Download - 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.