 It's 5 past 12. I welcome everybody, this huge number of participants in our first webinar in 2022. I will directly give the floor to our director who is very busy today so he will need to join another important meeting and I don't waste more minutes. Alexis, the floor is yours. Thank you. Thank you very much, Marika. Good afternoon everybody. Well, first of all, it's a real pleasure to welcome all of you. The topic of today is extremely important for the MCDDA and for me as director, both for women and drugs, but also for gender equality. So it's also about the MCDDA and its staff and all people working with us. I cannot resist to the idea to pay a special tribute to all women in Ukraine or fleeing Ukraine today in those weeks. But I would like to extend to women who are in other regions of the world, also in places where there is a war, because what's happening in Ukraine is totally horrible and unacceptable. But I think that it's equally unacceptable not to speak about the same kind of people, victim of other similar situation in other places of the world. So I think solidarity should be either all solidarity or nothing. So that's the message I want to share with you. I think those webinars, and of course specifically the topic for today, they illustrate one of the important changes we tried to bring as MCDDA to the way we work, both because you will certainly notice that most of the time we know webinars is not MCDDA speaking. And I think that's one of the originality of our webinars is to give the floor, to give visibility to our partners, to experts from the field, from the civil society, also scientific experts. And I think with Cristiana Sara and Christina today, we have another very good example and I'm very proud they accepted to speak and to participate in this webinar. A special message to Cristina from EAG, because her participation is a very concrete illustration of the cooperation that we established with other European agencies. They look a bit esoterical for those who don't know the kind of European galaxy, but actually there are all reasons for MCDDA to cooperate with the European Institute for Gender Equality. For the same reason we are cooperating with the Fundamental Rights Agency and we are developing a partnership regarding the work with migrants. And there are other corporations that are ongoing. So I certainly ask Cristina to convey my best regards to her director. And then I have special thanks to the permanent actor and promoter for the webinar. It's Marika and Alessandra. And of course, I don't want to forget Marco. I welcome also Judy Chang who joined us. And then I have extremely special, wonderful thanks to Linda because Linda is someone who's fully dedicated and Linda never abandoned. So every time, even when at MCDDA, we were less active or were less conscious of the importance to keep an eye on what's happening to with and for women and drugs. Linda always continued to work, provide support, provide input, and she has my full support for that and I'm extremely thankful for that. So as Marika said, and I really want you to believe me, I really hate the idea that I need to say I'm so busy and so important, I have another very important meeting. Usually when I'm there, I'm attending the entire webinar, and also sharing concluding remarks. Well, today it's not possible because actually we have just this afternoon, we have an informal webinar with all the members of our management board. Some of you probably know that there is a proposal of the European Commission to change the mandate of the MCDDA to broaden this mandate. And this afternoon, I'm expected to answer to the practical questions from the members of our management board, from the representative of the member states to explain what those proposals of the commission would mean in terms of action consequences for the agency, consequences for our customers. And I think for me the best way to prepare myself for that other presentation is to take a bit the taste of some of your presentation, I will not say bye bye, I will already close my webcam, I will listen to some of you then I will have to leave. But why is it important because with the new business model that was adopted by our management board in December on our proposal, we have the commitment to go to move forward in changing the business model of the MCDDA to make it even more customer centric. And for me to be customer centric means first of all, to be more useful for practitioners working on the drug field, to be more useful for people who are using drugs and their families, their relatives. And this cannot be done without you. And I think the participation, the audience, and the speakers in this webinar, they are the most concrete illustration of what we try to achieve as European drugs agency to be at the service of the community and the citizens. So I wish you a fruitful discussion. And I promise that I will watch the recorded version, not to lose anything of what you have shared together today. Thank you very much. Thank you Alexis for this wonderful and energy boosting introduction. I will leave the floor to Linda Linda Montanari, who will be the chair for this session today. Thank you very much. Thank you. Thank you, Marika. And thank you, Alexis, for the nice words. I would like to welcome everyone. And we are glad that we are so numerous and such a large audience for this topic. The winner of today's woman and drugs. We know that women are just a minority among the people who use drugs, but they have specific characteristics, specific needs and pathway to drug use and drug addiction in some cases. Despite this, the drug field has often be considered as a gender neutral phenomenon. And when gender, a gender dimension was considered, often it focused on women, and especially on specific characteristics and the maternal role of women. While this is, of course, really important because it's actually concerning mainly the women, the care of children and family and so on. Still, like in the rest of the society, there are other issues that are also important and like gender based violence stigma, but also women's agency in drug taking. It is important to consider this. In this webinar, we would like to discuss the role that gender as a social structure has on influencing women's behavior and, in particular, drug use behavior among women. We will discuss this and we will also like to see how and try to discuss how the changes in the gender role in the society may influence also changes in drug use behaviors. Also, we try to conceive this webinar thinking that women are not all the same. So when we look at the drug phenomenon, we should consider the gender dimension, but also the intersecting of this gender dimension with other factor, other dimension and consider also specific group of women, like sex workers, migrants, women in prison. So we will try to discuss this and women and drugs across also different generation and see how what has changed. And we will discuss with four distinguished experts that are here with us and that will present their perspective. So they will talk from different professional backgrounds, different experience, different countries and institution. But before giving the floor to the first speaker, I would like to show a motion graphic that we prepare in 2019, in occasion of the Women's Day. Let's see if I managed to show the graph, the motion graphic. 