Women’s Treatment
It is well recognized that substance abuse services for women and children are in short supply across the globe, especially in developing countries. Although there are fewer female than male drug users, the number of women drug users is on the rise. While many governments and NGO’s recognize that gender-responsive treatment is central to successful drug demand reduction, real barriers exist regarding women’s access to services. Over the years, global research has identified effective elements of women’s treatment. These elements guide the development programs, funding and evaluation requirements and workforce training curriculum, as well as the selection of treatment approaches.
Gender-responsive treatment
Gender-responsive programs are those that consider the needs of women in all aspects of their design and delivery, including location, staffing, program development, program content and program materials.
Barriers
Women face systemic, cultural, socio-economic and personal barriers to treatment.
Systemic Barriers
- Lack of childcare availability
- Limited or no services for pregnant women
- Location and cost of treatment programs
- Rigid program schedules
- Waiting list and immediate response capacity
- Denial of admission to women using psychoactive medication
- Limited information on treatment options
- Lack of identification, referral and intervention in primary care and other sectors
- Service coordination gaps to meet specialized needs
- Physical safety
Social, Cultural and Personal Barriers
- Societal and cultural stigma, shame and guilt
- Fear of losing custody of children
- Lack of family support, particularly husband/significant other
- Viewing substance abuse as a solution
- Lack of confidence in the effectiveness of treatment
Core Elements of Effective Women’s Treatment
Medical/Health services
- Nutrition
- Health promotion services
- Sexuality education
- HIV/AIDS education
- Reproductive health education
- Prenatal care
Child-Related services
- Child care
- Treatment services
- Parent education
Family issues
- Couple counseling
- Family therapy
- Exploration of familial substance use patterns
Education/Skills training
- Assertiveness
- Goal setting
- Stress reduction
- Communication skills
- Survival skills
- Relapse prevention
Psycho-Social issues
- Self-esteem development
- Exploration of shame and guilt
- Exploration of victimization issues
- Exploration of addressing co-existing problems (e.g., depression and anxiety)
- Address victimization issue
Community support connections
- Exploration of social and leisure needs
- Establishment of linkages to recreation, leisure and social service organisations
Vocational and employment support training
- Job-seeking skills
- Job training
- Education
- Referrals
Addressing life needs
- Referrals/support to acquire housing, monetary support or legal assistance
- Assistance with child care
- transportation needs
Special services required for diverse populations
- Exploration of cultural values and interrelationship with use and treatment
Best Practices to support Treatment Retention
- Treatment is flexible-allows women to move in and out as required.
- Treatment provides child care services or support.
- Treatment is provided to children, where this is required.
- treatment is client centred and individualized.
- Treatment supports women's empowerment-identifying life goals and developing the skills and insights to achieve them.
- Treatment is provided in the context of relationships with family and others.
- Treatment addresses the way women see and treat each other-establishing connections and trust is important.
- Relapse is not a defining point in recovery.
- Treatment offers a menu of services.
- Treatment addresses practical issues (e.g. money, housing, employment).
- Treatment looks at small goals and short-term success.
- Treatment (or a significant component of it) is gender specific.
- Treatment is matched specifically to client need.
- Treatment discharge is planned in advance.
- Staff have respectful and collaborative relationships with clients.
- Staff encourage and integrate continuous client feedback.
Training Curriculum
Guiding the Recovery of Women (GROW) Curriculum
The Guiding the Recovery of Women (GROW) is a comprehensive substance abuse treatment curriculum that stresses gender-specific treatment best practices, addressing a range of issues such as childcare, interpersonal relationships, pregnancy, HIV/AIDS, sexual identity, and domestic violence.
GROW’s lessons cover theories of addiction, treatment models, the psychology of women, and co-occurring disorders. They also teach clinicians the art of applying theory to every-day practice with cutting-edge treatment intervention research.
Treatment Approaches
| Issues Addressed | Best Practice: Key Expert Perspectives |
| Physical health issues | Offer menu of approaches and resources. Stress interrelationships between mind and body. Provide strong educational component (impact of substances on health). Stress nutritional counselling. Provide access to allied professionals to address specific health disorders. Support referral networks which address health issues. Support experiential learning and skills practice. Have specialized staff available on site (in-house physicians/staff, nurses). Provide specialized integrated approach to eating disorders. Introduce clients to alternative therapies. |
| Personal(mental health issues) | Use bio-psycho-social approach. Support referral networks which address health issues. Support experiential learning and skills practice.Use group work to explore issues (using connections and support betweenwomen). Use one-to-one therapy for specific purposes (useful to prepare clients forgroup). Educational approaches (methods of self-care, generational abuse, balancingneeds, handling relapse). Teach range of life (communication, stress reduction, assertiveness) andvocational skills. |
| Interpersonal issues | Use relational model to explore issues. Support referral networks which address interpersonal issues. Provide education about healthy relationships. Provide couple counselling (where feasible, appropriate and non-destructive). Focus on practical skills building (e.g. vocational training). Support experiential learning and skills practice.Provide treatment services for children, where required. Facilitate exploration of parenting styles, family of origin issues. Facilitate exploration of identity and co-dependency issues. Facilitate exploration of spirituality. |
| Relapse prevention/Management | Build on philosophical acceptance of relapse. Support experiential learning and skills practice. Start relapse management education at intake. Stress that relapse happens for a reason. Identify trigger scenarios and healthy responses. Use cognitive-behavioural approach to identify and respond to relapse. Employ variety of methods (narrative, motivational interviewing, group work,education) to explore relapse. Structure aftercare for clients consisting of:- post-treatment out-patient counselling;- connections to community support and self-help;- attention to basic life support issues. |
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