addiction; alcohol and drug treatment; barriers; facilitators; gender; motherhood; stigma; women; Health (social science); Health Policy
Abstract :
[en] Aims: Although treatment barriers are different for men and women, research is dominated by males' and practitioners' perspectives rather than women's voices. The purpose of this study in Belgium was to identify and obtain a better understanding of the barriers and facilitators for seeking treatment as experienced by substance (ab)using women themselves.
Methods: In-depth interviews were conducted with 60 female substance users who utilise(d) outpatient and/or residential treatment services. A content analysis was performed on women's personal accounts of previous treatment experiences as well as their experiences with services along the continuum of care, resulting in practical implications for the organisation of services.
Results: Female substance users experience various overlapping - and at times competing - barriers and facilitators when seeking treatment and utilising services. For most women, the threat of losing custody of their children is an essential barrier to treatment, whereas for a significant part of the participants it serves as a motivation to seek help. Also, women report social stigma in private as well as professional contexts as a barrier to treatment. Women further ask for a holistic approach to treatment, which stimulates the healing process of body, mind and spirit, and emphasise the importance of feeling safe in treatment. Participants suggested several changes that could encourage treatment utilisation.
Conclusion: Our findings demonstrate the need for a gender-sensitive approach within alcohol and drug services that meets the needs of female substance users, as well as gender-sensitivity within prevention and awareness-raising campaigns, reducing the stigma and facilitating knowledge and awareness among women and society.
FOD Volksgezondheid, Veiligheid van de Voedselketen en Leefmilieu
Funding text :
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Belgian Science Policy (DR/00/73) and the Federal Public Service Health, Food Chain Safety and Environment.
Abraham T. H., Lewis E. T., Cicciare M. A., (2017). Providers’ perspectives on barriers and facilitators to connecting women veterans to alcohol-related care from primary care. Military Medicine, 182, 1888–1894.
Ait-Daoud N., Blevins D., Khanna S., Sharma S., Holstege C. P., Amin P., (2019). Women and addiction: An update. Medical Clinics of North America, 103(4), 699–711.
Back S. E., Payne R. L., Simpson A. N., Brady K. T., (2010). Gender and prescription opioids: Findings from the National Survey on Drug Use and Health. Addictive Behaviors, 35(11), 1001–1007.
Covington S. S., (2015). Understanding and applying gender differences in recovery. In O’Neil A. L., Lucas J., (Eds.), Promoting a gender responsive approach to addiction (pp. 309–324). UNICRI Publication nr 104.
Dekkers A., De Ruysscher C., Vanderplasschen W., (2020). Perspectives on addiction recovery: focus groups with individuals in recovery and family members. Addiction Research & Theory. Advance online publication. https://doi.org/10.1080/16066359.2020.1714037
Del Boca F. K., Noll J. A., (2000). Collecting valid data from community sources. Truth or consequences: the validity of self-report data in health services research on addictions. Addiction, 95(3), 347–360.
De Wilde J., (2006). Gender-specific profile of substance abusing women in therapeutic communities in Europe (Doctoral dissertation). Academia Press Gent.
Dowling R., Lloyd K., Suchet-Pearson S., (2016). Qualitative methods I: Enriching the interview. Progress in Human Geography, 40(5), 679–686.
Elms N., Link K., Newman A., Brogly S. B., (2018). Need for women-centred treatment for substance use disorders: Results from focus group discussions. Harm Reduction Journal, 15(40).
Etikan I., Musa S. A., Alkassim R. S., (2016). Comparison of convenience sampling and purposive sampling. American Journal of Theoretical and Applied Statistics, 5(1), 1–4.
European Monitoring Centre for Drugs and Drug Addiction. (EMCDDA). (2006). Annual report 2006. Selected issue 2: A gender perspective on drug use and responding to drug problems. Office for Official Publications of the European Communities.
Fox S., (2020). “[…] you feel there’s nowhere left to go”: The barriers to support among women who experience substance use and domestic abuse in the UK. Advances in Dual Diagnosis, 13(2), 57–71.
Gilchrist G., Blazquez A., Rabasa A. P., Coronado M., Colom M., Torrens M., (2015). Sex differences in barriers to accessing substance abuse treatment, a qualitative study. In O’Neil A. L., Lucas J., (Eds.), Promoting a gender responsive approach to addiction (pp. 176–194). UNICRI Publication nr 104.