37 million women have used an illicit drug at least once in their lifetime. Around 100,000 women enter drug treatment every year. Nearly 2,000 die from drug overdose. Over the last decade, the gender gap has been narrowing among young school students who use drugs. Women represent only a fifth of clients in specialized drug treatment, but their problems are often more complex than for men. They tend to progress faster towards addiction, a phenomenon known as telescoping. They go through more severe withdrawal symptoms and report higher levels of depression and anxiety. Women often start using drugs through a drug-using male partner and are more likely to share needles and other equipment with their partner. In general, women are likely to have fewer socioeconomic resources. This is even more the case for women who use drugs. They experience more stigma because they may be perceived as contravening their roles as mother and caregiver. Some groups of women have specific needs, such as pregnant and parenting women, women from ethnic minorities, women in prison and those involved in sex work. A specific drug-related issue for women is intimate violence and drug-facilitated sexual assaults, which has serious psychological and social consequences. Services for women with drug use problems need to address these unique concerns. They need to be welcoming, non-judgmental, supportive and physically and emotionally safe. To achieve this, women who use drugs need to be fully involved in the planning and development of policies and services. The staff recruited in drug services need to have appropriate attitudes, knowledge and skills. Services need to be well-coordinated and integrated to address different issues, such as mental health, pregnancy and childcare. And monitoring and research needs to consider this gender dimension to optimize effective responses for women with drug-related problems. I hope you enjoyed the motion graphic and you can download the motion graphic and see it on our website and on YouTube. So now it's time to give the floor to the first speaker, Christina Fabre Rossell. Christina works as a gender-based violence team leader at the European Institute for Gender Equality. She's project manager of the studies related to administrative data collection on specific forms of gender-based violence and advancing the measurement and the conceptual framework of femicide. Christina was head of unit of observatory against domestic and gender-based violence and member of the Equal Rights Commission of the Spanish General Council of the Judiciary. As gender consultant she contributed to the project on establishing a gender-based violence measurement framework in Central America and those strengthening the victims right in criminal justice system in Turkey. Christina, she's also member of the European Group on Gender and Drugs. So we would like to ask Christina a question, not referring to the drug field but in general, how has changed the role of gender in society and how this has influenced women's behavior and main issues. Thank you, Christina. Thank you, Linda. And thank you also, Alexis, for inviting me here at this webinar. It's very encouraging to see how sensible your agency is towards gender issues and how committed you are to apply to gender perspective in the research and policies. So it's my pleasure to be here. Well, I will talk a bit on the links between the gender-based violence and drugs, but I will also introduce how we can use gender mainstreaming in our research and our policies. So I will start by the definition of gender from the Istanbul Convention so that the term gender explains based on the biological differences between male and female that are socially constructed, the roles, behaviors, activities and attributes that are given, that a given society considers appropriate for women and men. The concept of gender defines the expectations, entitlements and values that are proper to women and men in a specific context. For instance, we sadly saw few days ago how African girls happy to resume their education at the schools were sent back home. Highest schools for girls will remain close until new plans for attendance are formulated in accordance with the Islamic law. So research has shown that certain roles or stereotypes reproduce unwanted and harmful practices and may lead our societies to tolerate violence against women. We have overcome such gender roles. Article 12 of the Istanbul Convention, but also our gender equality strategy, frames the reduction of prejudices, customs, traditions and other practices, which are based on the idea of the inferiority of women or stereotypes gender roles as a general obligation to prevent violence. Elsewhere, the Convention calls for a gendered understanding of violence against women and domestic violence as a basis for all measures to protect and support the victims. This means that these forms of violence need to be addressed in the context of prevailing inequality between women and men existing stereotypes gender roles and discrimination against women in order to adequately respond to the complexity of the phenomenon. Gender mainstreaming has been adopted internationally to achieve gender equality and to combat discrimination. This approach forces the inclusion of gender perspective in the preparation, design, implementation, monitoring and evaluation of policies, legal measures and spending programs. Thus making policies more responsive to the needs of all citizens, men, women, girls, boys. When the notion of gender is mainstreaming policymaking and in legislative provisions, public interventions become more effective and avoid the perpetration of inequalities. Gender is effectively mainstream only when there is a true political commitment and when a proper legislative framework is in place. Gender indicators, gender equality training, gender statistics, gender awareness raising campaigns and sex disaggregated data are just some of the concrete methods applied to identify gender inequalities and to help improve the quality of policymaking and the functioning of our public institutions. According to the UN gender statistics are statistics that adequately reflect differences and inequalities in the situation of women and men in all areas of life. Statistics needs to be collected and presented disaggregated by sex as a primary and overall classification and reflecting gender issues. Gender statistics must be based on concepts and definitions that reflect the diversity of women and men and capture all aspects of their life and be collected