Problematic drug use is a multidimensional phenomenon. Clinicians formulating plans to treat problematic drug users must therefore consider the factors that influence use, including gender-related factors.
The prevalence of drug use in Chile has generally been higher among men than among women. Nonetheless, prevalence among Chilean women is rising, especially among adolescents and with alcohol consumption becoming a more notable problem (1).
To respond to this situation, Dianova Chile has launched three specific programs for women that focus on gender. This article highlights the details and challenges that these three programs illustrate in order to promote good practices for treating women with addictions.
The Gender Perspective
Before exploring these details and challenges, it is important to state what we mean by the gender perspective. Gender is a symbolic construction based on differences between the sexes, and is thus subject to change and to questioning. Gender construction focuses on subjective constitution and prescribes behavioral standards. Moreover, there is a long record of inequality between the sexes that results from the devaluation of women through history (2).
Addressing addiction from a gender perspective allows clinicians to consider the effects of gender socialization. Clinicians need to identify the specific issues that affect women, and the effects of undergoing socialization as women. These issues and effects influence women’s histories of using drugs (motivations, the process of relapsing, use patterns, etc.)
One of the main obstacles to women starting treatment is the lack of appropriate services (it is difficult to find child care or accommodate fixed schedules).
To meet these needs, programs have treated children as a part of the intervention. This has meant providing physical spaces for children (day care) and staff who specialize in caring for children. Programs also include the development workshops to promote adherence and provide tools to promote healthy relationships. These strategies help avoid repeating childhood patterns affected by violence or negligence.
Programs have also adopted flexible schedules and provided greater access, with clinicians going to the homes of users. This is especially important for mothers with infants, who may not be able to leave their homes.
Flexible schedules include longer hours that allow access for users who work and are unable to visit a clinic during normal business hours. Consequently, compliance among these patients has improved.
Therapy includes questioning the traditional identification of women as mothers, both by the treating team and users themselves. All parties consider the wide range of meanings that womanhood has in a highly patriarchal society today. Team members and users also acknowledge their ongoing exposure as women to structural and state violence. Addressing these issues allows users to question assumptions that motherhood is natural, and helps them deal with unwanted pregnancies. Users receive psychological support and reassurance to counter guilt for not fulfilling the traditional roles assigned to women: “good mother” or “good wife.”
Another frequently observed factor associated with drug use is traumatic partner or domestic violence, especially sexual violence. These forms of violence can contribute to the development of mood or personality disorders, as well as post-traumatic stress. Substance use in this context is usually pharmacological, serving as a form of self-medication or a coping strategy.
Users with additional sources of conflict require special attention, as they are at risk of repeated abuse. They can suffer violence, drug addiction, and deal with institutions that neglect them by referring them from one department to another. The latter scenario forces women to repeat their stories to different people, none of whom gains a comprehensive understanding of the woman’s situation.
To avoid that kind of neglect, we have reinforced our network with services such as “Homes for Women.” We have also taken an active part in the “Communal Gender Network.” This organization provides training in addiction to the various agencies that deal with violence and children, as well as the courts. This training helps reduce discrimination against women and helps them avoid prosecution.
It is crucial to stress as a conclusion how incorporating the gender perspective has allowed us to provide more specialized services to meet the needs of our clients. Nonetheless, we need to continue strengthening our focus on empowering women. A future challenge will be to implement programs with a greater impact on regions with more vulnerable women, such as the homeless or prostitutes. Those populations will require more inclusive treatments that cover heterogeneous populations and reduce gaps in access to health care and opportunities for social integration.
1. SENDA (2015). Décimo primer estudio nacional de drogas en población general, 2014. National Service for the Prevention and Rehabilitationof Drug and AlcoholConsumption, Ministry of the Interior and Public Safety, Santiago. http://www.senda.gob.cl/media/estudios/PG/2014_EstudioDrogas_Poblacion_General.pdf
2. Martínez, P. (2008). Gender perspective applied to drug addicts. Outpatient Drug Addiction Centers Association. Salamanca, Spain. Downloaded from http://www.asecedi.org/docs/GENERO.pdf