1. 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

2. 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)
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3. 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.
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4. 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
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5. 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
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6. 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
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7. Results: Socio demographic characteristics
299 Women
Average Age 34,5 years
Average Age 37, 0
Average Age 26,5
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8. Subjects according to age range (%)
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9. Subject according to frequency’s drug service period (%)
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10. Subject according to type of treatment (%)
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11. Subjects according to therapeutical phase in TC (%)
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12. 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.
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13. 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
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14. 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
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15. 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
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16. 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
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17. 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
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18. 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
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19. 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
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20. 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
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21. 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
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22. 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
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23. 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
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24. 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
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25. 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
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26. Questionnaire Item 16 and Results
Item 16: As a woman, are you satisfied with your health service?
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27. 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
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28. Questionnaire Item 17 and Results
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29. 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
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30. 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
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