Gender and drug use: Challenges for communication Pratima Murthy Professor of Psychiatry and Chief, Centre for Addiction Medicine NIMHANS, Bangalore, India Presentation made on behalf of the UNODC, ROSA
Format of presentation Drug abuse as a global problem Growing problem among women Antecedents and implications of drug use among women Adolescent girls and drug use Girls grow up indications for prevention Challenges for communication
Drug use as a growing problem 210 million users (UNODC 2011), almost 200000 die each year from drugs. Stable recorded consumption in many regions but increase in AFR and SEAR (WHO 2011), 2.5 million die each year. Rising consumption most pronounced in women and young people (Lancet 2008) 80% of smokers live in low and middle income countries where burden of tobacco related illness and death is maximum 6 million die each year from tobacco (WHO Fact Sheet 2011). Women and children also affected by second hand smoking, use of tobacco products including smokeless forms and green tobacco sickness
Impact of substance use Individual Tobacco Community Substance use Family Alcohol Drugs Workplace
US In 2010, 6.8% females and 11.2% males reported current illicit drug use Brazil: a higher proportion of females than males initiated cocaine use in a study in Sao Paulo Chile- alcohol use increased among adolescent females compared to males Higher rates of cocaine dependence reported among females than males (though lifetime use and recent use more among males) Columbia- similar rates of initiation of smoking, alcohol, illicit drugs among boys and girls Germany : 15-25 per cent of the hard-core substance users women EU- rates of pharmaceutical abuse higher among women Hardly any gender differences between teenage girls and boys in rates of cannabis use UK-5.4% of women reported using drugs in 2009/10; 21% girls reported ever using drugs in 2009 Kenya- one heroin using women for every 20 males; many work in the sex industry South Africa growing methamphetamine use among women, including pregnant women Russian Federation 10 times increase in addiction among women Afghanistan increasing use of opiates and pharmaceuticals among refugee women Iran -6% of drug users are women China-increasing number of women using substances; report of sex for drugs among womenopiates most common Research reports indicate that women are currently using drugs in Bangladesh, China, India, Indonesia, Japan, Malaysia, Nepal, Pakistan, Philippines, Sri Lanka, Taiwan, Thailand and Vietnam, while there are likely many undocumented cases in other Asian nations Australia: 37.4 per cent of male and 37.9 per cent of female 14-19 year olds report ever using an illicit substance. Female rates of ever injecting a substance in this group exceed those of males (1.7 per cent versus 1.0 per cent).
Growing problem among women Often seen as a problem affecting males, hence most interventions, preventive or therapeutic, invariably male centred In many countries where epidemiological surveys are done for alcohol and drugs, usually done only among males Lack of gender disaggregated data where data is available Drug use among women is triply stigmatised (Blame for drug use in partner x Drug use x Gender disadvantage in an unequitable society)
A case in point- gender inequity 970 Females per 1000 males 960 955 960 950 940 930 945 946 941 930 933 927 933 940 Females per 1000 males 920 910 1921 31 41 51 61 71 81 91 2001 2011 India- Census
Interacting factors for drug abuse among women Social disadvantage, dislocation Stigma and Fear Predisposition Modelling Peer influence Ongoing stresses emotional problems Role transition and lifestyle Lack of knowledge of harm Ignorance of treatment facilities and lack of gender sensitive services Fx-Modified from Murthy 2002
Consequences Physical health consequences including gynaecological and reproductive health Drugs and violence Drugs and sex Drugs and mental health Drugs and children Drug use and social supports
Barriers for help seeking- 1. Systemic Lack of decision making power Limited awareness of gender Differences in factors that determine health status and outcome Lack of knowledge of problems and treatment needs relevant to Different socio-cultural and political circumstances Lack of appropriate, gender sensitive, evidence-based treatment models Differences in funding and organization of health services Lack of recognition of the need for a comprehensive array of services UNODC 2004
2. Structural barriers for treatment seeking Childcare Location and cost of treatment Lack of flexibility in programmes Selectivity (e.g. only HIV related/only IDU) Physical safety Specific and limited goals of drug treatment Lack of treatment options and lack of information on treatment options Lack of service co-ordination and networking Needs of special populations (pregnant women, homeless, women drug users in prison, women in sex work)
3. Social and cultural barriers Disadvantaged life circumstances Stigma, shame and guilt Fear of losing custody of children Lack of family support Lack of alternative solutions for life situations (drug use as self-medication) Lack of knowledge and lack of confidence in existing treatment options
Adolescent girls Growing pains, growing problems INDIA Urban India (2011) Indore girls spark drinking age limit debate An ASSOCHAM survey shows that 45% of Class XII students in metropolitan cities consume alcohol excessively, at least five to six times a month. The results indicate that there is an almost 100% increase in teenage drinking in the last 10 years. India shocked as moral police beat girls out of pub (2009) A protest has taken place in the Indian capital Delhi over the release of a group of men who beat up young women in a pub. The case of so-called moral policing has shocked the country.
