… Alcohol

1. Seminar April 24th 2017“How to initiate and implement holistic gender-responsive prevention (policy) of drug and alcohol abuse”Leena HarakéGeneral manager, WOCAD Women´s Organizations committee on Alcohol and Drug Issues, Stockholm, Sweden

2. Basic approaches and features of holistic gender-responsive prevention (policy) of drug and alcohol abuse

3. …Alcohol • Worldwide, 3.3 million deaths every year result from harmful use of alcohol,2 this represent 5.9 % of all deaths. • The harmful use of alcohol is a causal factor in more than 200 disease and injury conditions. • Overall 5.1 % of the global burden of disease and injury is attributable to alcohol, as measured in disability- adjusted life years (DALYs).3 • Alcohol consumption causes death and disability relatively early in life. In the age group 20 – 39 years approximately 25 % of the total deaths are alcohol-attributable.

4. …Alcohol • There is a causal relationship between harmful use of alcohol and a range of mental and behavioural disorders, other noncommunicable conditions as well as injuries. • The latest causal relationships have been established between harmful drinking and incidence of infectious diseases such as tuberculosis as well as the course of HIV/AIDS. • Beyond health consequences, the harmful use of alcohol brings significant social and economic losses to individuals and society at large.

5. …Global Strategy - Alcohol “In 2010, the World Health Assembly approved a resolution endorsing a global strategy to reduce the harmful use of alcohol. The resolution urges countries to strengthen national responses to public health problems caused by the harmful use of alcohol.” (WHO)

6. …EU DrugsStrategy 2013-2020 • EU drugs strategies and action plans direct collective action in the field of drugs both within the European Union and at international level. Internationally, the EU drug strategies aim to add value to Member States’ policies by offering a platform for coordination in relation to international issues and promoting the EU approach to tackling the drugs problem. • A final external evaluation of the previous EU drug strategy (2005–12) found that it provided a forum for • consensus building and decision-making and a platform for information sharing and mutual learning. • It also enhanced the ‘voice’ of the EU in international fora and • promoted a culture of harmonised data collection and • best practices identification.

7. A new strategy… The EU drugs strategy (2013–20) and the EU action plan (2013–16) were endorsed by the Justice and Home Affairs Council of the European Union respectively on 7 December 2012 and on 6 June 2013. The main features of the current strategy and its first action plan, and how they aim to address Europe’s changing drugs problem, are presented in this analysis.

8. … addressing health and social issues For the first time, the 2013–20 strategy incorporates the ‘reduction of the health and social risks and harms caused by drugs’ as a policy objective, alongside the two traditional drug policy aims of reducing supply and demand. Full edition of this article with interactive features available online at: emcdda.europa.eu/topics/ pods/eu-drugs-strategy-2013-20

9. …responding to new challenges in the drugs market There are a number of significant changes in the EU drugs market which the 2013–20 strategy aims to address. In particular the rapid increase in number of new psychoactive substances becoming available on the market as well as diversification in drug trafficking routes and methods of transport are among the challenges that Member States now face.The strategy also proposes that special attention be paid to communication technologies, which play a significant role in the spread of drugs, particularly new psychoactive substances.

10. …civil society involvment • The role of civil society in the drug policy-making process is also enhanced, with regular dialogues envisaged between the Civil Society Forum and the Horizontal Working Party on Drugs (HDG) of the Council of the European Union. • The social reintegration and recovery of all drug users are expected to receive increased attention over the eight-year period as the ultimate goal of drug treatment services. Drug use in prison has also been given increased emphasis, to ensure that the care received by drug users in penal institutions is equivalent to that provided by health services in the community.

11. International standard of prevention UNODC

12. WOCAD experience in interaction with authorities in the field of policy-making for holistic gender-responsive prevention

13. WOCAD’s interaction with authorities • Referralbodyin legislative issues • SiS SoL/LVU/LVM Quality, legal security and integrityof patients • Socialstyrelsen, national guidelinesofstrategies • Jämställdhetsrådet, equality, gender issues • ANDT-råd, national alcohol and drugsstrategies • EU Civil Society Forum • Folkhälsomyndigheten, FHM, public health and prevention issues • MUCF, women’sorganization and CEDAW • Regional authorities, raisingawareness and educating in women’sdrugissues

14. EAD – European Action on drugs • In June 2009 WOCAD’s drug preventive work for girls was validated by the EU-commission as an EAD-activity. • WOCAD´s EAD –report ”Gender specific drug prevention – an investment for life” chosen by EU- commission 2013 as one of the EAD Top Ten Stories.

