International Journal of Drug Policy 56 (2018) 30–39

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International Journal of Drug Policy

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Research Paper

Representations of women and drug use in policy: A critical policy analysis T

a,b,⁎ a
Natalie Thomas , Melissa Bull
a
Griffith Criminology Institute, Griffith University, Brisbane, Australia
b
Faculty of Humanities, Arts and Social Sciences, University of New England, Armidale, Australia

A R T I C LE I N FO A B S T R A C T

Keywords: Contemporary research in the drugs field has demonstrated a number of gender differences in patterns and
Women experiences of substance use, and the design and provision of gender-responsive interventions has been iden-
Drug use tified as an important policy issue. Consequently, whether and how domestic drug policies attend to women and
Drug policy gender issues is an important question for investigation. This article presents a policy audit and critical analysis
Gender
of Australian national and state and territory policy documents. It identifies and discusses two key styles of
Critical policy analysis
problematisation of women’s drug use in policy: 1) drug use and its effect on women’s reproductive role (in-
Problematisations
cluding a focus on pregnant women and women who are mothers), and 2) drug use and its relationship to
women’s vulnerability to harm (including violent and sexual victimisation, trauma, and mental health issues).
Whilst these are important areas for policy to address, we argue that such representations of women who use
drugs tend to reinforce particular understandings of women and drug use, while at the same time contributing to
areas of ‘policy silence’ or neglect. In particular, the policy documents analysed are largely silent about the harm
reduction needs of all women, as well as the needs of women who are not mothers, young women, older women,
transwomen or other women deemed to be outside of dominant normative reproductive discourse. This analysis
is important because understanding how women’s drug use is problematised and identifying areas of policy
silence provides a foundation for redressing gaps in policy, and for assessing the likely effectiveness of current
and future policy approaches.

Introduction
Contemporary clinical academic discourse on substance use en-
dorses the idea that women who use drugs demonstrate unique char-
acteristics and treatment needs, as evidenced by the push for ‘gender-
sensitivity’ in treatment and policy (Grella, 2008; Martin & Aston, 2014;
Tang, Claus, Orwin, Kissin, & Arieira, 2012). Research indicates that
women who use drugs have high rates of mental health problems as
well as histories of childhood victimisation and trauma, and have
greater vulnerability to health and social harms from their drug use and
dependence (Ashley, Marsden, & Brady, 2003; Copeland, 1997;
Greenfield et al., 2007; Pelissier & Jones, 2017; Shand, Degenhardt,
Slade, & Nelson, 2011). Women who use drugs are also less likely than
men to enter treatment for their drug use, and they experience parti-
cular barriers to treatment entry, including childcare responsibilities,
inappropriate treatment models, and gendered stigmatisation (Ashley
et al., 2003; Copeland, 1997; Greenfield et al., 2007; Pelissier & Jones,
2017). Consequently, gender differences in drug use patterns, char-
acteristics, and intervention needs represent an important policy issue.
At the international level, United Nations governing bodies have been
concerned to ensure that gender issues and the specific needs of women
and girls are considered in drug policy. The recent resolutions adopted by
the United Nations General Assembly Special Session in 2016 provides an
example of this by encouraging the adoption of ‘operational re-
commendations on cross-cutting issues: drugs and human rights, youth,
children, women and communities’ (General Assembly resolution S30/1,
2016). Reflecting the broad push for ‘gender mainstreaming’ across a
range of policy arenas, one of these operational recommendations is to:
[m]ainstream a gender perspective into and ensure the involvement
of women in all stages of the development, implementation, mon-
itoring and evaluation of drug policies and programmes, develop
and disseminate gender-sensitive and age-appropriate measures that
take into account the specific needs and circumstances faced by
women and girls with regard to the world drug problem and, as
States parties, implement the Convention on the Elimination of All
Forms of Discrimination against Women (General Assembly resolu-
tion S30/1, 2016, p. 12).
From this, it is clear that the international community is committed
to ensuring that gender is considered in drug policy and interventions,

⁎
Corresponding author. Present Address: Faculty of Humanities, Arts and Social Sciences, University of New England, Armidale, NSW, 2350, Australia.
E-mail addresses: natalie.thomas@une.edu.au, natalie.thomas@griffithuni.edu.au (N. Thomas).

