developing gender-specific peer-led support to support recovery pathways.

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