Scottish Drug Forum - Substance use, exchanging sex and harm reduction in practice
Substance use and selling or exchanging sex can be very interconnected issues in the lives of some women. To better understand how these cycles overlap, we spoke to two members of the Scottish Drugs Forum (SDF): Adrienne Hannah (Programme Manager) and Louise Bowman (National Training and Development Officer).
Adrienne and Louise were part of the team which researched the vulnerability, harm and risk for women in Scotland who use drugs and who also sell or exchange sex – their findings were published in an academic paper in 2022. In this interview they share insights from this research and from their vast experience working closely with women and service providers.
Can you start by explaining what the Scottish Drug Forum is and the work you have developed in relation to women?
Louise: SDF was established in 1986 to lead and represent the drugs field in Scotland in order to improve Scotland’s response to problem drug use, and the work has grown from that. Workforce development is a large part of SDF’s current work and multiple training courses are on offer on the website. We work within the Harm Reduction Training Team that Adrienne now manages.
Adrienne came into post eleven years ago because drug services were not talking about sex and sexual health services were not talking to their patients about drug use. The idea was to get drug services and wider sectors to have those discussions. Our research study on vulnerability, risk and harm for women came directly out of that effort: we were tasked to look at specific populations, one of which were people who use drugs and exchange sex. The original research wasn’t aimed at women but most participants were. The goal was to inform a training programme to take what women told us about exchanging sex to services, so they know how to respond to women’s needs.
At what point did you identify the need to talk about women who sell or exchange sex who are also drug users?
Adrienne: As Louise said, when I started eleven years ago my role was to make the links between poor sexual health and drug use, and very quickly it became clear – as most services know – that services are set up for men, and very few women actually access them. Within SDF we noticed that the women who were part of the Addiction Worker Training Project (AWTP) were feeling quite isolated. So I set up a wee time to get together and talk about the issues for women who had previous experience of problematic drug use and were now working within SDF as part of the AWTP.
In that group, there was a woman who was selling sex who remembered being with her partner, and the two of them were really strung out. They had no money and no drugs, and he said to her: “you’re sitting on a purse.” I also remember working with a woman who had been previously involved in selling sex – there were more women in this situation, but she approached me and said, “I have been away from drug use for more than two years, and if I don’t get the opportunity now to talk to someone about selling sex, I’m going to start using again.” She described going through a whole range of services without ever being offered a female support worker, a woman-only space where she might have felt able to talk about her experience, and no one ever asked her if she’d ever sold or exchanged sex. And she felt so ashamed by it, there was no way she was going to raise it until I asked her.
That’s so interesting, because like with any form of gender-based violence there is so much stigma and shame, and the encouragement to talk about it is about saying “you don’t need to carry that shame.”
Louise: That’s right, the women in the study said to us “just ask me the question” and I have noticed that most will open up if they feel safe to do so. How you ask the question is vital. You might not get an answer straight away, but at least the woman knows that as a support worker you are not dismissing it. It’s not a taboo subject, she can come and say “you know how you mentioned that, well actually it is happening or has happened.” That is one of the biggest learnings that we have passed on to service staff: ask the question.
As mentioned in the CSE Aware trauma-informed webinar, the question should be asked with a solution. This means explaining that you are asking in order to help if possible, and outline what that help looks like (e.g. phone credit, STI check, safety plan, access to benefits, making phone calls, whatever you can offer to reduce harm or improve safety). If you ask without a solution, women will think staff are being nosey and this will break down the trust.
Before the research though, my inspiration to deliver women-specific groups came from attending an SDF event in 2014 curated by Adrienne, called “Listening To Women.” It blew my mind as I hadn’t even given gender differences a thought, but it made me sit up and take action. Through that I realised that all women were affected by gender-based violence and that selling or exchanging sex was a prevalent issue. Women won’t always see the same harm as you do, they won’t recognise being stalked, for example. Also women may feel completely in control of situations, so it’s really important to listen to their perspective and offer safety strategies that work for them.