https://doi.org/10.1016/j.drugpo.2018.02.015
Received 6 November 2017; Received in revised form 8 February 2018; Accepted 12 February 2018
0955-3959/ © 2018 Elsevier B.V. All rights reserved.
N. Thomas, M. Bull
and as such domestic drug policies should reflect this commitment.
Despite this recognition that gender should be an important con-
sideration in drug policy, there is still only a relatively small literature
on whether and how gender issues are attended to in policy, including
the ways that women are constructed as objects of government in of-
ficial drug policy discourse (for exceptions, see Campbell, 2000; Du
Rose, 2015; Harding, 2006; Malinowska-Sempruch & Rychkova, 2015;
Moore, Fraser, Törrönen, & Tinghög, 2015). A recent special issue in the
Howard Journal of Criminal Justice highlights the gendered nature of
issues related to ‘drug mules’, and in particular draws attention to
gendered discourses in international drug policy around women who
use or traffic drugs, particularly in Latin American countries and South
East Asian countries (Fleetwood & Seal, 2017; Giacomello, 2017).
Furthermore, the journal of Contemporary Drug Problems has also re-
cently released a special issue on gender in critical drug studies, inviting
drug policy authors to incorporate gendered analysis into emerging
scholarship on all aspects of drug use, markets, interventions and policy
(Campbell & Herzberg, 2017). There is still relatively little research,
however, that investigates domestic drug policies and whether they
address gender issues (again, see for an exception Manton & Moore,
2016; Moore et al., 2015). Consequently, the purpose of this study was
to investigate whether and how Australian governments have addressed
women and gender issues in drug policy. Based on this broad purpose,
data collection and analysis occurred in two main stages: 1. a policy
audit of Australian drug and health policies federally and across all
states and territories to investigate whether these policies attend to
women and gender issues; and 2. a critical policy analysis of key do-
mestic policy documents to examine how women and gender issues are
represented in policy.
This article, which reports the outcomes of this work, begins by
surveying what is known about the prevalence of drug use amongst
women in Australia and briefly outlining a number of key issues in
relation to this use. Second, we outline our methods of data collection
and analysis including the policy audit and critical policy analysis.
Following this, we summarise the results of our policy audit and review
a number of relevant national and state/territory policies and pro-
grams. The policy audit provides a springboard for thinking about
policy representations of women who use drugs. In this article we de-
ploy a critical approach to draw attention to both the over-production
of certain discourses around women and drug use, as well as areas of
‘policy silences’ — issues that are largely neglected in policy (Bacchi,
2000, 2009; Ball, 1993; Scheurich, 1994; Taylor, 2006). Overall, we
argue that in Australia women have been represented in drug policy in
two key overlapping ways, which focus on 1. reproductive and popu-
lation health, and 2. vulnerability to harm.
Women and drugs
There are significant gender differences in patterns of drug use,
reasons for use, experiences, circumstances and characteristics of users,
as well as treatment experiences and needs of people who use drugs. To
provide context for the analysis and discussion presented in this article,
this section reviews prevalence data on women’s drug use in Australia
before discussing research on women’s experiences of drug use and
interventions. The 2016 National Drug Strategy Household Survey
(NDSHS) delivers the most recent population prevalence data on al-
cohol, tobacco and other drug use in Australia (Australian Institute of
Health and Welfare, 2017b). Overall, women were less likely to report
illicit drug use, alcohol consumption or tobacco use than males
(Australian Institute of Health and Welfare, 2017b). This finding is
consistent across all recent previous iterations of the NDSHS (Australian
Institute of Health and Welfare, 2008, 2011, 2014b). In 2016, males
aged 14 or older were almost twice as likely to report drinking daily
compared with females (Australian Institute of Health and Welfare,
2017b). Similarly, more males reported any use of illicit drugs than
females in 2016 (Australian Institute of Health and Welfare, 2017b).
31
International Journal of Drug Policy 56 (2018) 30–39
Recent use of an illicit drug was higher amongst males: 18.3% of males
reported recent use of an illicit drug, compared with 13.0% of females
(Australian Institute of Health and Welfare, 2017b). Rates of recent
illicit drug use are highest amongst young women (ages 14–29)
(Australian Institute of Health and Welfare, 2017a). The NDSHS 2016
report notes, however, that there was a statistically significant increase
in females in their 30 s reporting recent use of illicit drugs — cannabis,
ecstasy, and cocaine — between 2013 (12.1%) and 2016 (16.1%)
(Australian Institute of Health and Welfare, 2017b).
Whilst fewer women report use of illicit drugs and alcohol than
men, there appears to be less difference between men and women in the
rate of occurrence of ‘problematic’ substance use and drug-related
harm. In a review of the literature on gender differences in substance
abuse, Pelissier and Jones (2017) note that there is inconsistent evi-
dence around whether there are significant gender differences in sub-
stance abuse problem severity and co-morbid disorders (p. 353). These
authors note, however, that there is more consistent evidence for
‘higher rates of sexual abuse, employment problems, and drug use
problems among at least one family member experienced by women, as
well as the greater percentage of women being responsible for a de-
pendent child’ (p. 353). Research on drug trends suggests that women
may be more likely to engage in risky practices and experience harm
from drug use (Breen, Roxburgh, & Degenhardt, 2005; Swift, Copeland,
& Hall, 1996). For example, whilst women comprise a smaller percen-
tage of the population of people who inject drugs, an Australian study
found that women who inject drugs may be more likely to engage in
risky behaviours such as sharing needles or injecting equipment and
performing sex work (Breen et al., 2005).
Women who use drugs demonstrate unique characteristics and
treatment needs (Ashley et al., 2003). Women who use drugs have high
rates of mental health problems, are more likely to experience adult
victimisation in the context of an intimate relationship, and are more
likely than males to have been introduced to substance use by a male
partner (Ashley et al., 2003; Shand et al., 2011). Women also experi-
ence particular barriers to accessing treatment and interventions, in-
cluding childcare responsibilities, problems accessing childcare, in-
appropriate treatment models based on male populations, and the
perception and experience of gendered stigmatisation from friends,
family or service providers (Ashley et al., 2003; Copeland, 1997).
Whilst people who use drugs are highly stigmatised (Lloyd, 2013),
gender is a key factor shaping how stigma impacts on people who use
drugs. A number of authors have suggested that women face greater
stigmatisation for their drug use than men, because of the breach of
traditional gender and care-giving roles that their drug use signifies
(Azim, Bontell, & Strathdee, 2015; Copeland, 1997; Greenfield & Grella,
2009; Simpson & McNulty, 2008). Research indicates that women who
use drugs perceive greater stigma from their drug use: for example, an
Australian study of pharmaceutical opioid dependent people found that
being female was associated with higher levels of perceived stigma from
drug use (Cooper, Campbell, Larance, Murnion, & Nielsen, 2018). For
women who use drugs and are also primary care givers, there may also
be the fear that health care providers will report them to child pro-
tection services (Azim et al., 2015; Taplin & Mattick, 2014). Factors
such as race, class, sexual identity, criminal history, injecting drug use,
HIV-status, contact with welfare and child protection systems, and in-
volvement in sex work, can compound the experience of gendered
stigma (Gunn, Sacks, & Jemal, 2016).
Gender appears to exert its major effect in terms of likelihood of
treatment entry, but shows no real effect on treatment process or out-
comes (Ashley et al., 2003; Greenfield et al., 2007) – although as
Pelissier and Jones (2017) note there is limited data on outcomes for
women. Research suggests that over the life-course women are less
likely than men to enter treatment for problematic drug use, however
once in treatment, gender does not predict treatment retention, rates of
completion or outcomes (Greenfield et al., 2007). The limited research
findings on gender-responsive treatment are less than equivocal. The
N. Thomas, M. Bull International Journal of Drug Policy 56 (2018) 30–39