using methods that take into account stereotypes and social and cultural factors that may induce gender biases in the data. Data must reflect women and men's conditions, roles and their needs and specific programs. Gender analysis of which data collection constitutes the first step is therefore the study of difference in the conditions needs, purpose, participation rates, access to services and resources between men and women. Gender analysis indeed attempts to unveil the underlying cause of gender discrimination and to tackle the cause of the problem with a view to and to responding to the different needs of women and men and to avoiding the policy measures led to further inequalities. The notion of gender is intrinsically linked to the intersectionality and factors such economic and migration status, race, ethnicity, disability and age should be considered in the development of implementation of gender sensitive policies. We live in the world where every third women has experienced physical and or sexual violence perpetrated by men. This comes from the latest data released by WHO last year. And it means that we live in a world where women are not safe neither at home on the streets at the workplace nor online on the virtual world. There is a common knowledge that violence against women and substance use are connected. However, the connection is complex and requires a deeper analysis and understanding of the trauma aspect of abusive experience, the women face, the dynamics of abusive relationships, and the associated aspects of tolerance of both gender based violence and substance use. Research show that women who have been abused by intimate partners are more likely to use or become dependent on substances as compared to women who have never experienced intimate partner violence. One recent study show that women with a recent history of experiencing intimate partner violence had nearly six times the risk of problematic alcohol use. Also, women under the effects of drugs may be more vulnerable because of their impaired ability to recognize and avoid predatory assignments or because of their higher chance to be exposed to them. Research has documented immediate adverse trauma related physical and mental health effects resulting from intimate partner violence, including chronic pain, injury, depression, post traumatic stress disorder and substance use. For many victims who use substance, it is a way to cope with the traumatic effects of abuse. Research also found that the highest number of women among users is found to take tranquilizers, sedatives and other pharmaceutical drugs. Thus, we see that women are mostly trying to calm themselves down, meaning that to deal with the inner noise caused by trauma, while men are more prone to recreational drugs. Similarly, by these study findings, we see how gender perspective is important. This finding suggests that the different reasons women and men may be seeking and using substances. Therefore, different treatment prevention and post intervention measures should be created and implemented. Other intimate partner violence victims are coerced into using by an abusive partner who then sabotage their efforts towards recovery and threaten to undermine them with disclosing their substance used to the authorities. These practices are used to further control their partner and have the chilling effect on victims' ability to access safety and support and to retain custody of their children. Emerging research demonstrates that substance use coercion is common within abusive relationships. Substance use coercion remains an emerging area of research in itself. It is an important contextual factor to consider when reviewing research on the relationship between intimate partner violence and substance abuse. A greater belief about alcohol consumption, gender roles, and violent behavior can also affect the risk of alcohol-related partner violence. For instance, in some societies, both heavy drinking and violent behaviors towards female partners are associated with masculinity. However, in some countries, beliefs that alcohol facilitates aggression have led to drinking so that individuals can carry out violence perceived to be socially expected. Equally, social belief that a women drinking is a cause of violence may be in some cultures we see as a mitigating factor. Thus, understanding the gender aspect of substance abuse and abuse is paramount. Research shows that children who witness violence, including threats of violence between their parents, are more likely to develop violent and delinquent behaviors during childhood and heavy drinking partners toward alcohol dependence later in life. Thus, preventing intimate partner violence would also be a prevention of substance abuse. So gender-based violence and substance abuse should be analyzed in conjunction. Thank you very much. Thank you very much, Christina, for this introduction. I'll give now the floor to the second speaker. There will be space for discussion after the four presentation, but you can already, if you have any question, you can put your question in the question and answer section. The second speaker is Cristiana Valespires. Cristiana is an integrated researcher and lecturer at the Faculty of Education and Psychology of the Catholic University in Porto, Portugal, and she's a founding member of Cosmic Air Association. She became researching the intersections of gender and drug use in 2014, and she led the creation of innovative harm reduction and bystander intervention approaches to prevent sexualized violence and other form of gender-based violence in drinking and drug use environments. Currently, she's consultant in the field of gender and drugs with the MCDDA and she's also member of the European Group on Gender and Drugs. Cristiana, the question for you is how drug use behavior among women change in the life course and how they've changed across generation, and we are particularly asking to focus on young women and in the recreational setting. Cristiana, the floor is yours. So hello, good morning. Hello Linda and colleagues. It's a pleasure for me to have the opportunity to present and build this discussion with you today. And good morning to all the people that are assisting to this conversation. To the other one. So I was invited to think about gender in particular, and particularly the experiences of youth and young women who use drugs. And having, you know, this generational discussion, like for one hand, the fact that youth and young adults are in a kind of transition phase of their lives from the dependence, financial and material dependence from their parents to autonomy, to their adulthood autonomy, but also experimenting a lot and being exposed to a lot of peer pressure and social pressure towards idealized images of adulthood and also idealized images of gender. So this is, this is relevant also to, to analyze or to build an understanding of drug use in these young ages from 16 to 34 that is the period