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It is well established that women face multiple barriers accessing treatment for problematic and unhealthy alcohol use, but less is known about how their interconnected problems affect how they seek help from, and access, alcohol-treatment services. This study aims to explore the dynamic nature of women’s help-seeking for problematic and unhealthy alcohol use and how this can be compounded by unsuitable treatment services, especially when women present with complex needs.

Thirteen semi-structured interviews with women who had accessed alcohol-support services were conducted, audio-recorded, transcribed and analysed thematically using the complexity theory.

For women with complex needs, the process of seeking help may trigger unpredictable behaviours, health or social problems and intermittent serial access to treatment. Current services do not always address women’s holistic needs. Unless services focus on addressing interconnected problems – including historic trauma – they may compound the complexity of women’s problems. Complexity theory offers novel insights into this process, a concept not applied to problematic and unhealthy alcohol use treatment previously.

Services should adopt the complexity-focused perspective featured in this study. While the authors acknowledge the increase in gender-responsive provision, the limitations of this study include a small sample size, the self-selecting nature of the sample and retrospective reporting. Participants were recruited and selected by service staff resulting in gatekeeping and possible sampling bias.

Services should adopt non-linear approaches to treatment. Implementing complexity approaches to treating women’s problematic and unhealthy alcohol use should capture the dynamics, complexity and non-linear nature of women’s help-seeking journeys as well as their internal and external responses that may result in relapse. The authors recommend complexity-focused, multiple-component and integrated collaborative strategies to address not only addiction but also all components of women’s needs, including past trauma.

Applying complexity-thinking to help-seeking experiences for alcohol treatment and recovery services is novel and proved useful in understanding the variety of women’s experiences and how these interact with their help-seeking behaviours, including treatment environments.

Introduction: Recent research studies focusing on the relationship between psychiatric illness and deviant behaviour (Huselid & Cooper, 1992; Holman, Jensen, Capell, and Woodard, 1993) suggest that a behaviour that is inconsistent with sex‐role expectations, particularly when it is defined as more appropriate for the opposite sex, is seen as deviant. By implication, women's alcohol misuse falls into this category of ‘deviant deviance’. In their research on gender roles as mediators of sex differences in adolescent alcohol use and abuse, Huselid and Cooper (1992), concluded that the relationships between gender roles and alcohol use were consistent with the hypothesis that individuals with conventional gender identities conform more closely to cultural norms that condone drinking among males but not among females. In addition to heavy and problem drinking of women judged frequently to be a deviation from the traditional feminine role, it is also viewed as a rejection of the traditional feminine sex‐role and adoption of an aspect of the traditional masculine role, or both (Chomak and Collins, 1987). In their research on sex‐role conflicts in alcoholic women, when the factors of age, socio‐economic status (SES), and marital status were controlled, Kroft and Pierre (1987) observed that alcoholic women scored as more depressed and more sex‐role undifferentiated than non‐alcoholic women. Alcoholic women were also found to have a relatively traditional sex‐role ideology, and remitted alcoholics expressed less satisfaction than other groups with some traditional female roles. The presence of conflict between perceived (real) and desired (ideal) gender‐role characteristics, rather than the specific pattern or direction of the conflict, may best predict problem drinking. Similarly, the research on gender‐role attitudes, job competition and alcohol consumption among women and men, conducted by Parker and Hartford (1992), concluded that among females, the non‐traditional role of employment in non‐traditional gender‐role attitudes concerning responsibilities for household labour and child‐care were associated with greater alcohol consumption. Among the employed, traditional females and non‐traditional males had greater alcohol use. The females and males who experience conflict between competition at the work‐place and substantial obligations at home consumed a greater amount of alcohol. The results of these clashes between feminine role pattern at home and traditionally masculine roles of paid employment will be social and psychological conflicts and tensions that could adversely affect women's mental health (McBroom, 1986). In other words, many women may find it stressful to switch between more masculine role expectations in the workplace and more feminine role expectations in the home (Gerson, 1985) and some may increase their alcohol consumption to alleviate distress resulting from mismatched gender‐related role expectations and preferences (Eccles, 1987).

Alcohol misuse leads to a massive drain upon an already stretched NHS budget. High numbers of individuals with alcohol related physical and health needs are being admitted into the secondary health care setting at great financial cost. This paper examines a profile of this population presenting to the secondary care setting over a 12‐month period. It is suggested that the misuse of alcohol does not take place in isolation. It is often accompanied by other problematic behaviours such as domestic violence, inappropriate, neglectful parenting, or child abuse, offending behaviour, and psychological problems. Evidence for the nature and extent of these associated behaviours is reported and discussed. Comparisons are made particularly with data related to tobacco smoking, and the positive aspects of smoking cessation programmes are outlined. Almost all of the population reported on over the 12‐month period were tobacco smokers. The re‐emergence of the incidence of smoking with the reduction of smoking cessation programmes is noted. The challenge for substance misuse services is how best to respond to the needs of this growing population who often present withalcohol misuse together with smoking behaviours. A collaborative model of response is outlined and suggested as the best way forward. This involves substance misuse services working together with professional colleagues within the acute hospital environment and community to ensure sustainable positive clinical outcomes following hospital discharge.

