{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T15:05:48Z","timestamp":1788793548991,"version":"build-2803163510"},"reference-count":58,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,2,17]],"date-time":"2022-02-17T00:00:00Z","timestamp":1645056000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Glob. Womens Health"],"abstract":"<jats:p>Women remain under-represented in addiction treatment, comprising less than a third of clients in treatment services. Shame, stigma, and fear of legal and social repercussions (e.g., child protection involvement) are major barriers impacting on treatment-seeking for women. This is compounded for women at risk of homelessness, with practical and logistical reasons for not engaging in treatment. We conducted a qualitative study with both clinicians and service-providers, and women with lived experience of addiction and at risk of homelessness, to identify barriers to access and help-seeking within this vulnerable population. Adult women with lived experience of homelessness and addiction were invited to participate in an online focus group. Interviews were transcribed and analyzed using framework analysis. Analysis resulted in the identification of barriers to access in three areas. These were system-related, socio-cultural, and emotional barriers. We also present findings from the focus group recorded in real-time, using the novel method of digital illustration. This study highlights key factors impacting on help-seeking and access to treatment for addiction faced by women at risk of homelessness. The findings of this study highlight important areas of consideration for clinicians and service-providers working with women who experience addiction, as well as informing future research directions for this priority population. Findings are discussed in the context of exigent literature.<\/jats:p>","DOI":"10.3389\/fgwh.2022.795532","type":"journal-article","created":{"date-parts":[[2022,2,17]],"date-time":"2022-02-17T04:46:11Z","timestamp":1645073171000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":18,"title":["Barriers to Accessing Addiction Treatment for Women at Risk of Homelessness"],"prefix":"10.3389","volume":"3","author":[{"given":"Davinia","family":"Rizzo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Temika","family":"Mu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia","family":"Cotroneo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shalini","family":"Arunogiri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,2,17]]},"reference":[{"key":"B1","volume-title":"Census of Population and Housing: Estimating Homelessness","author":"Statistics","year":"2018"},{"key":"B2","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.socscimed.2015.05.005","article-title":"From substance use to homelessness or vice versa?","author":"McVicar","year":"2015","journal-title":"Soc Sci Med."},{"key":"B3","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-030-70135-2_12","article-title":"Homelessness and substance use disorders","volume-title":"Clinical Management of the Homeless Patient: Social, Psychiatric, and Medical Issues.","author":"Stablein","year":"2021"},{"key":"B4","doi-asserted-by":"publisher","first-page":"106160","DOI":"10.1016\/j.addbeh.2019.106160","article-title":"Predicting homelessness among individuals diagnosed with substance use disorders using local treatment records","volume":"102","author":"Moxley","year":"2020","journal-title":"Addict Behav."},{"key":"B5","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1080\/00952990.2017.1357183","article-title":"Homeless women's service use, barriers, and motivation for participating in substance use treatment","volume":"44","author":"Upshur","year":"2018","journal-title":"Am J Drug Alcohol Abuse."},{"key":"B6","volume-title":"Specialist Homelessness Services Annual Report.","year":"2020"},{"key":"B7","doi-asserted-by":"publisher","first-page":"2021","DOI":"10.1186\/s12889-021-12104-w","article-title":"A qualitative examination of substance use service needs among people who use drugs (PWUD) with treatment and service experience in Ontario, Canada","volume":"21","author":"Russell","year":"2021","journal-title":"BMC Public Health"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/hsc.12857","article-title":"Homeless persons' experiences of health- and social care: a systematic integrative review","volume":"28","author":"Omerov","year":"2020","journal-title":"Health Soc Care Commun."},{"key":"B9","doi-asserted-by":"publisher","first-page":"230","DOI":"10.5694\/mja17.01264","article-title":"Homeless health care: meeting the challenges of providing primary care","volume":"209","author":"Davies","year":"2018","journal-title":"Med J Aust."