We (Sarah, Sharon and Joyce) want to say sorry for the lack of communication since the conference. We have all been getting on with our own workloads (Viva, teaching, writing up, data collecting, job hunting, working) and have had to pause all DAWF related activity as a result. We finally got the chance to catch up with each other this week and decide what we want DAWF to be moving forward. As such, we have agreed that the DAWF conference will run every two years, providing funding can be secured. We hope, to run smaller events at some stage during the year ahead, so please do keep an eye out. We are also aware that the presentations from #DAWF18 have not yet gone online, this is due to technical issues. We’ve now figured out how to overcome these issues and will be popping the slides online as soon as we can.
Moving forward, we want to create a network of researchers, practitioners, people with experience and academics. We want to use this network to share, learn, reflect and create impact in the area of substance use, women and families, so please sign up to our mailing list with the link attached in this tweet. We are also keen to continue to grow our blog, so if anybody would like to contribute then please get in touch at firstname.lastname@example.org.
In May 2018, Scotland became the first country in the world to implement minimum unit pricing. Alcohol cannot now be sold for less than 50 pence per unit, meaning that a 700ml bottle of vodka now costs at least £13.13 and a 3 litre bottle of strong white cider now costs at least £11.25. The World Health Organization has indicated that MUP is a policy ‘best buy’ to reduce alcohol-related harm such as hospitalisation, deaths, and harm to others. Minimum unit pricing targets the heaviest drinkers who buy most of the cheapest, strongest alcohol (Angus et al, 2016; Alcohol Focus Scotland, 2018).
Will MUP impact on a similar way on men and women, or might there be gender differences? On the one hand, we would expect population level policies to interact with structural inequalities and gendered expectations around drinking. Men are more likely than women to drink alcohol, to consume larger amounts of alcohol and to experience alcohol-related harm. Gendered double standards persist: women’s behaviour and appearance is judged more harshly than men’s if they have been drinking and female heavy drinkers continue to feel stigmatized which may be a barrier to accessing services (Rolfe et al, 2009). On the other hand, we know that the relationship between social and economic environment (measured by geographic location) and alcohol-related deaths is similar for men and women, suggesting that similar processes and factors are important in determining the risk of alcohol-related harm for both men and women in Scotland. (Emslie & Mitchell, 2009).
Part of the problem is that we have very little evidence about how population level policies such as alcohol pricing may affect men and women, as so many studies are ‘gender blind. Our recent work (Fitzgerald et al, 2016) found that gender relevant findings were reported in fewer than 25% of studies within systematic reviews of alcohol taxation or pricing, so we do not know whether the intended (or unintended) consequences of these population level policies were similar or different for women and men. There was some consistency in studies considering indirect impact, suggested that an increase in the price of alcohol may have reduced harms such as gender-based violence.
A robust programme of research is planned to monitor and evaluate minimum unit pricing in Scotland. This research should analyse results separately by gender to explore whether the effects of the policy are similar or different for men and women. There may be an increased demand for alcohol treatment services with the introduction of minimum unit pricing, and this needs to be monitored to ensure that services are appropriate for both men and women. From discussions with colleagues working in alcohol policy and practice we know that gender issues around alcohol are not routinely considered when developing or implementing policies. This needs to change.
Dr Carol Emslie is a Senior Lecturer at Glasgow Caledonian University and leads the Substance Use & Misuse research group (twitter: @SubMisuseGCU). You can find out more about Carol on her university profile, or via theSARN website. There is an event being held at Glasgow Caledonian University on Monday June 18th, titled ‘Women, Men, and Alcohol – Exploding the Myths’ – register here!
For the past two years, a team of us at Manchester Metropolitan University have been researching end of life care for people with alcohol and other drug problems with funding from the Big Lottery Fund. This scoping study has examined the good practice and challenges experienced by health and social care practitioners, service users and families when life-shortening conditions co-exist with problematic substance use.
There were six strands of work to our project:
A Rapid Evidence Assessment – a review of international published literature
Identification and analysis of existing national datasets
Interviews with people with current or past substance problems who have a life shortening condition
Analysis of interviews from a previous project on substance use and bereavement. Interviews with family members, friends and carers
Interviews and self-completion questionnaires for paid staff and volunteers
Key Informant Interviews
This is a very under-researched field, and our work has revealed particular knowledge gaps around the scale and prevalence of need for individuals and their families – that have resulted in this population remaining hidden from view. Yet we know that the UK has an ageing general population (with problem drinking known to be escalating among the over 50s), which combined with awareness of the cohort of ageing heroin users in treatment, highlights the pressing nature of this issue.
