Side event: Understanding the Desistance Journey of Female Substance Abusers and the Implications for their Interventions

Abdul Karim Shahul Hameed:  Opening. For many years research has focused on men.  We know that for instance pathways for drug use and recovery from addiction differs among men and women.  Sharing will also illustrate key support needed for female for their recovery.  Introduces each speaker

Lowshanthini Panesilvam, Psychologist, Singapore Anti-Narcotics Association: SANA formed 48 years ago to focus on drug prevention, aspiring for a drug free Singapore through education and people in recovery through intervention programs. Core programs help recovering abusers through aid, recovery support groups, drop-in centers. Also identify gaps in services for community-based treatment centers. Female incarceration has always been part of research.  What is the most effective path for rehabilitation? The rate of female substance abusers referred to treatment or incarcerated has slowly increased. Male offenders have been the target group of participants in previous research on desistance. Little research has been conducted in Singapore context. Singapore has used a rehabilitation approach.  Female desistance highlights 3 areas 1) self identity construct- reevaluate their social relationships. 2) Strong social relationships help change routine activities, increase social capital, but community programs alone is not enough.  Requires family support as well. 3) Reentry experience varies from men. Study gathered 11 female participants and conduct photo elicitation to understand the lived experience of narratives in the photographs. Based on interpretation, key findings found that desistance journey started during incarceration phase.  Artificial environment allowed them to rethink their identities.  Repositioning anchors by deconstructing and reconstructing their priorities and relationships.  Lastly, participants discover new roles and manage unmet expectations.  Throughout micro, meso, and macro level, there are implications on how to develop female programs and support.  However, there are limitations to the study such as small sample size, researcher bias, and non-generalizability of drug users.  Current studies highlight how desistance is a collaboration among the women and the relationships with their families and the society.

Evrim Akbas, Addiction Counsellor, Turkish Green Crescent Society: The prevalence of substance abuse disorders is lower among women than men.  But between 1980 and today show increasing number among women substance users.  Although men consume and misuse alcohol at higher rates, gender gap has decreased over time. While men are closer to taking initial drugs, females are more affected by substance abuse because of gender/biological differences. Women are more likely to use illicit and prescribed drugs.  The prevalence studies in Turkey in 2019, show 22.1% of respondents used alcohol at least once in their life, 10.7% are female, 34.3% are men. Three dimensions in abuse treatment 1) treatment entry- most difficult part for a woman because it is hard for them to come and get treatment due to fear of losing custody, needing their families, stigma, etc. 2) Treatment retention- includes trauma history, co-occurring psychiatric disorders and childcare 3) Drop out or continued treatment- psycho-education counselling, twelve steps programs, institutional collaboration.  Addiction profile index- women are 2.5 times more likely to receive psychological support than men.  Drop out rates at Yedam- 520 clients dropped out in 2016-17- 88.4% male compared to 5.4% females. If women can reach treatment they stay more than men. It is important for gender specified treatment approach.  Psychologist and social workers are respecting female with substance use disorders as human beings instead of stigmatizing addiction. It is also important to work with family groups. Addiction is more vital in pregnant women and causes harm to baby in the womb. Pregnant women are directed to health institutions.

Gloria Yau, International Federation of Non-Government Organisations for the Prevention of Drug and Substance Abuse (IFNGO): Since 1968, society serves female substance abusers.  2 centers for women also responsible for methadone treatment and female halfway house. Women, especially mothers are difficult to engage into treatment. In 2020, only 757 cases reported by Hong Kong narcotics division. Common types of drug abuse are heroin, ICE, Ketamine. Number of female substance abuse cases are under-reported. Reasons for women not to seek help include shame, fear of losing custody, stigma, and low self-esteem. Most barriers are gender issues.  Therefore need a gender sensitive approach to work with women. Some substance abuser mothers avoid to see professionals. However, if asked about children, they are more likely to talk. In 2003, there are educational programs for mothers to bring kids to the counseling services and set up female volunteer groups.  Women come to learn and volunteer leading to a breakthrough of services.  As a woman, they also have responsibility as a caregiver.  Therapeutic groups and counseling for mothers are possible. Need to reach out to women to have a proactive role and tailor made services to help them access treatment. Is motherhood a wake up call for change? Need to remove stigma and break the shame and guilt cycle.  Provide training with clinical psychologist using circle of security model and teach them how to communicate with their children. In 2016, inpatient detoxification and rehabilitation program was started for pregnant women. The need program has more than 50 pregnant women. Services also provided for mothers to vist their children in foster care or in residential homes as well as skills training.  More communication and understanding among professionals are needed to be able to tailor services to mothers as well as having gender-responsive programs.

Q&A

  1. Examples of semi-structured interviews- having free flow discussions using photos.  There were also some directed questions. [Lowshanthini]
  2.  Is the drop out rate of women caused by the fear of losing their children? It is hard for women to reach treatment but after being able to access treatment, we try to do our best.  I don’t think there is difference in men or women regarding their children [Evrim]
  3. Do the programs in Hong Kong address shame? In counseling, we need to tackle it because shame is internalized by social stigma. Use program to enhance self-identity and self-worth. [Gloria]
  4. Are there specific factors to identify alcohol and drug use for women? Based on experiences of female drug users, the initiation are mostly from male partners.  Unfortunately it becomes an addictive cycle. [Lowshanthini]

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