Video: Understanding Substance Use Problems and Addictions in Women

This video covers the range of substance use and addiction that leads to FASD.

About this video

Production date: December 8, 2010
Length: 1 hour, 42 minutes
Presenter: Nancy Poole
Download slide notes for this video (PDF, 24 pages)

Nancy Poole is known for her collaborative work in FASD research, training and policy initiatives with local, provincial and national organizations. Since 1996, her work at the BC Women’s Hospital and BC Centre of Excellence for Women’s Health has focused on policy and service provision for women with substance use problems.

She is the co-editor of ‘Highs and Lows: Canadian Perspectives on Women and Substance Use’ published by the Centre for Addiction and Mental Health in Ontario. She is also co-chair of the Prevention Action Team of the Canada Northwest FASD Research Network.

In this video, Nancy discusses the range of substance use and addiction.


This video will help you understand:

  • trends in alcohol, tobacco and other substance use and addiction by girls and women
  • health impacts of substance use by girls and women
  • key pathways to substance use by girls and women
  • linked issues such as trauma, violence and mental health concerns
  • other linked health factors
  • approaches to prevention, harm reduction, treatment and support
  • links to prevention of FASD

Nancy concludes that we must address women’s substance use before we can affect rates of FASD.

She also notes that there are differences in substance abuse between men and women. That is why treatment for women with substance-abuse problems must be woman-centered to be effective. Nancy argues that practitioners, policy makers and the public need to change their perspectives to ensure that women get the care they need.


  1. Introduction (1:07)
  2. Grounding documents (12:15)
  3. Taking the measure (19:33)
  4. Interconnections (16:16)
  5. Pregnancy and mothering (24:33)
  6. Responding with programs (18:09)


We should use what we know about women’s substance abuse to develop FASD prevention approaches.

We need to move from frustration to thinking about how we might position ourselves, our services and our governments so that we can do our best to support women to stop substance use during pregnancy.

Grounding documents

A National Treatment Strategy is being developed to address the points above, and recommends a tiered system:

  • Tier 1: community-based outreach, prevention and peer support
  • Tier 2: foundation of treatment, brief support and referral by range of professionals
  • Tier 3: structured outpatient treatment
  • Tier 4: intensive residential treatment

‘Highs and lows: Canadian perspective on women and substance use’ (Lorraine Greaves and Nancy Poole, 2008)

  • there’s a need for different responses to substance use and addiction with women
  • we must address stigma, reduce harms, and understand women-centered care
  • stigmas include persistent negative attitudes towards women who use substances
  • stigmas alienate these women, reducing likelihood that they will seek treatment

‘Rethinking substance abuse: What the science shows and what we should do about it’ (Miller and Carroll, 2006)

  • this paper looks at what needs to happen on the biomedical, clinical and health services level
  • intervention isn’t a specialist problem but a broad social duty

‘Substance abuse treatment and care for women: Case studies and lessons learned’ (United Nations Office on Drugs and Crime)

  • important to embrace the idea of gender responsive services
  • consider needs of women in all aspects of their design and delivery
  • consider location, staffing, program development, program content and program materials

‘FASD prevention: Canadian perspectives’

  • available on the Public Health Agency of Canada (PHAC) website
  • talks about 4 levels of FASD prevention and intervention:
    1. Raising Awareness
    2. Brief Counselling with Girls and Women of Childbearing Age
    3. Specialized Prenatal Support
    4. Postpartum Support

Taking the measure

There are gender aspects of substance use and addiction that underpin the need to respond in ‘gender-informed’ ways.