Graneheim U. H., Lindgren B.-M., Lundman B., (2017). Methodological challenges in qualitative content analysis: A discussion paper. Nurse Education Today, 56, 29–34. 10.1016/j.nedt. 2017.06.002
Green C. A., (2006). Gender and use of substance abuse treatment services. Alcohol Research and Health, 29(1), 55–62.
Greenfield S. F., Brooks A. J., Gordon S. M., Green C. A., Kropp F., McHugh R. K., Miele G. M., (2007). Substance abuse treatment entry, retention, and outcome in women: A review of the literature. Drug and Alcohol Dependence, 86(1), 1–21.
Greenfield S. F., Rosa C., Putnins B. A., Green C. A., Brooks A. J., Calsyn D. A., Cohen L. R., Erickson S., Gordon S. M., Heynes L., Killeen T., Miele G., Tross S., Winhusen T., (2011). Gender research in the National Institute on Drug Abuse National Treatment Clinical Trials Network: A summary of findings. American Journal of Drug and Alcohol Abuse, 37(5), 301–312.
Greenfield S. F., Trucco E. M., McHugh R. K., Lincoln M., Gallop R. J., (2007). The Women’s Recovery Group Study: A stage I trial of women-focused group therapy for substance use disorders versus mixed-gender group drug counseling. Drug and Alcohol Dependence, 90(1), 39–47.
Grella C. E., (2008). From generic to gender-responsive treatment: Changes in social policies, treatment services and outcomes of women in substance abuse treatment. Journal of Psychoactive Drugs, 40(5), 327–343.
Grella C. E., Greenwell L., Mays V. M., Cochran S. D., (2009). Influence of gender, sexual orientation, and need on treatment utilization for substance use and mental disorders: Findings from the California quality of life survey. BMC Psychiatry, 9(1), 52.
Gueta K., (2017). A qualitative study of barriers and facilitators in treating drug use among Israeli mothers: An intersectional perspective. Social Science and Medicine, 187, 155–163.
Hsieh H.-F., Shannon S. E., (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288.
International Narcotics Control Board. (2017). Report of the International Narcotics Control Board for 2016. United Nations.
Kalema D., Vanderplasschen W., Vindevogel S., Baguma P. K., Derluyn I., (2017). Treatment challenges for alcohol service users in Kampala, Uganda. International Journal of Alcohol and Drug Research, 6(1), 27–35.
Kerridge B. T., Mauro P. M., Chou S. P., Saha T. D., Pickering R. P., Fan A. Z., Grant B. F., Hasin D. S., (2017). Predictors of treatment utilization and barriers to treatment utilization among individuals with lifetime cannabis use disorder in the United States. Drug and Alcohol Dependence, 181, 223–228.
Keyes K. M., Hatzenbuehler M. L., McLaughlin K. A., Link B., Olfson M., Grant B. F., Hasin D. S., (2010). Stigma and treatment for alcohol use disorders in the United States. American Journal Epidemiology, 172, 1364–1372.
Kissin W. B., Tang Z. Q., Campbell K. M., Claus R. E., Orwin R. G., (2014). Gender-sensitive substance abuse treatment and arrest outcomes for women. Journal of Substance Abuse Treatment, 46(3), 332–339.
Kondracki N. L., Wellman N. S., (2002). Content analysis: Review of methods and their applications in nutrition education. Journal of Nutrition Education and Behavior, 34, 224–230.
Krippendorff K., (2013). Content analysis: An introduction to its methodology (3rd ed.). Sage Publications.
Lavee E., (2016). Low-income women’s encounters with social services: Negotiation over power, knowledge and respectability. British Journal of Social Work, 47, 1554–1571.
LeBel T. P., Burnett R., Maruna S., Bushway S., (2008). The “chicken and egg” of subjective and social factors in desistance from crime. European Journal of Criminology, 5(2), 131–159.
McCann T. V., Lubman D. I., (2018). Helpseeking barriers and facilitators for affected family members of a relative with alcohol and other drug misuse: A qualitative study. Journal of Substance Abuse Treatment, 93, 7–14.
Meulewaeter F., De Pauw S., Vanderplasschen W., (2019). Mothering, substance use disorders and intergenerational trauma transmission: an attachment-based perspective. Frontiers in Psychiatry, 10, 728.