Adrienne had already recognised the prevalence when working in family services many years ago. The research study was an opportunity to look at the issue in a robust way. What I learned from it was the breadth and width of how women end up in the situation where they need to sell or exchange sex, and how – like drug use – it is individual and can start and stop at any point.
Can you tell me more about how women’s problematic substance use links with selling or exchanging sex?
Louise: Here I am going to refer mainly to women with what is termed as ‘multiple complex needs,’ which is where the links to layers upon layers of lifelong traumas (including sexual abuse) are well documented. That’s the starting point, in my opinion. Drugs increase risk for those who sell or exchange sex and make it easy to draw women in and keep them under control. Depending on the drug type, women need more money; and they need it more desperately when withdrawing from drugs. The number of women who described being taken advantage of in that distressed state was pretty high and by the people they least expected it from. This then further distorts their trust in the world and reinforces worthlessness.
Some women feel they are taking control by setting up their own websites and arranging ‘safe’ punters to their house to avoid running out of drugs. This can also be a way to avoid services that the women feel might sanction them. There is now ‘same day prescribing’ available through the new Medication Assisted Treatment (MAT) Standards, which is an alternative for when someone is in withdrawal and needs medicated. Staff can let women know that they can access medication rapidly.
For the majority of women, though, there was coercion in the selling/exchanging of sex and, in addition to grooming, they were often forced to sleep with the man who offered shelter when they were homeless. This is why, when someone has to leave a tenancy and stay with a ‘friend,’ I always make a plan and let them know that they don’t have to have sex. I also arrange to send some shopping round so they don’t feel they owe anything to the ‘friend.’ Finally, I explain who to call if that person makes any sexual advances. I encourage services to hold a wee ‘slush fund’ for those types of ‘crisis’ situations, which can really make the difference in keeping someone safe. Whether it is paying for a taxi to get them home safely or helping buy a child’s birthday present, those tiny acts with minimal financial costs to services can be life-changing and save someone more trauma.
Women have had bad experiences in services and can tell when they are being judged or may expect to be judged. They may feel that the services hate them, and that the men love them because, who doesn’t want a happy ever after ending? Even when they see some potential ‘red flags,’ being alone can feel so much worse.
Adrienne: Going back to exactly what that woman’s partner said about sitting on a purse: in the eyes of the man, selling sex is such an easy way for her to get money for their drugs – especially if the woman has experienced domestic violence and then someone says: “don’t worry, I’ll look after you. I’ll inject your drugs for you so you don’t have to do it yourself. All you need to do is sleep with a few people every night.” Well, it might not sound too bad when you don’t have anything else.
Some women have mentioned using drugs to cope with the experience of selling or exchanging sex, can you explain more?
Louise: The peers who get others involved would come back and say they made £200 last night, they would say: “you don’t need to work, all you need to do is this…” Like anyone glamourising any work to friends. But once the women start to sell or exchange sex, they can’t go back either. We hear women saying, “I had to use more to get over the fact that I had to have sex with someone I didn’t want to sleep with.” Then the cycle starts: using more to blank out, and then having more sex to use more drugs.
Adrienne: Also, very often women who are selling sex approach the transaction terrified because they actually don’t know what could happen to them. We were discussing before that if a man comes into contact with a group of women, he is terrified that we might laugh at him. A woman who comes into contact with a group of men is terrified that she might get raped or murdered. Women selling sex don’t know what’s going to happen to them, and in order to deal with that unknown, they may choose to use more drugs, and so they have to sell more sex and the cycle goes on and on.
Thinking about the dynamic of drug using, can you talk about how women make the leap into injecting drugs?
Louise: There is a stigma about injecting that we really need to change so that we can keep people safe. Just like selling sex, we should always ask about injecting. It may be historical for some women, but they may have never had essential blood tests for HIV or Hepatitis. If it is current injecting, there are so many incentivised initiatives locally, based on Glasgow’s WAND, where people can get the tests and assessment of injecting risks and be paid to attend. Injecting Equipment Providers (Needle Exchanges) can be found online and staff can always call their local service provider to ask.
