A University of Staffordshire study has exposed serious gaps in how Britain addresses substance abuse among women. The research, published in the International Journal of Environmental Research and Public Health, found that the connection between women’s trauma and substance use sits at the heart of addiction patterns, yet remains poorly addressed in policy and practice.

The findings reveal what frontline workers have known for years: you can’t treat addiction without treating trauma. Yet the current system forces women to choose between getting mental health support and staying in recovery programmes.

The Trauma Connection

Researchers interviewed 28 women accessing community drug and alcohol services across the West Midlands, alongside 17 service providers and nine frontline professionals. What emerged was a consistent pattern: women’s trauma and substance use are inextricably linked through adverse childhood experiences, domestic violence, sexual exploitation, and having children removed by authorities.

The statistics are damning. Office for Health Improvement and Disparities data shows that only about one-third of people seeking substance treatment services are female, despite rising numbers of women with drug addictions. This suggests a significant treatment access gap that the research team set out to understand.

Professionals identified that approximately 99% of women in the study had experienced trauma from adverse childhood experiences and continued abuse from partners in adulthood. This wasn’t abstract theory. It was lived reality affecting recovery outcomes.

One participant described how an older male partner (a heroin dealer) got her addicted as a teenager. She didn’t realise what was happening until she was already dependent. Another woman talked about being sexually exploited by family members from age 14 to fund their own addictions.

Female drug-related deaths reached 1,803 out of the total 5,448 deaths recorded by the Office for National Statistics in 2023. Each death represents someone the system failed to help whilst they were still alive and asking for support.

Mixed-Gender Services Put Women at Risk

A major finding centred on the risks women face in mixed-gender treatment settings. Women reported being targeted by predatory men who groomed them into exploitative relationships, coercing them back into drug use and sex work to fund both their addictions.

“When we’ve been in mixed groups, a woman will disclose something about domestic violence and there will always be one man saying ‘what about the men?'” one participant explained. “We get it, but we’re talking about women.”

This dynamic meant women couldn’t be honest about their experiences. They shut down rather than risk being belittled or targeted. Male service users who were themselves perpetrators of domestic abuse were being placed in the same groups as their victims. This is a safeguarding failure that contradicts the government’s stated commitment to reducing violence against women and girls.

The research found that males in mixed-gender services have a higher probability of domestic violence perpetration than the general public. Placing female victims in treatment groups with potential perpetrators isn’t just poor practice. It’s actively dangerous.

Women described how men in treatment would approach them with what seemed like genuine interest, then gradually manipulate them back into destructive patterns. Some became “protectors” who encouraged sex work. Others weaponised the relationship to maintain control.

“I’ve experienced that in the rehab that I was in, it was mixed,” one woman said. “I noticed quite a lot the men predating women that were really vulnerable, and the affairs that were going on were unbelievable. They just preyed on the women.”

Mental Health Services Block Recovery: Women’s Trauma and Substance Use Ignored

The catch-22 facing women is stark: mental health services won’t accept you unless you’re abstinent, but achieving abstinence is nearly impossible when you’re using substances to cope with unprocessed trauma.

Women reported waiting three to four years for mental health assessments. When they finally got appointments, services would reject them for not being drug-free. One woman described calling a crisis line whilst suicidal, only to be told they couldn’t help because she’d been drinking. That drinking was a direct response to the crisis she was experiencing.

“I waited a year for an appointment and they said you need help, but because of the drugs and alcohol we won’t work with you,” another participant explained. She’d been trying to process the trauma of having her children removed into care, which had triggered her substance use in the first place.

The research found that women’s trauma often went undiagnosed. Few received PTSD diagnoses despite clear trauma histories involving domestic violence, sexual abuse, and significant head injuries from intimate partner violence. Instead, some were labelled with personality disorders, raising questions about whether women receive accurate diagnoses and appropriate treatment.

One woman stated: “I suffer with PTSD, well it’s yet to be diagnosed.” Her trauma was obvious to anyone listening, but the system hadn’t caught up.

Women’s Trauma Starts in Childhood

Most women in the study began using drugs and alcohol in their early teens as a coping mechanism for childhood abuse. Many grew up in violent households or were placed in looked-after care where their trauma needs went unaddressed.

“I was brought up with the feeling of not feeling wanted, not feeling loved,” one woman explained. “I had very low confidence and self-esteem, then I started getting into risky behaviour because I was getting attention from that.”

Without healthy relationship modelling or proper sex and drug education, these young women became vulnerable to exploitation. Older males would target them, getting them hooked on drugs, then using their dependency to control them. In some cases, parents themselves sexually exploited their daughters to fund their own addictions.

One professional described the pattern: “Some of our women were in prostitution from the ages of 14. That’s through family pressure and often that’s because of the parents themselves needing money for drugs and alcohol.”