From a policy perspective, despite recognition of the increasing importance of palliative care for an ageing population, little is known about how these services could best support people with substance use problems – many of whom do not access services and others who may not always be compliant with medication or health / social care regimes. This population generally experiences multiple long-term complex health and social care needs, combined with high levels of mental health difficulties and social isolation which can leave them particularly vulnerable. Quite often, reluctance to engage with services means that they rely on costly emergency hospital and ‘blue light’ services for their healthcare needs. Both for these individuals directly, but also for their families and informal carers (who frequently have long-term healthcare needs of their own), community-based approaches need to be developed to provide effective support and help prevent problems transferring down future generations.
Unfortunately, current substance use policy does not account for the needs of this group and there is no way of monitoring the extent to which palliative care reaches people with substance problems. But we are finding small pockets of developing good practice across the country and so we’re hoping that our research is the first step in helping to develop new policies and services that meet the needs of people with substance problems at the end of their lives, and also support their families/carers.
Dr Sam Wright is a research associate working in the Social Care and Social Work department of Manchester Metropolitan University. She has worked on many substance use research projects over her career: from treatment for amphetamine use; to interventions for drug using parents, to community alcohol projects; county-wide substance treatment needs assessments, to support for young people at risk of developing substance problems. Her current work focuses on end of life care needs for people with alcohol/other drug problems – as well as the support needs of their families and informal carers. Sam spoke about this project at the DAWF conference.
Addiction among women and girls is often inextricably linked to experiences of violence and abuse. When appropriate support is not easily available, women living with trauma use drugs and alcohol to cope.
Using data from the Adult Psychiatric Morbidity Survey, Agenda’s Hidden Hurt research shows that the greater the severity and frequency of the abuse, the greater the likelihood of substance misuse. An estimated one in 20 women in England and Wales had experienced extensive abuse both as a child and as an adult, according to the report. Women who had experienced the most extensive abuse were more than twice as likely to have an alcohol problem (31 per cent) than women with little or no experience of abuse. One in five women in the extensive violence group had used drugs in the previous year and eight per cent were dependent on drugs, compared to just one per cent of women who had experienced little or no abuse.
Using drugs and alcohol can make women much more vulnerable to further sexual and physical abuse and exploitation. For example, there are an estimated 80,000 women involved in prostitution in the UK and the vast majority of those women are addicted to either heroin or crack. We also know drugs and alcohol were used by perpetrators of child sexual exploitation rings across the country to help them abuse girls.
The entire introduction to substances and process of addiction among women and girls tends to look different to that of men and boys. Women who face addiction are more likely to be introduced to drugs through partners, whereas for men it is via their peers. Women face greater shame and stigma around drug and alcohol use, they can often be judged much more harshly because their behaviour goes against societal norms of what is expected of women. Women who are mothers are often more afraid of accessing support for fear their children will be taken away. While women of Black, Asian and Minority Ethnic groups can face additional barriers and stigma. But despite women having particular needs and experiences – they are continually overlooked in drugs policy and practice.
A recent report by Pulse showed that 87 per cent of councils had cut funding for general drug and alcohol services. This is particularly alarming because we know that there was so little out there for women in the first place.
Agenda’s recent report with AVA, Mapping the Maze, showed that less than half of local authorities in England and a fifth in Wales have substance misuse support specifically for women. Even then, the most common types of support were weekly women’s groups within a generic service or the availability of a substance misuse midwife, which obviously only supports women who are having a child. That means women often have no option but to access mixed services or nothing at all.
Given women’s likely histories of abuse, generic, mixed services, which are usually dominated by men, may at the very least be intimidating and can even be dangerous. Research suggests that 34 to 68 per cent of men in substance misuse treatment have a history of perpetrating intimate partner violence (IPV). Mixed services also often don’t have the capacity or expertise to deal with women’s experiences of abuse and trauma. This can result in women being misunderstood and even blamed for what has happened to them. This might explain why women who misuse substances often have particularly complex needs by the time they reach treatment, with poorer mental and physical health and worse quality of life than men, at both the start and end of treatment.
So what needs to happen to improve the situation? As part of Mapping the Maze, extensive research was conducted on what constituted a good service for women. It all pointed to specialist women’s services being the best way to meet women’s needs, with a caring culture and flexible support also being important, especially to the women themselves. We need to see more investment in such gender-specific and trauma-informed support that treats women as a whole person, taking into account their histories of violence and abuse, and the complex, overlapping needs they face. Not just responding to their label as ‘addict’ or ‘user’.
Lisa Jones is Communications & Campaigns Manager at Agenda, the alliance for women and girls at risk.
This is the third in a series of guest posts. If you would be interested in contributing, please get in touch!
Abuse, exploitation, mental health issues… there are many and varied reasons why people might become addicted to drugs or alcohol.
