GENDER MATTERS IN TREATMENT DEMAND

GENDER MATTERS IN GENDER MATTERS IN TREATMENT DEMANDTREATMENT DEMAND

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

Department of Mental Health and Substance Abuse

World Health organizationGeneva, Switzerland

1.3 billion smokers

2 billion alcohol users

200 million illicit drug users

Tobacco

Alcohol

Illicit Drugs

Source: UNODC, 2003

Source: WHO, 2002

Source: WHO, 2002

Global Extent of Psychoactive Substance Use

70 million with alcohol use disorders 15 million with drug use disorders

0 10000 20000 30000 40000 50000 60000 70000

Illicit drugs

Alcohol

Tobacco

High Mortality DevelopingCountries

Low Mortality DevelopingCountries

Developed Countries

WorldDisease burden (DALYs) in 2000 attributable to

Addictive Substances related Risks

Number of Disability-Adjusted Life Years (000s)

Percentage of total global mortality and DALYs attributable to tobacco, alcohol and illicit drugs

High mortality developing countries

Low mortality developing countries

Developed countries

Risk factor

M F M F M F

Glob

al

Mortality Tobacco Alcohol Illicit drugs DALYs Tobacco Alcohol Illicit drugs

7.5 2.6 0.5

3.4 2.6 0.8

1.5 0.6 0.1

0.6 0.5 0.2

12.2 8.5 0.6

6.2 9.8 1.2

2.9 1.6 0.1

1.3 2.0 0.3

26.3 8.0 0.6

17.1 14.0 2.3

9.3 -0.3 0.3

6.2 3.3 1.2

8.8 3.2 0.4

4.1 4.0 0.8

The GENACIS ProjectThe 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 collectedTypes 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)

Country Men Women

Germany

Italy

France

Finland

Norway

Sri Lanka

Nigeria

Argentina

Uganda

95.5

90.3

92.8

92.3

91.5

53.6

42.1

92.8

51.2

94.1

74.6

88.7

90.2

88.6

6.4

22.3

77.6

39.5

Drinking status by men and women in selected countries (%)

Source: GENACIS, 2004

Country Men Women

Germany

Mexico

Finland

Norway

Sri Lanka

Nigeria

Argentina

Uganda

42.4

46.3

48.8

19.7

13.1

52.2

27.9

44.1

13.4

5.6

14.9

7.7

0.0

6.4

1.6

16.7

Heavy episodic drinking by men and women (%)

Source: GENACIS, 2004

Country Men Women

Germany

Belgium

France

Finland

Japan

Mexico

Brazil

Argentina

Poland

6

9.5

13.3

6.5

8.4

4.2

17.1

6.7

23.3

1.5

3.6

4.1

1.5

0.7

0.2

5.7

1.7

4.1

Prevalence of alcohol dependence

Source: Global Alcohol Database, 2004

THE ATLAS-SU PROJECT

Data domainsData 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

WHO region

No. of member states

No. of responding countries

% response

AFR (Africa)

AMR (Americas)

EMR (E. Mediterranean)

EUR (Europe)

SEAR (S. East Asia)

WPR (W. Pacific)

Total

46

35

22

51

11

27

192

32

22

7

26

5

10

102

65

63

32

51

45

41

53

Number of member states in each WHO region and survey response rates (%)

Country Males Females

Barbados

Bolivia

Brazil

Costa Rica

Ecuador

Guatemala

Guyana

Nicaragua

Peru

90

88

90

96

75

83.3

98

93

77

10

12

10

4

25

16.7

2

7

23

% of male and female clients in treatment for alcohol problems in the Americas 2001-2002

Country Males Females

Barbados

Bolivia

Brazil

Costa Rica

Ecuador

Guatemala

Guyana

Nicaragua

Peru

-

-

-

98

60

83.3

92

89

-

-

-

-

2

40

16.7

8

11

-

% of male and female clients in treatment for drug problems in the Americas 2001-2002

Availability of treatment data Availability of treatment data reporting systemreporting 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.

3.3

27.3

71.4

65.4

40

36.4

6.7

22.7

28.6

11.5

0

18.2

0

0

0

26.9

20

0

0

4.5

0

11.5

0

0

6.7

22.7

14.3

30.8

40

0

13.3

18.1

14.3

15.4

0

9.1

0

9.1

0

11.5

20

9.1

AFR

AMR

EMR

EUR

SEAR

WPR

Medical detoxification

Therapeutic communities

Methadone maintenance programmes

Other substitution programmes

Out-patient abstinence-based programmes

Residential chemical dependencyprogrammes (12-step model)

Programmes in correctional or custodialfacilities

PERCENTAGES OF COUNTRIES REPORTING "HIGH LEVEL" OF AVAILABILITY OF SELECTED

TREATMENT MODALITIES

Source: WHO Atlas-SU project

Other relevant findingsOther 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 WHO's CEE Pharmacotherapy of Opioid Pharmacotherapy of Opioid

DependenceProjectDependenceProject

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 CEE Project: Documentation of Tx Dataof 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 Gender and Tx Demand in BulgariaBulgaria

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

In MM Tx as 31 December: 58 F & 143 MMean age – 29 F & 31 MYoungest patient in MM: 19F, 20MOldest patient: 48F, 57M

LithuaniaLithuania

Males account for 75% of opioid users entering tx.

Overdose deaths– 1998: Males - 23, Females - 9– 1999: Males - 30, Females - 7

Russian FederationRussian Federation

In 2000, 286,630 opioid dependent patients treated

15.3% were female

Gender and Substance Gender and Substance Use/DependenceUse/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.