Introduction

Alcohol treatment provision in the United Kingdom has undergone rapid change over the last 20 years, from something on the edges of substance misuse treatment, often treated in primary care, or by voluntary sector alcohol counselling services funded through charitable donations, to something that now features highly on the political agenda. This may in part be due to the economic impacts and variety of harms that alcohol creates in our communities.

The issue of gender, and, in particular, how services could or should respond to the needs of women accessing treatment, remains largely unexamined. For example, guidelines from the National Institute for Health and Care Excellence for the clinical treatment of alcohol use disorders (NICE, 2011) only mention women specifically in relation to accounting for differences in metabolic rates, and make no mention of other differences that need to be considered. While there are specific protocols for pregnant women and mothers – particularly in relation to risks such as foetal alcohol syndrome and child protection issues – there is scant acknowledgement of the wider impacts of alcohol misuse on women's social wellbeing. Services remain male-oriented in their approach, and the wider social context surrounding women's alcohol use is almost invariably not addressed.

For women experiencing difficulties as a result of hazardous, dependent or problematic alcohol use, there are some issues that need to be considered differently from those of men. These range from health considerations through to current and past domestic and sexual violence and abuse, issues of self-esteem, labelling, identity and the impact of role expectations. Those entering treatment services for the first time are likely to be presenting with high levels of anxiety and isolation, while those with wider experience of treatment services can often feel that they are just ‘more of the same’, with little hope on their own of delivering sustainable change in their lives.

What is particularly evident is that women are often poorly served by current service models (Staddon, 2012). This chapter considers the impact of alcohol treatment on women, and seeks to answer the question: What impact could a feminist perspective have on the development of a social model of treatment for women accessing services?