majority of studies indicate that women-only treatment does not dis-
play greater efficacy than mixed-gender treatment (Greenfield et al.,
2007), although it can assist with likelihood of treatment entry and
retention for particular groups of women (for example, women with a
history of trauma, women who have engaged in sex-work, and same-sex
attracted women) (Ashley et al., 2003; Copeland, & Hall, 1992). A study
by Prendergast, Messina, Hall, and Warda (2011) assessing the relative
effectiveness of women-only (WO) outpatient programs compared with
mixed gender programs found mixed results, with women in the WO
group reporting less substance use and criminal activity than those in
the mixed-group treatment. Of course, the provision of women-only
treatment groups is not the only method of providing gender-responsive
treatment. Gender-responsive treatment programming and interven-
tions that address problems common to women who use drugs can
enhance treatment entry, retention, and outcomes among certain sub-
groups of women who use drugs, for example for women with children
or women who have experienced trauma (Greenfield et al., 2007). In
general, whilst there is a lot of literature advocating the need to address
gender issues in treatment and interventions, there are far fewer com-
prehensive outcomes studies of gender-specific programming (Pelissier
& Jones, 2017).
This brief review of literature on women, drug use and treatment
indicates that policies and interventions should be gender-responsive,
and should be tailored to the needs of women who use drugs. As the
clinical literature has been concerned to identify gender differences in
treatment needs, critical and feminist scholars have been concerned to
highlight the normative assumptions underlying clinical academic dis-
course in the drug field, suggesting that the production of this kind of
knowledge actively contributes to and reproduces the stigmatisation
and exclusion of women who use drugs (Campbell, 2000; Du Rose,
2015; Ettorre, 2004; Martin & Aston, 2014). So while the clinical ad-
diction literature has seen a push towards ‘gender-sensitivity’ in treat-
ment programming and policy, the critical and discursive literature has
observed how these constructions of women as objects of government
can serve to reproduce the same inequalities they seek to address
(Martin & Aston, 2014). The critical drug policy literature has shown
that the way problems are constructed in policy has consequences for
the kinds of practices or ‘solutions’ that are advocated, and results in
areas of relative policy silence or neglect (Bacchi, 2015; Fraser &
Moore, 2011; Lancaster & Ritter, 2014; Manton & Moore, 2016; Moore
et al., 2015). Consequently, in this study we were interested to in-
vestigate not just whether governments have attended to gender issues
in drug policy, but how these documents construct the ‘problem’ of
women’s drug use and contribute to areas of ‘policy silence’.
Method
Our investigation of whether and how Australian governments have
addressed women and gender issues in drug policy involved a doc-
umentary analysis. To achieve our overall research purpose, the fol-
lowing two questions guided document collection and analysis: 1. Have
federal and state and territory governments in Australia attended to
women and gender issues in drug policy and are there any best practice
guidelines around gender-responsive policy and treatment? 2. How
have Australian governments addressed drugs, women and gender is-
sues in policy? To answer the first question, the first stage of our project
involved a policy audit of national and state and territory drug policy
documents and programs that identified a number of relevant policy
strategies and documents (see the description below). The second stage
was a critical analysis of the ways these documents attended to women
and drug issues. Below, we outline our process of data collection and
analysis.
Document collection (Policy audit)
The first stage of our analysis involved a policy audit. The documents
selected included all national and state/territory drug strategy documents,
as well as health documents, and service plans and guidelines relevant to
women and drug use (see Table 1). All identified policy documents were
available online and obtained through searches of a range of state, terri-
tory and federal government websites, including: the National Drug
Strategy website; the National Health and Medical Research Council

Table 1
Policies and guidelines selected for analysis.

Policy Year Policy Document

Drug Strategies 2011 National Drug Strategy 2010–2015a

Women’s Health Policies
Treatment Guidelines/Principles
Gender-Responsive Treatment or
Interventions
2015 Queensland Alcohol and Other Drugs Action Plan 2015–17: Thriving communities
2013 Reducing the alcohol and drug toll: Victoria's plan 2013–2017
2006 NSW Health Drug and Alcohol Plan 2006–2010a
2011 South Australian Alcohol and Other Drug Strategy 2011–2016
2010 Australian Capital Territory Alcohol, Tobacco and Other Drug Strategy 2010–2014a
2009 Strategic Directions for 2009–12 for the Northern Territory Building Healthier Communities: A framework for health
and communities services 2004–2009a
2011 Drug and Alcohol Interagency Strategic Framework for Western Australia 2011–2015a
2013 Tasmanian Drug Strategy 2013–2018
2010 National Women’s Health Policy 2010
2010 ACT–Improving women’s access to health care services and information: A Strategic Framework 2010–2015
2013 NSW Health Framework for Women’s Health 2013
2005 South Australian Women's Health Policy
2013 Victorian Women’s Health and Wellbeing Strategy 2010–2014.
2010, 2016 National Co-morbidity Guidelines 1st and 2nd Edition–funded by Australian Government Department of Health and
Ageing
2013 Western Australian Drug and Alcohol Office: Counselling guidelines: Alcohol and other drug issues
2008 NSW Drug and Alcohol Psychosocial Interventions Professional Practice Guidelines
2013 Victorian Alcohol and Drug Treatment Principles
2011 NGO–Trauma-Informed Treatment Guide for Working with Women with Alcohol and Other Drug Issues: Funded by the
Australian Government Department of Health and Ageing for the ‘Improving Services for Women with Drug and
Alcohol and Mental Health Issues and their Children Project’
2011 Victorian Department of Health Service guideline on gender sensitivity and safety: Promoting a holistic approach to
wellbeing
2015 NGO: NADA Practice Resource Working With Women Engaged In Alcohol And Other Drug Treatment

a
Current at time of analysis. Draft strategies for some of these states and territories had been released but not approved.