Montanari L., Serafini M., Maffli E., Busch M., Kontogeorgiou K., Kuijpers W., Ouwehand A., Pouloudi M., Simon R., Spyropoulou M., Studnickova B., Gyarmathy V. A., (2011). Gender and regional differences in client characteristics among substance abuse treatment clients in the Europe. Drugs Education Prevention and Policy, 18(1), 24–31.
Mrazek P. J., Haggerty R. J., (1994). Reducing risks for mental disorders: Frontiers for preventive intervention research. National Academy Press.
Myers B., Louw J., Pasche S., (2011). Gender differences in barriers to alcohol and other drug treatment in Cape Town, South Africa. African Journal of Psychiatry, 14, 146–153.
Neale J., Nettleton S., Pickering L., (2014). Gender sameness and difference in recovery from heroin dependence: A qualitative exploration. International Journal of Drug Policy, 25, 3–12.
Neale J., Tompkins C.N.E., Marshall A.D., Treloar C., Strang J., (2018). Do women with complex alcohol and other drug use histories want women-only residential treatment. Addiction, 113, 989–997.
Noori R., Pashaei T., Panjvini D., Khoshravesh S., (2019). Treatment needs of drug users: The perspective of Iranian women. Journal of Substance Use, 24(3), 280–284. https://doi.org/10.1080/14659891.2018.1562573
Palinkas L. A., Horwitz S. M., Green C. A., Wisdom J. P., Duan N., Hoagwood K. E., (2015). Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental Health and Mental Health Services, 42(5), 533–544.
Phelan J. C., Link B. G., Stueve A., Pescosolido B. A., (2000). Public conceptions of mental illness in 1950 and 1996: What is mental illness and is it to be feared? Journal Health Social Behaviour, 41, 188–207.
Probst C., Manthey J., Martinez A., Rehm J., (2015). Alcohol use disorder severity and reported reasons not to seek treatment: A cross-sectional study in European primary care practices. Substance Abuse Treatment, Prevention, and Policy, 10(1), 32.
Schamp J., Simonis S., Van Havere T., Gremeaux L., Roets G., Willems S., Vanderplasschen W., (2018). Towards gender-sensitive prevention and treatment for female substance users in Belgium. Final report. Belgian Science Policy.
Stringer K.L., Baker E.H., (2018). Stigma as a barrier to substance abuse treatment among those with unmet need: An analysis of parenthood and marital status. Journal of Family Issues, 39(1), 3–27.
Substance Abuse and Mental Health Service Administration. (SAMASHA). (2012). National survey on drug use and health. Substance Abuse and Mental Health Service Administration.
Tang A., Claus R. E., Orwin R. G., Kissin W. B., Arieira C., (2012). Measurement of gender-sensitive treatment for women in mixed-gender substance abuse treatment programs. Drug and Alcohol Dependence, 123(1–3), 160–166.
Terplan M., Longinaker N., Appel L., (2015). Women-centered drug treatment services and need in the United States, 2002–2009. American Journal of Public Health, 105(11), 50–54.
Van Havere T., Vanderplasschen W., Broekaert E., De Bourdeaudhui I., (2009). The influence of age and gender on party drug use among young adults attending dance events, clubs, and rock festivals in Belgium. Substance Use and Misuse, 44(13), 1899–1915.
van Olphen J., Freudenberg N., (2004). Harlem service providers’ perceptions of the impact of municipal policies on their clients with substance use problems. Journal of Urban Health, 81(2), 222–231.
Vanderplasschen W., Van Rompaye E., Littera L., Vandevelde D., (2016). Geen kinderspel: Opvoeding door aan drugs verslaafde ouders na residentiële ouder-kind behandeling [No joke: Parenting by drug dependent parents after mother-child treatment]. Tijdschrift Verslaving, 11(3), 162–175.
Virokannas E., (2020) Treatment Barriers to Social and Health Care Services from the Standpoint of Female Substance Users in Finland. Journal of Social Service Research, 46(4), 484–495.
Xu J., Wang J., Rapp R. C., (2007). The multidimensional structure of internal barriers to substance abuse treatment and its invariance across gender, ethnicity, and age. Journal of Drug Issues, 37(2), 321–340.
