Drugs and Alcohol Women Network Project Evaluation of care services provided by Drug Addiction Department in female patients: a national survey Drugs and Alcohol Women Network Project

Background (1) Women with addiction are a minority, but face serious problems in their lives: Once a woman has developed an addiction, she deviates more from the female norm, compared with a man with an addiction. And the consequences of deviating from the norm may be seriuos (Coplan, 2007) Women with drug and alcohol problems have been described as stigmatized by society in that they are viewed (and often viewed themselves) as having deviated from the traditional societal norms expected of women in their suitability as mothers and carers. This self-image is often accompanied by a feeling of shame and guility (Torner, 2008) Women with drug problems can cope with their life situation by providing sex in exchange for housing, sustenance and protection but often suffer violence from sexual partner and are in a situation where the may have to practice unsafe sex (Pinkam, 2008) 1/2/2019 United Nations Interregional Crime and Justice Research Institute

Background (2) When women to develop problems with drugs and alcohol the problems seem to develop faster than among men. Piazza et al (1989) describe this as telescoping effect. Women with a problematic use of drugs or alcohol seem also to experience that family and friends support this strategy of concealment to protect the woman from outsider Generally women with addiction problems are more likely than men (with addiction problems) to have an alcohol or drug using partner who support her substance use (Green, 2006). Compared to women with a male partner not using drugs this group generally experience less support, or even resistance, to enter abstinence-based treatment and generally tend to be retained in treatment for a shorter period of time. Having childbearing responsibilities is likely to influence women’s treatment-seeking behaviour. Women are more inclined than men to feel under threat of losing custody of a child, or to be suffering from a recent loss of custody (Jessup, 2003). Disrupting or threats of disruption of family relationship can prevent the woman from entering treatment. 1/2/2019 United Nations Interregional Crime and Justice Research Institute

Objectives Collect and review specific indicators about access either to the drug addiction service or the treatment’s phase Collect their opinion about the involvement of PARENTS and PARTNER when there are specific situations such as pregnancy, minor age Determine factors could enhance their access to the services Measure preferences on factors that can cause a delay in accessing the services Determine the overall level of satisfaction of services provided 1/2/2019 United Nations Interregional Crime and Justice Research Institute 4

Methodology Self-administered Questionnaire 16 item, scale LikerT (1-7) The items and sub-items were developed per suggestions and recommendations given by subject matter experts Preliminary analysis on a small group of women Questionnaire administred at Centers involved in DADNET Project Data's Elaboration 1/2/2019 United Nations Interregional Crime and Justice Research Institute 5

9 Dependence and Mental Department 2 Therapeutic Communities Milano - Exodus Pordenone Varese Verona Torino Modena Savona Rimini- San Patrignano Foligno Matera Catania 9 Dependence and Mental Department 2 Therapeutic Communities 1/2/2019 United Nations Interregional Crime and Justice Research Institute 6

Results: Socio demographic characteristics 299 Women Average Age 34,5 years Average Age 37, 0 Average Age 26,5 1/2/2019 United Nations Interregional Crime and Justice Research Institute 7

Subjects according to age range (%) 1/2/2019 United Nations Interregional Crime and Justice Research Institute 8

Subject according to frequency’s drug service period (%) 1/2/2019 United Nations Interregional Crime and Justice Research Institute 9

Subject according to type of treatment (%) 1/2/2019 United Nations Interregional Crime and Justice Research Institute 10

Subjects according to therapeutical phase in TC (%) 1/2/2019 United Nations Interregional Crime and Justice Research Institute 11

Questionnaire: Item 1-3 Item 1: When a woman first approaches the health service, she should be received by female professional staff. Item 2: When a woman is ADMITTED to a health service, her privacy should be thoroughly protected. Item 3: The health service provides for specific admission gender oriented programmes. 1/2/2019 United Nations Interregional Crime and Justice Research Institute 12

Results: Item 1-3 Questionnaire Protection of Privacy evaluated as the most important aspect (average 6,4) Presence of specific admission gender oriented programmes almost equally important (average 5,5) Availability of Female professional staff considered less important (average 4,6) 1 not important 7 very important 1/2/2019 United Nations Interregional Crime and Justice Research Institute 13

Questionnaire: Item 4 Item 4: During the FIRST CONTACT with the health service, the health professional should ask questions pertaining to: Unprotected sex Sex with partners at risk for STD Prostitution Physical/psychological violence and abuse Exposure to crime 1/2/2019 United Nations Interregional Crime and Justice Research Institute 14

Results: Item 4 Questionnaire The most important aspects are: sex with partners at risk for STD (average 5,5) physical/psychological violence and abuse (average 5,4) Sex worker activity less rated (average 4,3) 1 not important 7 very important 1/2/2019 United Nations Interregional Crime and Justice Research Institute 15