From my experience, a lot of women are initiated into injecting by a male partner or a dominant peer. Sometimes it can be the first method of using drugs. Some people in the 90s didn’t know heroin could be smoked, and their first introduction to the drug was injecting. On some occasions, injecting was borne out of a necessity when there wasn’t enough heroin to share for smoking, and then it became the main route. SDF carried out a study that links childhood trauma to injecting drug use. If you ask women how it started, they will tell you; but one thing that is clear is that they often use it to obliterate the sorrow and devastation they experience from life, especially when having children removed.
Some people inject heroin and smoke things like crack, but never inject both; others will do it differently. It is always important to ask people how they use drugs, and specifically injecting. By asking women to talk you though their injecting process, you will learn more about the dynamics and be able to identify risks, such as sharing or reusing equipment and poor hygiene practices, which can result in viruses and infections that may lead to death. SDF provides e-learning and face to face training for staff to feel more equipped. However, your client is your expert guide – if they sense you are genuinely interested in their wellbeing, they will be more than happy to explain.
Why is it so vital for services to be aware of drug cocktails when supporting women?
Louise: Take nothing at face value and make no assumptions. When it comes to drugs, we deal with the who, what, where, why, when and how. We try to identify how a person uses their drugs and why. Who is involved? Who is she with? Is there someone who can look after her? What is she expecting from the drug use and does that match up? Maybe someone uses to be able to sleep, so can you suggest another strategy. When does it take place? Is there a pattern? For example, a woman might take drugs only when she is anxious – well that makes sense. Is it every few hours, is it nonstop or is it only once in a while? Already you will see there’s different variations. And what else do you use alongside it? Do you have Naloxone and can someone intervene if you overdose? Soon you’ll see no two people use the same drugs at the same time and have the same pattern. Even if we are talking about a couple, one might use to cope with trauma symptoms and the other for fun.
We look at the risk with all these mixes that are a potentially there. For example, a woman might say or an assessment might determine that a female solely uses prescribed methadone and gabapentin [an anticonvulsant prescription drug]. When you have a good relationship and ask more questions, you might find that they have come to harm or experienced seizure due to taking a weeks’ worth of gabapentin at once. You may see an ongoing pattern and the woman may ask for help to get that under control. On the other hand, a woman who is injecting would automatically be considered higher risk, but when you ask more questions, the woman will be injecting safely and taking many precautions.
Some women involved in selling or exchanging sex that we interviewed for the study were using prescribed substances to avoid going to dealers. Women are terrified of losing their prescriptions. It’s their lifeline, so it is down to staff to make people feel safe when discussing the impacts of their drug use. Others in the study explained that their crack cocaine use has changed how they sell sex – they may have one punter a night who pays for all the cocaine, and no cash is exchanged. Often the women advertise this as a ‘service’ and/or get propositioned by punters. However, the women described having to have sex with the men for hours, which can lead to sexual injury, meaning women cannot sell sex for the next few nights and must attend sexual health services to get checked.
Our training always looks at the impact that different drugs have on sexual behaviour. Substances can either increase or reduce sexual desire, and people can be given particular drugs which will result in them being unable to consent to sex. This topic is vast, and the specific training that we offer is bespoke and designed in line with service needs.
What do you think services can do to better support women who sell or exchange sex who are also substance using?
Adrienne: Harm reduction. Starting with “we want to keep you alive. You have been honest with us, you have told us what you’re doing. How can we make sure that you don’t get an STI, that you don’t have an unintended pregnancy, that you don’t end up with HIV, that you have access to injecting equipment? What can we provide you with?”
