Introduction

This chapter looks at what can be done to encourage a greater number of women to attend substance misuse services and how the location of the service can be an important part of encouraging women to attend. It examines the community detoxification audit based in primary care. It discusses how women are more likely to attend a service where there is a non-judgemental approach and easy access to services, with minimal waiting times. It also illustrates that services situated in general practice can be seen as a non-stigmatising ‘space’ and therefore easier to attend for substance misuse services.

A service that is provided in a ‘safe space’ aligns with the social model of alcohol treatment (Introduction, this volume) in that it perceives women's issues as being different from men’s, and responds by offering a social approach. Gender, together with race and ethnicity, are key factors shaping Western industrialist capitalist societies, and lead to persistent structural inequalities, and hence divisions and differences (Haralambos and Holborn, 2000). In healthcare, gender factors can influence presentations (Gabe et al, 2004). Women are much more likely than men to be frequent presenters to primary care, partly because of their responsibilities for young children. They are also more vulnerable to poverty and hence to increased health problems. Some studies have shown that women are more prone to stress and to seek help from primary healthcare services for this (Brady, 2009). Consequently, they are also more likely to use mental healthcare services and to present to their general practitioner (GP) for disorders such as depression. On the other hand, men may be more likely to use and misuse drugs and alcohol.

In the area of substance misuse, the ratio for men and women using treatment services is 4:1 (Jones et al, 2009). This is a very marked difference in favour of men. Jones et al (2009) have suggested that this could be due to men as a group being more vulnerable to alcohol and drug misuse problems and therefore making them as a cohort more likely to present to these services. It is not clear how much of this difference is due to the greater reluctance of women who do have alcohol issues to access services.