Although rates of AOD use and related harms have historically been higher among men compared to women, the gap between men and women has narrowed in recent years, particularly among young adults [1806, 1807]. The changing rates of AOD use among women are important to consider, as the psychological, social, and physical contexts of AOD use and mental health are quite different for women as opposed to men [1807–1809]. 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 [389, 1801, 1810]. This stigma may lead some women to delay treatment seeking so that, by the time they enter treatment, their AOD use is quite severe. Childcare considerations, family responsibilities, fear of the removal of children, factors related to relationships (e.g., family conflict, support from partner), and financial issues have also been identified as some of the barriers experienced by women seeking treatment [827, 1810, 1811]. Women presenting for AOD treatment are also more likely to show greater financial vulnerability compared to men, including a decreased likelihood of employment despite similar education levels, and an increased likelihood of being financially dependent on another person [1812].
Among women with problems related to their AOD use, rates of depression, anxiety, and personality disorders are particularly high [1813, 1814]. Poor self-esteem and self-image, high rates of suicide attempts and self-harm, psychological distress, loneliness, and co-occurring ED are also particularly common to women with AOD use issues [1811, 1815–1819]. Women, and younger women in particular, are more likely to use maladaptive coping mechanisms like AOD use [1820] to cope with negative emotional situations, manage pain, and cope with trauma [1821–1824].
Women who experience problems with AOD use are more likely than men, or women who do not experience problems with AOD use, to have experienced neglect or sexual, physical, or emotional abuse as children, as well as domestic violence [434, 1812, 1813, 1825, 1826]. Relative to men, this abuse is also more likely to be severe, occur at home, and be instigated by a current or former romantic partner [1827, 1828]. In addition, AOD use can often lead to revictimisation via dangerous or risky situations such as unsafe sex and sex work [1829]. Because of the high rates of trauma among women, often perpetrated by men, it is imperative to provide a treatment environment in which women feel safe and secure [389]. The following strategies may be helpful in creating such an environment [389, 1811]:
- 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.