},{"key":"B10","volume-title":"Examining the Relationship Between Structural Factors, Individual Characteristics, and Homelessness.","author":"Johnson","year":"2015"},{"key":"B11","volume-title":"Homelessness in Australia.","author":"Chamberlain","year":"2014"},{"key":"B12","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1023\/A:1016688707698","article-title":"Gender differences in self-reported reasons for homelessness","volume":"10","author":"Tessler","year":"2001","journal-title":"J Soc Distress Homeless."},{"key":"B13","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1016\/j.whi.2016.12.011","article-title":"Differences in health and social support between homeless men and women entering permanent supportive housing","volume":"27","author":"Winetrobe","year":"2017","journal-title":"Womens Health Issues."},{"key":"B14","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1111\/j.1525-1446.2004.21103.x","article-title":"Factors influencing homelessness in women","volume":"21","author":"Anderson","year":"2004","journal-title":"Public Health Nurs."},{"key":"B15","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1177\/1403494808099972","article-title":"Physical diseases among homeless people: gender differences and comparisons with the general population","volume":"37","author":"Beijer","year":"2009","journal-title":"Scand J Public Health."},{"key":"B16","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1016\/S0140-6736(17)31869-X","article-title":"Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis","volume":"391","author":"Aldridge","year":"2018","journal-title":"Lancet."},{"key":"B17","doi-asserted-by":"publisher","first-page":"605","DOI":"10.1080\/01612840.2019.1565875","article-title":"Mental ill health in homeless women: a review","volume":"40","author":"Duke","year":"2019","journal-title":"Issues Ment Health Nurs."},{"key":"B18","doi-asserted-by":"publisher","first-page":"199","DOI":"10.3109\/10884600109052654","article-title":"Considering pathways into homelessness: mothers, addictions, and trauma","volume":"13","author":"Belcher","year":"2001","journal-title":"J Addict Nurs."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/10530789.2018.1534427","article-title":"Women and homelessness, a complex multidimensional issue: findings from a scoping review","volume":"28","author":"Phipps","year":"2019","journal-title":"J Soc Distress Homelessness."},{"key":"B20","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1002\/jcop.22465","article-title":"Differences in stressful life events between men and women experiencing homelessness","volume":"49","author":"Rodriguez-Moreno","year":"2021","journal-title":"J Community Psychol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"8852","DOI":"10.1177\/0886260519853410","article-title":"Child abuse victimization, depression, and substance use among homeless women: application of general strain theory","volume":"36","author":"Song","year":"2019","journal-title":"J Interpers Violence."},{"key":"B22","doi-asserted-by":"publisher","first-page":"3379","DOI":"10.1177\/0886260517708405","article-title":"\u201cEvery time I try to get out, I get pushed back\u201d: the role of violent victimization in women's experience of multiple episodes of homelessness","volume":"35","author":"Broll","year":"2020","journal-title":"J interpers Violence."},{"key":"B23","doi-asserted-by":"publisher","first-page":"827","DOI":"10.3109\/01612840.2013.831149","article-title":"\u201cThe second thing to hell is living under that bridge\u201d: narratives of women living with victimization, serious mental illness, and in homelessness","volume":"34","author":"Bonugli","year":"2013","journal-title":"Issues Ment Health Nurs."},{"key":"B24","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1080\/03630242.2017.1296060","article-title":"Reproductive health rights and survival: the voices of mothers experiencing homelessness","volume":"58","author":"Cronley","year":"2018","journal-title":"Women Health."},{"key":"B25","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1300\/J013v40n02_06","article-title":"Access to women's health care: a qualitative study of barriers perceived by homeless women","volume":"40","author":"Gelberg","year":"2004","journal-title":"Women Health."},{"key":"B26","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1080\/10530789.2018.1548091","article-title":"Mothering in the margin: a narrative inquiry of women with children in a homeless shelter","volume":"28","author":"Azim","year":"2019","journal-title":"J Soc Distress Homelessness."},{"key":"B27","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1002\/jnr.23963","article-title":"Sex differences, gender and addiction","volume":"95","author":"Becker","year":"2017","journal-title":"J Neurosci Res."