BackB to navigation page Vienna International Centre, PO Box 500, A 1400 Vienna, Austria Tel: +(43) (1) 26060-0, Fax: +(43) (1) 26060-5866, www.unodc.org Substance abuse treatment and care for women: Case studies and lessons learned Printed in Austria V.04-55683—November 2004—1,150 Drug Abuse Treatment Toolkit Drug Abuse Treatment United Nations publication Sales No. E.04.XI.24 ISBN 92-1-148194-5 UNITED NATIONS OFFICE ON DRUGS AND CRIME Vienna Substance abuse treatment and care for women: Case studies and lessons learned UNITED NATIONS New York, 2004 The United Nations Office on Drugs and Crime would like to thank the Smithers Foundation for its generous contribution towards the cost of publishing this report. Vienna, August 2004 UNITED NATIONS PUBLICATION Sales No. E.04.XI.24 ISBN 92-1-148194-5 The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations con- cerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Acknowledgements The present publication was commissioned by the insights on the lessons learned in the implementa- United Nations Office on Drugs and Crime tion of their projects; (UNODC), Global Challenges Section. • The members of the panel of experts, who provi- ded their insights and feedback to earlier drafts; The United Nations Office on Drugs and Crime • The drug demand reduction experts and focal points expresses its gratitude to the following: at the regional and country offices of the United Nations Office on Drugs and Crime, who shared • The staff of all treatment services who, despite a their knowledge about treatment services for women heavy workload, took the time to provide answers in their regions and made recommendations on to the survey among candidate projects; the projects to be included in the booklet. • The contributors to the present volume who pro- vided detailed information on their work and an The United Nations Office on Drugs and Crime also in-depth analysis of their projects with regard to wishes to acknowledge the contribution of Virginia various criteria. Included in these thanks are the Carver, the project consultant, who identified the case staff working on the projects; studies, facilitated the meeting in Vienna and com- piled the draft publication; also Pilar Cuellar and My • The participants of the meeting held in Vienna in Hue McGowran, who supported the meeting and edi- December 2003, who shared their experiences and torial process. iii Panel of Experts Susan Beckerleg, Kenya Maristela Monteiro, World Health Organization/ Jan Copeland, Australia Pan American Health Organization Stephanie Covington, United States of America Pratima Murthy, India Marie Louise Ernst, Switzerland Dace Svikis, United States of America Gabriele Fischer, Austria Nancy Usher, Canada Dagmar Hedrich, European Monitoring Centre for Drugs and Drug Addiction Irmgard Vogt, Germany Anna Chisman, Inter-American Drug Abuse Control Cora-Lee Wetherington, National Institute on Drug Commission Abuse, United States of America Case study representatives Silvia Brasiliano and Patricia Hochgraf (Brazil) Murièle Lasserre Bergerioux (Switzerland) Dr. Miguel Cedeño (Panama) Lotta Länne (Sweden) Abdoulaye Diouf (Senegal) Margaret Leslie (Canada) Karin Goger (Austria) Ashita Mittal (India) Ann Harrison (United States of America) Harlie Outhwaite, Nellie Manley and Colleen Allan Christine Heinrichs (Germany) (Canada) Katarina Jiresova (Slovakia) Barbara Rich (Australia) Kamil Kalina and Jiri Richter (Czech Republic) Elizabeth Selhore (India) Karol Kaltenbach (United States of America) Sepideh Sigara (Islamic Republic of Iran) Jehanzeb Khan and David MacDonald (Afghanistan; Wendee Wechsberg (United States of America) Pakistan) Martha J. Wright (United States of America) Marcela Lara Orellana (Chile) iv Preface The present booklet is about gender-responsive sub- their treatment needs. Women with substance use stance abuse treatment services for women. It is part problems also experience significant barriers to access- of the United Nations Office on Drugs and Crime ing treatment, and are believed to be underrepresen- (UNODC) project to develop tools to support the ted in treatment settings. Cultural taboos and stigma development and improvement of substance abuse mean their substance use problems are often not treatment services, based on evidence from the literature acknowledged by themselves, their families or helping and case studies that illustrate practical experiences professionals who could support them in seeking and lessons learned in providing substance abuse treatment. Pregnant and parenting women using sub- treatment services in various regions of the world. stances face particular societal condemnation, and Other publications in this Drug Abuse Treatment pregnant women often delay seeking services with Toolkit series are: Investing in Drug Abuse Treatment: a serious implications for the mother and the foetus. Discussion Paper for Policy Makers; Contemporary Drug Women who are parents usually have primary respon- Abuse Treatment: a Review of the Evidence Base; and sibility for childcare, as well as other household Drug Abuse Treatment and Rehabilitation: a Practical responsibilities. However, few treatment services pro- Planning and Implementation Guide.