Gender and drugs

Women make up approximately a quarter of all people with serious drug problems and around one-fifth of all entrants to drug treatment in Europe. They are particularly likely to:

• experience stigma and economic disadvantage, and to have less social support;
• come from families with substance use problems and have a substance-using partner;
• have children who may play a central role in their drug use and recovery; and
• have experienced sexual and physical assault and abuse and have co-occurring mental disorders.

A number of sub-groups of women with drug problems have special needs. Theese sub-groups, which often overlap, include pregnant and parenting women; women involved in sex work, who may often experience violence and stigma; women from ethnic minorities, who may have been trafficked; and women in prison.

Main health and social problems faced by women with drug problems

In the Europe Union an estimated 35 million women and 54 million men aged 15 to 64 have tried an illicit drug at some time in their life. Generally the gender di erence in overall drug use is smaller among young people and the gap appears to be decreasing among younger age groups in many countries of Europe. However, for more intensive and problematic forms of drug use, the di erence between the genders is larger.

Women make up approximately a quarter of all people with serious illicit drug problems and around 20 % of all entrants to specialist drug treatment in Europe. In some studies women have been found to be more likely to access treatment because of needs arising from pregnancy or parenting or the general tendency for women to more readily seek care. Other studies have found women less likely to seek specialised services than men because of stigma. Women may attribute their problems to physical or mental health issues and seek care in the physical or mental health sectors. The extent and nature of the treatment gap within different regions and sub-groups in Europe requires further study.

Women differ from men with drug problems in their social characteristics, consequences of substance use and in the development and progression to dependence. Women present unique concerns that are sex and gender-based, but many drug services are male-oriented.

These specific problems are:

Stigma: Women who use drugs experience more stigma than men because they are perceived as contravening their roles as mothers and caregivers. Stigma can exacerbate guilt and shame, while discriminatory and unsupportive services may deter help-seeking.

Socio-economic burdens: these are heavier for women who use drugs because they have lower employment and income levels. e cost of drug treatment may be a barrier when services are not provided by the state and there is no insurance coverage. Transport costs may impede access to treatment.

Social support: Women who use drugs may have less social support than men because they are more likely to come from families with substance use problems and have a substance-using partner. For example, among English drug treatment-entrants, three-quarters of women had drug-using partners as against two- fths of men.

Children: Relationships with children are very important and may play a central role in womens drug use and recovery. Female treatment entrants are more likely than males to live with their children.

Drug-using partners: Having a partner who uses drugs can play a significant role in womens drug use initiation, continuation and relapse. It also a ects their exposure to blood-borne viral infections and violence. Substance-using men may be unsupportive of treatment and women may fear loss of the relationship if they become drug-free.

In addition, compared with men, women who use drugs are more likely to have experienced sexual and physical assault and abuse as children or as adults and to be exposed to intimate partner violence.

Post-traumatic stress disorders and other mental health problems, such as anxiety and depression, are more common among women drug users. As a consequence, the exclusion of persons with dual diagnoses from services may impact more on women than men.

Women who inject drugs have speci c vulnerabilities to blood-borne viral infections. ey have a higher HIV prevalence than men because they are likely to share injecting equipment with more people. ey are also more likely to trade sex for drugs or money and have di culties negotiating condom use with sexual partners.

A number of sub-groups of women have particular needs and may need specific responses that address these.