I'm focusing. And I would like also to think in terms of generation, generations, and in this case I would be talking about millennials and also Generation Z that it's curious that these generations are more exposed to an increasing gender gender discussions and becoming topics. So probably they, they are building their gender identities with, you know, more amplified references considering the globalization and you know communication and information growing and these processes that allow them to to build identities in a more complex way. In addition, no, before that, in addition, these two generations they, you know, they somehow had access to drinking and drug use contexts that traditionally were male dominated and male exclusive. And this is, is relevant, because these are places of for risk and pleasure experimentation, and somehow in the last decades, women were invited by the capitalistic and neoliberalist culture to participate and be consumers in this space times and this is also relevant in terms of gender production or the production or reproduction of crystallized gender relations, but also offer interesting stages for gender experimentation and building new femininity and masculinities and this may be, related also with the drug use. So we can say that two women began entering these male exclusive and intoxication cultures that for several centuries were, you know, merely for the, you know, these hedonistic dimensions were exclusive for men. So now you can change. And for this presentation I used data from ash pots. And what we can see here is that in general when we talk about lifetime prevalence of alcohol use. And also in the last last 30 days, since the 2000, 1995, sorry, there was a kind of decrease in alcohol use a slow decrease and this may be related with change and seen, you know, in law. And it is also interesting to note that when we talk about heavy episodic drinking specifically or binge drinking that is the drinking pattern that we can find in nightlife environments. It is decreased or a bit in boys but is increasing in girls. So what we are seeing, you know, when we analyze alcohol is that the gender gap is narrowing. And probably there are gender negotiations in the access to the intoxication culture and sobriety culture, because contemporaneously there are several people talking about sobriety culture because you use groups. And I don't seem to not having the same relationship with alcohol as before. And this, I think this. But on the other hand, more women are engaging in this kind of heavy drinking patterns. So probably it would be relevant to have, you know, a gender land to understand this, these changes in drinking patterns. And it's also interesting and I bring and I brought also cannabis because we can see that in recent uses. Also the that it's growing the use of cannabis among men and women. And this may also be related with the social acceptability with an increase in the social acceptability of cannabis promoted but by all these discussion regarding medical use of cannabis and so on. We can change it now. And when we talk about other drugs or illicit drugs other than cannabis also data from his path shows us that we can find a gender gap, but considering with 1995 we see that there was an increase and this probably is related with the theory of normalization. And somehow the use of illicit drugs in certain environments or in certain places are seen as more normal than before, let's say. Yeah. And this is a data that I, I like I would like to highlight this connected with something that Christine also said before, that is the relation that women tend to have, and this is a long term relation with, you know, medicines, let's say with sedatives and tranquilizers, psychopharm, pharma, pharmax. And in this case, also among youth females, we can find, you know, and this is the only indicator, or the only substance where the, you know, the rates of women are higher than the rates of men have, you know, use tend to use more prescribes rank, not prescribed medicines. So this, this is also we can also see this, this is a graph from recent report from the Sexism Freight Project. And that analyzes, you know, people that go out with go go out at night from any state and most of the people that answered the survey was around 18 and 34 years old, and we can see here that again, the gender gap is lower. When we talk about legal and socially more acceptable drugs, let's say. And however, these in terms of lifetime prevalence, when you look at, you know, uses in the last 12 months, six months and even 30 days, the gender gap is a bit higher. But it's always smaller when we talk about, you know, legal and more socially accepted, accepted drugs so you can pass to the other one. So what we can see here is that women tend to use more, you know, tend to connect more with the legal or this kind of markets. And this is, and this is, sorry, I got distracted by the chat. And this is interesting because probably, probably if we only think or if we only analyze drugs from the perspective of illicit markets, probably we are not getting good information regarding gender dynamics in terms of drug use. And here I would like to state several things that are relevant when analyzing drug use among youth and young women who use drugs in social environments. Firstly, is that this context remain male dominated. So women, of course, are invited to lose control and to contact with intoxication. But at the same time, they have to self control and, you know, keep their gender mandates and their gender rules very active. In the space times that there are also sexualization of the women participation and is this reproduction of what happens when women enter in the social sphere, that their participation tend to be sexualized and these increases if they are using drugs heavily, let's say. And at the same time, we can we can consider that women are adopting, you know, the behaviors of reference on that context that are, you know, male dominated, let's say, or masculine, because these space times and these behaviors were were male exclusive until recently. We also can find and this is data from Sexism Freight reports. We also can find gender differences in drug use motivation, women report more social motivations, for example, to dance, to fit with the group, you know, to facilitate the social interaction. Men is interesting that they report more sexualized motivations like to flirt, to have sexual relations or to increase sexual arousal. Also, in what refers to drug acquisition, I already told it, women tend to connect more with legal and more socially accepted drug markets. They tend also to be introduced by drugs and drug use patterns, the way the drugs are used by, you know, male partners. And this is also interesting. And in a focus group, some focus group I did some years ago, they were saying that they tend to have heavier drug use patterns when they are in a relationship with a man that have heavier drug use