This week, I was invited to attend the NSW Drug Summit in Lismore to discuss the challenges facing people with lived experience of addiction. Widjabul Wia-bal Elder Aunty Thelma James and Yaegl and Widjabul Wia-bal Elder Uncle Gilbert Laurie welcomed us to Bundjalung country, reflecting on the unique struggles their community has faced since the devastating 2022 floods. They spoke of trauma rippling through their region, and for some, alcohol and drugs became coping mechanisms amid the loss and disorientation—a sentiment that echoed throughout the summit’s discussions.
Trauma was a central theme of the day. The links between trauma and substance use are undeniable, yet the summit highlighted how the system is failing to address these needs in a way that truly supports underserved communities. We discussed how women escaping domestic violence often turn to alcohol or drugs to cope with their immense psychological trauma. However, most women’s shelters in Australia can’t accept residents using substances due to a lack of clinical support for safe withdrawal and recovery. This leaves women with an impossible choice: remain in an unsafe environment or face homelessness without adequate support.
Stigma was another key theme throughout the day. All women struggling with addiction, and particularly mothers and expectant mothers, face intense stigma and fear, often worried about losing custody of their children and feeling ashamed of their struggle. Women typically access treatment at lower rates than men and are more likely to hide their drinking from their families.
As a woman who has personally experienced alcohol dependence, I find it both heartbreaking and enraging that these issues persist. I know what it’s like to battle in silence, fearing stigma and isolation. When I needed help, despite my privileged position and healthcare background, I struggled to understand my own drinking problem. The media’s portrayal of alcohol dependence didn’t match my reality, so I assumed my struggle was a personal failure and believed that residential rehab was my only option—an option I couldn’t consider due to work and family commitments.
I participated in a discussion at the summit regarding the importance of choice and respect in treatment – this isn’t just a “nice to have”; it’s essential. Many women, especially those with gender-related trauma or from Aboriginal and Torres Strait Islander backgrounds, feel safer choosing the gender of their clinician. Cultural sensitivity in addiction services is critical, respecting traditions around “men’s business” and “women’s business.” For Aboriginal and Torres Strait Islander people, these considerations can mean the difference between accessing treatment or staying away due to fear or discomfort.
Another significant issue discussed throughout the day was the lack of aftercare. Women often leave treatment with minimal support, increasing the risk of relapse. This revolving door of short-term treatment without follow-up fails women, particularly those balancing caregiving roles. Aftercare should be standard practice in addiction treatment, and offered through virtual models to improve access, but chronic underfunding and workforce shortages make this challenging.
The summit also sparked conversations about harm reduction versus abstinence. Some attendees with lived experience shared their perspective that abstinence, especially with drugs, is a more effective approach for rehabilitation. I personally advocate for a goals-based and self-empowerment approach, with supported discussions (in groups and 1-2-1 with clinician), alongside at least an initial period of abstinence for anyone who needs to withdraw from a substance. This allows clarity and space for individuals to assess their long-term goals. For many, life improves so dramatically after a period of abstinence that moderation either loses its appeal or becomes more achievable.
During the morning’s plenary session, the summit also highlighted the potential for social enterprise to innovate in healthcare. While social enterprises have pioneered impactful models in other industries, they remain rare in addiction treatment. I am proud to lead a social enterprise in the sector, which focusses on social impact, innovation through technology, and sustainability, but we need more. Recent funding for social enterprises in Queensland and federally signals growing recognition of their potential, though healthcare has been slow to adopt these models.
Solutions: Addressing the gaps in women’s addiction treatment
To bridge these critical gaps, we need a comprehensive, compassionate approach that tackles the specific issues discussed at the NSW Drug Summit:
- Destigmatisation campaigns: Mothers often fear losing custody, and pregnant women face intense stigma when accessing services. Destigmatisation campaigns can combat societal judgement, alleviate fears of punitive measures, and raise awareness about the disproportionate trauma, abuse, violence, and financial hardship affecting women with substance dependence, encouraging a more compassionate approach.
- Choice of clinician gender and cultural sensitivity: Women with gender-related trauma and Aboriginal & Torres Strait Islander people need the option to choose the gender of their clinician, respecting cultural traditions around “men’s business” and “women’s business.” This choice should be standard in all addiction treatment settings.
- Commitment to aftercare and virtual care options: The lack of accessible, long-term aftercare contributes to poor outcomes. Virtual treatment options and expanded aftercare could ensure that women have continuous support beyond their initial treatment.
- Integrated services across sectors: Effective treatment for women must be holistic, addressing substance dependence, mental health, trauma, domestic violence, and family responsibilities. Stronger connections between addiction providers and mental health, domestic violence, and social services are essential. At Clean Slate Clinic has recently trialed in-reach withdrawal support into women’s shelters, demonstrating that such integrated models can work.
- Self-empowerment approaches: There’s ongoing debate about harm reduction versus abstinence. For many, abstinence provides crucial stability, helping them gain clarity and rebuild confidence. Services should adopt goals-based approaches, supporting each individual’s preferences while discussing the risks of moderation and benefits of abstinence.
- Social enterprise as a model for innovation: Social enterprises can drive innovative, impactful solutions in addiction treatment. Clean Slate Clinic has grown from supporting one new female client each week in 2021 to twenty-five new female clients every week today. Almost 60 per cent of our clients are women, and 78 per cent meet their goals three months after starting—a success rate far higher than traditional services. Funding and policy incentives for social enterprises in addiction treatment can encourage more organisations to adopt this approach, driving meaningful change.
Final Call to Action
The NSW Drug Summit highlighted that now is the time to advocate for these changes. If policymakers and healthcare leaders are serious about closing the gaps in addiction treatment, we need a system that respects choice, prioritises accessible and long-term support, integrates essential services, allows flexible recovery pathways, and fosters innovation. Critically, this must be backed by adequate funding and workforce resources.
Feature image: CEO of Clean Slate Clinic, Pia Clinton Tarestad