Women's Month: Research highlights urgent need for women-centred addiction care

• Women often delay seeking help because of stigma, fear of judgement, fear of losing their children.
• Many don’t make it into treatment; are lost after intake with little follow-up.
• Current services not always effective, safe or relevant for them.

Women who try to access treatment for addiction often face multiple, intersecting barriers – from stigma and fear of being judged as bad, irresponsible or morally flawed mothers to high transport costs, as well as a lack of money, childcare, and adequate housing. And to make matters worse, current services are not always effective, safe or relevant for them.

This is according to Dr Danyschka Jacobs of the Department of Social Work at Stellenbosch

University (SU). Jacobs obtained her doctorate in social work from SU recently. She focused on the challenges women in the Western Cape face when seeking treatment for addiction.

Jacobs, who is also an addiction counsellor, says it became clear from her work in communities and during conversations with clients and families that women were using substances but were not making it into treatment. Even when they did, many were lost after intake with little follow-up.

According to Jacobs, we often fail to realise that trauma, stigma, caregiving responsibilities and poverty shape women’s experiences of addiction in ways that are deeply interconnected. 

“For many women, substance use is not just recreational or impulsive but is often associated with survival, a means of coping, unsafe relationships, trauma, unstable housing and the pressure of caring for children or family members. These factors make both access to treatment and recovery more difficult. 

“Women often delayed seeking help because of shame, fear of judgement, fear of losing their children, or because treatment was financially and practically out of reach due to transport and childcare costs. 

“For women who did reach intake, their mistrust of services was often high, and when programmes were not trauma-informed or responsive to their realities, treatment itself became another barrier rather than a source of support.” 

Jacobs adds that women-specific treatment spaces are severely limited, and services for girls under 18 are almost non-existent. Women’s voices have also largely been excluded from the design of programmes that are supposed to benefit them.

She says effective recovery requires trauma-informed and gender-responsive care, but many services still fall short in this area, with limited staff training, weak trauma support and underfunded programmes that do not fully reflect women’s lived realities.

According to Jacobs, women’s struggles to access addiction treatment have been overlooked because lower treatment numbers have often been accepted as proof that fewer women use substances when the reality is quite different. 

She explains: “Women are underrepresented in treatment, even though they also use substances. Because addiction research and treatment models have historically been based largely on men, women’s recovery needs, risks and circumstances have not been captured properly. 

“That treatment gap has been normalised in practice. Fewer women in treatment leads to less research, fewer dedicated beds, reduced funding for women-only programmes, and limited professional experience in responding to women’s needs. In that way, the system keeps reinforcing the idea that this is a smaller issue than it really is.”

Jacobs argues that access to addiction treatment should be seen as a human right because addiction is not a moral failing, but a serious health and social issue that affects individuals, families, communities, and society more broadly. 

“In line with our Constitution’s commitment to dignity, equality and access, addiction treatment should be recognised as both a healthcare and a human rights issue, because substance dependence affects the brain, the body, and a person’s ability to live with dignity and stability. When women are excluded from treatment because of stigma, discrimination, poverty, or services that do not meet their needs, their rights are being undermined.” 

She emphasises the importance of proper training and support for professional staff, including funded training for social workers and other service providers in trauma-informed and gender-responsive care, as well as the creation of safe women-only spaces. 

“Gender-responsive services would address trauma, gender-based violence, motherhood, reproductive health, parenting, and financial vulnerability as part of treatment rather than as side issues. They would also require programmes that are relevant to the needs of women to review their language, policies and daily practices so that they do not reinforce harmful stereotypes. Most importantly, women themselves must be included in shaping what effective treatment looks like.”

Jacobs calls on government to move beyond policy commitments and provide funding for women-centred addiction care. 

“We need direct footwork with stronger visibility in our communities, and real investment in reaching women before they are lost. That means reopening treatment spaces closed by funding cuts, restoring specialist training opportunities, supporting current staff and programmes, and building a stronger presence in the places where women live and use substances. 

“Women need to know that treatment services are there, that they can be trusted, and that we are allies in their recovery rather than merely systems that punish, shame or humiliate them.”