},{"key":"B28","doi-asserted-by":"publisher","first-page":"995","DOI":"10.1111\/adb.12382","article-title":"Why we should consider sex (and study sex differences) in addiction research","volume":"21","author":"Sanchis-Segura","year":"2016","journal-title":"Addict Biol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/j.cpr.2017.10.012","article-title":"Sex and gender differences in substance use disorders","volume":"66","author":"McHugh","year":"2018","journal-title":"Clin Psychol Rev."},{"key":"B30","doi-asserted-by":"publisher","first-page":"1052","DOI":"10.1111\/adb.12383","article-title":"Sociocultural context for sex differences in addiction","volume":"21","author":"Becker","year":"2016","journal-title":"Addict Biol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1111\/adb.12589","article-title":"Sex hormones in alcohol consumption: a systematic review of evidence","volume":"24","author":"Erol","year":"2019","journal-title":"Addict Biol."},{"key":"B32","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1007\/s40263-018-0525-5","article-title":"Role of exogenous progesterone in the treatment of men and women with substance use disorders: a narrative review","volume":"32","author":"Peltier","year":"2018","journal-title":"CNS Drugs."},{"key":"B33","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1016\/j.jsat.2018.08.008","article-title":"Group therapy for women with substance use disorders: In-session affiliation predicts women's substance use treatment outcomes","volume":"94","author":"Valeri","year":"2018","journal-title":"J Subst Abuse Treat."},{"key":"B34","doi-asserted-by":"publisher","first-page":"1","DOI":"10.35946\/arcr.v40.3","article-title":"Sex and gender effects in recovery from alcohol use disorder","volume":"40","author":"Holzhauer","year":"2019","journal-title":"Alcohol Res Curr Rev."},{"key":"B35","doi-asserted-by":"publisher","first-page":"108341","DOI":"10.1016\/j.jsat.2021.108341","article-title":"Difficult binds: a systematic review of facilitators and barriers to treatment among mothers with substance use disorders","volume":"126","author":"Barnett","year":"2021","journal-title":"J Subst Abuse Treat."},{"key":"B36","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1097\/CXA.0000000000000025","article-title":"Barriers to treatment for substance use disorders among women with children","volume":"9","author":"Brogly","year":"2018","journal-title":"Can J Addiction."},{"key":"B37","doi-asserted-by":"publisher","first-page":"107652","DOI":"10.1016\/j.drugalcdep.2019.107652","article-title":"Treatment for substance use disorders in pregnant women: motivators and barriers","volume":"205","author":"Frazer","year":"2019","journal-title":"Drug Alcohol Depend."},{"key":"B38","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1186\/s40352-015-0015-5","article-title":"Pregnant women and substance use: fear, stigma, and barriers to care","volume":"3","author":"Stone","year":"2015","journal-title":"Health Justice."},{"key":"B39","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/j.jsat.2020.01.005","article-title":"Treatment barriers among individuals with co-occurring substance use and mental health problems: examining gender differences","volume":"112","author":"Agterberg","year":"2020","journal-title":"J Subst Abuse Treat."},{"key":"B40","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1089\/lgbt.2020.0293","article-title":"Mental health and substance use diagnoses and treatment disparities by sexual orientation and gender in a community health center sample","volume":"8","author":"Batchelder","year":"2021","journal-title":"LGBT Health."},{"key":"B41","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1111\/ajad.12826","article-title":"Gender differences in mental health and substance use disorders and related healthcare services utilization","volume":"28","author":"Brand","year":"2019","journal-title":"Am J Addictions."},{"key":"B42","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.jsat.2015.09.006","article-title":"Treatment access barriers and disparities among individuals with co-occurring mental health and substance use disorders: an integrative literature review","volume":"61","author":"Priester","year":"2016","journal-title":"J Subst Abuse Treat."},{"key":"B43","article-title":"Alcohol and other drug treatment services in Australia: early insights","year":"2021"},{"key":"B44","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1186\/s13561-019-0227-9","article-title":"Out-of-pocket healthcare expenditure in Australia: trends, inequalities and the impact on household living standards in a high-income country with a universal health care system","volume":"9","author":"Callander","year":"2019","journal-title":"Health Econ Rev."