32
N. Thomas, M. Bull
(NHMRC); and the Australian Institute of Health and Welfare (AIHW); the
state and territory Department of Health websites (New South Wales
[NSW], Victoria [VIC], Australian Capital Territory [ACT], the Northern
Territory [NT], South Australia [SA], Queensland [QLD]; Tasmania
[TAS]); the Western Australian [WA] Drug and Alcohol Office website;
and the Queensland Mental Health Commission website. We also per-
formed Google searches to locate gender responsive guidelines using a
combination of key terms including gender, responsive, sensitive, drug,
substance, treatment, best practice, counselling, and women. This search
elicited additional service guidelines and policies from research centres
and non-government organisations. Documents from research centres and
non-government organisations were used to identify oversights or silences
within policy and to offer another view of activity in the Australian AOD
field. This was not a systematic search, and as such there may be grey
literature that was not located. We examined 26 policy documents in total,
published between 2006 and 2016 (See Table 1).
Approach to critical analysis
The second stage of our analysis involved a critical analysis of the
selected policy documents. The methodology adopted to analyse the
policy documents takes a critical approach to policy analysis. Critical
policy analysis is a diverse field, and researchers using this frame have
drawn on a range of theoretical perspectives to critique contemporary
policy-making issues, processes and policy content (Diem, Young,
Welton, Mansfield, & Lee, 2014; Fischer, Torgenson, Durnova, & Orsini,
2015). Critical policy analysis can be distinguished from positivist ap-
proaches or ‘policy science’, as it does not see policy formation and
implementation as a straightforward process of responding to objec-
tively identified social problems (Orsini & Smith, 2006; Taylor, 2006).
Instead, policy is viewed as an active process of problem formation:
social problems are represented and constructed in particular ways as
domains of government and political intervention, and with particular
effects (Bacchi, 2009; Diem et al., 2014; Fischer et al., 2015; Orsini &
Smith, 2006). The ideas of discourse and problematisations have been
used as a theoretical tool within critical policy studies and in drug
policy studies. For example, there has been a recent turn to discursive
methods to analyse the construction of a range of drug policy ‘problems’
in policy (Fraser & Moore, 2011; Lancaster & Ritter, 2014; Lancaster,
Ritter, & Colebatch, 2014; Lancaster, Duke, & Ritter, 2015; Moore et al.,
2015). Problem representations shape what are thought of as possible
solutions to problems, also creating areas of silence or omission (Bacchi,
2009). As Stenson and Watt (1999, p. 92) explain,
[d]iscourses create, inter alia, a cast list of political and economic
agents which governments must consider, objects of concern,
agendas for actions, preferred narratives for making sense of current
situations, conceptual and geographical spaces within which pro-
blems of government are made recognisable. They also create a
series of absent agendas, agents, objects of concerns and counter-
narratives which are mobilized out of the discursive picture.
Therefore, in our analysis we were concerned to examine how the
problem of women’s drug use is represented in policy, and the effects of
these representations in terms of policy silences.
We conducted a critical policy analysis of the policy documents
identified during the policy audit. Considering that our second research
question asked ‘How have Australian governments addressed drugs,
women and gender issues in policy?’, we were influenced by critical
policy scholars’ concerns with problem representations in policy. Carol
Bacchi's (2009) ‘What’s the problem represented to be?’ (WPR) ap-
proach, in particular, has been used as a framework to analyse the
construction of a range of drug policy ‘problems’ in policy documents
(Bacchi, 2015; Fraser & Moore, 2011; Lancaster & Ritter, 2014;
Lancaster et al., 2015; Manton & Moore, 2015). Bacchi (2009, p. 2)
suggests the following six structured questions that can be used to in-
terrogate policy texts:
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International Journal of Drug Policy 56 (2018) 30–39
1. What is the problem represented to be in a specific policy?
2. What presuppositions or assumptions underlie the representation of
this problem?
3. How has this representation of the “problem” come about?
4. What is left unproblematic in the problem representation? Where
are the silences? Can the “problem” be thought about differently?
5. What effects are produced by this representation of the “problem”?
6. How/where has this representation of the “problem” been pro-
duced, disseminated and defended?
For the purposes of the analysis presented in this paper, we focused
on question 1 and 4 of Bacchi’s (2009, p. 2) questions, although ques-
tions 2 and 6 were also briefly addressed as part of our analysis. These
questions framed our critical analysis of how the policy documents have
attended to women and drug issues, directing us towards the pre-
dominant representations of women’s drug use in these strategy docu-
ments, and the policy silences that result from these problem re-
presentations. This helped us to address the second part of our research
question, which asked how governments have attended to women and
gender issues in drug policy. We used NVivo 10 to manage and code our
data set. Below, we present the results firstly of the policy audit, and
then present our critical analysis of the assumptions around women and
drug use present in our selected texts.
Results
Women & drugs in Australian policy: results of the policy audit
Drug policy in Australia is a complex field, requiring partnerships
and coordination across multiple agencies (e.g. health, law enforce-
ment, education) and Commonwealth, state, territory and local levels of
government, as well as the non-government sector, the community and
people who use drugs (Ritter, Lancaster, Grech, & Reuter, 2011). Since
the 1980’s, the Federal government has played an important role in
coordinating, developing and implementing drug policy in Australia. In
1985, the Hawke-Labor government introduced the National Campaign
Against Drug Abuse (NCADA); the purpose of the NCADA was to in-
stitutionalise a national approach to drug policy. Federal government
policy, now in the form of the National Drug Strategy, provides an over-
arching framework for drug policy in Australia, and also informs ex-
penditure decisions (Ritter et al., 2011). Ritter et al. (2011) note that
since the 1980’s, the key themes driving Australian drug policy have
been: harm minimisation, partnership approaches, a balance between
policy elements and a commitment to evidence-informed policy. The
overarching approach of harm minimisation in Australia now en-
compasses the ‘three pillars’ of supply reduction (i.e. law enforcement
efforts), demand reduction (treatment and prevention efforts), and
harm reduction (to reduce the harmful consequences of substance use).
While the federal government guides overarching drug policy in
Australia, the states and territories also have a responsibility for more
jurisdictionally focused drug policy development, implementation and
evaluation. The majority of states and territories have developed their
own guiding policy documents specific to substance use, with the ex-
ception of the Northern Territory which includes substance use policies
within its overarching health strategy. In-line with the National
Strategy, each of the state and territory strategy documents are guided
by a commitment to harm minimisation as an overarching approach,
including the three pillars of supply reduction, demand reduction and
harm reduction. All of the strategy documents analysed are char-
acterised by a concern with both licit and illicit drugs, with most policy
documents including aims, goals and strategies to reduce the use of
alcohol, tobacco, and ‘drugs’. All national and state and territory drug
strategies emphasised the importance of effective and evidence-based
approaches, with all documents (nine) articulating evidence-based or
effective policy and practice as an underlying principle, goal or aim.
Lancaster and Ritter (2014) also note the focus on ‘evidence’ in the
N. Thomas, M. Bull
national drug strategies.
Another commonly cited goal was increasing access to service. Five
out of nine Strategy documents specifically discussed increasing equity
of access to services for ‘vulnerable groups’, although not all of these
acknowledged gender differences explicitly, or identified solutions or
specific targets around women as a ‘special population’. Only two jur-
