Video: Gender and Addiction

This video covers what is unique about gender and addiction, as well as the barriers that might prevent women from seeking help.

About this video

Production Date: November 20, 2013
Length: 1 hour, 42 minutes
Presenter: Kirsty Prasad

Kirsty has worked with Alberta Health Services (AHS) Enhanced Services for Women since 2002 where she works with women who use substances. In recent years Kirsty has been training other service providers in the strategies and techniques that she and her AHS colleagues have developed. Prior to coming to AHS, Kirsty worked for Streetworks and the Mental Health Unit in the inner city. Kirsty has a strong knowledge and passion for working with marginalized populations with substance use concerns.


This video will help you understand:

  • what is unique about women and substance use
  • the barriers that women face


  1. Does gender matter? (6:51)
  2. Relational model (13:39)
  3. What might prevent a woman from seeking help? (41:35)
  4. Interventions (1:02:47)
  5. Principles of harm reduction (1:15:47)

Does gender matter?

  • society views drinking as ‘macho’
  • it conflicts with societal views of femininity
  • women may be viewed as ‘lushes,’ ‘sluts,’ or ‘bad mothers’
  • women internalize this stigma
  • women are more often prescribed medication to combat emotional issues than men are
  • historically women were expected to be clean, dress appropriately and put their problems aside
  • this attitude still lingers in society, although less explicitly
  • media shows young girls binge drinking as glamorous
  • research shows that men who have addictions build up their sense of self
  • traditional treatment focuses on challenging and breaking down this grandiose sense of self, and discovering the true self
  • women with addictions already have a diminished sense of self
  • the approach of breaking down can cause more damage

Relational model

Women use alcohol and drugs to:

  • Make connections
    • women are rooted in their relationships
    • relationships are critical factor in their use of alcohol and drugs
    • women or girls who begin using with their partners, family or friends may continue to do so in order to have a common activity
    • disconnections may result in decreased self-worth
    • increased feelings of guilt, shame, and helplessness
    • may actually cause increased reliance on substance to feel better
  • Medicate feelings
    • provides comfort in stressful relationships
    • manage symptoms of addiction
    • then addiction takes its own course

What might prevent a woman from seeking help?

Personal barriers:

  • shame and guilt
  • shame and guilt is the number one reason women do not seek help for substance use
  • expectation of abstinence in treatment
  • poor physical or mental health
  • addiction to the street (roles, community)

Interpersonal barriers:

  • fear of losing their children
  • service providers can work to reduce this fear by touring the hospital, meeting workers and helping prepare for the baby’s delivery
  • lack of low cost and reliable child care
  • lack of family or partner support
  • lack of education and job skills
  • outstanding criminal justice issues
  • often, residential facilities will not accept women with outstanding warrants
  • power imbalance with service providers
  • it takes time to build this trust

Structural and program barriers

Lack of flexible services:

  • costs associated with treatment
  • the ‘working poor’ who make minimum wage do not qualify for income support but cannot afford residential programming
  • they often have no health insurance

Lack of community capacity:

  • programs tend to operate in silos
  • we must work together as a team
  • it is more effective to refer women to a specific person, rather than an agency

Lack of gender specific treatment:

  • men do well in mixed groups
  • in mixed groups, women tend to become caregivers and may not share as much
  • women share more deeply and are more engaged in women-specific groups


Discussion and approach

  • engagement (therapeutic alliance) is one of the most important factors influencing change
  • from the moment they walk into the building, women should feel welcomed and respected


  • for risk of problems
  • for readiness to change


  • all women
  • as part of overall health
  • questions or life issues
  • about all substance use (before pregnancy and now)
  • more than once in her pregnancy, because things change

Personal reflection:

  • is it difficult for me to talk about substance use?
  • if so, why?

Offering information (ask about):

  • her knowledge of the risks of substance use during pregnancy
  • any concerns she may have about her use for herself and the baby
  • how she feels about these concerns
  • connect her to supportive, understanding physicians and care providers who can provide the right information

Explore options for change:

  • harm reduction
  • treatment
  • community support

Principles of harm reduction

  • no universal definition of harm reduction
  • strategies that reduce negative consequences of certain behaviours
  • meets people ‘where they are at’
  • reflects individual and community needs
  • non-judgmental, non-coercive
  • continuum of harm reduction interventions, which can be used within the care provider’s personal philosophy and the organizational philosophy

Goals are to:

  • reduce risk related to use of alcohol, tobacco and/or other drugs
  • access good prenatal care and overall health care
  • promote good health practices (nutrition, sexual health)
  • reduce stress and stabilize living situation

Substance use interventions:

  • teach safer substance use (proper injection techniques)
  • methadone maintenance for heroin and morphine users
  • abscess management, vein care
  • information about substance combinations and interactions
  • suggesting changes in method of use (from injection to smoking)
  • substitution of less harmful substance (overdose prevention)
  • modifying substance use (control dosage, cutting down)
  • make related behavior safer (condom use, avoid violence)
  • relapse prevention

Basic tenets:

  • recognize dignity
  • maximize social and health assistance
  • recognize the right for care
  • emphasize the reduction of drug-related harm
  • recognize the competency of users
  • involvement in co-creation strategies
  • expects flexible, accessible, non-judgmental care
  • supports syringe exchange and supply of sterile drug using equipment
  • challenges misinterpretation and misinformation
  • accepts that drug use is present in all facets of all societies and chooses to minimize harmful effects
  • acknowledges that certain ways of doing drugs are safer than others
  • builds on quality of life for persons based on their own perceptions
  • empowering relationship with individuals
Modified: 2015-09-09
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