Gender matters in treatment demand
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GENDER MATTERS IN TREATMENT DEMAND. Isidore S. Obot, Ph.D., M.P.H. Department of Mental Health and Substance Abuse World Health organization Geneva, Switzerland. Global Extent of Psychoactive Substance Use. 200 million illicit drug users. Source: UNODC, 2003. Illicit Drugs.

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Isidore S. Obot, Ph.D., M.P.H.

Department of Mental Health

and Substance Abuse

World Health organization

Geneva, Switzerland

Global Extent of Psychoactive Substance Use

200 million illicit drug users

Source: UNODC, 2003

Illicit Drugs

2 billion alcohol users

Source: WHO, 2002



1.3 billion smokers

Source: WHO, 2002

  • 70 million with alcohol use disorders

  • 15 million with drug use disorders


Disease burden (DALYs) in 2000 attributable to

Addictive Substances related Risks

Number of Disability-Adjusted Life Years (000s)

The GENACIS Project

  • Gender, Alcohol and Culture: An International Study

    • More than 30 countries involved

    • Sponsored by the EU, NIH, WHO,etc.

    • Similar instrument in LDCs

    • Central data management

    • Data collection completed

Types of data collected

  • Demographics

  • Work experiences

  • Social networks

  • Drinking behaviour

  • Familial and other drinking contexts

  • Drinking consequences

  • Intimate relations and sexuality

  • Violence and victimization

  • Health and lifestyle (e.g., use of other substances)

Drinking status by men and women in

selected countries (%)

Source: GENACIS, 2004

Heavy episodic drinking by men

and women (%)

Source: GENACIS, 2004

Prevalence of alcohol dependence

Source: Global Alcohol Database, 2004


Data domains

  • No. of males and females in Tx for alcohol and drug problems

  • Injecting drug use

  • Drug law and policy

  • Treatment service administration

  • Types of services

  • Financing treatment

  • Human resources

  • Treatment data system

  • Prevention services

Number of member states in each WHO region

and survey response rates (%)

% of male and female clients in

treatment for alcohol problems

in the Americas 2001-2002

% of male and female clients in

treatment for drug problems

in the Americas 2001-2002

Availability of treatment data reporting system

  • Overall, 72% and at least 50% of the countries in each region (except AFR) reported the existence of a treatment data system.

  • Treatment data covered in the reporting system included: total number of admissions, types of drugs used by clients, mortality, IDU and HIV/AIDS data, and completion rates.

  • However, data included in the systems did not seem to be easily accessible.


Source: WHO Atlas-SU project

Other relevant findings

  • Few countries reported the existence of harm reduction programmes. For example, needle exchange programmes existed in only 28 of the countries with the highest proportions of countries in Europe and Southeast Asia.

  • Psychiatric and general hospitals were the most usual place where people went for treatment for substance use problems.

WHO's CEE Pharmacotherapy of Opioid DependenceProject

  • 15 countries – Belarus, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Estonia, Hungary, Kyrgyz Republic, Latvia, Lithuania, Poland, Russian Federation, Slovak Republic, Slovenia, Ukraine

CEE Project: Documentation of Tx Data

  • Client/patient data

    • Entry data: demographic, family history, personal history, social network, substance use, past tx experiences, convictions, legal status

    • Data at discharge: Type of discharge, follow-up tx, changes from entry data

  • Service description

    • Structural: legal basis, funding, programme, target population

    • Annual: staff turnover, conceptual changes

  • Tx description: diagnostic assessment, tx plan, medical care, etc.

Gender and Tx Demand in Bulgaria

  • 79% M and 21% F in 2000 (stable over the past 5-6 years)

  • In MM Tx as 31 December: 58 F & 143 M

  • Mean age – 29 F & 31 M

  • Youngest patient in MM: 19F, 20M

  • Oldest patient: 48F, 57M


  • Males account for 75% of opioid users entering tx.

  • Overdose deaths

    • 1998: Males - 23, Females - 9

    • 1999: Males - 30, Females - 7

Russian Federation

  • In 2000, 286,630 opioid dependent patients treated

  • 15.3% were female

Gender and Substance Use/Dependence

  • Women are less likely than men to drink or use illicit drugs but the gaps are closing in many countries, especially among the young.

  • The gap is least with heavy episodic or binge drinking, a pattern of drinking associated with increased physical, social and psychological problems requiring treatment.

  • Access to treatment is a problem in all parts of the world, influenced by availability and price.

  • There are many internal and external barriers to help seeking and care among women with alcohol and other drug problems (e.g. shame, fear of losing custody of children, service availability, etc.)

  • Primary care is an ideal opportunity for the identification and management of alcohol and other drug problems.

  • Reliable estimates of substance use and treatment data are essential for planning and service delivery in every country of the world.

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