According to OHID ’ s Adult substance misuse treatment statistics 2020 to 2021 , around two thirds of people in drug treatment are men and one third women , while in alcohol treatment it ’ s roughly 60 / 40 . As the Women ’ s Treatment Working Group points out , although the number of women dying a drug-related death has risen by almost 80 per cent over the last decade , the figures for women seeking treatment have remained mostly unchanged ( www . drinkanddrugsnews . com /

new-group-champions-womensright-to-high-quality-services /). So what ’ s deterring them – is it still the stigma ?

CHAOTIC SERVICES ‘ It ’ s an uncomfortable conversation for many people to have , but the stigma is huge ,’ says Sophie Carter , head of the family justice team at the Centre for Justice Innovation – an organisation that recently published a report warning that many women were experiencing ‘ chaotic ’ and ‘ intimidating ’ treatment services ( DDN , November , page 5 ). ‘ Whether we like it or not , it ’ s perfectly acceptable in society for a father to not be the primary carer for their child , but for a mother to not be the primary carer – or not be seen as a fit parent – is much more significant .’

It ’ s long been pointed out that services are still not set up for women with caring responsibilities , and while individual practitioners are

‘ committed to getting it right , the reality of how it ’ s set up doesn ’ t always allow that ,’ says Carter . So is it the case that , as so with many things , treatment services have basically been designed with men in mind ? ‘ I think it is , and I know practitioners recognise that , but the reality of what steps you can take – from a day-to-day point of view all the way through to changing your strategies and partnerships – is not always easy .’ Things have been improving in recent years , and there are some excellent women ’ s services , but it does remain very much a postcode lottery . ‘ Not just that , but a transport and accessibility lottery alongside it ,’ she points out .

TRAUMA RESPONSES Closely connected to questions of stigma are women ’ s responses to trauma , and the behaviours that can often result from that . These can be difficult to manage , and many services still aren ’ t set up in a way that allows the

building of the relationships needed to do that , and with women ‘ stigmatised again for not fitting into the processes ’ as a result .

People frequently talk about a trauma-informed approach , but how many services are genuinely geared up to deliver that – with staff who are properly trained and capable ? ‘ That ’ s a good question , because it can be a bit of a buzzword . How you translate that into day-to-day practice is the most important part . The realities of commissioning – access to resources , being able to signpost to relevant services , non-attendance and outreach policies – are not always designed to match the knowledge that practitioners have . So there ’ s still a lot of work to be done around how you can upskill organisations as a whole to have that trauma awareness , and understand those interlinking factors for women coming into services .’

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