},{"key":"B45","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1016\/j.jsat.2010.11.006","article-title":"Predictors of substance abuse treatment need and receipt among homeless women","volume":"40","author":"Tucker","year":"2011","journal-title":"J Subst Abuse Treat."},{"key":"B46","doi-asserted-by":"publisher","first-page":"103974","DOI":"10.1016\/j.ijnurstu.2021.103974","article-title":"\u201cStripped of dignity\u201d \u2013 women in homelessness and their perspectives of healthcare services: a qualitative study","volume":"120","author":"Kneck","year":"2021","journal-title":"Int J Nurs Stud."},{"key":"B47","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1186\/1471-2288-13-117","article-title":"Using the framework method for the analysis of qualitative data in multi-disciplinary health research","volume":"13","author":"Gale","year":"2013","journal-title":"BMC Med Res Methodol."},{"key":"B48","volume-title":"Workable Sisterhood : The Political Journey of Stigmatized Women with HIV\/AIDS.","author":"Berger","year":"2006"},{"key":"B49","doi-asserted-by":"publisher","first-page":"249","DOI":"10.4172\/2375-4494.1000249","article-title":"The promise of intersectional stigma to understand the complexities of adolescent pregnancy and motherhood","volume":"3","author":"Chambers","year":"2015","journal-title":"J Child Adolesc Behav."},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.1007\/s11469-021-00560-9.","article-title":"Negotiating multiple stigmas: substance use in the lives of women experiencing homelessness","author":"Thomas","year":"2021","journal-title":"Int J Mental Health Addict."},{"key":"B51","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1111\/j.1471-6712.2004.00275.x","article-title":"Ill health is powerlessness: a phenomenological study about worthlessness, limitations and suffering","volume":"18","author":"Margaretha Strandmark","year":"2004","journal-title":"Scand J Caring Sci."},{"key":"B52","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1111\/j.1447-0349.2009.00599.x","article-title":"Powerlessness, marginalized identity, and silencing of health concerns: Voiced realities of women living with a mental health diagnosis","volume":"18","author":"Van Den Tillaart","year":"2009","journal-title":"Int J Ment Health Nurs."},{"key":"B53","doi-asserted-by":"publisher","first-page":"388","DOI":"10.3389\/fpsyt.2019.00388","article-title":"The relationship between self-control and self-efficacy among patients with substance use disorders: resilience and self-esteem as mediators","volume":"10","author":"Yang","year":"2019","journal-title":"Front Psychiatry."},{"key":"B54","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1177\/1359105308090933","article-title":"Interventions to increase self-efficacy in the context of addiction behaviours: a systematic literature review","volume":"13","author":"Hyde","year":"2008","journal-title":"J Health Psychol."},{"key":"B55","doi-asserted-by":"publisher","first-page":"1120","DOI":"10.1016\/j.addbeh.2011.07.032","article-title":"The role of self-efficacy in the treatment of substance use disorders","volume":"36","author":"Kadden","year":"2011","journal-title":"Addict Behav."},{"key":"B56","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1186\/s12954-020-0356-9","article-title":"What constitutes effective problematic substance use treatment from the perspective of people who are homeless? A systematic review and meta-ethnography","volume":"17","author":"Carver","year":"2020","journal-title":"Harm Reduct J."},{"key":"B57","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12954-018-0247-5","article-title":"Need for women-centered treatment for substance use disorders: results from focus group discussions","volume":"15","author":"Elms","year":"2018","journal-title":"Harm Reduct J."},{"key":"B58","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1080\/14659891.2019.1620891","article-title":"What motivates people with substance use disorders to pursue treatment? A patient-centered approach to understanding patient experiences and patient-provider interactions","volume":"24","author":"Gressler","year":"2019","journal-title":"J Substance Use."}],"container-title":["Frontiers in Global Women's Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fgwh.2022.795532\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,17]],"date-time":"2022-02-17T04:46:17Z","timestamp":1645073177000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fgwh.2022.795532\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,17]]},"references-count":58,"alternative-id":["10.3389\/fgwh.2022.795532"],"URL":"https:\/\/doi.org\/10.3389\/fgwh.2022.795532","relation":{},"ISSN":["2673-5059"],"issn-type":[{"value":"2673-5059","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,17]]},"article-number":"795532"}}