The number of women reporting drug and alcohol use in Ireland is rising steadily. However, we know that women are less likely than men to attend drug and alcohol treatment services.
The Supporting Women to Access Appropriate Treatment (SWAAT) Study was established to explore why this is the case and to examine the experience of women attending the drug and alcohol services in Ballyfermot and Tallaght, as well as to gain insight from key stakeholders working in the treatment centres.
The study illuminates the real and harrowing lives some of the women lead. One of the most troubling findings from the study was the level of trauma the women have endured, and in some cases continue to endure. For many, the experience of trauma was central to the initiation and escalation of their drug and alcohol use.
The traumatic experiences endured by the women included:
- domestic violence,
- parental drug use,
- sexual exploitation.
Whilst all the trauma reported by the women in the study was of a very serious nature the descriptions of sexual coercion are particularly concerning and distressing - there were reports of women being forced by drug dealers to have sex with men in their own homes early in the morning before bringing their children to school in order to repay drug debts. These women urgently require very specialised, multi-faceted support and treatment services.
It is well documented in international literature that women face significant barriers when attempting to access drug and alcohol treatment services. Unfortunately, the experience of women in Ireland is no different.
All of the women in the study expressed a strong desire to engage in treatment. However, they identified challenges to accessing and attending services such as age, stigma, lack of childcare facilities, perceived concerns about losing custody of their child and lack of information on services and pathways to recovery.
More than three-quarters of the women expressed feelings of stigma, shame and judgement due to their drug use. Community ties were often tenuous, and the perceived feeling of judgment overshadowed the thoughts of sharing their story in the hope of getting help.
In the words of one woman, “women kind of keep it private whereas men are going around and they’ll speak about where or what they want”.
The majority of the women interviewed had children and in most cases were single parents with little access to childcare supports. There was a strong sense from these women that they were actively seeking ways to ‘get recovery’ to improve their circumstances for their children.
However, they feared attending services and disclosing their situation to service providers as they felt there was a potential threat of losing custody of their children - “I was terrified to say that I was, you know, a mother that was struggling”...
In most cases this led to women reaching ‘rock bottom’ before seeking help.
So what improvements can be made to drug treatment services for women, and how can the barriers to accessing and attending treatment be addressed and overcome? Many drug treatment services provide very good care to men and women and some place an emphasis on trauma-informed care.
However, in line with the international evidence and the study’s findings, we believe there is an urgent need to build on qualities of existing services to ensure all drug and alcohol treatment services are trauma informed, holistic, integrated and gender transformative so that they can respond to women’s needs, including complex issues such as domestic violence and sexual exploitation.
The study also identifies specific changes in treatment services that are required 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 recovery pathways.
Finally, we argue that, currently in Ireland recovery is examined through the narrow lens of abstinence. However, it is crucial to take a more holistic view of recovery that focuses on health, relationships, well-being, education, employment, and self-care at individual, community and societal level.
Of particular importance is identifying ways to build community capital (that is, resources an individual can access in their community to aid their recovery) and to collect robust data that will inform the development of new and existing services and supports for women initiating and sustaining recovery.
- Dr. Gillian Paul, Assistant Professor in Public Health and Health Promotion, Dublin City University and Dr Jo-Hanna Ivers, Assistant Professor in Addiction, Trinity College Dublin