isdictions listed ‘women’ as a ‘special’ or ‘priority’ target of policy or
interventions (NSW and the ACT). The New South Wales Drug and
Alcohol Plan 2006–2010 (NSW Department of Health, 2006) specified
the importance of ‘build[ing] better relationships and strengthen[ing]
structures with special population groups identified in this plan’,
women were included as one of these groups. The foreword of the
Australian Capital Territory Alcohol, Tobacco and Other Drug Strategy
2010–2014 (ACT Health, 2010) noted that ‘the ACT Government is
aware that some issues impact men and women differently and that
responses need to include consideration of the underlying causes of
alcohol, tobacco and other drug use’ (ACT Health, 2010, p. 3). This
document goes on to identify women as a priority population group
several times, largely in relation to the demand and harm reduction
objectives of enhancing uptake and accessibility of treatment and ser-
vices (ACT Health, 2010).
‘Young people’ are identified as a target population in the majority
of drug strategy documents; however references to ‘young people’ are
overwhelmingly gender-neutral, and the differences between young
men and women are rarely discussed (this degendering of ‘young
people' in the NDS is also noted by Moore et al., 2015). In the rare cases
where these discussions are gendered, the main issue highlighted is the
higher prevalence of drug and alcohol use amongst males. Exceptions to
this include a specific reference to higher rates of ATOD use amongst
same-sex attracted young women, and the reference to young women’s
increased use of ecstasy in the National Drug Strategy 2010–2015
(Ministerial Council on Drug Strategy, 2011, p. 5). Our search did not
locate any government produced policy on gender-responsive service
guidelines or similar for working with young people; the only work that
we could locate that did discuss best practice guidelines for working
with young people was produced in the non-government sector — the
Dovetail Youth alcohol and drug good practice guide (Crane, Buckley, &
Francis, 2012) — and we could find only one document specifically
discussing young women in youth alcohol and other drug services
produced by an NGO (YSAS) (Daley & Kutin, 2013).
Our search identified other documents relevant to women and drug
use. These included five women’s specific health policies, one at the
national level and four at the state/territory level (ACT, NSW, South
Australia and Victoria). All of these discuss women’s alcohol, tobacco or
drug use in different ways and to different degrees. Perhaps un-
surprisingly (being gender and women-specific policies), all of these
documents advocated ‘gender-responsive’ services as a policy solution
to women’s health (and drug and alcohol problems).
We were unable to locate any national gender-responsive service
guidelines or any general substance abuse treatment or intervention
guidelines for alcohol and other drug services (perhaps because this is
considered a matter for Health departments in the states/territories).
We did identify two other documents relating to best practice in
treating women, or gender responsive services: one produced by a
government department, the Service guideline on gender sensitivity and
safety produced by the Victorian Department of Health (2011) and the
other by NADA, the New South Wales peak body for non-government
AOD organisations (Network of Alcohol and other Drug Agencies
(NADA, 2015). The document produced by NADA was part of a project
funded by the Department of Health to ‘build the capacity of the NSW
non-government drug and alcohol sector to meet the needs of substance
using women and their children’ (NADA, 2015). There is a strong his-
tory of involvement of NGOs in Australian drug policy and service
delivery (Thomas, Bull, Dioso-Villa, & Smith, 2016) – although it varies
by jurisdiction, a significant portion of AOD services are delivered by
the non-government sector (Australian Institute of Health and Welfare,
34
International Journal of Drug Policy 56 (2018) 30–39
2014a). We included four documents that described guidelines or
principles addressing women and gender in drug and alcohol services in
our critical analysis (see Table 1).
The audit of documents described above provided the platform for
considering how women’s drug use is represented in Australian drug
policy and practice. The discussion below focuses on two dominant and
inter-related ‘problematisations’ of women’s drug use that were evident
in our critical analysis of these documents: 1) Drugs and their effects on
women’s reproductive role, and 2) Drugs and their relationship to
women’s vulnerability to harm (most often discussed in relation to their
potential for sexual and violent victimisation).
Problematising women’s reproductive role
Pregnant women and women with children
One of the key ways that women’s drug use is problematised is in
relation to its effects on their reproductive role. Here, the focus is on the
role of women in producing children and the potential negative effects
of drug use on this role; women matter by virtue of their capacity to
reproduce (Bull, 2008). References to drug use in pregnancy was one of
the main ways that these drug policy documents discussed gender is-
sues.
Neo-liberal concern with pregnancy is most often expressed through
‘risk’ discourse (Lupton, 2012; Martin & Aston, 2014). Throughout the
majority of documents, pregnant women are specifically singled out as
an ‘at-risk’ or ‘high-risk’ group in relation to alcohol and other drug use.
The National Drug Strategy (NDS) 2010–2015 discusses gender only a
handful of times throughout the document, and in the majority of in-
stances, it is in reference to pregnant women or women who are mo-
thers (also noted by Moore et al., 2015). Under the demand reduction
objective to ‘reduce use of drugs in the community’, one of the objec-
tives identifies pregnant women as an ‘at-risk’ group: it specifies the
goal of ‘improv[ing] access to screening and targeted interventions for
at-risk groups such as young people, people living in rural and remote
communities, pregnant women and Aboriginal and Torres Strait Is-
lander peoples’ (Ministerial Council on Drug Strategy, 2011, p. 11). The
Tasmanian Drug Strategy 2013–2018–which only specifically mentions
gender in relation to pregnant women as an ‘at-risk group’ – makes a
similar recommendation for ‘targeted intervention’:’ repeating the aim
of ‘improv[ing] access to screening and targeted interventions for at
risk groups e.g.: young people, people living in rural and remote
communities, pregnant women, Aboriginal and Torres Strait Islander
people’ (Interagency Working Group on Drugs, 2013, p. 10). Under the
harm reduction objective to ‘reduce harms to families’, pregnant
women are mentioned several times.
Maternal consumption of licit drugs and their effects on the unborn
child is highlighted in a number of documents. The NDS notes that
‘efforts to reduce smoking among pregnant women, and prevention of
the exposure of pregnant women and babies to second-hand smoke
should be particular priorities’ (Ministerial Council on Drug Strategy,
2011, p. 18). A number of documents highlight the effects of maternal
alcohol use on ‘children in utero’ (Ministerial Council on Drug Strategy,
2011, p. 18), particularly in relation to birth defects and fetal alcohol
syndrome (FASD). Pregnant aboriginal women are particularly visible
in these documents for their ‘higher rate’ of smoking and drinking. For
example, the NDS notes that ‘FASD has been a particular issue in some
Indigenous communities.’ (Ministerial Council on Drug Strategy, 2011,
p. 18). For pregnant women who use ATOD, the majority of policy
solutions suggested in these drug strategy documents centre around
demand reduction, including treatment and preventive approaches
(including community education and early interventions).
There has been a considerable governmental concern to regulate
and respond to women’s use of drugs during pregnancy, as evidenced
by the number of national and jurisdictional guidelines specifically
discussing the management of drug use by pregnant women. The
Ministerial Council on Drug Strategy commissioned national clinical
N. Thomas, M. Bull
guidelines on this topic (Ministerial Council on Drug Strategy, 2006),
published by NSW Health, and a number of other states and territories
have also produced their own related guidelines and/or policy docu-
ments. Of course, there are also other policies specific to women’s al-
cohol use during pregnancy as well (for a review of these alcohol po-
licies see O'Leary, Heuzenroeder, Elliott, & Bower, 2007). Most of the
clinical guidelines outlined in Table 1 address a range of issues and