Louise: It’s about giving women options and choice. When we asked women what can services do to help, they didn’t know apart from kindness and things that should always be there. But when we asked what could help to reduce harm, they couldn’t think of anything. We started mentioning some things that they agreed would work. We need to give people that menu of options so they can decide what would help them to reduce harm. Since the pandemic, there are increasing welfare and anti-poverty interventions available through local authorities, but women won’t always be aware of them and staff may not be either. It is important to find out what is available locally to make that link for the women.
I know it’s not easy as services are working from a deficit because women don’t trust anyone, and they often wonder: “why am I being asked about sex and drugs, is there a catch? What’s going to happen to me?” Which is why we must work hard, because we are never going to get instant results. We need to build a relationship, be steadfast, say “I’m not going anywhere. I’m here” and ensure women get the support they need.
Adrienne: Yes, workers need to follow through with whatever they agree to do for women. Keep appointments, make phone calls, etc. otherwise the women will continue to feel let down by the system.
Louise: I don’t want anyone to feel like I’m stating the obvious, but it is essential to recognise that complex trauma can affect how some women initially engage. We are also just beginning to understand neurodiversity and health literacy. Attachments and decision-making is very poor, as a baseline, for many women. Then there’s cognitive impairment and a constant state of fear, a broken heart, confused head and the need to score drugs. That is a lot for anyone, so we need to remove the stressors by offering to help.
Many women are told things verbally, yet auditory issues and memory problems are prevalent, so we need to get better at simplifying resources, use technology and visual aids to explain interventions and processes in a digestible way. Some women know already what would help them, so please ask and I guarantee that the solution already exists. They may just need help navigating what can feel like complex systems.
To summarise, it is really important to know what harm reduction services exist, and check when sexual health clinics are open. Find out about MAT standards, especially ‘same day prescribing’ and the locations of clinics. Ask your council or Health and Social Care partnership about welfare in the area. Locate drop-in cafes and places where hot food is served. Alcohol & Drug Partnerships have details of services they fund and you can ask about women-only spaces, residential rehab and structured community interventions. It’s helpful to make links and find out beforehand if there is any criteria to access the services. You can always contact me or Adrienne if you need us to make any links.
Substance use is such a vast cross cutting subject so it can seem overwhelming. However, the SDF website and YouTube channel have webinars, which are great learning tools on all the individual subjects we have raised here.
Adrienne and Louise were part of the team which researched the vulnerability, harm and risk for women in Scotland who use drugs and who also sell or exchange sex – their findings were published in an academic paper in 2022. In this interview they share insights from this research and from their vast experience working closely with women and service providers.
Can you start by explaining what the Scottish Drug Forum is and the work you have developed in relation to women?
Louise: SDF was established in 1986 to lead and represent the drugs field in Scotland in order to improve Scotland’s response to problem drug use, and the work has grown from that. Workforce development is a large part of SDF’s current work and multiple training courses are on offer on the website. We work within the Harm Reduction Training Team that Adrienne now manages.
Adrienne came into post eleven years ago because drug services were not talking about sex and sexual health services were not talking to their patients about drug use. The idea was to get drug services and wider sectors to have those discussions. Our research study on vulnerability, risk and harm for women came directly out of that effort: we were tasked to look at specific populations, one of which were people who use drugs and exchange sex. The original research wasn’t aimed at women but most participants were. The goal was to inform a training programme to take what women told us about exchanging sex to services, so they know how to respond to women’s needs.
At what point did you identify the need to talk about women who sell or exchange sex who are also drug users?
Adrienne: As Louise said, when I started eleven years ago my role was to make the links between poor sexual health and drug use, and very quickly it became clear – as most services know – that services are set up for men, and very few women actually access them. Within SDF we noticed that the women who were part of the Addiction Worker Training Project (AWTP) were feeling quite isolated. So I set up a wee time to get together and talk about the issues for women who had previous experience of problematic drug use and were now working within SDF as part of the AWTP.
