The psychological, social and physical contexts of AOD use and mental health are quite different for women as opposed to men [1106]. There is increased stigma associated with female AOD use (particularly among those who are pregnant) which is likely to lead to greater guilt and shame [276, 1106, 1107]. This stigma may lead some women to delay treatment seeking, so that by the time they enter treatment their AOD problem is quite severe. Childcare considerations, fear of the removal of children, and financial issues have also been identified as barriers for women seeking treatment [1107-1109].
Women who misuse substances are more likely than men, or non-misusing women, to have experienced sexual, physical, or emotional abuse as children, as well as domestic violence [1109-1112]. In addition, AOD use can often lead to revictimisation via dangerous or risky situations such as unsafe sex and prostitution [1109]. Among women engaging in AOD treatment, the rates of depression, anxiety, and personality disorders are particularly high [1113]. Poor self-esteem and self image, high rates of suicide attempts, and comorbid ED are also particularly common to women with AOD use issues [1114, 1115]. Because of the high rates of trauma in female clients, often perpetrated by men, it is imperative to provide a treatment environment in which women feel safe and secure [276]. The following strategies can be helpful in working with female clients [276, 1108]:
- Provide the client with the option of a female AOD worker.
- If attending group therapy, offer a women-only group if possible.
- If attending rehabilitation services, offer information and/or referral to women-only AOD services.
- Ensure that treatment is gender-sensitive and addresses gender-specific issues and barriers to treatment.
- If appropriate, consider facilitating access to childcare, which can enable female parents and caregivers to attend treatment.
- Where appropriate, consider family inclusive practice, which incorporates the client’s family and community relationships.
- Where appropriate, ensure sexual health and safety are incorporated into the treatment plan.