interventions for working with pregnant women, including drug and
alcohol assessment, confidentiality, communication and cultural issues,
assessment, early and brief intervention, and pharmacotherapies, as
well as drug-specific information (de Crespigny, Talmet, Modystack,
Cusack, & Watkinson, 2003; Government of Western Australia Drug and
Alcohol Office, 2008; Ministerial Council on Drug Strategy, 2006; New
South Wales Health, 2008). These documents highlighted the necessity
of balancing the needs of the mother with the needs of the unborn child
(for example, in relation to pharmacotherapies for pregnant women
who use heroin and its benefits versus drawbacks for the unborn child).
Perhaps unsurprisingly, the discussion in these documents is over-
whelmingly set in a medical frame, with the consensus across policy
and medical opinion being that substance use by pregnant women
causes harm to the developing child and that policies and strategies
need to be developed to manage that harm (Ettorre, 1992).
Ettorre (1992) observes that for women, ‘substance use is viewed as
damaging to biological and ideological reproduction’ (p. 139). Inspired
by Foucault’s sketch of biopolitics, feminist scholars have highlighted
how the health and wellbeing of children has become a central concern
in neo-liberal discourse because of their ‘future potentiality’ (Lupton,
2012, p. 335). Pregnant women are a site for policies directed at pro-
tecting the future population: ‘Pregnant women have thus become a
prime target for neoliberal governmental strategies directed not only at
the “care of the self”, but even more importantly, the “care of the
(foetal) other”: the valuable potential child’ (Lupton, 2012, p. 336).
This link between women’s substance use and risk to children’s
wellbeing is also expressed through a focus on women who are mothers
(and parents). Women with children are also to be targeted for inter-
vention. As Ettorre (1992), notes ‘motherhood is viewed as the most
natural way of being a woman in society’ (p. 156). The Drug and Alcohol
Interagency Strategic Framework for Western Australia 2011–2015
(Government of Western Australia Drug and Alcohol Office, 2011) re-
ferences women only three times; it focuses principally on women who
are pregnant or those who are mothers. Two relevant key initiatives in
this document include: targeting priority groups such as women with
children in the development of early intervention strategies, and im-
proving access to a broad range of AOD treatment services for ‘high risk
populations’ including youth, Aboriginal people, and parents with
children (including pregnant women) (Government of Western
Australia Drug and Alcohol Office, 2011). Some suggested policy so-
lutions centre around increasing the visibility of children (and families)
in AOD treatment, such as the action listed in the NDS and the Tas-
manian Drug Strategy of enhancing child and family sensitive practice
in alcohol and other drug treatment services (Interagency Working
Group on Drugs, 2013; Ministerial Council on Drug Strategy, 2011).
Where documents are not concerned directly with the risk to chil-
dren of women’s drug use, they also express concern at the effect of
women’s drug use on women’s potential reproductive role. In this dis-
course, drug use is conceptualised as a threat to women’s reproductive
health. The most recent National Women's Health Policy (2010) identifies
four priority health issues for women: prevention of chronic diseases
through the control of risk factors; mental health and wellbeing; sexual
and reproductive health; and healthy ageing (Department of Health and
Ageing, 2010). Women’s use of alcohol, tobacco and other drugs are
identified as ‘risk factors’ for reproductive and sexual health. To be
sure, the National Male Health Policy does not include a priority in
relation to sexual and reproductive health (although it does discuss it in
passing). The Victorian Department of Health (2012) discusses young
women’s alcohol and other drug use in terms of sexual and reproductive
35
International Journal of Drug Policy 56 (2018) 30–39
health, noting that ‘alcohol and illicit drug use is commonly associated
with sexual experiences for young women’ (p. 28). NADA’s guideline on
women’s services also discusses issues specific to women’s experience of
substance use and reproductive health, highlighting issues around
contraception and safe sex.
Problematising women’s vulnerability
Women ‘at-risk’: violence, sexual assault, mental health and trauma
The other major area of problematisation of women’s drug use is the
relationship between AOD use and women’s vulnerability to harm. This
discourse is intimately linked with women’s reproductive role.
Women’s vulnerability here figures in a range of ways linked with
gender norms. First, women’s drug use is linked with their risk of vio-
lent and sexual victimisation. A number of documents make de-gen-
dered statements about the relationship of alcohol consumption to
violence, although most also make gendered statements about the re-
lationship between violence and alcohol use. The Victorian drug
strategy, Reducing the alcohol and drug toll: Victoria's plan 2013–2017,
largely makes reference to women in relation to family violence, par-
ticularly ‘the contribution of alcohol to violence against women and
children’ (Victorian Department of Health, 2013, p. 12), stating that the
government seeks to address this through various alcohol-related stra-
tegies and Victoria’s action plan to address violence against women and
children 2012–2015. The Queensland Alcohol and other Drugs Plan
2015–17 also specifically mentions violence against women, and a re-
lated policy solution of developing the ‘Violence Against Women Pre-
vention Plan’ (Queensland Mental Health Commission, 2015). The ACT
Alcohol, Tobacco and Other Drug Strategy 2010–2014 reviews a range of
research on alcohol and violence (ACT Health, 2010), noting for ex-
ample that ‘…for women, it is almost as common to die from assaults
caused by risky/high risk drinking as from suicide’ (p. 21). The National
Women's Health Policy (Department of Health and Ageing, 2010) iden-
tifies four priority health issues for women: prevention of chronic dis-
eases through the control of risk factors; mental health and wellbeing;
sexual and reproductive health; and healthy ageing. Links are made
between women’s use of alcohol, tobacco and other drugs and violence,
for example where it is stated that ‘Studies also indicate evidence that
intimate partner violence is also associated with hazardous alcohol use’
(Department of Health and Ageing, 2010, p. 52).
Recognition of the link between AOD use, gender, and violence has
not happened in a vacuum. In recent years, there have been widespread
concerted campaigns to recognise various forms of violence and its
gendered nature, and this has been reflected in policy campaigns
around violence against women (for example, the National ‘Respect’
Campaign) in the Australian context (for example, the National
‘Respect’ Campaign or the QLD Violence Against Women Prevention
Plan). Recognition of women’s violent victimisation is unambiguously
gendered, and is driven in large part by a desire to acknowledge that
women are most often the victims of men’s violence. As Hollander
(2002, p. 476) notes, vulnerability discourses ‘portray women as weak,
violable, and inherently vulnerable to violence from dangerous
men...Men, in contrast, are portrayed as physically competent – as
capable of violating women or, paradoxically, protecting them from
danger’. Drugs and health policies reproduce the dominant discourse
that women are vulnerable to violence(Hollander, 2002), but few of the
policies make explicit mention of men as the gender most often per-
petrating violence, particularly sexual violence, against women. The
Western Australian Counselling Guidelines is an exception to this, noting
the ‘high rates of trauma, usually perpetrated by men, amongst female
clients presenting for AOD treatment’ (Marsh, O'Toole, Dale, Willis, &
Helfgott, 2013 p. 161).
Women’s vulnerability to men’s violence is linked with their re-
productive role. A number of documents explicitly discuss the link
between women’s alcohol consumption and sexual assault. The ACT
Plan states:
N. Thomas, M. Bull
It is well documented that in Australia there are many sexual as-
saults that occur each year following perpetrators spiking drinks
with alcohol. These sexual assaults are almost always against
women who are voluntarily consuming drinks almost always bought
by male friends or acquaintances, who do not inform the women
that the drinks are double or triple “shots” of spirits. They then
sexually assault the women when the latter are so affected by al-