Gender differences

Women are more likely than men to:

  • develop cirrhosis after consuming lower levels of alcohol over a shorter period of time
  • develop brain shrinkage and impairment, gastric ulcers and alcoholic hepatitis
  • experience impaired bone health
  • have bones that don’t overcome the damaging effects of early chronic alcohol exposure
  • women are more likely than men to use prescribed psychoactive drugs, for example: pain relievers 24% women vs 20% men

Patterns of use

  • approximately 56.1% of women reported consuming 5 or more drinks on a single occasion at least once during the school year (70% of men)
  • approximately 25.2% of women reported consuming 8 or more drinks on a single occasion during the school year (46.5% of men)
  • however, women metabolize alcohol differently than men and the health impacts of drinking are more severe for women

Pathways to use

  • The Formative Years’ (PDF, 242 pages) report demonstrates that girls and young women use cigarettes, alcohol and drugs for reasons different from boys
  • the signals and situations of high risk are different and girls are more vulnerable to substance use and abuse
  • entertainment media, alcohol and cigarette advertising promote unrealistic messages about smoking, drinking and weight loss to girls and young women
  • high concurrence of mental health concerns in student populations
    • for example: hazardous drinking and psychological distress (female is 11.6%; male is 5.7%)

A recent study of concurrent disorders by the Centre for Addictions and Mental Health (CAMH), of 196 clients aged 12-25 years concluded that:

  • 50.5% had post-traumatic stress disorder
  • 75.5% had obsessive compulsive disorder

The most profound gender difference in alcohol use is often considered to be the risk of alcohol use during pregnancy causing birth defects and developmental disabilities in offspring.

Intersections of substances and their gender-specific impacts:

  • alcohol use is also linked to smoking, poverty and histories of abuse
  • health risks are heightened for multi-users
  • need to link treatments

Differences in the stigma of substance abuse

  • it’s well documented that women need non-judgmental  information and support
  • mothers are seen as deliberately harming children when they abuse substances

Visual tools are effective and available to teach female-specific consequences of alcohol use:


Alcohol abuse is often linked to:

  • partner violence
  • childhood sexual abuse
  • depression
  • disordered eating
  • poverty
  • housing
  • polydrug use

The web of complexity in prevention, treatment and recovery needs to be addressed.


  • media must accept their responsibility for their role in alcohol abuse

Violence against women

  • in Canada 51% of women over 16 had experienced at least one case of physical or sexual assault
  • approximately 25% abused by close partners
  • abuse most common cause of injury to women
  • abuse during pregnancy estimated to range from 5.7% to 21% in Canada

Violence and women’s substance use are interconnected, and efforts to quit using may increase risk of violence.

Trauma-informed counseling

  • there are multiple and complex links between trauma and addiction
  • understanding trauma-related symptoms as attempts to cope
  • a woman should not have to disclose trauma history to receive trauma-sensitive services
  • all services will be trauma-sensitive
  • all staff will be knowledgeable about impact of violence and trained to behave in ways that are not re-traumatizing
  • women will have access to trauma-specific services

Systems and services must also be trauma-informed to create context of safety and support.

Pregnancy and mothering

The report ‘Act Now: Healthy Choices in Pregnancy’ examined barriers to accessing treatment by mothers:

  • shame (66%)
  • fear of losing children (62%)
  • fear of prejudicial treatment on the basis of their motherhood status (60%)
  • most common reason for seeking help was when a provider asked if they needed help

There is an ongoing tension between child and maternal welfare and rights:

  • support healthy life changes of women through broad awareness
  • competence of all providers
  • treat mother-child pair in all cases

Responding with programs

Issues include:

  • defining, creating and evaluating woman-centered programs in the field of substance use and addictions
  • identifying and addressing the challenges in translating women-centered and harm reduction principles into clinical and community settings
  • there’s a need for programs that continue support when the children are no longer infants
    • the programs should be based on a relational model, such as mutual help groups
    • these groups must be women-only groups. In mixed groups, women tend to focus on facilitating male sharing and share less themselves

Examples of effective programs:


Seeking safety’ (Lisa Najavits)

  • offers safe coping skills

Reclaiming Connections: Understanding Residential School Trauma Among Aboriginal People” (Chansonneuvre, 2005) (PDF, 169 pages)

Modified: 2015-09-09
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