In that group, there was a woman who was selling sex who remembered being with her partner, and the two of them were really strung out. They had no money and no drugs, and he said to her: “you’re sitting on a purse.” I also remember working with a woman who had been previously involved in selling sex – there were more women in this situation, but she approached me and said, “I have been away from drug use for more than two years, and if I don’t get the opportunity now to talk to someone about selling sex, I’m going to start using again.” She described going through a whole range of services without ever being offered a female support worker, a woman-only space where she might have felt able to talk about her experience, and no one ever asked her if she’d ever sold or exchanged sex. And she felt so ashamed by it, there was no way she was going to raise it until I asked her.
That’s so interesting, because like with any form of gender-based violence there is so much stigma and shame, and the encouragement to talk about it is about saying “you don’t need to carry that shame.”
Louise: That’s right, the women in the study said to us “just ask me the question” and I have noticed that most will open up if they feel safe to do so. How you ask the question is vital. You might not get an answer straight away, but at least the woman knows that as a support worker you are not dismissing it. It’s not a taboo subject, she can come and say “you know how you mentioned that, well actually it is happening or has happened.” That is one of the biggest learnings that we have passed on to service staff: ask the question.
As mentioned in the CSE Aware trauma-informed webinar, the question should be asked with a solution. This means explaining that you are asking in order to help if possible, and outline what that help looks like (e.g. phone credit, STI check, safety plan, access to benefits, making phone calls, whatever you can offer to reduce harm or improve safety). If you ask without a solution, women will think staff are being nosey and this will break down the trust.
Before the research though, my inspiration to deliver women-specific groups came from attending an SDF event in 2014 curated by Adrienne, called “Listening To Women.” It blew my mind as I hadn’t even given gender differences a thought, but it made me sit up and take action. Through that I realised that all women were affected by gender-based violence and that selling or exchanging sex was a prevalent issue. Women won’t always see the same harm as you do, they won’t recognise being stalked, for example. Also women may feel completely in control of situations, so it’s really important to listen to their perspective and offer safety strategies that work for them.
Adrienne had already recognised the prevalence when working in family services many years ago. The research study was an opportunity to look at the issue in a robust way. What I learned from it was the breadth and width of how women end up in the situation where they need to sell or exchange sex, and how – like drug use – it is individual and can start and stop at any point.
Can you tell me more about how women’s problematic substance use links with selling or exchanging sex?
Louise: Here I am going to refer mainly to women with what is termed as ‘multiple complex needs,’ which is where the links to layers upon layers of lifelong traumas (including sexual abuse) are well documented. That’s the starting point, in my opinion. Drugs increase risk for those who sell or exchange sex and make it easy to draw women in and keep them under control. Depending on the drug type, women need more money; and they need it more desperately when withdrawing from drugs. The number of women who described being taken advantage of in that distressed state was pretty high and by the people they least expected it from. This then further distorts their trust in the world and reinforces worthlessness.
Some women feel they are taking control by setting up their own websites and arranging ‘safe’ punters to their house to avoid running out of drugs. This can also be a way to avoid services that the women feel might sanction them. There is now ‘same day prescribing’ available through the new Medication Assisted Treatment (MAT) Standards, which is an alternative for when someone is in withdrawal and needs medicated. Staff can let women know that they can access medication rapidly.
For the majority of women, though, there was coercion in the selling/exchanging of sex and, in addition to grooming, they were often forced to sleep with the man who offered shelter when they were homeless. This is why, when someone has to leave a tenancy and stay with a ‘friend,’ I always make a plan and let them know that they don’t have to have sex. I also arrange to send some shopping round so they don’t feel they owe anything to the ‘friend.’ Finally, I explain who to call if that person makes any sexual advances. I encourage services to hold a wee ‘slush fund’ for those types of ‘crisis’ situations, which can really make the difference in keeping someone safe. Whether it is paying for a taxi to get them home safely or helping buy a child’s birthday present, those tiny acts with minimal financial costs to services can be life-changing and save someone more trauma.
Women have had bad experiences in services and can tell when they are being judged or may expect to be judged. They may feel that the services hate them, and that the men love them because, who doesn’t want a happy ever after ending? Even when they see some potential ‘red flags,’ being alone can feel so much worse.