cohol that they are incapable of consenting to sex. (ACT Health,
2010, p. 20)
In other documents, however, the gender of perpetrators is not
discussed, and women who consume alcohol at ‘risky’ levels are posi-
tioned as ‘more likely’ to experience victimisation:
When women consume high levels of alcohol, they are more likely
to experience some type of sexual aggression, including unwanted
sexual contact, sexual coercion, attempted rape and rape.
(Department of Health and Ageing, 2010, p. 52)
Elsewhere in the National Women’s Health plan, binge drinking is
linked with ‘violence and sexual reproductive health’ and an un-
gendered ‘perpetrator’, stating that ‘Rates of alcohol use and binge
drinking have increased among young people. Binge drinking is asso-
ciated with increased perpetration of sexual violence, coercive sexual
activity and victimisation’ (Department of Health and Ageing, 2010, p.
57). The National Co-Morbidity Guidelines also link women’s substance
use with women’s sexual and reproductive health and links substance
use with the possibility of re-victimisation via ‘risky situations’:
‘Women who misuse substances are more likely than men, or non-
misusing women, to have experienced sexual, physical or emotional
abuse as children, as well as domestic violence… In addition, sub-
stance use can often lead to victimisation via dangerous or risky
situations such as unsafe sex and prostitution’ (p. 102).
Although we are not trying to diminish the links between use of
substances and victimisation, these portrayals linking women’s con-
sumption with their own risk of victimisation are potentially proble-
matic because there is a danger in representing women’s victimisation,
particularly sexual victimisation, and its relationship to alcohol and
drug use, as a personal responsibility rather than addressing it also as a
structural and cultural issue. In this way, the policy focus on women’s
consumption of drugs and alcohol renders them as agents of their own
sexual and/or violent victimisation and neglects the responsibility of
the perpetrator (most often men) in these cases. This neglect or di-
minishing of men’s culpability in violence where victims have con-
sumed alcohol and/or drugs has also been noted by Moore, Fraser,
Keane, Seear, and Valentine (2017) in relation to alcohol research and
policy, as well as Seear and Fraser (2016) in relation to the use of ad-
diction discourses in legal processes.
The solutions advocated here largely involve improving the ability
of service deliverers to respond to these issues. For example, the
National Women’s Health Plan states that ‘Gender-sensitive program-
ming and policy making has the potential to significantly improve these
risk factors for women’ (Department of Health and Ageing, 2010, p. 52).
It also discusses the importance of capacity building ‘of work sectors to
train general practitioners, nurses, mental health, drug and alcohol
services and other frontline health workers to identify and respond
effectively to women experiencing violence’ (Department of Health and
Ageing, 2010, p. 25). The NSW Health Framework for Women’s Health
advocate that AOD services screen for sexual, domestic and family
violence against women amongst their clients.
A number of service guidelines on addressing gender issues in ser-
vice delivery note the importance of responding to trauma through
service delivery. For example, the Victorian Service Guidelines on Gender-
Responsive Services advocates ‘trauma-informed care’, as do the WA
Guidelines (Marsh et al., 2013; Victorian Department of Health, 2011).
A whole guide to trauma-informed care with women substance users
36
International Journal of Drug Policy 56 (2018) 30–39
was also released in 2012 (Marsh, Towers, & O'Toole, 2012). Under the
‘Improving Services for Women with Drug and Alcohol and Mental
Health Issues and their Children Project’, the Australian Government
Department of Health and Ageing provided funding for the Trauma-
Informed Treatment Guide for Working with Women with Alcohol and Other
Drug Issues (Marsh et al., 2012).
Women’s vulnerability is also problematised in relation to the
physiological and mental harm related to substance use. Links are made
between women’s consumption of drugs and alcohol and their experi-
ence of ‘chronic disease’ and health problems, as well as mental health
problems. The WA Guidelines note that women and men experience the
physiological effects of drugs differently, and that ‘Women are more
vulnerable to experiencing negative medical consequences of substance
use and dependence (Greenfield et al., 2007).’ (Marsh et al., 2013 p.
46). The National Co-morbidity Guidelines note the high rate of ‘co-oc-
curring’ mental health and alcohol and other drug issues’ amongst both
men and women, but point to the high rates of depression, anxiety and
personality disorders amongst women engaging in AOD treatment
(Marel et al., 2016). Similarly, the WA counselling guidelines note that
‘the mental health profile of men and women who develop AOD dis-
orders is different; women with AOD issues are more likely to experi-
ence co-occurring mental health problems, such as mood disorders,
personality disorders, and eating disorders’ (Marsh et al., 2013 p. 161).
Some of the documents identify specific vulnerable groups or po-
pulations of women, such as same-sex attracted women and Aboriginal
women. Along with same-sex attracted men, same-sex attracted women
and transgender women are identified as particularly vulnerable both
because of their higher rate of drug use and their vulnerability to
psychological distress (Marel et al., 2016). Aboriginal and Torres Strait
Islander people are identified as an ‘at-risk’ group in the NDS and the
Tasmanian drug strategy, and as a vulnerable (QLD, SA), ‘priority’
(WA), ‘special’ (NSW) or ‘target’ (ACT) population group in the majority
of the other jurisdictional drug strategy documents. Aboriginal and
Torres Strait Islander women are made particularly visible in these
documents, for example the ACT document states that:
Aboriginal and Torres Strait Islander women identify alcohol as a
major cause of violence and chaos within their lives. Indigenous
women are five times more likely to call police to attend a family
violence incident and 16 times more likely to seek support from the
integrated family violence services system than non-Indigenous
women (ACT Health, 2010, p. 3).
Several of the drug strategy documents discussed issues relevant to
intersectionality, or the ‘intersection’ of structural issues in substance
use issues and the relationship between race, gender, sexuality and
disadvantage (examples include the ACT Strategy and the NSW
strategy). The ACT strategy that observes ‘ACT Government is aware
that some issues impact men and women differently’ and that ‘the un-
derlying causes of harmful drug use can include: … marginalisation
such as that experienced through social class, ethnicity, lifestyle choice,
and gender’ (ACT Health, 2010, p. 3).
Areas of policy silence
The findings above highlight how women’s drug use is framed
predominantly around ideas of gender-specific risks of women’s sub-
stance use, particularly in relation to women’s reproductive role and
women’s vulnerability to harm. The consideration of these dominant
policy representations allows us to identify some of the ‘policy silences,’
— the discussions absent from policy reports (Bacchi, 2000, 2009; Ball,
1993; Scheurich, 1994; Taylor, 2006).
The reviewed policy documents reflected the dominant discursive
link between women and their relationship to reproduction and role as
mothers. This problem representation constructs pregnant women and
women with children as the necessary targets of government and ser-
vice intervention (Boyd, 2015). In her study tracing cultural
N. Thomas, M. Bull
representations of women who use drugs in American drug policy,
Nancy Campbell (2000) also highlights this hyper-focus on women and
their reproductive roles, particularly on pregnant bodies and women
who are mothers: ‘women’s reproductive capacities and responsibilities
place them in a more complex position [than men who use drugs].
Addicted women are understood to reproduce their own (in)humanity,
as well as offspring who are not fully human.’ (p. 138). In this discourse,
the ‘drug-using mother’ is both ‘over-produced’ and silenced at the same
time — mothers who use drugs are themselves largely denied agency;
policy solutions in this case involve interventions delivered by profes-
sionals. Feminist and post-structural scholars have commented on how
expert knowledge is drawn on in constructing women as objects of
government intervention (Campbell, 2000; Du Rose, 2015). This does
not deny the significance of women’s particular reproductive role and
