1. 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

2. 1.3 billion smokers 2 billion alcohol users 200 million illicit drug users Tobacco Alcohol Illicit Drugs Source: UNODC, 2003 Source: WHO, 2002 Global Extent of Psychoactive Substance Use 70 million with alcohol use disorders 15 million with drug use disorders

3. World Disease burden (DALYs) in 2000 attributable to Addictive Substances related Risks Number of Disability-Adjusted Life Years (000s)

5. The GENACIS Project 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

6. Types of data collected 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)

7. CountryMenWomen Germany Italy France Finland Norway Sri Lanka Nigeria Argentina Uganda 95.5 90.3 92.8 92.3 91.5 53.6 42.1 92.8 51.2 94.1 74.6 88.7 90.2 88.6 6.4 22.3 77.6 39.5 Drinking status by men and women in selected countries (%) Source: GENACIS, 2004

8. CountryMenWomen 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 Heavy episodic drinking by men and women (%) Source: GENACIS, 2004

9. CountryMenWomen Germany Belgium France Finland Japan Mexico Brazil Argentina Poland 6 9.5 13.3 6.5 8.4 4.2 17.1 6.7 23.3 1.5 3.6 4.1 1.5 0.7 0.2 5.7 1.7 4.1 Prevalence of alcohol dependence Source: Global Alcohol Database, 2004

10. THE ATLAS-SU PROJECT

11. Data domains 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

12. WHO region No. of member states No. of responding countries % response AFR (Africa) AMR (Americas) EMR (E. Mediterranean) EUR (Europe) SEAR (S. East Asia) WPR (W. Pacific) Total 46 35 22 51 11 27 192 32 22 7 26 5 10 102 65 63 32 51 45 41 53 Number of member states in each WHO region and survey response rates (%)

13. CountryMalesFemales Barbados Bolivia Brazil Costa Rica Ecuador Guatemala Guyana Nicaragua Peru 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 alcohol problems in the Americas 2001-2002

14. CountryMalesFemales Barbados Bolivia Brazil Costa Rica Ecuador Guatemala Guyana Nicaragua Peru - 98 60 83.3 92 89 - 2 40 16.7 8 11 - % of male and female clients in treatment for drug problems in the Americas 2001-2002

15. 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.

16. PERCENTAGES OF COUNTRIES REPORTING "HIGH LEVEL" OF AVAILABILITY OF SELECTED TREATMENT MODALITIES Source: WHO Atlas-SU project

17. 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.

18. 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

19. 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 Service description – Structural: legal basis, funding, programme, target population – Annual: staff turnover, conceptual changes Tx description: diagnostic assessment, tx plan, medical care, etc.

20. 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

21. Lithuania Males account for 75% of opioid users entering tx. Overdose deaths – 1998: Males - 23, Females - 9 – 1999: Males - 30, Females - 7

22. Russian Federation In 2000, 286,630 opioid dependent patients treated 15.3% were female

23. Gender and Substance Use/Dependence 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.