What's so different about women and substance abuse?

  Ask that question of Nancy Poole, and she tells of an entire career spent trying to let others know that there are differences, that they are basic and that they hold a key to successful treatment for women. The fact that she's been saying so for a couple of decades, however, doesn't always mean she's been heard as she works to pull people around to her perspective.

  "Sometimes I feel like the little tugboat trying to drag the Queen Mary around," says Poole , research associate with the BC Centre of Excellence for Women's Health.

   Poole said the field of treatment has tended to treat all drug users as "people," rather than as men and women with gender-specific needs. That baffles Poole , who said women's use of drugs, backgrounds, rate of mental health problems, speed of addiction, health effects, experiences of trauma and access to treatment are, typically, different from men's.

"Women do have very different reactions to drugs and experience much more serious direct effects than men," Poole said, adding that women who use drugs tend to have a history of depression.

"In general the barriers for women getting the treatment are so much higher (than for men)."

  These days, Poole has been traveling around the province, talking to professionals in different sectors who work with women; she describes the differences between men's and women's experiences regarding substance use. She leads them in discussions on how to raise the issue of substance abuse with women. "You can see a lot of old biases coming in," she said, particularly in the area of pregnant drug users.

That's unfortunate because Poole sees that treatment is not reaching pregnant women, mainly because of the stigma against pregnant women admitting that they use drugs. Naturally, they fear that if they admit to taking drugs, they risk having their children removed from their home. "We really have to come to some kind of paradigm shift with pregnant women," Poole said. "That is a group that we really do want to reach."

Women have to understand that they will not automatically lose their kids if they disclose drug use and there must be ways to support women to keep their kids. Poole points to the vast resources put into the foster-care system. "What if we put that same amount of money into the mother and allowed her to keep her kids?"

In her talks around the province, Poole is also showing service providers that if care for women integrates trauma, mental health and substance-abuse treatment, the women show better outcomes. "The trauma piece is so critical."

Poole said there are now some agencies that recognize the link of post-traumatic stress disorder in women abusing substances. But in the field generally, trauma is not seen as a pressing issue because, with men, the violence among users is male on male violence. "Violence is seen more as a criminal justice issue."