Many women seeking treatment face impossible choices. They shouldn’ t have to lose everything to get help, says Rachel Clegg

The choice can feel false – recovery or your children, your relationship, or the life you’ ve held together despite everything. The problem is not unwillingness to seek help, but systems that make help feel dangerous to access.

When a woman presents with substance use, the first question is often: Why is she using? An equally important question is asked far less often: What has happened to her? For many women, substance use exists alongside trauma, exploitation, domestic abuse and coercive control. Substance use may be a response to harm or part of it. An abusive partner may encourage use, create dependency, sabotage recovery or threaten disclosure, making substances another tool of control.

Maya ' s experience reflects this. Introduced to drugs by a trusted partner, she still

struggles to understand how someone she loved became part of the harm.‘ All I wanted was to settle down,’ she says.‘ Looking back, I still don ' t understand why someone who is supposed to care about you would do that?’

Here, substance use is not simply a health issue but part of a wider pattern of abuse. Yet services can treat the substance separately from the violence surrounding it. The addiction, crisis presentation, missed appointments or safeguarding concerns remain visible – the coercion, fear and violence shaping them often disappear from view.

A woman may be labelled chaotic when somebody else has made her life chaotic, or irresponsible while navigating impossible circumstances. She may be judged as an unfit mother while trying to protect her children from violence and control. This is clear in safeguarding and child removal. Domestic abuse is a significant factor in care proceedings, yet mothers can be held responsible for abuse perpetrated against them. They may be asked why they stayed, returned or could not protect their children, while the perpetrator ' s behaviour receives less focus.

Some mothers therefore believe seeking support could

bring greater scrutiny rather than safety. Fear of judgement, blame and losing their children becomes a powerful barrier to asking for help.

For Nadia, everything changed after her baby was removed. After years of domestic abuse, she was left coping with overwhelming grief and trauma.‘ People talk about my drug use like it ' s the cause of everything, but it wasn ' t,’ she says.‘ It was a way to cope.’ Her experience shows how the response to trauma can become more visible than the trauma. Services can unintentionally

The problem is not unwillingness to seek help, but systems that make help feel dangerous to access.

reinforce an abuser ' s messages – that she is the problem, no one will believe her and she does not deserve support.

Women who use substances, particularly mothers, are often portrayed as irresponsible, neglectful or dangerous, and professionals – like everyone else – are influenced by cultural attitudes. Without trauma-informed approaches, assumptions about addiction, parenting and risk can shape how women are understood and supported.

Phoenix Futures ' Women and Families Pathway provides specialist residential support for women affected by substance use, trauma,

domestic abuse and family challenges. Its gender-specific, trauma-informed services offer the safety, stability and support needed to recover and rebuild. The pathway includes women-only Ophelia House and Sheffield Family Service, the country ' s only residential treatment service where women can access treatment alongside their children. Both recognise that recovery, parenting and safety are interconnected, not competing priorities.

Women need more than access to treatment. Support must feel safe enough to use, remain flexible enough for their lives and recognise the experiences that brought them there. Accessibility is more than an open door: it means enabling honesty without fear of judgement, punishment or losing everything that matters. For Maya, the women-only environment at Ophelia House made a difference.‘ Everybody understands,’ she says.‘ People have been through similar things. You don ' t have to pretend.'

Women seek treatment because they want what everyone else wants – safety, stability, a home, healthy relationships and the chance to look forward rather than simply survive. Too many women face a false choice between recovery and what matters most, not because these goals must conflict, but because systems make them seem that way. The question is whether the help offered feels safe enough to reach for. She shouldn ' t have to lose everything to get help.

Rachael Clegg is head of residentials – women and families at Phoenix Futures

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18 • DRINK AND DRUGS NEWS • NOVEMBER 2026

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