17. Main activities of WOCAD

18. What is WOCAD? • WOCAD/Women's Organizations Committee on Alcohol and Drug Issues is the Swedish women's organizations collaborating body for issues concerning alcohol, narcotics and addictive drugs founded in 1943. WOCAD's main work is preventive. Our target groups comprise girls and women. • WOCAD is a politically independent and non-denominational organisation with 38 member organisations. WOCAD embraces a total of 340,000 women. • Dependency on alcohol, narcotics and drugs is a national health problem, girls and women being the most vulnerable groups. Research is largely based on men as well as various forms of treatment and care. WOCAD's activities concentrate on girls and women.

19. The DEA Society of Women’s Museums Feminist Initiative Forum – Women and disability The Fredrika- Bremer Association Girls’ zone NGO Tänk Om! Green Women HOPP National organisation against sexual abuse IOGT-NTO Sweden The Swedish medical women’s association The Women association of the Christian Democratic Party Christian women The Swedish Federation of Liberal Women The Green Party’s Committee on Equality The Moderatewomen The Women’s Club Council of the Swedish Abstaining Motorists’ Association RFHL Women The Swedish National Association Home and Society RIFFI/National Federation for International ImmigrantWomen The Women’s Committee of SIMON Swedish association of school nurses ROKS/The National Organisation for Women’s Shelters and Young Women’s Shelters in Sweden SKIS Somali Women in Scandinavia The Swedish Association of Midwives Federation of Swedish Leftist Women Swedish Dentist Nurses federation Swedish Ecumenical Women’s Council Swedish Association School Social Workers Swedish Association of Women’s Shelter S-Women/The National Federation of Social Democratic Women in Sweden SWIS, Somali Women in Sweden WCTU in Skåne The Left Party Committee for Women’s Policies 1,6 Million Club for Women´s Health TRIS – Girls, rights in society KAF – Association of Academic Women Swenurse Qvinnokällan Member organizations

20. WOCAD’s statutes AIMSWOCAD wishes to contribute to a social environment without harm and abuse as a result of alcohol, drugs and other addictive substances such as sleeping pills and tranquilisers.WOCAD is primarily involved in preventive activities in these subject areas from a woman’s perspective with the following aims: - Disseminating information- Increasing understanding of the connection between use and harm- Stimulating debate- Influencing attitudes and values- Following and supporting research- Working with these issues at national and international levels

21. CEDAW for girls and women with drug problems? Sweden has had 35 years to fulfil the Convention. In spite of this: • there is no access to early prevention measures • there are few gender specific treatment methods • there is no protection against being hit, raped, sold, abused and even insulted by professionals

22. WOCAD – also a member of other organisations / networks Folkrörelser mot droger – NGO´s working for a restrictive drug policy Sveriges Kvinnolobby (SKL) – Swedish Women´s Lobby European Women’s Lobby (EWL) - WOCAD is a member of European Women´s Lobby through the membership in Swedish Women´s Lobby. EWL is an association for women´s organisations in Europe. CAN – Swedish Council for Information on alcohol and other drugs

23. WOCAD – also a member of other organisations / networks (cont.) World Federation Against Drugs (WFAD) – an international organisation that works for a world free from illegal drugs. International Council on Alcohol and Addictions (ICAA) – International network for prevention and reduction of harmful use and effects of alcohol and other drugs. The Vienna Non-Governmental Organization committee (VNGOC) NordAN – Nordic Alcohol and Drug Policy Network.

24. WOCAD’s activities WOCAD concentrates on prevention in the form of: - Informational materials/Campaigns - Conferences/Seminars - Projects - Education - Following and supporting research - Collaborating with authorities and other organisations - Collaborating within the Nordic countries, with the EU, and internationally

25. Projects - From cradle to grave Some examples of our projects: • Alcohol and pregnancy • Bella, Eye of the storm • Bella the Driver • Girls/young women and pills • Bella Europe • National/International Network BellaNet • What’s up? Eye of the storm in Belarus • Mothers of the world • "See you at the bar” • Somali Girl Groups • Freedom • Women 55+

26. Alcohol and pregnancy

27. National/International Network for Girl group leaders • The national network for girl group leaders was established in 2005, and has members in all of Sweden’s 21 counties. • An international network was launched in the summer of 2009-2012 as an EAD-action. Members from several different countries today. • Gender specific drug prevention is important and must be developed! • Promote, strengthen and forward girl group cooperation.