The pattern continued into adulthood. Women who’d been failed as children found themselves in abusive relationships, using substances to cope, then having their own children removed. This perpetuated the cycle.

Social workers emerged as a particular concern. Women described being judged rather than supported, with unrealistic expectations about how quickly they could achieve abstinence whilst dealing with ongoing trauma, domestic violence, and the grief of child removal.

“I have three kids,” one woman said. “He (the social worker) was awful, awful. I knew from the day he knocked on the door and I opened the door he just didn’t, that was it, he had made his mind up and I never got them back.”

Another woman stated that social workers seemed to make decisions within “the first 30 seconds” about removing children, without giving mothers sufficient chance to change their lives.

What Actually Works for Women’s Trauma Recovery

Women who accessed women-only services reported significantly better experiences. These settings allowed them to speak openly about abuse without being dismissed or targeted. Female peers and trauma-informed support workers helped them recognise exploitation patterns and understand what healthy relationships look like.

Healthy relationship education courses proved valuable, teaching women to spot “red flags” of abusive behaviour. Whilst not a complete solution (learned patterns from years of trauma don’t disappear overnight), this education gave women tools they’d never had.

One women’s centre provided daily activities including art, music, IT, courses, crafts, and cooking alongside talk-therapy and advice services. This wraparound approach kept women engaged and away from drug dealers between appointments, giving them positive ways to fill time rather than returning to old patterns.

The most effective services brought multiple agencies under one roof. As one professional explained: “Community hubs, multi-agency working, where everybody’s under one roof. There needs to be everything from somewhere where there’s childcare, a warm welcome space, a clothes bank, foodbank, education, DWP support. It’s not as simple as just supporting women to be not involved in the substance misuse.”

One project had its own counsellors, meaning they didn’t need to refer to NHS waiting lists. “When somebody moves into (the supported accommodation house) they go straight to the top of the waiting list for counselling,” a professional explained. This immediate access made a tangible difference.

Policy Failures Compound Women’s Trauma

The research highlighted how Britain’s From Harm to Hope drug strategy overlooks gender-specific needs. Understanding women’s trauma and substance use patterns requires policies that address both simultaneously, yet the current approach treats them as separate issues. The policy’s emphasis on abstinence and tougher sentences for recreational drug users may deter women from seeking help, particularly those who fear having children removed.

The disconnect between the drug strategy and the Women’s Health Strategy leaves women falling through gaps. One strategy aims to improve women’s mental health and reduce violence against women and girls. The other pushes approaches that may increase stigma and barriers to treatment.

Professionals expressed frustration that these issues have been known for years yet remain unresolved. Austerity has gutted services that once provided more comprehensive support. Waiting lists stretch on for years. Women who finally reach the front of the queue get turned away for not being abstinent—despite using substances to cope with the very trauma that mental health services should be treating.

“We have our clients saying ‘we need help’ and we’re like ‘we have referred you,'” one professional stated. “I think that’s probably the biggest thing for us, isn’t it? Just the wait times for the mental health support.”

Another professional described supporting a woman with schizophrenia who came out of prison: “It’s taken three months for (a mental health appointment) to happen. We are having to try and get adult social care involved because there’s been a de-escalation in mental and physical health. It could potentially lead to her committing a further crime but through no fault of her own.”

Breaking the Cycle

Addressing women’s trauma and substance use won’t improve without significant changes to policy and practice. That means:

Treating trauma as the root cause, not abstinence as a prerequisite. Mental health services must work with women where they are, not where services wish they were.

Recognising that mixed-gender treatment settings can harm women. When domestic violence perpetrators and their victims share group therapy, you’re not providing treatment—you’re creating opportunities for further exploitation.

Understanding that childhood trauma doesn’t resolve itself. Children in care need trauma treatment, healthy relationship education, and proper support to prevent them becoming the next generation of adults using substances to cope.

Training social workers to respond appropriately to women with addictions. Unrealistic expectations about rapid recovery and failure to understand how domestic violence affects parenting capacity perpetuates family separation and intergenerational addiction.

Funding women-specific services properly. One appointment per week isn’t enough when women need daily support, practical activities, and somewhere safe to go that isn’t surrounded by drug dealers.

The researchers concluded that women’s public health needs around substance use, mental health, and the connection with childhood and adult violence require better policy responses. Women are using drugs and alcohol to cope with trauma, yet the system denies them the trauma treatment they need to stop.

Those wait times are costing women their health, their children, and in some cases, their lives. With 1,803 female drug-related deaths in 2023, and only one-third of treatment service users being women despite rising addiction rates, the gender gap in addressing women’s trauma needs urgent attention.

Source: dbrecoveryresources