Growing problem among female adolescents In several European countries, alcohol consumption increased among female adolescents between 1993 and 2003 (NIIAA) Data from 37 low- and middle-income countries indicate that 14% of girls aged 13 15 years reported drinking alcohol in the past month compared to 18% of boys Data from 151 countries indicate that approximately 10% of adolescents (12% among boys and 7% among girls) smoke cigarettes and 10% use tobacco products other than cigarettes (e.g. pipes, water pipes, smokeless tobacco, and bidis). Smoking among girls is more common in highincome countries than in lower income countries Women and health : today's evidence tomorrow's agenda-who-2009
The Formative Years: Pathways to Substance Abuse Among Girls and Young Women Ages 8-22 Three-year study by the National Centre on Addiction and Substance Abuse (CASA) at Columbia University High school girls more likely to report feelings of sadness, hopelessness, suicidal ideas and relationship of such symptoms with substance use more likely College women reported drinking to overcome shyness Increased rates of mental health morbidity among young women who present for drug use treatment Trauma very important precipitant of substance use among adolescent girls (vicious cycle of trauma) Body image and self-esteem often tie in with drug use
Common factors associated with adolescent drug use Availability, Accessibility, acceptability of drug use lack of alternatives Peer influence, influence of popular media, poor life skills Temperament and coping, life events Family history (genetic vulnerability, modelling) Family support (composition, drug use, monitoring)
C4D 1. Principles of prevention Enhance protective factors and reduce risk factors Should address all forms of drug abuse (licit/illicit, prescription drugs, any substance with abuse potential) Messages should be tailored to audience characteristics (age, background, location) In order to be effective, preventive efforts should be long-term and repeated (NIDA 2003)
Addressing risks and protective factors NIDA 2003
C4D 2. To whom should communication be addressed Families Parental monitoring and supervision Drug education and information for families Family focused interventions to reduce problem behaviours which may later impact the child School programs Focus on building socio-cultural and emotional competence (life skills including drug resistance) Identify and intervene for children at risk Community programs Consistent, community wide message for different settings (schools, workplaces, clubs, faith-based organisations, sports organisations)
Challenges for communication 2. Whom to communicate to? All Girls? Girls in disadvantaged situations? Same for all drugs? Which age groups? Different backgrounds (literacy/urban rural/those in impoverished situations) Highly vulnerable groups (Disadvantaged girls, girls living in substance using environments, girls in restrictive environments) How do you reach young girls not in any organisational settings?
Challenges for communication 3. Service providers Health care service providers Educators Social sector service providers Law enforcement staff Peer educators Challenges Need to be sensitive to social stereotypes, attitudes to drug abuse, attitudes to drug abuse by women/girls Does the gender of the service provider pose a challenge?
Engaging adolescents and young women using drugs Safe environment to discuss substance use related problems Trusting care relationships Greater attention to extra-treatment needs Emphasis on follow-up Help for drug using girls in difficult circumstances (shelter, occupation, finance)
Drug use vulnerabilities in non-drug using girls Environments of deprivation, abuse and drug abuse Female partners of males who use drugs also suffer from the burden of drug use (health, particularly sexual high risk, emotional trauma, violence) Specific challenges in how to deal with partner related issues among young women Young women who are coerced into selling drugs
Shortfalls of a Gender-Insensitive approach
Challenges for communication Society s ambivalence to drug use Socio-cultural sensitivities Poor use of communication in health care Can we address adolescents drug problems without engaging adults with drug problems? Alternatively, can engaging adolescents be a meaningful entry not only to help them but help in engaging the older generation too?
Summary Drug abuse among women a growing global concern and has major implication for girls Divisions between different drugs is artificial and many use licit and illicit drugs both of which produce serious problems for individuals, families and the community Programs must take into concern holistically addressing antecedent factors and consequences of drug use among girls Being sensitive to gender perspectives of women using drugs will help in evolving effective communication for prevention and early intervention