SMMGP - Substance Misuse Management Good Practice

Substance Misuse Management Good Practice

Supporting good practice in drug and alcohol treatment

Post-its from Practice:
Gender sensitive care is needed (Jun 2012)

I saw Maria in a routine appointment last week. The first thing she said was "Are you still writing that column and can you write about me?" I said I was and I was going to speak about women next week at a conference, so asked her why? Maria responded that she thought she had done really well and wanted everyone to know it. I agreed and cast my mind back, with some amazement, to the first time I had met her over 8 years ago when she was 4 months pregnant, she was battered and angry, and demanded - in a very strong Dublin accent - that I give her methadone.

Maria's told me that day that she had left her abusive partner and fled to London. She felt she would manage with her baby, that she so desperately wanted, but knew she could no longer take the abuse, even if it meant leaving her family and home. She pleaded that I didn't involve social services, but I explained it was better to have them on board early as support. Fortunately, we were lucky and the allocated social worker understood what was needed and the local hospital has a great specialist midwife and Maria was supported throughout the remainder of her pregnancy.

She settled on 80mg of methadone and wanted to try to reduce, but each time she tried, she became less stable and hence we agreed to revisit this when the baby was a few months old. Maria took to motherhood and bonded well with her baby daughter. Over the course of that first year, every time I gently probed for information about her past life, Maria completely clammed up and became angry.

But over the next 3-4 years she slowly told me her story: born to alcoholic parents, youngest of 5 siblings, time in and out of care, abused by an uncle who would "look after" her whilst her parents went to the pub, escaped at 16 years into the arms of a older man who drank and start to hit her from the first day they were married. This violence intensified when she became pregnant. Maria began using heroin only after she was married as a way of coping.

Since then she has continued to flourish and remained on methadone whilst pursuing her recovery. Now her daughter is 8 years old and doing well, Maria has a part-time job working in the kitchens of her daughter's school and she is happy with what she has now. Maria has started to go to NA and is thinking about reducing her methadone but doesn't want to upset what she sees is her recovery.

Women start using drugs for a variety of reasons, many have been abused, more than average have been in care. Often, again like Maria, they have started drugs and/or alcohol as a coping mechanism.

Like Maria, many have been the victims of domestic violence. One in 4 women will have experienced domestic violence in their lifetime and women victims are 15 times more likely to misuse alcohol and are 9 times more likely to have problematic drug use. Rates of alcohol and drug use rise after the first episode and 30% of domestic violence either starts or will intensify during pregnancy.

Many drug services focus primarily on the problem i.e. substance mis-use rather than the person and don't understand the context and meaning of drugs and/or alcohol in people's lives. We must be gender-sensitive and be aware of women's risks and vulnerability; and nurture hope and purpose in their lives.

Maria has come a long way on her journey of recovery and she has taught me many things including patience and humility. She may have more distance to go but if, when and how is for her to decide. At the moment she feels she has done well - I agree!

- Dr Chris Ford
GP Lonsdale Medical Centre, Clinical Director for IDHDP, and a Member of the Board of SMMGP