Is drug use solely a man issue? For decades, there was a belief that women used drugs far less than men. At that time, the majority of researchers—mostly men—focused their studies on male drug consumption. Female researchers gradually developed more inclusive studies, but their findings were often ignored or downplayed in academic publications, primarily led by men.

Over time, with the increasing presence of women in academia, research has shown that women do consume drugs, and much more than previously thought. Today, while statistics still show some differences between men and women, these differences are sometimes minimal and the gap is narrowing. However, women remain largely underrepresented in addiction treatment pathways. Why is that?

Persistent Stigma Around Drug Use

More and more, drug addiction is viewed as a public health issue rather than a criminal one. Despite this, a strong stigma against people who use drugs persists. This stigma manifests in three different forms :

• Social stigma. This refers to the societal perspective on drug use issues—often negative and tainted with misunderstanding towards the realities experienced by people who use substances. It can be expressed through judgment, degrading comments, or even discrimination.
• Self-stigma. This is often a consequence of social stigma. After being repeatedly exposed to society’s negative perceptions, the person internalizes these judgments and applies them to themselves. Self-stigma can then lead to a feeling of shame that prevents the person from seeking help.
• Structural stigma. This type of stigma is embedded in the core of healthcare and social service systems. It can manifest as a refusal to offer certain services to people because they use drugs, for example. In other cases, it might mean not taking a physical or mental health issue seriously, assuming that drug use is the root of all problems and failing to explore other possibilities.

Women Judged More Harshly Than Men

These three forms of stigma can have major consequences for anyone who uses drugs. However, it is observed that these are even stronger among the women population. In a 2023 Franco-Quebec study, they reported that “being a woman is associated with high expectations and pressures related to, for example, their parental responsibilities and physical appearance. “

Indeed, the weight of parenthood falls more heavily on women’s shoulders. Regardless of their personal choices, women are still systematically associated—or even reduced—to the role of motherhood. The role of a mother is seen as incompatible with substance use, fueling strong social stigma. Some mothers even refrain from discussing their drug use with healthcare professionals for fear of losing custody of their children.

“We often see women accessing specialized addiction services after several years of struggling because they did not talk about it to their family doctor or psychologist, for fear of being judged, losing custody of their child, or being seen as an unworthy person… There’s fear about how the professional in front of us will judge us.”

Karine Bertrand, PhD, Psychologist, Full Professor in the Department of Community Health Sciences at the University of Sherbrooke, Scientific Director of the Institut universitaire sur les dépendances, during the expert panel organized by Drugs: Help and Referral on April 12, 2023.

There is a direct link between the stigma faced by drug users and their access to appropriate care pathways. It is a difficult cycle to break: the stronger the social stigma, the more self-stigma and shame are reinforced. The more shame builds up, the less likely people are to seek help. The less help is sought, the less healthcare services adapt, and the further the process of destigmatization recedes.

These inadequate services then fuel distrust of the system among women. A recent study highlighted “the importance of feeling in a safe space that would allow them to disclose sensitive experiences, for example, related to trauma.”

Other Barriers Specific to Women

Shame and distrust add to other barriers in accessing care, particularly those stemming from persistent gender inequality in society. We know that, even today, women are more likely to have lower incomes than men, hold precarious jobs, have more family responsibilities, and make up the majority of single-parent families. All these factors make access to care much more difficult, even when a call for help has been made.

This minority presence of women in various care pathways also makes it harder to evaluate the effectiveness of programs and their ability to meet their specific needs. Furthermore, research projects encounter difficulties in recruiting female participants who have entered a treatment pathway, for similar reasons related to distrust. Yet, these research projects are crucial to identify the specific needs of certain populations and better address them.

Moving in the Right Direction?

Addressing the issue of stigma specific to women is a step in the right direction. The various studies mentioned above, some of which are very recent, demonstrate the research community’s interest in better understanding this reality. Although much remains to be done, these efforts will help guide healthcare and social service systems towards more inclusive practices for women, as well as for people of diverse gender identities.

At Drugs: Help and Referral, we observe that the proportion of women using our service is higher than their actual representation in addiction care pathways. Karine Bertrand, invited to speak at our 2023 fundraising event, sees this as a sign that the confidentiality of our service, as well as its entirely remote intervention mode, make it a serious and effective option for addressing the needs of female drug users and combating stigma.

This is also a good opportunity to remind that our services are available for free, 24/7, throughout Quebec:

• If you are looking for help for yourself but don’t know where to turn,
• If you know someone who could benefit from our services,
• If you want to equip yourself to support a loved one in their journey.

Contact us by phone at 1-800-265-2626 or via chat at the bottom right of your screen. Our team offers listening, support, information, and referrals.

To Learn More

• Stigma: Why Words Matter
• Addictions: Putting an End to Stigma (video – French only)
• Alcohol, Opioids, Crack: Isabelle’s Journey (video – English subtitles)
• All Our Content

Ce contenu a été traduit grâce au soutien du Secrétariat aux relations avec les Québécois d’expression anglaise.