Adrienne: Going back to exactly what that woman’s partner said about sitting on a purse: in the eyes of the man, selling sex is such an easy way for her to get money for their drugs – especially if the woman has experienced domestic violence and then someone says: “don’t worry, I’ll look after you. I’ll inject your drugs for you so you don’t have to do it yourself. All you need to do is sleep with a few people every night.” Well, it might not sound too bad when you don’t have anything else.
Some women have mentioned using drugs to cope with the experience of selling or exchanging sex, can you explain more?
Louise: The peers who get others involved would come back and say they made £200 last night, they would say: “you don’t need to work, all you need to do is this…” Like anyone glamourising any work to friends. But once the women start to sell or exchange sex, they can’t go back either. We hear women saying, “I had to use more to get over the fact that I had to have sex with someone I didn’t want to sleep with.” Then the cycle starts: using more to blank out, and then having more sex to use more drugs.
Adrienne: Also, very often women who are selling sex approach the transaction terrified because they actually don’t know what could happen to them. We were discussing before that if a man comes into contact with a group of women, he is terrified that we might laugh at him. A woman who comes into contact with a group of men is terrified that she might get raped or murdered. Women selling sex don’t know what’s going to happen to them, and in order to deal with that unknown, they may choose to use more drugs, and so they have to sell more sex and the cycle goes on and on.
Thinking about the dynamic of drug using, can you talk about how women make the leap into injecting drugs?
Louise: There is a stigma about injecting that we really need to change so that we can keep people safe. Just like selling sex, we should always ask about injecting. It may be historical for some women, but they may have never had essential blood tests for HIV or Hepatitis. If it is current injecting, there are so many incentivised initiatives locally, based on Glasgow’s WAND, where people can get the tests and assessment of injecting risks and be paid to attend. Injecting Equipment Providers (Needle Exchanges) can be found online and staff can always call their local service provider to ask.
From my experience, a lot of women are initiated into injecting by a male partner or a dominant peer. Sometimes it can be the first method of using drugs. Some people in the 90s didn’t know heroin could be smoked, and their first introduction to the drug was injecting. On some occasions, injecting was borne out of a necessity when there wasn’t enough heroin to share for smoking, and then it became the main route. SDF carried out a study that links childhood trauma to injecting drug use. If you ask women how it started, they will tell you; but one thing that is clear is that they often use it to obliterate the sorrow and devastation they experience from life, especially when having children removed.
Some people inject heroin and smoke things like crack, but never inject both; others will do it differently. It is always important to ask people how they use drugs, and specifically injecting. By asking women to talk you though their injecting process, you will learn more about the dynamics and be able to identify risks, such as sharing or reusing equipment and poor hygiene practices, which can result in viruses and infections that may lead to death. SDF provides e-learning and face to face training for staff to feel more equipped. However, your client is your expert guide – if they sense you are genuinely interested in their wellbeing, they will be more than happy to explain.
Why is it so vital for services to be aware of drug cocktails when supporting women?
Louise: Take nothing at face value and make no assumptions. When it comes to drugs, we deal with the who, what, where, why, when and how. We try to identify how a person uses their drugs and why. Who is involved? Who is she with? Is there someone who can look after her? What is she expecting from the drug use and does that match up? Maybe someone uses to be able to sleep, so can you suggest another strategy. When does it take place? Is there a pattern? For example, a woman might take drugs only when she is anxious – well that makes sense. Is it every few hours, is it nonstop or is it only once in a while? Already you will see there’s different variations. And what else do you use alongside it? Do you have Naloxone and can someone intervene if you overdose? Soon you’ll see no two people use the same drugs at the same time and have the same pattern. Even if we are talking about a couple, one might use to cope with trauma symptoms and the other for fun.
