We are failing to reach women, connect with them and provide a safe environment in treatment, hears DDN. Read the full article in DDN here Drug-related deaths among women are the highest since records began. In the decade since 2006 there was a 95 per cent increase in women dying as a result of drug misuse, meaning that 697 women lost their lives in 2016. So what\u2019s going wrong and where are we failing? And how can we turn this situation around? At a meeting of the Drugs, Alcohol and Justice Cross-Party Parliamentary Group, speakers were asked to give their thoughts on how we can break down barriers to improve women\u2019s access to treatment. \u2018Abuse and violence are underpinning problems,\u2019 said Jessica Southgate, policy manager at Agenda \u2013 the Alliance for Women and Girls at Risk. In many cases women\u2019s substance misuse was likely to be intertwined with violence, criminal justice and mental health issues and linked to hidden violence and trauma. \u2018Drugs are often used as a way to numb the pain of trauma,\u2019 she said. \u2018Women often end up in abusive relationships and remain in them because of their dependencies.\u2019 Among the population of women prisoners, it was found that 66 per cent had committed offences to buy drugs and 48 per cent had offended to support the drug use of someone else (compared to 22 per cent of men). As well as abuse and trauma, recurring themes in the lives of women facing addiction were poor socio-economic circumstances and strong feelings of stigma and shame, which could include specific cultural disapproval among BAME communities. The many complicated reasons that women turned to substance misuse meant that getting them appropriate help could be extremely difficult. \u2018Women substance misusers typically have complex needs and are often overlooked in service provision and policymaking,\u2019 said Southgate. As well as being overlooked in mainstream services they could also find themselves in \u2018intimidating spaces\u2019, particularly if they had experienced violence in their relationships with men. Her organisation, Agenda, had partnered with AVA (Against Violence and Abuse) to produce Mapping the Maze \u2013 a project looking at the provision of services for women across the sectors of substance misuse, mental health, homelessness, offending and complex needs in England and Wales. They found that only 19 areas out of 173 in England and Wales had services that addressed all of these issues, and that most services only tackled a single issue. Many services were focused entirely on pregnant women or those with young babies, while provision for BAME women was extremely rare. There was nothing at all specifically for LGBTQI, those with disabilities, or refugees and asylum seekers. While funding cuts and contract requirements were found to be serious obstacles to delivering good and effective services, the Mapping the Maze model was being suggested as a framework for developing effective interventions. \u2018Service design is one of the key pieces from evidence,\u2019 said Southgate, and this included making sure staff were trained to look for, recognise and understand issues relating to multiple disadvantage and the impact of trauma, particularly in terms of violence and victimisation. Talking to women who were affected had revealed that getting the right help could be extremely difficult and could take a long time where services did not link up. Drugs were often used to numb the pain of trauma, she said, and it was important that all the appropriate support services were primed to help. A collaborative approach with women worked best in understanding the links with substance misuse, asking their opinions and valuing the \u2018lived experience\u2019 of peer support. At the moment, women were being \u2018systematically excluded\u2019 as \u2018so often policy is made in silos\u2019, she said, when we needed to \u2018put women\u2019s voices at the heart of it\u2019. Having been in the sector for 20 years, Addaction\u2019s executive director of external affairs Karen Tyrell wanted to talk about some \u2018long-standing issues\u2019. \u2018Drug and alcohol services have failed to meet the needs of women,\u2019 she said. \u2018We inadvertently create barriers.\u2019 There was a perception that women didn\u2019t need services as much as men, but they actually had more complex needs. \u2018They are often deeply concerned about social services getting involved and taking their children away,\u2019 she said, and \u2018they often don\u2019t have positive experience of authority figures\u2019. Women in Addaction\u2019s services had nearly always experienced some kind of trauma, she explained, and it wasn\u2019t \u2018a simple relationship between childhood experiences and drug use\u2019. Many had been abused by a partner. Services needed to enquire carefully about individual experiences and look for trauma symptoms. \u2018Our job is about taking a strength and resilience-based approach \u2013 changing it from \u201cwhat\u2019s gone wrong?\u201d to \u201cwhat\u2019s happened to you?\u201d,\u2019 she said. First impressions of treatment were important, and the experience could be negative if the first person they saw was male. Making progress also depended on understanding the level of stigma many had experienced \u2013 \u2018what kind of a mother are you?\u2019 \u2013 which tended to be very different from the attitude towards a dad who used drugs and alcohol. \u2018The fear of having children taken away can\u2019t be underestimated,\u2019 she said, and there was much to be done in becoming trauma and gender aware. Safe spaces for women were not just \u2018nice to have\u2019 services that could be cut first \u2013 they were vital and must be protected. \u2018I\u2019m fed up with women\u2019s provision just being through the lens of childbirth and childcare \u2013 we have got to change,\u2019 said Tyrell. \u2018We need to demand more from each other as treatment providers. There must be ways we can work together differently.\u2019 Kim Morris, Addaction\u2019s North Somerset Women\u2019s Group coordinator felt that women represented \u2018a section of society that we\u2019re not reaching effectively\u2019. She recently started a group to let women explore relationships and improve self-esteem and self-awareness, looking at trauma through the context of adverse childhood experiences (ACE). Substance misuse was \u2018the red herring\u2019 \u2013 not the root cause of problems, but an effect. Providing a safe environment for discussion gave the opportunity to talk about all kinds of issues that could be barriers to treatment, such as fear of being judged, socially ingrained sexism, lack of faith that life could be different, and being dubious of the support that services could give them. The idea that services were \u2018the enemy\u2019 could be intensified by previous experiences with social services, particularly if children had been taken away from them. Morris described how the group was helping women to grow in confidence and develop \u2018a greater sense of honesty and behaviours\u2019. Trainee social workers were encouraged to sit in on the group and this further contributed to helping relationships. \u2018I have learned to stop blaming myself and apologising for everything,\u2019 one group participant had commented. There was a lot to do, said Morris \u2013 the \u2018Orange Guidelines\u2019 only mentioned women in relation to pregnancy. But there was a growing interest around the group, and although it had started small it was going well and now needed commissioners on board. \u2018All services need to commit to being gender informed,\u2019 she stated. \u2018We need to ask about barriers and be open to listening about what would make a difference.\u2019 Does your service run specific support for women? Do you have ideas on what would make a difference? Please email the editor or comment below.