Summary Report Treatment And Rehabilitation For Women With Substance Use Problems Workshop On Best Practices June 6 And 7, 2002

5.0 Barriers to Treatment and Rehabilitation

5.1 Presentation by Colleen Allan

Colleen presented some of the barriers to treatment and rehabilitation that women with substance use problems may have to overcome:

• Shame and guilt. Many women feel shame for not meeting what they perceive to be society's expectation, and are socialized to attend to others' needs before their own.
• Problems acknowledging the impact of their use. Some women do not realize fully the significance of drug interactions or believe that the problem does not apply to them.
• Fear of losing love and support or of being isolated. Many women are emotionally and financially dependent on their partners. Others fear losing their children
• Being overwhelmed by other issues or problems. The poor, working poor and seniors face increased barriers to recovery.
• Resources. For example, lack of access to transportation, nutritious food, medication and adequate housing are additional barriers that add to women's stress and distress.
• Lack of family support. The majority of women who are experiencing substance use problems lack the family support needed for successful treatment and rehabilitation.
• Social stigma. In general society views women who misuse substances more harshly than men.
• Culture. Some cultures and certain religious denominations have sanctions against the use of alcohol. This can inhibit women from acknowledging a problem and seeking help.
• Literacy and language issues. It is extremely difficult for women who lack basic literacy skills or the agency's primary language to feel comfortable and safe accessing and participating in treatment and rehabilitation programs.

The Addiction Foundation of Manitoba (AFM) works to reduce these barriers for women by collaborating and advocating on their behalf with agencies and organizations who provide services and programs to women. Their strategy has been to establish a Community Prevention Program and Education Prevention Consultants (PEC).

• Community Prevention Programs Unit in Winnipeg and PEC's. Across the province of Manitoba, PEC's staff provide agencies, workplaces, professional associations, educational institutions and the general community with a range of programs and services from primary to tertiary prevention. Special attention is given to training immigrant women's groups to offer addiction services.

The AFM also works to reduce the structural and program barriers that exist:

• Limited program outreach: AFM has an overall marketing strategy with a multi media approach and provides the public and physicians with a range of resource materials. They have also partnered with Manitoba's major educational institutions to integrate drug and alcohol information into professional training curriculums.
• Inadequate referral systems/attitude of service providers. The AFM provides education and training programs for the majority of referral sources (for example, family violence workers, paraprofessional training programs, child and family services, community health nurses and many others).

Colleen concluded her presentation by emphasizing the need to continue to foster and build on inter-agency cooperation and collaboration. There is an ongoing need for health and social service professionals to have current information about the prevention, treatment and rehabilitation, and continuing care needs of women, to ensure timely and appropriate referrals based on their needs. The sharing of information and resources will reduce many of the personal, interpersonal, sociocultural, and structural barriers women are currently facing and greatly assist with the development of a comprehensive continuum of care.

5.2 Challenges and Strategies - Barriers to Treatment and Rehabilitation Identified by the Participants

Context of Women's Lives
Isolation in the home, the fear of leaving, abuse, co-dependence, unstable housing, lack of transportation and many other factors in women's lives are barriers to successful treatment and rehabilitation.

Gaps in Services
Many women return to their communities without ongoing support. This could be remedied by providing aftercare, long term care programs, or services to help them reconnect with family/friends they may have been estranged from. This is particularly an issue for women without transportation or telephone. More recognition of the gaps in services, along with resource allocation, is needed by governments.

Physical Accessibility
Wheelchair access continues to be a barrier and where the physical installations exist they need to be inspected more regularly.

Coordination Among Agencies
Coordination is generally not adequate. Agencies should be doing more mutual screening and referral as it would allow them to focus on providing specific services, rather than being 'everything to everyone'. This requires a willingness to be clear about the services that they do not provide, which is sometimes a challenge.

Child Protection
Inadequate information-sharing with child protection units continues to be a barrier in providing effective treatment and rehabilitation to women. Agencies in British Columbia developed a protocol to clarify the relationship with child protection units.

Staff Training
Sometimes the philosophy of an agency is not known or understood by staff and is therefore not adequately reflected in the delivery of services. Staff should be involved in policymaking for the agency and should have ongoing opportunities to discuss how policies translate into action.

Drug Trends
Increasing use of a variety of opiates and narcotics that agencies are not familiar with can be a barrier because services may need to be adjusted to the differing manifestations of drug dependencies. Early warning systems, such as CCENDU (Canadian Community Epidemiology Network on Drug Abuse), need to be utilized and agencies need to work closely with the police and justice system to be able to provide timely responses.

Use of Volunteers
Volunteers who are former clients or other interested individuals can be helpful in many ways, for example, as educators in specific areas, or to assist with organizational tasks that agencies do not have the resources for paid personnel. There are concerns about using volunteers to provide direct services to clients and most do not.