Women who use Drugs and have Experienced Gender-Based Violence: Barriers and Facilitators to Accessing Substance Use Services in Scotland
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Against the backdrop of Scotland’s escalating drugs deaths crisis, women who use drugs face severe and unique challenges to accessing substance use support. Among these challenges are widespread experiences of gender-based violence. While international research demonstrates that gender-based violence creates multiple, complex barriers to accessing substance use services, little is known about how these barriers manifest for women in Scotland. Guided by intersectionality theory, this study aims to address this research gap by exploring barriers and facilitators to substance use services for women who use drugs and have experienced gender-based violence in Scotland. Semi-structured interviews were conducted with 11 professionals working in substance use services and policy. Reflexive thematic analysis was undertaken, and interviews were triangulated against an analysis of 13 documents on Scottish drugs policy. Child removals, controlling partners, self-confidence, insufficient service integration, and knowledge deficits among staff were identified as barriers to service access for women affected by gender-based violence. Policy silence on gender-based violence emerged as a barrier, alongside a perceived conflict with the needs of men. Facilitators identified include assertive outreach, co-location of gender-based violence and substance use services, and gender-specific programming. Women involved in transactional sex, or experiencing homelessness, mental illness, poverty, or parenthood were found to face additional barriers. These findings call for greater consideration of gender-based violence in Scottish drugs policy. Services are recommended to introduce mandatory gender-based violence training, explore co-location with gender-based violence services, and consider expanding gender-specific support.