patterns. So that there is also this relation. And it's also interesting to note that women who use drugs that allow frequencies have more probability than men of acquiring drugs for free. So again, this, like a free relation with illicit, illicit drugs markets, so you can change it now. I like to, you know, we already know that we don't burn with, we don't burn. We are born with a, you know, sexual characteristics, but not with a gender so we learn what gender means and we are socialized for gender. And in this context, we can consider that drug use itself can be a gender performance. And this means that probably this behavior, you know, in drug using probably that there are a negotiation between the traditional gender roles and experimenting with drugs. But I think it's also important because Linda said it before, several times we tend to see women who use drugs uniquely as victims and disempower it. But the thing is that there are also these agency dimensions, you know, and experimenting with drugs intentionally in building and expressing new feminine femininity in these, you know, contemporary contemporary lifestyles. So there are also differences in terms of risk and protective behaviors. And as I said before, women tend to self protect more so limit the amount of alcohol of drugs they use. And for example, to protect their drink to avoid chemical submission among other dimensions. And there are also gender differences in terms of the negative consequences related with drug use. And in this case, sexualized violence and social humiliation after heavy drinking or heavy drug use are gender, you know, gender specific risks. Since they affect this proportionately tend to affect this proportionately women. And finally, just to finalize, we can also it's also relevant to think in terms of social norms and social reactions and gender it's moralities towards women who use drugs. And of course we have gender double standard since drug use, what means that we analyze the same behavior, having gender as reference. Okay, so we don't see drug use we, we consider drug use differently if the person that are using the drug is a woman or a man. And this is very relevant for us in terms of thinking. We, you know, the people with whom we work. And then there are always this kind of moralities that tend to make women, you know, that blame women in case they are victimized that that's, and also that produce these courses that tend to degrade their public image, especially when we are talking about heavy drug uses. And finally, there are also these psychological consequences that we don't don't talk a lot. Because women tend to experience more moral hangover, meaning that after a drug use occasion, they tend to feel more guilt, and regret, and this may be related with internalized it. You know, with internal internalization of traditional gender norms, and with the fact that they feel that somehow they, they, they fail in their gender amendments. I would like to say that it's very relevant to build to build a gender perspective when we analyze drug use among young younger women, because probably the social penalizations related to drug use are more subtle than when we analyze other other groups. But, but they must be addressed and I probably finish here. Thank you. Thank you, Diana, for offering this first view on women and drug use considering really the gender as a social structure and construction. So now I would like to give the floor and I still there are some questions, but we will discuss we hope to have some time to discuss to discuss later. So now I give the floor to the third speaker is Sarah Morton. Sarah is the director of the community drugs program University College in Dublin, and has a particularly interesting women substance use particularly how these issues intersect with gender based violence. She's also a member of the European group on gender and drugs. And, and we ask also Sarah the same question that we have asked to Christiana, how drug use behaviors among women change in the life course and how they've changed across generations with particular focus on older women and women who have developed drug related problems Sarah, the floor is yours. Thank you so much Linda, and I just welcome the opportunity to to speak with Christine and Christiana and later Judy. This is just such an important topic. So I wanted her to approach this struggles as I did with the idea that maybe if we weren't young were old, maybe as across the life course. So I might just go on to the next slide. I really thought about from which perspective will we look at this particular topic. And I was thinking to add a local and a regional and a national level very often we get caught into a consideration of what women are doing. And I thought what I would much prefer to do is talk to you for kind of 10 minutes around. How do we understand that the context and the experiences of women have changed so rather than what they are doing. How do we understand the context within which they are surviving, thriving or behaving. I'm going to look at some of the changes in drug trends and drug markets because of course they impact on women substance use trajectories particularly over the life course. I also wanted to build on what Christina and Christiana had said and look at some of our own emerging understandings and knowledge of women's experiences, and from a very situated practice based knowledge and focusing again on what we understand perhaps over about women's experience than perhaps we did 10 or 15 years ago so just moving on to the next slide. I have a few ideas here around drug trends and drug markets which you will see we will link with the previous presentations. So one of the interesting things that Anderson and Kavanaugh talk about is how we need to think about new ways of how gender organizers and is embedded within illicit drug markets, including for them they highlight the overlap and interplay of legal and illegal drugs and producing drug problems. And this is what we see when we're working with women over the life course particularly around medication misuse and kind of choice of substances. Novel distribution styles and I'm going to talk a little bit more about that in a second, and also what the consequences for women are in relation to engaging in drug use. Some of the things that we've seen from a practice perspective is the impact of digitalization of drug sale and supply medication misuse and the changes in development and illicit medication supply and use which particularly impacts on women. We've also seen in different contexts in Europe and beyond the increasing cocaine and crack cocaine supply and use. And finally, another point that I'd add from this kind of situated knowledge is the impacts on all forms of transactional sex, sex working exchange of sex for drugs prostitution due to the digitalization and types of substances available and the digitalization both of those both markets. And I suppose the question we're