Questionnaire Item 5-11 Item 5: During treatment, a woman should be followed by a female professional staff Item 6: Medical examinations (including taking samples for urine testing) should be carried out with the presence of female professional staff Item 7: The health service provides women with oriented care/treatment therapies Item 8: The health service offers treatment of eating disorders Item 9: The health service is staffed with at least one gynecologist Item 10: Sex, contraception and reproduction issues are addressed during treatment Item 11: A woman with drug problems who wants to became pregnant, should be counselled and supported in her choice by the health service staff and gynecologist 1/2/2019 United Nations Interregional Crime and Justice Research Institute 16

Results: Item 5-11 Questionnaire During treatment the aspects more valued were related to : specific support for women who wants to have a baby (average 6,3) availability of at least one gynecologist (average 5,8) management of eating disorder (average 5,9) Less important that a woman should be followed by a female professional staff (media 4,6) 1 not important 7 very important 1/2/2019 United Nations Interregional Crime and Justice Research Institute 17

Questionnaire: Item 12 Item 12: The presence/involvement of parents/relatives during treatment is important in case the woman is: A minor Pregnant (regardless of age) Affected by co-occuring clinical pathologies (HIV/AIDS, hepatitis, etc.) Affected by co-occuring eating disorder Affected by co-occuring psychiatric/psychological disorder (anxiety, depressione, etc) Victim of physical or psychological violence The mother of the minor At risk of suicide Exposed to criminogenic enviroments 1/2/2019 United Nations Interregional Crime and Justice Research Institute 18

Results: Item 12 Questionnaire The presence of parents is highly valued in case of minor and at risk of suicide (average) Less important is the exposure at criminogenic enviroments 1 not important 7 very important 1/2/2019 United Nations Interregional Crime and Justice Research Institute 19

Questionnaire Item 13 Item 13: The presence/involvement of the PARTNER during treatment, is important in case a woman is: Pregnant The mother of a minor Affected by co-occuring clinical pathologies (HIV, AIDS, hepatitis etc.) Affected by co-occuring psychiatric/psychological disorder (anxiety, depression, etc) Alcohol dependent Partner’s alcohol or drug dependence At risk of suicide Exposed to criminogenic enviroments 1/2/2019 United Nations Interregional Crime and Justice Research Institute 20

Results: Item 13 Questionnaire The most important aspects are : pregnancy, risk of suicide, presence of minor Less important is the exposure at criminogenic enviroments 1 not important 7 very important 1/2/2019 United Nations Interregional Crime and Justice Research Institute 21

Questionnaire Item 14 Item 14: How important are the following factors in a woman's decision to abandon treatment: Poor patient-oriented treatments (standard or not sufficiently targeted to the personal/individual needs or not gender oriented treatments) Privacy is not sufficiently respected/use of obtrusive methods Professionals’ inability to support patients in addressing other problems (alcohol, food, anxiety, depression) Fear of being reported to the police/fear of separation from children Parents/relatives or partner’s involvement in the treatment, without having previously obtained the patient’s consent 1/2/2019 United Nations Interregional Crime and Justice Research Institute 22

Results: Item 14 Questionnaire Highest valued items were: Fear of being reported to the the police/ separation from children Poor privacy, involment of parent/partner without patient’ consent 1 not important 7 very important 1/2/2019 United Nations Interregional Crime and Justice Research Institute 23

Questionnaire Item 15 Item 15: How important are the following factors in discouraging a woman from accessing treatment (or delaying/postpone access to treatment): Lack of knowledge on the services available or on the kind of support offered Fear of being identified by other services (e.g. police or law enforcement, social services, etc) In the presence of children, fear of receiving social services control or being reported to the police by social services or of reports being made 1/2/2019 United Nations Interregional Crime and Justice Research Institute 24

Results: Item 15 Questionnaire Highest valued items were: the fear of receiving social service control being identified by other service 1 not important 7 very important 1/2/2019 United Nations Interregional Crime and Justice Research Institute 25

Questionnaire Item 16 and Results Item 16: As a woman, are you satisfied with your health service? 1/2/2019 United Nations Interregional Crime and Justice Research Institute 26

Questionnaire Item 17 and Results Item 17: What is the main aspect that should be improved, in order to make your health service more responsive to the needs and expectations of women patients? The availibility of a gynecologist at the drug service Availability of a specific room for women accessing the drug service Female group therapy 1/2/2019 United Nations Interregional Crime and Justice Research Institute 27

Questionnaire Item 17 and Results 1/2/2019 United Nations Interregional Crime and Justice Research Institute 28

Conclusion (1) Comparing the data from the two subgroups (women attending the public services for addiction or the Therapeutic Community) it was noted that aspects such as personal security (episode of abuse/violence) were more rated by women attending the drug service, whilst the other subgroup highly valued the opportunities of female tailored treatments or eating disorder issue program. The difference in the overall rating may be explained by the fact that the women attending the service feel in a secure setting and they have already processed their drug dependence issue 1/2/2019 United Nations Interregional Crime and Justice Research Institute 29

Conclusion (2) Ensuring the protection of the subject privacy from initial access till their dismissal Ensuring the availability and presence of a gynaecologist in case of pregnancy The fear to be reported to the police or to lose the children are the main reasons that determine the delayed access of the care services or even more important its abandon 1/2/2019 United Nations Interregional Crime and Justice Research Institute 30