To outline the paradoxes and contradictions inherent in debates about sport, alcohol, and addiction. It appears that a growing number of sportspeople suffer from addiction to alcohol and other drugs while at the same time alcohol use is widely sanctioned and celebrated in sport. The high-profile falls from grace are a public display of a more insidious, problematic relationship to drugs and alcohol in sport, yet cultural change is often difficult given long standing associations between sport and alcohol.

In the first part of the chapter, the key themes in the drugs, alcohol, and sport debate (notably health and ethics) are discussed. In the second part, some of the relationships between sport and alcohol, such as sponsorship and the cultural sanctioning of particular forms of drinking and masculine identities are examined. In the third, the issues of drug and alcohol addiction and recovery, and the implications for sport and sporting identities are discussed.

The chapter reveals the tensions that underpin the social contexts of drug and alcohol use and misuse in sport. The chapter suggests that a recalibration of popular understandings of masculinity in sport may provide a safe space through which to share battles with alcohol and addiction.

Discussion of the paradoxes and contradictions inherent in the relationships between sport and alcohol have important implications for a discussion and analysis of addiction and alcohol in sport, and for sport and social policy, health promotion, and social care more broadly.

Against Violence & Abuse (AVA) and DrugScope undertook research into good practice interventions for supporting women involved in street-based prostitution and substance use. The purpose of this paper is to report on the findings of a survey of service providers and interviews with both service users and providers about women's involvement in prostitution and substance use, their associated support needs and how these can be met by services.

As part of a mixed methods study, this paper focuses on the findings of interviews with 19 women involved in prostitution and of a survey of and interviews with 64 services that support women involved in prostitution.

Generic substance misuse services are more likely to associate women's involvement in prostitution with funding their own or their partner's substance use. By comparison, specialist sex work projects are more likely to report women using substances to manage the emotional and physical pain of selling sex. These beliefs impact on the interventions delivered, with specialist services offering a more diverse package of care than generic services.

This study covered predominantly two English regions. A more systematic study of service provision across the UK would be welcomed and could be used to inform guidance for national and local policymakers.

This paper adds to the existing evidence base of “what works” in supporting women involved in prostitution. It is novel in its focus on women involved in prostitution who also use substances and in offering a detailed picture of the types of support currently available in England.

This paper is based on a survey of service provision for women experiencing domestic violence and who have additional complex mental health or substance use needs. Postal questionnaires were sent to domestic violence organisations, community mental health teams, mental health NHS trusts and substance use services. The views of women survivors of domestic violence were also sought. The survey, undertaken by Women's Aid, identifies some shortcomings in existing provision and makes recommendations for future development of services. More refuge provision is needed which can accommodate women with mental health and substance use needs, and their children.Mental health professionals and those working in drug and alcohol services also need training in domestic violence, to enable them to respond more appropriately to the needs of abused women and to work effectively in partnership with refuge organisations.

The purpose of this paper is to review the literature on the factors related to women’s ability to achieve and maintain abstinence from alcohol.

A rapid evidence assessment was carried out in four stages: definitions and research questions were agreed, search and selection were completed, data were extracted, quality of studies was assessed, and findings were synthesised and presented.

Medline, PsycINFO, CINAHL and ASSIA were searched for cohort studies published in English during January 2000–February 2015. Expanded search terms for Women, Alcohol and Abstinence, and Cohort were used to identify relevant studies for inclusion, resulting in 1,040 records. Of these, 32 manuscripts from 31 studies were eligible for inclusion in the review. Alcohol-related factors such as increased quantity and frequency of alcohol consumption were related to lower likelihood of achieving and maintaining abstinence; treatment factors such as type of treatment and number of treatment episodes were related to higher and lower likelihood; demographic factors such as financial problems and poor housing status were related to lower likelihood; and psychological factors such as craving, other drug use and comorbid health problems were linked to lower likelihood.

To the authors’ knowledge, this is the first time the factors related to the specific outcome of abstinence in women have been synthesised. Many of the factors found are also known to contribute to vulnerability for developing alcohol problems. The review revealed the paucity of studies with female only samples, or where results for women were reported separately.

This paper seeks to explore the views and experiences of female offenders with problem drug/alcohol use living in rural areas and to provide their perspectives on shortcomings in support services.

The research used in‐depth interviews with (ex) female offenders with problem drug/alcohol use living in rural areas in the East of England.

The research indicates that the barriers to adequate provision of services for women in rural areas have distinct, but overlapping, gender and geographical elements. Gender issues centre on the failure to see the female offenders in the context of their roles as mothers and partners. The geographical element includes a significant and under‐reported lack of public transport and childcare support.

Given the localised and opportunistic nature of the study, no attempt is made to claim that one can necessarily generalise from these results to all rural areas.

Increased recognition of women attending drug/alcohol support services as mothers with children, faced with problems of organising childcare, or accessing public transport. This is exacerbated by inadequate, public transport provision.

The importance of service providers recognizing the insight which clients could provide through their own lived experiences as users of services. In a rural situation with thinly spread provision, the importance of women‐only provision should not take precedence over quality of service provision.