left with which, which links back exactly to our first presentation was do our monitoring systems incorporated gender view of emerging trends and impacts. So just moving on to the next slide. Just one kind of, I suppose, two sets of ideas that I wanted to run through around this. Colar talks around these kind of gender stigma normative standards, which again links very much with what Christiana talked about for for young women and gendered accessibility. This urges us to think about the gendered social organization of drug markets and how this impacts on women and their use in patterns, and also how we have conversations with women around this. Because of course traditionally how we understand drug markets and how those have been monitored have been from a more patriarchal perspective. And I'll just move on to the next slide. One of the things that I find interesting when thinking about this is Anderson and Kavanaugh again, look at these kinds of gender relations and the intersectionality of race and class and how that shapes experience. And how does that also shape our understanding of drug markets and women's rules and functioning within this. For instance, they highlight that very often women's drug involvement intersects with situations of extreme economic and social disadvantage and other experiences of trauma. And also very often, even if they're in a relationship and a male partner is then incarcerated, that often impacts on women's access to material provisions. So if we think about if we don't acknowledge the context of women's experience and the structural context of that, how can we basically support any positive change in her life when there's substance misuse issues, but also if those contexts and structural difficulties remain unchallenged or changed, then how can we also expect women to change. I'm going to talk very briefly around our kind of knowledge base on the next slide. What I would I suppose like to argue at this point is that practice and intervention can serve as some of our main sites of knowledge of women's substance use patterns and trajectories over the life course. Some of the challenges around this is that our knowledge and understanding can remain very local and situational. That knowledge extrapolation can be really difficult due to both the kind of patriarchal roots of our treatment and intervention systems and the underpinning ideology of treatment and intervention. So very often when we talk about this issue, there's real understanding of what women are experiencing, but we find that difficult to extrapolate into major system change. One example of this would be an action research study that we did a year and a half ago, and when we took to practitioners and asked them to consider their organizations around substance misuse treatment for women, there was a realization that they often internalized even in quite subtle ways the gender roles and expectations within their treatment and interventions and their work with women. So where does that leave us. I'll just move on to the next slide. There's two more themes that I want to touch on before we look at the end of the kind of implications. We talked about this idea of trauma. And again, aces is one that is a particular view of trauma. What we know around aces and women is that sexual experiences of sexual abuse, physical abuse and exposure to parental domestic violence as a child have independent positive relationships to lifetime drug and alcohol issues. But what we also know is that 90% of women in substance misuse treatment have a history of traumatic violence. This is evidence of this lifespan victimization and a combination of adverse childhood experiences and trauma in childhoods and substance use puts women at further risk for future domestic violence and sexual abuse. So this lifespan aspect is key. In one study it was found that women involved in the criminal justice system linked themselves their whole trajectory and experiences of substance misuse and later harms to adversity experienced in childhood. So just the next slide has a couple of points around intersectionality. We know that substance use patterns and trajectories are often different from women, and Christina talked already about this idea of telescoping and accelerated progression. And we also know that women substance use may intersect with these wider social factors. So other factors may also predicate or compound experiences of exclusion, you know, migrant status, disability, poverty, homelessness. There are three implications for us around this. And I came up with three because I thought this is so complicated we need a way forward. And these are the three questions that I was left with that I thought it might be useful to think about. How do we design and develop interventions and responses that circumnavigate patriarchal constructs and understandings of drug markets and substance misuse treatment. How do we incorporate the embodied and lived experience of women substance use across the life course and beyond the lens of pregnancy and motherhood, which is very often how policy and intervention has started to focus or initial focus. And also my final kind of implication was we, I feel we really need to consider how we may be internalizing or normalizing these dominance constructs and expectations of women's behavior and life course within our responses and interventions. And Christiana and I did not manage to actually link those ideas but we linked them perfectly. So I just moved to my final slide. And that's just my contact details so thank you very much. Thank you very much Sarah for offering also as you say a way forward or just pointing out the main issues which is important and also you offer really the link to the next presentation, which is the last but not least of course, Judy chunk. Judy is the executive director of the international network of people who use drugs. Judy has worked in the HIV and the community based health and development field for over a decade, and has close to 20 years of lived experience of as a women who use drugs, and as a client of harm reduction services to her role. Judy holds a master's international development and Bachelor of Arts in writing and contemporary culture and she attended the first European technical meeting on gender and drugs. So we would like to ask the same question that we have asked to Christiana and Sarah to Judy but from the perspective the user perspective so how drug use behaviors change among women who use drugs. Judy doesn't have a PowerPoint but she will reply. Directly on the screen. Thank you Judy before she's yours. Thank you Linda and to EMC DDA as well for their skillful organization and bringing together of this webinar on women who use drugs. So just to start off with, just, you know, want to also acknowledge that I think, you know, any, as any of us who've worked and researched drug person harm reduction for any significant amount of time. You know, we know that the more we work