Women who use drugs face particular issues over and above those experienced by men. For some women, these issues may act as obstacles to seeking, entering, engaging with and remaining in treatment.

Experiences of stigma are more likely among women who use drugs, who are often perceived as contravening ascribed roles, primarily those of mothers and caregivers. Discriminatory, disparaging and unsupportive responses from service providers may impede the access and use of required services (EMCDDA, 2009; Arsova Netzelmann et al., 2015; Benoit and Jauffret-Roustide, 2016). Services should, therefore, create environments that are welcoming, non-judgemental, nondiscriminatory and supportive (Brentari et al., 2011; WHO, 2014). Anonymity and non-punitive policies would also encourage women to seek care by removing fear of negative reprisals (EMCDDA, 2009; Zermiani et al., 2013).

Women who use drugs may also have less social support than their male counterparts (EMCDDA, 2006; Arsova Netzelmann et al., 2015). For example, women are more likely than men to have families of origin that have substance use problems and to have a substance-using partner (Jones et al., 2007; Tuchman, 2010).

Relationships are important in women’s lives, and drug-using men play a role in their female partner’s initiation into and continuation of drug use, including risk of relapse (Bloom et al., 2003; Grella et al., 2008; Neale et al., 2014; Arsova Netzelmann et al., 2015), risk of blood-borne infections (see Roberts et al., 2010) and exposure to violence (Neale et al., 2014; Benoit and Jauffret-Roustide, 2016). Substance-using men may also be more resistant to, and less supportive of, their partner’s treatment, and women may fear damaging the relationship if they become drug free (UNODC, 2016).

Relationships with children are also very important and children may play a central role in issues surrounding women’s drug use and recovery (Grella, 2015). Given the importance women place on relationships, it is recommended that responses promote healthy connections to children, family members and significant others (Bloom et al., 2003). Family involvement can be an important adjunct to treatment and can enhance drug treatment effectiveness (Greenfield et al., 2007; Espinet et al., 2016; Selbekk, 2016; Slesnick and Zhang, 2016). Connections to the community are also important (UNODC, 2004).