We look at the risk with all these mixes that are a potentially there. For example, a woman might say or an assessment might determine that a female solely uses prescribed methadone and gabapentin [an anticonvulsant prescription drug]. When you have a good relationship and ask more questions, you might find that they have come to harm or experienced seizure due to taking a weeks’ worth of gabapentin at once. You may see an ongoing pattern and the woman may ask for help to get that under control. On the other hand, a woman who is injecting would automatically be considered higher risk, but when you ask more questions, the woman will be injecting safely and taking many precautions.
Some women involved in selling or exchanging sex that we interviewed for the study were using prescribed substances to avoid going to dealers. Women are terrified of losing their prescriptions. It’s their lifeline, so it is down to staff to make people feel safe when discussing the impacts of their drug use. Others in the study explained that their crack cocaine use has changed how they sell sex – they may have one punter a night who pays for all the cocaine, and no cash is exchanged. Often the women advertise this as a ‘service’ and/or get propositioned by punters. However, the women described having to have sex with the men for hours, which can lead to sexual injury, meaning women cannot sell sex for the next few nights and must attend sexual health services to get checked.
Our training always looks at the impact that different drugs have on sexual behaviour. Substances can either increase or reduce sexual desire, and people can be given particular drugs which will result in them being unable to consent to sex. This topic is vast, and the specific training that we offer is bespoke and designed in line with service needs.
What do you think services can do to better support women who sell or exchange sex who are also substance using?
Adrienne: Harm reduction. Starting with “we want to keep you alive. You have been honest with us, you have told us what you’re doing. How can we make sure that you don’t get an STI, that you don’t have an unintended pregnancy, that you don’t end up with HIV, that you have access to injecting equipment? What can we provide you with?”
Louise: It’s about giving women options and choice. When we asked women what can services do to help, they didn’t know apart from kindness and things that should always be there. But when we asked what could help to reduce harm, they couldn’t think of anything. We started mentioning some things that they agreed would work. We need to give people that menu of options so they can decide what would help them to reduce harm. Since the pandemic, there are increasing welfare and anti-poverty interventions available through local authorities, but women won’t always be aware of them and staff may not be either. It is important to find out what is available locally to make that link for the women.
I know it’s not easy as services are working from a deficit because women don’t trust anyone, and they often wonder: “why am I being asked about sex and drugs, is there a catch? What’s going to happen to me?” Which is why we must work hard, because we are never going to get instant results. We need to build a relationship, be steadfast, say “I’m not going anywhere. I’m here” and ensure women get the support they need.
Adrienne: Yes, workers need to follow through with whatever they agree to do for women. Keep appointments, make phone calls, etc. otherwise the women will continue to feel let down by the system.
Louise: I don’t want anyone to feel like I’m stating the obvious, but it is essential to recognise that complex trauma can affect how some women initially engage. We are also just beginning to understand neurodiversity and health literacy. Attachments and decision-making is very poor, as a baseline, for many women. Then there’s cognitive impairment and a constant state of fear, a broken heart, confused head and the need to score drugs. That is a lot for anyone, so we need to remove the stressors by offering to help.
Many women are told things verbally, yet auditory issues and memory problems are prevalent, so we need to get better at simplifying resources, use technology and visual aids to explain interventions and processes in a digestible way. Some women know already what would help them, so please ask and I guarantee that the solution already exists. They may just need help navigating what can feel like complex systems.
To summarise, it is really important to know what harm reduction services exist, and check when sexual health clinics are open. Find out about MAT standards, especially ‘same day prescribing’ and the locations of clinics. Ask your council or Health and Social Care partnership about welfare in the area. Locate drop-in cafes and places where hot food is served. Alcohol & Drug Partnerships have details of services they fund and you can ask about women-only spaces, residential rehab and structured community interventions. It’s helpful to make links and find out beforehand if there is any criteria to access the services. You can always contact me or Adrienne if you need us to make any links.
Substance use is such a vast cross cutting subject so it can seem overwhelming. However, the SDF website and YouTube channel have webinars, which are great learning tools on all the individual subjects we have raised here.