Women with drug and alcohol problems: What works?

1. Women with drug and alcohol problems: What works? Gemma Lousley Policy and Engagement Officer, DrugScope

2. Women, the criminal justice system and ‘Transforming Rehabilitation’ • Historically, women’s needs haven’t been well recognised/addressed by the criminal justice system. • Significant progress has been made since the Corston Report (2007) – but a lot remains to be done. • Offender Rehabilitation Bill, clause 11: “Place[s] a statutory requirement on the Secretary of State for Justice to ensure that the contracts with the new providers of probation services consider and identify the particular needs of female offenders, so that the issue will be expressly considered when commissioning rehabilitation and supervision services” (Government response to Justice Committee report on women offenders – October 2013).

3. Background facts and figures • Corston Report (2007): “Drug addiction plays a huge part in all offending and this seems to be disproportionately the case with women. Around 70% of women coming into custody require clinical detoxification compared with 50% of men.” • Oxford University report (2006): • 58% of female prisoners had used drugs daily in the six months before prison; 75% had taken an illicit drug. • Crack cocaine, heroin, cannabis and benzodiazepines = most widely used drugs. Crack and heroin most likely to be used daily. • 42% of women in prison drank alcohol in excess of government guidelines prior to imprisonment (comparable figure of 22% of general adult female population). • 48% of women using women’s community projects have drug or alcohol problems.

4. Background facts and figures • Clear, though complex, links between substance misuse and domestic violence; women who have experienced gender-based violence are 5.5 times more likely to be diagnosed with a substance use problem over their lifetime. • Links between substance use and involvement in prostitution e.g. Drug Treatment Outcomes Research Study (2007) –10% of women commencing drug treatment said they had exchanged sex for money, drugs or something else in past four weeks. • Women will be disproportionately affected by new licence and supervision proposals for short-sentenced prisoners under ‘Transforming Rehabilitation’, as more likely to serve short sentences. In 2012, those entering prison to serve 12 months or less = 71% of all women entering prison under immediate custodial sentence (men = 57%).

5. What works? • What works for women with substance misuse problems to reduce reoffending? Very little quantitative evidence/ evidence in terms of outcomes. • BUT: quite a lot of qualitative/narrative evidence of what appropriate service provision for women with drug and alcohol problems is/what ‘good’ looks like. • Ministry of Justice: “In the absence of decisive evidence, partners will want to have a sound theoretical rationale for their approaches, and will want to draw on the extensive insight and learning offered from a range of different research types, both qualitative and quantitative, to inform their thinking” (‘A summary of evidence on reducing reoffending, 2013).

6. Women-only provision • Can mean women-only services, but also women-only spaces or times in generic provision; importance of access to female keyworkers, too. • Can help women to ‘open up’ and discuss issues affecting them. • Also about women’s safety in treatment: may be vulnerable to exploitation or abuse by men using the service, or may find themselves coming into contact with abusive partners /former partners in the service environment. • Concerns re Drug Appointment Requirement in Offender Rehabilitation Bill: if women-only provision isn’t in place, women could be mandated to attend inappropriate, potentially unsafe provision, with threat of breach if don’t attend.

7. Childcare/demands of women’s lives • Women very often primary or sole carers for children: demands of this can have a very real impact on women’s ability to attend appointments and engage with support. • Importance, therefore, of childcare provision/support with childcare arrangements. • Need to recognise demands of their lives in other ways – for instance: • Sensitive timetabling of appointments (e.g. Drug Appointment Requirement) • Not overloading/‘setting them up to fail’ (e.g. Rehabilitation Activity Requirement)

8. Multiple needs • Women with drug and alcohol problems rarely just have substance misuse problems – there are often a range of associated and interlinking problems that need addressing. • ‘Challenge of Change’, DrugScope and AVA report on women involved in street-based prostitution and substance use –highlighted mutually reinforcing nature of involvement in prostitution and substance use; some women explained that they were selling sex to support their partner’s drug use, too. • Importance of holistic, integrated provision that addresses range of needs women have to support them to make positive, long-lasting changes in their lives. • Strong partnership working can help to deliver this, but there are clear advantages to the ‘one-stop-shop’ model.

9. Women and peer support • Peer support: popular theme throughout development of ‘Transforming Rehabilitation’ proposals, and already quite widely used across the drug and alcohol treatment sector. • Importance of ‘real peers’ – e.g. for women who have substance misuse problems and are involved in street-based prostitution, provision of support by women who have also been through these experiences. • ‘Real peers’ and importance of women-only support; also issue of stigma/‘double stigma’. • Provision of ongoing and robust support for peer mentors themselves is also key.

10. Resources • Corston Report (2007): http://www.justice.gov.uk/publications/docs/corston-report-march-2007.pdf • DrugScope and AVA, ‘The Challenge of Change: Improving services for women involved in prostitution and substance use’ (2013): • http://www.drugscope.org.uk/Resources/Drugscope/Documents/PDF/Policy/Challenge%20of%20change_policy%20briefing.pdf • DrugScope/LDAN, ‘Making the connection: Developing integrated approaches to domestic violence and substance use’ (2013): • http://www.drugscope.org.uk/Resources/Drugscope/Documents/PDF/Policy/DVReport.pdf • Stella Project – addresses overlapping issues of domestic and sexual violence, drug and alcohol use and mental health: • http://www.avaproject.org.uk/our-projects/stella-project.aspx

11. www.drugscope.org.uk gemmal@drugscope.org.uk