We are failing to reach women, connect with them and provide a safe environment in treatment, hears DDN.
Drug-related deaths among women are the highest since records began. In the decade since 2006 there was a 95 per cent increase in women dying as a result of drug misuse, meaning that 697 women lost their lives in 2016.
So what’s going wrong and where are we failing? And how can we turn this situation around? At a meeting of the Drugs, Alcohol and Justice Cross-Party Parliamentary Group, speakers were asked to give their thoughts on how we can break down barriers to improve women’s access to treatment.
‘Abuse and violence are underpinning problems,’ said Jessica Southgate, policy manager at Agenda – the Alliance for Women and Girls at Risk. In many cases women’s substance misuse was likely to be intertwined with violence, criminal justice and mental health issues and linked to hidden violence and trauma.
‘Drugs are often used as a way to numb the pain of trauma,’ she said. ‘Women often end up in abusive relationships and remain in them because of their dependencies.’
Among the population of women prisoners, it was found that 66 per cent had committed offences to buy drugs and 48 per cent had offended to support the drug use of someone else (compared to 22 per cent of men). As well as abuse and trauma, recurring themes in the lives of women facing addiction were poor socio-economic circumstances and strong feelings of stigma and shame, which could include specific cultural disapproval among BAME communities.
The many complicated reasons that women turned to substance misuse meant that getting them appropriate help could be extremely difficult.
‘Women substance misusers typically have complex needs and are often overlooked in service provision and policymaking,’ said Southgate. As well as being overlooked in mainstream services they could also find themselves in ‘intimidating spaces’, particularly if they had experienced violence in their relationships with men.
Her organisation, Agenda, had partnered with AVA (Against Violence and Abuse) to produce Mapping the Maze – a project looking at the provision of services for women across the sectors of substance misuse, mental health, homelessness, offending and complex needs in England and Wales. They found that only 19 areas out of 173 in England and Wales had services that addressed all of these issues, and that most services only tackled a single issue. Many services were focused entirely on pregnant women or those with young babies, while provision for BAME women was extremely rare. There was nothing at all specifically for LGBTQI, those with disabilities, or refugees and asylum seekers.
While funding cuts and contract requirements were found to be serious obstacles to delivering good and effective services, the Mapping the Maze model was being suggested as a framework for developing effective interventions.
‘Service design is one of the key pieces from evidence,’ said Southgate, and this included making sure staff were trained to look for, recognise and understand issues relating to multiple disadvantage and the impact of trauma, particularly in terms of violence and victimisation.
Talking to women who were affected had revealed that getting the right help could be extremely difficult and could take a long time where services did not link up. Drugs were often used to numb the pain of trauma, she said, and it was important that all the appropriate support services were primed to help.
A collaborative approach with women worked best in understanding the links with substance misuse, asking their opinions and valuing the ‘lived experience’ of peer support. At the moment, women were being ‘systematically excluded’ as ‘so often policy is made in silos’, she said, when we needed to ‘put women’s voices at the heart of it’.
Having been in the sector for 20 years, Addaction’s executive director of external affairs Karen Tyrell wanted to talk about some ‘long-standing issues’.
‘Drug and alcohol services have failed to meet the needs of women,’ she said. ‘We inadvertently create barriers.’ There was a perception that women didn’t need services as much as men, but they actually had more complex needs. ‘They are often deeply concerned about social services getting involved and taking their children away,’ she said, and ‘they often don’t have positive experience of authority figures’.
Women in Addaction’s services had nearly always experienced some kind of trauma, she explained, and it wasn’t ‘a simple relationship between childhood experiences and drug use’. Many had been abused by a partner.
Services needed to enquire carefully about individual experiences and look for trauma symptoms. ‘Our job is about taking a strength and resilience-based approach – changing it from “what’s gone wrong?” to “what’s happened to you?”,’ she said.
First impressions of treatment were important, and the experience could be negative if the first person they saw was male. Making progress also depended on understanding the level of stigma many had experienced – ‘what kind of a mother are you?’ – which tended to be very different from the attitude towards a dad who used drugs and alcohol.
‘The fear of having children taken away can’t be underestimated,’ she said, and there was much to be done in becoming trauma and gender aware. Safe spaces for women were not just ‘nice to have’ services that could be cut first – they were vital and must be protected.
‘I’m fed up with women’s provision just being through the lens of childbirth and childcare – we have got to change,’ said Tyrell. ‘We need to demand more from each other as treatment providers. There must be ways we can work together differently.’
Kim Morris, Addaction’s North Somerset Women’s Group coordinator felt that women represented ‘a section of society that we’re not reaching effectively’. She recently started a group to let women explore relationships and improve self-esteem and self-awareness, looking at trauma through the context of adverse childhood experiences (ACE). Substance misuse was ‘the red herring’ – not the root cause of problems, but an effect.
Providing a safe environment for discussion gave the opportunity to talk about all kinds of issues that could be barriers to treatment, such as fear of being judged, socially ingrained sexism, lack of faith that life could be different, and being dubious of the support that services could give them. The idea that services were ‘the enemy’ could be intensified by previous experiences with social services, particularly if children had been taken away from them.
Morris described how the group was helping women to grow in confidence and develop ‘a greater sense of honesty and behaviours’. Trainee social workers were encouraged to sit in on the group and this further contributed to helping relationships. ‘I have learned to stop blaming myself and apologising for everything,’ one group participant had commented.
There was a lot to do, said Morris – the ‘Orange Guidelines’ only mentioned women in relation to pregnancy. But there was a growing interest around the group, and although it had started small it was going well and now needed commissioners on board.
‘All services need to commit to being gender informed,’ she stated. ‘We need to ask about barriers and be open to listening about what would make a difference.’
Does your service run specific support for women? Do you have ideas on what would make a difference? Please email the editor or comment below.