Transcript WHY GENDER MATTERS IN TREATMENT DEMAND

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
2 billion alcohol users
Source: WHO, 2002
Alcohol
Tobacco
1.3 billion smokers
Source: WHO, 2002
70 million with alcohol use disorders
15 million with drug use disorders
World
Disease burden (DALYs) in 2000 attributable to
Addictive Substances related Risks
Tobacco
High Mortality Developing
Countries
Low Mortality Developing
Countries
Developed Countries
Alcohol
Illicit drugs
0
10000
20000
30000
40000
50000
60000
Number of Disability-Adjusted Life Years (000s)
70000
Percentage of total global mortality and DALYs
attributable to tobacco, alcohol and illicit drugs
Risk factor
High mortality
developing
countries
M
F
Low mortality
developing
countries
M
F
Developed
countries
M
F
Glob
al
Mortality
Tobacco
Alcohol
Illicit drugs
7.5
2.6
0.5
1.5
0.6
0.1
12.2
8.5
0.6
2.9
1.6
0.1
26.3
8.0
0.6
9.3
-0.3
0.3
8.8
3.2
0.4
DALYs
Tobacco
Alcohol
Illicit drugs
3.4
2.6
0.8
0.6
0.5
0.2
6.2
9.8
1.2
1.3
2.0
0.3
17.1
14.0
2.3
6.2
3.3
1.2
4.1
4.0
0.8
The GENACIS Project
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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
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

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 (%)
Country
Men
Germany
95.5
Italy
90.3
France
92.8
Finland
92.3
Norway
91.5
Sri Lanka
53.6
Nigeria
42.1
Argentina
92.8
Uganda
51.2
Source: GENACIS, 2004
Women
94.1
74.6
88.7
90.2
88.6
6.4
22.3
77.6
39.5
Heavy episodic drinking by men
and women (%)
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
Source: GENACIS, 2004
Prevalence of alcohol dependence
Country
Men
Women
Germany
6
1.5
Belgium
9.5
3.6
France
13.3
4.1
Finland
6.5
1.5
Japan
8.4
0.7
Mexico
4.2
0.2
Brazil
17.1
5.7
Argentina
6.7
1.7
Poland
23.3
4.1
Source: Global Alcohol Database, 2004
THE ATLAS-SU PROJECT
Data domains
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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 (%)
No. of
No. of
%
member responding response
WHO region
states
countries
AFR (Africa)
46
32
65
AMR (Americas)
35
22
63
EMR (E. Mediterranean)
22
7
32
EUR (Europe)
51
26
51
SEAR (S. East Asia)
11
5
45
WPR (W. Pacific)
27
10
41
Total
192
102
53
% of male and female clients in
treatment for alcohol problems
in the Americas 2001-2002
Country
Barbados
Bolivia
Brazil
Costa Rica
Ecuador
Guatemala
Guyana
Nicaragua
Peru
Males
Females
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 drug problems
in the Americas 2001-2002
Country
Barbados
Bolivia
Brazil
Costa Rica
Ecuador
Guatemala
Guyana
Nicaragua
Peru
Males
Females
98
60
83.3
92
89
-
2
40
16.7
8
11
-
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.
PERCENTAGES OF COUNTRIES REPORTING "HIGH
LEVEL" OF AVAILABILITY OF SELECTED TREATMENT
MODALITIES
3.3
0
AFR 0
6.7
6.7
13.3
0
AM R
0
22.7
4.5
22.7
18.1
9.1
71.4
Therapeutic communities
M ethadone maintenance programmes
14.3
14.3
0
Other substitution programmes
65.4
11.5
Out-patient abstinence-based programmes
26.9
11.5
30.8
15.4
11.5
40
0
20
SEAR 0
40
0
0
W PR 0
0
M edical detoxification
28.6
0
EM R 0
EUR
27.3
20
18.2
9.1
9.1
36.4
Source: WHO Atlas-SU project
Residential chemical dependency
programmes (12-step model)
Programmes in correctional or custodial
facilities
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
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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
Lithuania

Males account for 75% of opioid users
entering tx.
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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
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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.