Women battling addiction face barriers to treatment as GBV and trauma fuel hidden crisis

Women struggling with substance use face significant barriers to accessing addiction treatment, with a shortage of women-only treatment spaces, funding cuts and a lack of trauma-informed care leaving many without the help they need.

Experts warn that these gaps are particularly concerning in a country battling one of the world’s highest rates of gender-based violence (GBV), where trauma and addiction are often deeply intertwined.

South Africa’s response to substance use disorders is guided by the Prevention of and Treatment for Substance Use Disorders Policy and the National Drug Master Plan, which focus on reducing demand, limiting the supply of illicit substances and promoting harm reduction.

However, researchers and advocates argue that these policies have yet to translate into sufficient investment in gender-responsive addiction services.

They say women-centred programmes that address the complex intersection of substance use, trauma, gender-based violence, poverty, caregiving responsibilities and financial vulnerability remain underfunded and inaccessible, leaving many women without the specialised support they need to recover.

Research by Dr Danyschka Jacobs of the department of social work at Stellenbosch University found that many women who use alcohol and other drugs never make it into treatment. Even when they do seek help, many are lost after the initial intake because of inadequate follow-up and support.

Jacobs, who is also an addiction counsellor, said addiction among women cannot be understood without considering the realities of trauma, violence, poverty and caregiving responsibilities.

“For many women, substance use is not simply recreational or impulsive. It is often a survival strategy, a way of coping with trauma, abusive relationships, unstable housing and the burden of caring for children or extended family,” she said.

Mistrust of services is often high, and when programmes are not trauma-informed or responsive to women’s realities, treatment itself becomes another barrier rather than a source of support.

—  Dr Danyschka Jacobs, department of social work at Stellenbosch University

She said shame, stigma, fear of being judged, concerns about losing custody of their children and the costs of transport and childcare often delayed women from seeking help.

Even when women reached treatment services, many encountered programmes that were not equipped to deal with their experiences.

“Mistrust of services is often high, and when programmes are not trauma-informed or responsive to women’s realities, treatment itself becomes another barrier rather than a source of support,” Jacobs said.

She said women-specific treatment facilities remain severely limited, while specialised services for girls younger than 18 are almost non-existent.

“Effective recovery requires trauma-informed and gender-responsive care, yet many services still fall short because of limited staff training, weak trauma support and underfunded programmes that do not reflect women’s lived realities.”

Jacobs said women have historically been underrepresented in addiction research and treatment programmes, leading to a cycle in which their needs continue to be overlooked.

“Lower treatment numbers have wrongly been interpreted as evidence that fewer women use substances. In reality, many women cannot access treatment.

“The treatment gap has become normalised. Fewer women in treatment leads to less research, fewer dedicated beds, reduced funding for women-only programmes and limited professional experience in responding to women’s needs. The system then reinforces the misconception that this is a relatively small problem.”

Researchers have also found that women who use alcohol and other drugs face a greater risk of intimate partner violence and other forms of abuse than the general population, highlighting the close relationship between addiction and GBV.

According to the South African Medical Association’s (Sama) Women’s Wing, South Africa continues to experience some of the highest rates of gender-based violence in the world, with women and girls bearing the greatest burden.

Healthcare facilities routinely treat survivors of physical assault, sexual violence and intimate partner violence, many of whom require ongoing medical, psychological and social support. However, many incidents are never reported because survivors fear retaliation, stigma or cannot access support services.

Sama’s women’s wing warned that GBV is not only a human rights crisis but also a major public health emergency that places sustained pressure on emergency departments, trauma units, primary healthcare facilities and mental health services.

The latest South African Police Service crime statistics illustrate the scale of the crisis. During the most recent reporting period, police recorded 9,782 rape cases, while sexual assault cases increased by 4.2% and attempted sexual offences rose by 2%.

The figures also show that violence is overwhelmingly committed by people known to victims rather than strangers. Nearly half of all reported rape cases, 4,620 of the 9,782 incidents, occurred either in the victim’s or perpetrator’s home.

Sama said the consequences extend far beyond physical injuries. Survivors often experience depression, anxiety, post-traumatic stress disorder, substance misuse, sleep disorders and other long-term mental health conditions that can affect every aspect of their lives.

The association said repeated exposure to GBV places enormous strain on South Africa’s healthcare system, with hospitals and clinics managing thousands of preventable cases every year that require multidisciplinary care involving doctors, nurses, psychologists, social workers and forensic practitioners.

Jacobs believes addiction treatment must become part of South Africa’s broader response to GBV.

“Gender-responsive services should address trauma, gender-based violence, motherhood, reproductive health, parenting and financial vulnerability as core components of treatment rather than treating them as side issues,” she said.

She also called for women to play a greater role in designing programmes intended to support them.

“Most importantly, women themselves must help shape what effective treatment looks like.”

Jacobs urged government to move beyond policy commitments and invest meaningfully in women-centred addiction services.

“We need stronger community outreach and real investment in reaching women before they are lost. That means reopening treatment spaces that closed because of funding cuts, restoring specialist training, supporting frontline staff and building a stronger presence in the communities where women live and use substances.

“Women need to know that treatment services exist, that they can be trusted and that they will be met with compassion rather than shame, punishment or humiliation,” she said.