on it, the bigger more conflicts and more unwieldy the issue becomes, you know illicit drug use patterns and trends have indeed changed from more traditional drugs such as heroin cannabis cocaine and speed to newer drug drugs such as NPS synthetic cannabinoids synthetic opioids such as fentanyl and methamphetamine. So as I think, as you know we've seen drugs researchers also become more complex, as we've seen from the two excellent presentations today, and as overtime I think we've learned to bring in more of the nuance and more reflection on this complexity. Gender along with many other intersecting social and structural factors such as class race and ethnicity sexual orientation and gender identity influence patterns of use, but it also influences how we use drugs and what impacts, not only drug use drug policies have on our experiences of drug use. I think any consideration, any serious consideration of gender and other social factors means that we can't just simply accept that drug dependencies easily explained as a disease to be simply cured. Being able to acknowledge this nuance and complexity means we can begin to produce more accurate and once research, which will lead to better policies that are more appropriate. There are currently healthy socially integrated people that aren't disconnected incarcerated or literally dying in their hundreds of thousands from preventable deaths. So my talk I also wanted to focus, of course, on to centre my own lived experience of drug use over life courses you know from a gendered perspective. I'll be a young person that uses drugs anymore but definitely once was I would probably be defined now in my middle age. But I'm in a position to reflect on my drug using career up till now. I think drug use which not many people really consider is also a search for meaning for the individual in a lot of ways. Like many people if I look at the start of my drug using career, you know started from a young age 1314. Of course these are the teenage years I'm sure everyone can relate their typical ages for experimentation. So the recreational use of cannabis, acid, ecstasy, speed. I think you know during this point as well most of the experiences were positive and there's always that element of you know seeking pleasure. I would say yes about 19 about 1819. You know moved to heroin use can develop the habit so drug dependent. I think, unlike some trends amongst women who inject drugs also learn to inject myself very quickly you know so have that independence. I think, you know, it's not as much as the media says dependency isn't immediate developing habit isn't immediate. But it wasn't done you know completely inadvertently either. You know there's reasons that people and women use drugs. It helps to you know numb people, it helps to you know regulate emotions and mental state. And I think generally you know we accept the stereotype of people use drugs and probably particularly of women who use drugs of this you know sense of being out of control that it always means being out of control of our own bodies and minds. But you know that's not the whole truth. And many of us who use drugs do use drugs to have some control some semblance of control over the state of mind and how we respond and react to situations. So it was about two years later so you know probably quite early on that I entered into methadone treatment. And you know contrary to people's beliefs also you know treatment doesn't always mean you stop taking drugs many people continue to use drugs but it does help to better control and regulate that drug use. You know this consideration does should be and was supposed to be at the heart of harm reduction programs right this non judgment that it shouldn't be tied to expectations of abstinence or accepting that it's okay to try and punish people who don't stay abstinent. So considering the role of gender in this use, you know looking I think we do need to look at alternative framings as well. And I, when we apply a feminist lens to it, I think you know there's just a different framing and consideration and kind of widening of meaning for drug use as well. It came from when I come from a migrant family and you know experimentation and drug use is a lot of times a part of rebelling you know it's pushing back on what was expected of me, what society my family told me I should do will be. The two other speakers have said you know we know women who use drugs that judge way more harshly than men. This is because drug use is seen as risk taking behavior and drug dependency you know is often perceived as selfish and women are expected to conform to gender norms of good behavior and selflessness. So it's not to say that you know personal trauma does not play a role, but I think we do inordinately focus a lot on individualized trauma and we don't really, you know weight enough the structural harms of criminalization drug policies and gender equality. So for instance, because of stigma and discrimination that is very much fueled by drug laws, women who use drugs, including myself are much more likely to hide our drug use, which means we use a loan, and that means we're more likely to overdose. We're more avoidant of harm reduction and healthcare services because of the shame and judgment. And as other speakers have mentioned before you know we're more vulnerable to sexual harassment, not only from police but also from medical personnel and doctors, because once we're out about our drug use even if it's you know just in front of one doctor. There's this, you know sense that they can get away with things that they never would in front of other clients. So I think now at my age middle age when I you know look at my drug use career. I feel that there is more control of my drug use than ever before. I think in a lot of ways that does accord with life stages. You know people generally find their lives becoming more stable it's less about experimentation and more about consolidation. You know I also come from a place of privilege and that you know I have found a place and meaning in life I get to have a job and live a life where I don't have to feel ashamed about drug use. And I think you know in some ways that's part of a feminist impulse of not allowing others to make you feel shame for wanting to make your own decisions about your own body and mind. It's not to say you know the way society judge judges that people are immune to this judgment that I have been fortunate in many ways. So I haven't been incarcerated but have definitely lived through the fear of fear and harassment. I've never lost a job because of my drug use. I was able to be financially dependent independent. In the sex industry, I've never been a mother who's had to watch their child being taken away, though I know at the same time you know a court will most likely never allow me to adopt as an out drug user. I've pretty much always had access to harm reduction or found innovative ways to access it. So I think there are all these