March 27, 2024

Women and alcohol and other drug treatment

women walk and talk

Alcohol and other drug (AOD) use and dependence is generally more common in men, than women.1

However, even when factoring this in, women who use alcohol or drugs still access treatment at lower rates than men, in Australia and internationally. This is the case for both trans and cis women.1

To make sure Australians get the help they need, it’s important to reduce the barriers women, girls, trans and gender diverse people face in health settings – particularly in alcohol and other drug treatment.

Stigma and treatment

Women often face greater stigma and discrimination for their AOD use than men, particularly in relation to pregnancy and parenting.2

This largely comes from traditional gender-based roles and values that are placed on women, such as being a mother and caregiving.1

When people don’t stick to traditional roles, it can lead to social and institutional stigma.1, 3

Experiencing stigma, or being worried about being stigmatised, can mean women are less likely to seek treatment for AOD issues, or chat openly about them.

Personal and social barriers (such as family and caring responsibilities) can impact anyone’s ability to access treatment. But, research suggests social barriers impact women much more than men.1

Barriers to treatment for women

When beginning treatment, women often have more personal and clinical challenges, even though they’ve often used substances for a shorter amount of time, and use in smaller quantities than men.1

Some challenges to starting treatment are:

  • stigma
  • discrimination
  • employment and financial difficulty
  • lack of affordable, appropriate, family-inclusive housing
  • lack of supportive and adaptable care planning
  • childcare and custody challenges - particularly if state and social systems are involved
  • complex trauma and co-occurring mental health conditions - often from childhood physical and sexual abuse and/ or family and domestic violence.1

Family responsibilities are also a big barrier to treatment for women. This can include a lack of childcare options, the stigma associated with being a ‘mother dependent on substances’, and the fear of being punished (for example, losing custody of their children).1

Family and domestic violence and its impact on AOD treatment

Family and domestic violence has a major impact on women’s AOD use and engagement with treatment.

Women in treatment have much higher rates of experiencing family violence, compared to women in the general community.4

And women experiencing dependence often have co-occurring mental health conditions, and are more likely to have faced early childhood and lifetime trauma.5

The threat of partner violence can often impact someone’s ability to get treatment, especially if substance use is central to the relationship.6

Although family and domestic violence often involves male violence against their female partners, it can also exist in queer, non-spousal, carer, or parent-child relationships.1

Housing, prison, and legal support

For women who’ve been in prison or who don’t have a stable place to live, the challenges to getting treatment can be even bigger.

These experiences can make it difficult to access safe housing, education, employment assistance, and to stay engaged in treatment.7

For women who are exiting prison, there are a few key factors that put them at risk of returning to custody. These include insecure housing, substance use challenges, and lack of post-release support.8,9

It’s also important to note that the risk of adverse episodes, illness, or death is especially high in the first month after release for women with substance use disorders. These deaths are usually preventable.9

To help women throughout their AOD treatment – and to give them the best chance of completing it - it’s important they’re provided with financial, legal, housing, and family/relationship support.

For trans and gender diverse people, there are much better, often lifesaving, treatment outcomes when they have access to peer support and gender affirming care.1,10

Improving treatment and mental health support for women

Improving access to treatment for women can look like:

  • minimal waiting times
  • low cost/free treatment
  • access to childcare
  • access to transport
  • women-only services
  • follow-up and outreach support.1

Effective treatment options when working with women include:

  • family inclusive treatment – that works to repair relationships with family and children, and improve the quality of their environment
  • developing support systems
  • comprehensive services for pregnant women
  • relapse prevention, particularly for women with PTSD, marital distress, and alcohol dependence.
  • therapies that focus on addressing trauma and abuse.1

When women understand the links between their trauma and AOD use, they’re able to better understand their coping behaviours and engage more meaningfully with their treatment.10

Sometimes, when people stop using substances as a coping tool, a re-emergence of previous trauma can happen. Services that provide mindful and tailored support around this can improve treatment outcomes for women who experience this.1

  1. NADA. Working with Women Engaged in Alcohol and Other Drug Treatment 2021 [cited 2024 28 Feb]. 3
  2. Burns L, Breen C. It’s time to have the conversation: Understanding the treatment needs of women who are pregnant and alcohol dependent.: Foundation for Alcohol Research & Education, National Drug and Alcohol Research Centre, University of New South Wales; 2013 [cited 2024 05 March].
  3. Roozen S, Stutterheim SE, Bos AER, Kok G, Curfs LMG. Understanding the Social Stigma of Fetal Alcohol Spectrum Disorders: From Theory to Interventions. Foundations of Science [Internet]. 2022 2022/06/01 [cited 2023 23 May]; 27(2):[753-71 pp.].
  4. Greenfield SF, Pettinati HM, O’Malley S, Randall PK, Randall CL. Gender Differences in Alcohol Treatment: An Analysis of Outcome From the COMBINE Study2010 [cited 2024 06 Mar].
  5. Greenfield SF, Brooks AJ, Gordon SM, Green CA, Kropp F, McHugh RK, et al. Substance abuse treatment entry, retention, and outcome in women: A review of the literature2007 [cited 2024 06 Mar]. Available from:
  6. Michael White, Ann Roche, Roger Nicholas, Caroline Long, Stefan Gruenert, Samantha Battam. Can I Ask...? An alcohol and other drug clinician’s guide to addressing family and domestic violence.: National Centre for Education and Training on Addiction; 2013 [cited 2024 06 Mar].
  7. Hall MT, Golder S, Conley CL, Sawning S. Designing Programming and Interventions for Women in the Criminal Justice System.American Journal of Criminal Justice [Internet]. 2013 [cited 2024 06 Mar].
  8. Australian Institute of Health Welfare. Specialist homelessness services annual report 2022–23 Canberra: AIHW; 2024 [cited 2024 07 Mar].
  9. Edwards L, Jamieson SK, Bowman J, Chang S, Newton J, Sullivan E. A systematic review of post-release programs for women exiting prison with substance-use disorders: assessing current programs and weighing the evidence2022 [cited 2024 07 Mar].
  10. Salter M. Gender, use and abuse: Sexually abused women in alcohol and drug treatment. 2012. In: Gender-based violence and public health: International perspectives on budgets and policies [Internet]. Routledge.

Share this