Equally, there are many and varied methods that could aid someone in their recovery journey.
I’ve been working to support people across Plymouth at different stages of their recovery journey – and most recently with women who have suffered judgement and shame, some of whom have also battled to keep their children while they address their addiction issues.
And there’s one thing that I believe can help as they fight their battle. Creative ways with Food.
There is very little available evidence on the nutritional intake and role food plays for women in recovery, something that I am supervising my dietetic/nutrition dissertation students to research this year*. But I believe the notion of food, what it means socially, culturally and creatively, can potentially help to empower women as they continue to strive and succeed.
In 2016, I led an exploratory ‘food dialogue’ activity with 25 women from Trevi House and Longreach (female rehabilitation services) in Plymouth, laying out food images and asking them to select one they ‘liked’ and one they ‘disliked’, then discussing their images (image 1). This creative approach generated diverse and varied narratives uncovering the meaning of food for these women (see Pettinger, 2016 ‘Food Narratives’ Critical Dietetics abstract).
Others were transported back to their childhood food experiences and emotional episodes they associated with it. This approach brought about so much from individuals who may well have frozen up if asked ‘how are you feeling?’
Connectivity was another key theme drawn from the activity, as women spoke about the importance of preparing, cooking and eating with others, especially their children, and how it provided a sense of togetherness. The physical action of sharing food went hand in hand with sharing stories, experiences and realising they weren’t on their own – it was so empowering.
This project also included a series of (ESRC Festival of Social Science) participatory food events run in a local Plymouth based day rehabilitation centre. Women from several local rehabilitation services were active participants in a range of creative food activities that formed part of research data collection, including audio interviews, collage and food games (images 2 and 3).
All of the women involved have complicated and often chaotic lives, but there seemed to be so much that they took from these simple creative food-themed activities.
So can we actually measure how successful these creative food activities are?
Food research is an incredibly complex area – dealing with everything from basic food science, to improving nutritional intake of socially marginalised groups. Participatory Art-based research methods don’t provide definitive answers, but they can open up new questions, which is just as valuable – if not more so (See Flint et al 2017, Using the Arts for Food Research and Dialogue).
Creative methods help us to understand both what the problems are and why these problems might exist. Women in recovery are so much more than the addiction they are recovering from. They are strong, brave and have huge potential to empower others who are going through similar situations.
“Creativity, compassion, connectivity and courage are crucial to help women in recovery. Their determination unites them, and food can empower them – so I feel privileged to be in a position to support”
(Clare Pettinger, research lead)
This preliminary research has led to my involvement in the Sunflower Recovery Project, a Plymouth based project, designed to support and empower women accessing residential drug and alcohol services. At the heart of Project Sunflower is the idea of aspiration – the strong belief that women who are recovering from drug and alcohol dependency should be empowered and supported to achieve their full potential. The project has set up a peer mentor training programme, to support women to support other women on their journey. A new Sunflower women’s centre has just opened in Plymouth, providing a safe space for women in recovery to meet, support and empower each other. I am leading on the evaluation of the project and work is underway to collect data on how the women feel about the project. I will be talking at the DAWF conference about creative participatory evaluation approaches, involving the sunflower women as co-researchers. Data collection will include case studies, interviews and collecting inspirational stories which will be formed into a Sunflower ‘Book of Hope’ which will be used to inspire and empower other women in recovery.
Even our students are passionate about helping
Dietetic and nutrition students Deanne Carlson et al* will be presenting a poster of their Undergraduate dissertation methods at the DAWF conference in May. Their dissertation aims to investigate the role of food and nutrition for women in recovery from alcohol and substance misuse using a multi-centre cross-sectional survey design combined with 24hour recall, taking a snapshot of the women’s knowledge, attitudes, and behaviours around food. The students have highlighted the value of exploring an ‘under-researched’ yet important topic for women in recovery. This pilot study will provide evidence to support the importance of the involvement of expert nutrition professionals to deliver nutrition interventions in these services that might improve health outcomes and facilitate relapse prevention.
All photos are courtesy of my amazing community partners Fotonow CIC.
Dr Clare Pettinger is a lecturer in Public Health Dietetics at the University of Plymouth. Her research focuses on the use of creative methods to engage ‘harder to reach’ individuals and communities in (food and) wellbeing dialogues. Participatory, co-production and empowerment approaches are at the heart of her work. For more information, see Clare’s staff profile.
Deanne Carlson, Chloe Berry, Jemma Jones, Kirsty Williams, Robyn Eede and Nicole Harris are final year dietetic/nutrition students in the School of Health Professions, University of Plymouth. They are conducting their dissertation project on the topic of ‘exploring the role of food and nutrition for women in recovery from alcohol and substance misuse’ supervised by Clare Pettinger.