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Supporting Women with Substance Use Disorder: Integrating Harm Reduction and Trauma-informed Care Principles in Treatment Approaches


By: Ashmitha Gnanapragasam


Despite the pervasive stereotype that substance abuse is predominantly a male issue, women are also susceptible and often face harsher biological, psychological, and social consequences. Why then, does the narrative continue to focus on men, and what are we missing when we overlook women in discussions about substance use disorder?


What is Substance Use Disorder (SUD)?

Substance use disorder (SUD) is a mental disorder that affects a person’s brain and behaviour, leading to their inability to control their use of substances (U.S. Department of Health and Human Services, n.d.). SUD represents a significant public health challenge that disproportionately impacts women, often with detrimental consequences. Comorbidity, the presence of two or more diseases or conditions at once, is immensely prevalent for women with SUD and they are also more likely to have histories of trauma, such as physical or sexual abuse, compared to their male counterparts. The intersection of substance abuse and trauma necessitates a nuanced approach to treatment that not only addresses addiction but also the underlying emotional and psychological issues.


The Importance of Integrated Treatment Approaches

The integration of harm reduction and trauma-informed care principles establishes a compassionate and non-judgmental environment to improve treatment outcomes for women struggling with SUD. Harm reduction works to minimize the negative consequences associated with drug use without necessarily demanding abstinence. Consequences of substance use for women can include physical health obstacles, losing custody of children, and increased exposure to domestic violence. Additionally, trauma-informed care shifts the focus from asking, “What’s wrong with you?” to “What happened to you?”, recognizing the profound impact of trauma on the life course of an individual. 


Harm Reduction: Reducing Stigma and Danger

Harm reduction includes many programs and services that reduce harm related to substance use policies (Understanding harm reduction: Substance use, n.d.). It aims to support the health and well-being of people who use substances regardless of their recovery status. Harm reduction is an approach to service delivery that prioritizes evidence, human rights, and eliminating damaging stigmas. Some examples of services available to prevent harm from substance use include outreach and support programs, information and educational resources on the safest ways to consume substances, overdose prevention services, and substance-checking services to learn what an illicit drug sample may contain. Harm reduction proves to be immensely beneficial as it helps eradicate the stigma surrounding substance use while simultaneously increasing the knowledge about safer substance use practices.


Trauma-Informed Care: Recognizing and Addressing Trauma

Trauma can occur as a response to an incredibly distressing event or series of events that have a significant psychological impact on a person (Centers, 2024). It can often overwhelm an individual’s ability to cope, causing them to exhibit adverse behaviours and emotions. Trauma history and victimization are highly correlated with SUD in women. Considering the high co-occurrence of trauma and substance abuse, it is essential to develop an understanding of the implications of trauma-informed care when treating people in treatment for addiction. A trauma-informed care approach in the treatment of substance abuse acknowledges the trauma’s impact on an individual's life, well-being, and the path to recovery. Creating trauma-informed environments, providing services sensitive to the unique needs of trauma survivors, and offering trauma-specific interventions can help facilitate recovery and healing in people struggling with a substance use disorder. 


Future Considerations in Treatment Approaches

Adopting a trauma-informed approach that integrates harm reduction is a step in the right direction for treating women with SUD (Greenfield & Grella, 2009). This includes developing useful coping strategies for trauma or post-traumatic stress disorder. Providers should initiate skill-building with their female clients immediately instead of waiting for an adverse incident to occur. If the treatment assessment discloses any signs that a woman is living in an unsafe or unstable environment, clinicians must work to remove her from that situation and provide a safe living environment. It is far more complicated to alleviate trauma symptoms when they are heightened rather than when they are at lower, more controllable intensity levels.


Although developing the ideal treatment is of utmost importance, many women are less likely than men to obtain treatment for SUD. The deep-rooted stigma attached to substance use among women, which fabricates negative images of women’s sexuality and questions the capability of mothers, accompanied by social and familial ostracism, is often the reason that women do not seek treatment. Therefore, it is possible that increased access to women-focused substance abuse treatment can potentially enhance treatment-seeking among some women. 


The Path Towards Healing

In conclusion, the path to recovery for women grappling with substance use disorder is not linear and is often compounded by layers of trauma and societal stigma. By adopting an integrated treatment approach that encompasses both harm reduction strategies and trauma-informed care principles, healthcare providers can offer more than just addiction management—they can offer a gateway to healing. This holistic approach not only acknowledges the unique challenges faced by women but also empowers them to regain control of their lives in a supportive and understanding environment. As we move forward, it is crucial for treatment programs to continue evolving, ensuring they are accessible, effective, and deeply attuned to the complexities of each individual's journey toward recovery. Embracing such comprehensive care models not only benefits the individuals directly affected but also contributes positively to the broader societal shift towards more compassionate and inclusive healthcare systems.



References

Centers, A. (2024, March 6). Principles of trauma-informed care in substance abuse treatment

Greenfield, S. F., & Grella, C. E. (2009). Alcohol & Drug Abuse: What Is “Women-Focused” 

Treatment for Substance Use Disorders? Psychiatric Services, 60(7), 880–882. https://doi.org/10.1176/ps.2009.60.7.880

Understanding harm reduction: Substance use. Understanding harm reduction: Substance use | 

U.S. Department of Health and Human Services. (n.d.). Substance use and co-occurring mental 




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