28. Parenthood, drugs and criminality Freedom- a course in writing for women • Supporting substance abusing mothers in prisons and rehabilitation centres • Continuous development of methods in order to reach other target groups

29. Mammanet A National Support Forum

30. Elderly women and prescription drugs 55+ • Co-operation with the Swedish National Association of Senior Citizens and RFHL since 2002 • Current research seminars on alcohol and abuse of prescription drugs • Building public awareness

31. New Sober Norms in the Nordic Countries • Youth is soberingup • The adultsaremore and moredrunk

32. National alcoholawarenessweek 45

34. …WOCAD advocates for gender-informed treatment Treatment for women-only with focus on • building self esteem • dealing with anxiety and depression • creating a safe environment for working with feelings of guilt and shame • supporting their responsibilities within the family Traditional treatments usually do not include these methods. (Christina ScheffelBirath)

35. …and trauma-informed approach A program, organization, or system that is trauma-informed: • Realizesthe widespreadimpactof trauma and understands potential paths for recovery; • Recognizesthe signs and symptoms of trauma in clients, families, staff, and othersinvolvedwith the system; • Respondsby fullyintegratingknowledgeabout trauma intopolicies, procedures, and practices; and • Seekstoactivelyresistre-traumatization. A trauma-informed approach can be implemented in anytypeof service setting or organization and is distinct from trauma-specific interventions or treatmentsthatare designed specificallytoaddress the consequencesof trauma and tofacilitate healing.(SubstanceAbuse and Mental Health Service Administration)

36. …with 6 Key Principles of a Trauma-Informed Approach A trauma-informed approach reflects adherence to six key principles rather than a prescribed set of practices or procedures. These principles may be generalizable across multiple types of settings, although terminology and application may be setting- or sector-specific: • Safety • Trustworthiness and Transparency • Peer support • Collaboration and mutuality • Empowerment, voice and choice • Cultural, Historical, and Gender Issues

37. …Trauma-Specific Interventions Trauma-specificintervention programs generallyrecognize the following: • The survivor'sneedto be respected, informed, connected, and hopefulregardingtheirownrecovery • The interrelation between trauma and symptoms of trauma such as substance abuse, eating disorders, depression, and anxiety • The needtowork in a collaborativewaywithsurvivors, family and friendsof the survivor, and other human services agencies in a mannerthatwillempowersurvivors and consumers. (SubstanceAbuse and Mental Health Service Administration)

39. The NGO of the year

41. Analysis of some examples of interventions with dependent women, discussion

42. Interventions • Lisa, lawyer, 53 years, seeksdoctor for insomnia, anxiety and stomachache. • Maria, homeless, 44 years, seeks social office for housing, economical support and addictiontreatment. • Jasmine, student, 21 years, pregnant and singlemotherof a 2-year old girl, arrested for DWI and posessionof heroin. • Ada, retirednurse, 78 years, faints in the supermarket during shopping, disoriented and confused, withclearscentofalcohol and pills fall outofher pocket

43. Discussion Ada Lisa Maria Jasmine

44. Conclusions

45. New challenges when working with gender specific drug policies and action plans • WOCAD’s work with gender specific drug prevention is evolving since 1943 as new challenges face those who work with drug issues • Various actions carried out to raise awareness and build opinion about the ruling norms, strategies, policies and actions set and made by men for men – women considered as ”vulnerable populations” and offered actions, plans, treatments, punishments etc. with evidence for men • Future successfull policymaking means dealing with new realities emerging to challenge long-held certainities and requires a holistic approach including women

46. Key issues • Process of transiting knowledge, not translating. • Process of innovating methods, not implementing. • Process of sharing experiences, not bearing. • Gender specific drug prevention.

47. Thank you for your attention! leena.harake@ksan.se +468101051 www.ksan.se WOCAD (KSAN) Östermalmsgatan 33 11426 Stockholm Sweden