its relationship to women’s drug use. However, it is important to re-
cognise how this particular focus can serve to further the neglect of and
even marginalisation of the needs of some women, including women
who do not have (nor desire to have) children, young women, as well as
same-sex attracted women and transwomen who do not conform to
normative assumptions around women’s reproductive role.
The discourse around women’s vulnerability is problematic because
it is constructed as either an individual problem or a problem for ex-
perts to manage. To a significant degree the policy solutions that stem
from the problem representations in these documents are for women to
either take personal responsibility (by simply not using substances in
the first place) or for experts to be responsibilised in addressing wo-
men’s particular issues (eg. as seen in gender-responsive, trauma-in-
formed treatment). The focus on personal responsibility and expert
management results in inattention to the structural issues underlying
the risk of and experience of drug-related harm. A danger lies in fo-
cusing on deficits here rather than strengths (although NADA’s docu-
ment on services for women explicitly mentions a strengths-based ap-
proach). Discourses emphasising women’s vulnerability to violence, for
example, neglect their ability to resist, and in particular what women
are already doing to resist as well as their strengths (Hollander, 2002)
and how these might be cultivated in productive ways. Hollander
(2002) observes that ‘women are not inevitably vulnerable to men's
violence’ (p. 476). An emphasis on women’s drug and alcohol use and
its role in their victimisation produces women as agents in their own
victimisation and erases the role and responsibility of perpetrators
(most often men). As Moore et al. (2017) state, in relation to re-
commendations stemming from alcohol research, “the constitution of
women and men as equally culpable unfairly allocates responsibility for
violence to women who are (sometimes fatally) its targets” (p. 316).
This corresponds with Seear and Fraser (2016)’s observations that re-
ferences to victim’s consumption of alcohol and/or drugs in legal pro-
cesses results in a perception of increased responsibility on the part of
the victim, and where the perpetrator has consumed drugs/and or al-
cohol, a diminishing of the perpetrator’s culpability for their own vio-
lence. References to the relationship between women’s drug and al-
cohol use and their risk of becoming a victim, as well as degendered
references to ‘perpetrators’, result in significant policy silences around
men’s drug and alcohol use, and neglect holding perpetrators to account
for their violence.
The drug policy documents analysed were silent about the con-
sequences of supply reduction and law enforcement measures for all
people who use drugs, let alone the consequences for women in parti-
cular. Drug-related offending is one of the major areas of crime that
women are arrested and imprisoned for (Australian Bureau of Statistics,
2016a, 2016b; Boyd, 2017; Malinowska-Sempruch & Rychkova, 2015).
Any account of the impact of this on women, children, families and the
wider community was entirely absent in the documents we considered.
Feminist scholars have highlighted how the ‘intersectionality’ of aspects
of social inequality – of gender, race, class, sexuality, and place – shape
women’s experiences of drug policy and the criminal justice system, and
in particular impact disproportionately on women from ethnic minority
37
International Journal of Drug Policy 56 (2018) 30–39
groups, lower incomes and from rural and regional areas (Boyd, 2015;
Campbell, 2000; Miller & Carbone-Lopez, 2015). The drug policy
documents analysed in this study were silent about the actual con-
sequences and lived experiences of people that are affected by the im-
plementation of supply reduction policies, and in particular how harms
created by the criminal justice system are unequally distributed along
class, race, and gender lines. As Du Rose (2015) argues, the sub-
jectivities assigned to women who use drugs through drug policy has
consequences for their identities and their experiences, and can actually
reinforce problematic drug use and social exclusion for women who use
drugs.
The ‘policy solutions’ addressing problem drug use among women
articulated in the majority of documents overwhelming relate to de-
mand reduction – particularly treatment – and to a lesser extent, early
screening and prevention. Harm reduction is discussed far less. This
means that the harm reduction needs of women are relatively neglected
(except where they are talked about in terms of ‘prevention’ programs).
This is concerning, particularly in light of research that indicates that
women are more likely to experience harms from their drug use. In
particular, the unique needs of women in particular harm reduction
service contexts (eg. needle and syringe exchange programs, peer-based
programs etc.) are almost entirely neglected. Consequently, there is a
policy gap in relation to harm reduction activities that women and
service providers can undertake, for example, providing women-only
harm reduction peer support groups and ‘safe environments’, as well as
practical concerns e.g. reviewing rules against children in needle and
syringe exchange programs, the provision of child care facilities and
flexible opening hours (Hankins, 2008). As Ettorre (2004) notes, harm
reduction programs need to take gender issues into consideration to
work, so these considerations should be addressed in future drug policy
formulation.
Conclusion
This article has identified a number of policy gaps in the response to
women who use drugs in the Australian context. Whilst there are pie-
cemeal acknowledgements of the need for gender responsivity across
the drug policy documents analysed, there is a lack of coordination or
guidelines on how to implement this in practice specifically in the
context of substance use interventions. Very few of the drug strategy
documents identify women as a priority population group for targeted
drug and alcohol use interventions. Interestingly, women were identi-
fied as a ‘special population group’ in the first national Australian drug
policy in 1985 (NCADA) and considerable effort was put into in-
vestigating gender issues at that time. In their discussion of re-
presentations of young people’s risky drinking and gender, Manton and
Moore (2016) note that gender has been a focus of policy and research
for many years, so this may have resulted in ‘a kind of “policy fatigue”
in responding to the endemic issue of gender’ (p. 156) There are cur-
rently no national policies or guidelines on gender-responsive AOD
services (although there have been government-funded publications on
women’s service issues), and only one state has produced guidelines
specifically on gender issues in services (Victoria); although there is
acknowledgement of gender issues in service guidelines from other
jurisdictions.
The point of this article is not to deny the significance of women’s
substance use in light of their particular needs and experiences as
mothers, or in light of women’s particular histories of victimisation or
trauma. Rather, the intended contribution of this article is to highlight
gaps in policy that can be addressed in future drug policy formulation.
The silences in governmental policy and the lack of national and state/
territory guidelines on gender issues in drug and alcohol interventions
is concerning, especially considering the UNGASS priority to ensure
that women are considered at all stages of the drug policy cycle
(General Assembly resolution S30/1, 2016). Moreover, the needs of
young women, same sex-attracted women, transwomen, and older
N. Thomas, M. Bull
women should be a consideration in policy formulation. Policy should
recognise and seek to address the structural issues around the inter-
section of race, gender and class and supply reduction policies focused
on criminal justice responses. The relationship between drug and/or
alcohol consumption and violent and sexual victimisation is also an
important policy issue, however future policy needs to be formulated in
a way that emphasises holding perpetrators to account, and does not
produce women as agents of their own victimisation. Furthermore, the
harm reduction needs of women have not been addressed in any
meaningful way in the policy documents analysed in this study; con-
sidering that Australian and international literature shows that women
are more likely to engage in ‘risky’ practices such as needle and syringe
sharing and sex-work, the harm reduction needs of women are an im-
portant area for future policy work.
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