* These can be vide childcare, and in some cultures it is very difficult found on the UNODC web site (www.unodc.org/ for women to leave their homes and family responsi- unodc/en/treatment_toolkit.html). bilities to seek treatment. The project on women’s substance abuse treatment More often than men, women have been introduced services was launched in response to the Declaration to substances and continue to use substances with on the Guiding Principles of Drug Demand their spouses or partners, who may also be physically Reduction (General Assembly resolution S-20/3, or sexually abusive. With little emotional support, or annex) and the measures to enhance international financial resources to pay for treatment, childcare or cooperation to counter the world drug problem transportation, women find it difficult to enter and (Assembly resolutions S-20/4 A to E), adopted by the remain in treatment. Women also have more severe General Assembly at its twentieth special session. The problems at treatment entry than men. Many have Guiding Principles indicate that demand reduction experienced trauma and use substances to cope with programmes should be designed to address the needs these experiences. They are more likely to have men- of the population in general, as well as specific popu- tal health problems such as anxiety or depression or lation groups. post-traumatic stress disorder than men. They also have fewer resources in terms of education, employ- In most countries of the world, the circumstances of ment and finances. At the same time, because more women’s lives are very different from those of men. men than women use illicit and other substances of This is also reflected in their experience of substance abuse, most treatment programmes have been use problems. Women’s substance use problems are designed with men in mind and do not take into more stigmatized and less likely to be acknowledged account gender differences. The goal of this publica- than men’s. As a result, much less is known about the tion is to raise awareness about the treatment needs of prevalence and patterns of women’s substance use, and women and to provide tools, suggestions and practical *United Nations publication, Sales No. E.03.XI.II. v Substance Abuse Treatment and Care for Women: Case Studies and Lessons Learned examples for overcoming access barriers, engaging • Presentations and discussions that took place at a women in treatment and providing treatment that is meeting of representatives of case study projects, responsive to the specific needs of women. members of the international panel of experts and staff of the United Nations Office on Drugs and The booklet brings together information from a variety Crime, entitled “Women’s Drug Treatment: Lessons of sources: Learned” held in Vienna, from 15 to 17 December 2003, referred to thereafter in the following chapters • A review of the literature. Published articles and as “the Vienna meeting”. reports were identified through a search of Medline/PubMed, EMbase and PsychInfo databases The present publication is about substance abuse treat- from 1998 to 2003; as well as from web sites of ment for women in general. Though it is recognized international and national bodies and organizations that adolescent women and older adult women have that contain guidelines, full text articles or other rel- specific treatment needs because of their different sub- evant information. Members of an international stance use patterns and life circumstances, treatment panel of experts formed to advise on various phases and rehabilitation issues for these two population of the project and representatives of case studies groups will be addressed in more depth in other publi- included in this booklet were also a rich source of cations of the United Nations Office on Drugs and articles, reports and other information. The litera- Crime in the Drug Abuse Treatment Toolkit series. ture review built on several other recent literature Prevention is an extremely important aspect of address- reviews, particularly the literature review by Gillian ing