By Centre for Justice Innovation

For some women, substance use can cause significant harm and problems for themselves and for those around them. Problems with substance use among women have well-established links to gendered experiences of trauma, abuse and exploitation, and women deserve to receive the kind of support that is appropriate for them. Our previous research identified that many of the mainstream, mixed-gender treatment services we looked at were not working well for women. We found evidence that women were accessing treatment services in spaces that exposed them to risks of abuse or exploitation, and that did not give them space to explore their gendered experiences. Our research indicated that treatment services were not able to effectively respond to the needs of women with trauma. This project set out to explore what a better system of substance use treatment would look like from the perspective of women in treatment. Working with women’s centre and treatment provider The Nelson Trust, we spoke to women accessing treatment in seven different locations, and asked about their experiences of a range of treatment provision and what they wanted from treatment services. We explored their perceptions of effective treatment and what support they would want women to be able to access in an ideal system. The women who participated identified six key characteristics of effective treatment: 1. Effective treatment is holistic. It considers and responds to all of a woman’s needs and strengths, including issues like domestic abuse, mental health, offending and children’s social care involvement. 2. Effective treatment is compassionate and respectful. It respects women’s dignity and agency, and responds to their individual needs and experiences with understanding rather than judgement. 3. Effective treatment is person-led and non-coercive. It enables women to determine what treatment and recovery looks like for themselves and to work towards it in their own time, without threat of further scrutiny or punitive measures. 4. Effective treatment addresses the root causes of substance use problems. It supports women to work through drivers of their substance use, heal from past traumas and have their wider needs met. 5. Effective treatment is trauma-responsive. It embeds understanding of trauma and shame throughout, following principles of safety, collaboration and transparency. It does not label women or discharge them when they go quiet. 6. Effective treatment builds strength and resilience. It promotes women’s agency through interventions aimed at promoting self-worth, confidence and acceptance, providing them with new skills and ways of coping. Delivering an effective treatment system requires a significant shift in the way treatment services are commissioned and managed. Current funding models have usually promoted the delivery of large-scale, one-size-fits-all provision in isolation from other services. Whole system approaches – where all services with a role in supporting women are integrated into a cohesive system of care – represent an alternative model that could more effectively address women’s needs. Local areas seeking to implement whole system approaches face significant challenges in breaking down funding silos, supporting information sharing and securing sufficient resources. One solution may be found in place-based approaches to funding and commissioning – approaches that work at local or regional levels to combine funding from multiple sources to co-commission a range of services for women. We therefore call on central government to remove the structural barriers inhibiting the growth of whole system approaches, and for local commissioners to explore place-based approaches as a way of implementing more whole system ways of working. Adopting these new approaches would not only improve the efficacy and efficiency of services, but it would also, more importantly, enable women to lead fulfilling lives. 

London: Centre for Justice Innovation, 2025. 56p.