title: Access to treatment for substance-using women in the Republic of Georgia: socio-cultural and structural barriers.
abstract: BACKGROUND
  In the Republic of Georgia, women comprise under 2% of patients in substance use treatment and to date there has been no empirical research to investigate what factors may facilitate or hinder their help-seeking behaviour or access to treatment services.
  
  
  METHODS
  This study included secondary analysis of in-depth interviews with 55 substance-using women and 34 providers of health-related services.
  
  
  RESULTS
  The roles and norms of women in Georgian society were identified as major factors influencing their help-seeking behaviour. Factors that had a negative impact on use of drug treatment services included an absence of gender-specific services, judgmental attitudes of service providers, the cost of treatment and a punitive legal position in regard to substance use. Having a substance-using partner served as an additional factor inhibiting a woman's willingness to seek assistance.
  
  
  CONCLUSIONS
  Within the context of orthodox Georgian society, low self-esteem, combined with severe family and social stigma play a critical role in creating barriers to the use of both general health and substance-use-treatment services for women. Education of the public, including policy makers and health care providers is urgently needed to focus on addiction as a treatable medical illness. The need for more women centred services is also critical to the provision of effective treatment for substance-using women.
authors.affiliation: Addiction Research Center, Alternative Georgia, Tbilisi 0177, Georgia. Electronic address: dato@altgeorgia.ge.
authors.forename: David
authors.initials: D
authors.lastname: Otiashvili
authors.affiliation: Addiction Research Center, Alternative Georgia, Tbilisi 0177, Georgia.
authors.forename: Irma
authors.initials: I
authors.lastname: Kirtadze
authors.affiliation: Department of Psychology, University of Maryland, College Park, College Park, MD 20742, USA.
authors.forename: Kevin E
authors.initials: KE
authors.lastname: O'Grady
authors.affiliation: RTI International, Research Triangle Park, NC 27709, USA.
authors.forename: William
authors.initials: W
authors.lastname: Zule
authors.affiliation: Department of Addictions, Bekhterev Research Psychoneurological Institute, St.-Petersburg 192019, Russia.
authors.forename: Evgeny
authors.initials: E
authors.lastname: Krupitsky
authors.affiliation: RTI International, Research Triangle Park, NC 27709, USA.
authors.forename: Wendee M
authors.initials: WM
authors.lastname: Wechsberg
authors.affiliation: RTI International, Research Triangle Park, NC 27709, USA.
authors.forename: Hendrée E
authors.initials: HE
authors.lastname: Jones
mesh_terms: D000328:Adult; D003466:Cultural Characteristics; D055030:Drug Users / Q000331:legislation & jurisprudence / Q000523:psychology; D005195:Family Relations; D005260:Female; D005846:Georgia (Republic) / Q000453:epidemiology; D006291:Health Policy; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012649:Self Concept; D012737:Sex Factors; D012959:Socioeconomic Factors; D013240:Stereotyping; D016320:Substance Abuse Treatment Centers / Q000331:legislation & jurisprudence; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D014932:Women's Health Services / Q000331:legislation & jurisprudence
keywords: Barriers; Republic of Georgia; Substance abuse; Treatment policies; Women