The overall aim of this study is to assess the availability of and need for gender-sensitive prevention and treatment approaches in Belgium and the obstacles and challenges that are experienced by female substance users in utilizing these services. The scope is not limited to illicit substances, but also alcohol, prescription drugs and NPS are included. Importantly, gender-sensitivity is not only studied in treatment settings, but along the continuum of care including prevention, early intervention, harm reduction and continuing care settings.

The study will apply a multimethod design and will integrate quantitative and qualitative data. The project is structured around six workpackages: First, existing initiatives specifically targeted at (single-gender) or addressing women’s needs (mixed-gender) throughout the continuum of care in Belgium will be mapped and compared with available practices abroad (via EMCDDA best practice portal). All alcohol and drug services in Belgium will be send a short e-mail questionnaire to identify their services. Next, semi-structured interviews (approx. 30) with the project coordinators of all identified organisations offering single- or mixed gender-sensitive services will give more detailed information on the services offered. To measure to which extent programs offer gender-sensitive services a standardized instrument (based on the literature review) will be used in the interviews. Second, to identify good practices of gender-sensitive approaches for female substance users the international peer-reviewed literature will be reviewed. Also, the EMCDDA ‘best practice’ portal will be consulted as well as European national focal points on drugs and drug addiction to monitor specific interventions for women regarding prevention, treatment or harm reduction. Third, female substance users’ experiences and perspectives on good practices and barriers regarding alcohol and drug prevention and treatment will be explored by means of semi-structured in-depth interviews. We aim to recruit at least 60 female substance users (30 in Flanders, 10 in Brussels and 20 in Wallonia) with alcohol and/or drug problems from specialised (women only) services, as well as non-specialised services addressing the target population and specialised mixed-gender alcohol and drug services. After the first contacts with female substance users have been made, a strategy of snowball sampling will be adopted as a method to reach and find so-called hidden populations. Fourth, quantitative data for Belgium are further analyzed to assess the ‘gender gap’ in national population and treatment samples. Several existing databases will be analyzed: The Belgian Health Interview survey, the school surveys in Flanders (VAD), the Belgian branch of the Global Drug Survey, the VAD nightlife survey, the Treatment Demand Indicator (TDI) register and UGent-data on the evaluation of alcohol treatment programs in psychiatric hospitals. Data from these sources will be compared and integrated to estimate the extent of the ‘gender gap’ in population and treatment samples for all substances covered by the TDI. Fifth, we want to explore experts’ opinions regarding necessary services and programs for female substance users and prerequisites for implementing these services. In 4 focus groups (one on prevention, early intervention and harm reduction; one on treatment and continuity of care; two focus groups in Dutch, two in French) involving various stakeholders (service providers, practitioners, service users, …) who are familiar with the needs and expectations of female substance users, the challenges and obstacles will be discussed. During the focus groups we will use the GPS brainstormkit as a structural method to structure the brainstorm and to formulate specific recommendations for developing and implementing more gender sensitive approaches. Finally, the findings will be integrated into coherent and grounded recommendations. Based on the findings from the five work packages, conclusions will be formulated regarding the accessibility of alcohol and drug services for women and the availability of gender-sensitive alcohol and drug demand reduction in Belgium. Also, suggestions and recommendations for improving the accessibility of services and making them more gender-sensitive will be proposed. Particular attention will be paid to prevention and harm reduction initiatives and other services along the continuum of care which now pay little attention to female substance users’ needs.