unique ways we found to punish women use drugs which the world justifies because of misconceptions and stereotypes. But how the world views women who use drugs you know does not match my own experiences, nor my world view of the people and the community that I see around me. So I really do see women who use drugs as being some of the most real, authentic, smart, insightful, funny and pathetic and incredibly resilient. You know we survived through a world that truly tries to break you down and wants to make you feel that there is something inherently wrong with you. You know so much to the point that we imprison women use drugs and sometimes resort to torture in order to fix people. So the only women who are able to survive this and still retain some semblance of pride and dignity and who refused to be who refused to hide and be silent, you know are the strongest. So looking forwards and you know what needs to change. So just, you know five recommendations. Not simple, but very important, and we should be looking to progress them. So one to be able to change our perceptions and attitudes and counter misinformation on drug use by acknowledging its nuance and complexity. And we need to be sharing narratives that aren't all negative because there are also positive stories to share. So one example that I would point to is a not perfect it's called the not perfect feminism story share project. It's run by Urban Survivors Union in the US. So it's basically a story telling project of women who use drugs. Two, so the need to produce research particularly qualitative research that captures the complexity of drug use amongst women and make sure women who use drugs the meaningfully involved in this research. Three to fully decriminalize drug use. You know as we all know there are successful country examples in Europe so there isn't the need to look very far. Four, services need to understand the needs of women who use drugs. And we know that understanding these needs will only come from listening and treating women who use drugs as equal partners. And I do agree with Sarah's presentation as well that the treatment system is very patriarchal with, you know, lots of rules and regulations to try and like shape people into you know what the system thinks people should be. And five, last but not least, the critical to fund and politically support women who use drugs, led organizations and responses in line with the global AIDS targets that every country in Europe has committed to. Thank you. Thank you. Just, yeah, you are really on we are really on time perfectly on time so we have time for some question. I saw that they were already some question for Christina Christina reply to some of these questions I don't know if you want to add something in the question and regarding. I see that that you. Yeah, the first question regarding if a gay would pay specific attention to women use drugs in your work related to gender based violence. Do you want to answer Christina. Yes, yes, yes, apologize because I was so fast I wanted just to type answer and I, and I click on answer life so now I cannot go backwards. The only thing that we are planning to do in relation to integrate the drugs used into the gender based violence projects is that you know that we are now able to start has conducted the new gender based violence survey. And Fra and a get together in a joint project will cover the member states that are not taking place in the Eurostat survey on the on violence against women. And what we have done, I think that mainly because of your initiative and the concept of Europe initiative is to include a question or what we will try to have a set of questions in relation to drug use. And the results of this survey that it's, it's planned to be published in 2024, and in some countries, they have already started implementation of the survey in the eight countries that Friday will cover the survey will be conducted this year. So, this is the only thing that I do think that you know in order to have this intersectional approach and to cover all women's experience we should include in our in our gender based violence projects. This is in the drug use dimension so I think that it, we will try to think how to integrate this dimension because I think that it's really important for to let the liais with the MCVBA and see if we can have a joint project on this. Thank you Christina. There was another question I'm not sure if I understood regarding, I think the link between like neuroscience and social sciences, how the changes also in the bodies or can affect the changes in drug use behavior but we would like to just to point out it is difficult to reply to this question and it's really important always to consider the influence of the social context and as he was saying in all this presentation in every type of behavior on drug use behavior in particular for women. Linda, I noticed another questions for Christina from Aege about the inclusion of non binary gender definitions. I would say that there are great expectations about the work of your agency, Christina, these questions highlight a huge interest in your present and future work. Yeah, it's very difficult to answer so we want to expand the collection of data and to include also that non binary but when we are talking about administrative data and when we are collecting data on violence against women, we are talking mainly about administrative data so that it's a data that it's coming from the recorded data in the national statistical systems and most of the time this data is collected based on sex. So you know that, that we need, I think that we, we need to have a better conceptual framework, you know, because we will be collecting data on non binary, but are we sure that we will know how to interpret this data, you know, so we have this framework when we have data is aggregated by sex and we have the gender as a category of analysis for our for our interpretation. But when we are talking about non binary, and if we don't have this sex disaggregation also, you know, it's, it's difficult. And for policy reasons for for measures I think that you know that it's it's very rich we can have like you know that which is the impact on the health on the access to sharp disease on everything by non binary person so in this sense it's, I think that it's very rich and we need to include non binary in our data collections. And when we want to really analyze the impact you know for instance in this drug use, if we are, if we are losing the sex dimension and we are using the socialization based on gender but based on the sex that you were born. I think that it's really difficult to interpret no. So I think that we need to build a better conceptual framework on how to interpret this data. And, but for sure it's like I think that you know this is a way to go no not to not to leave people behind or aside that we need to include everybody in our in our in our statistics, but we need also to build a framework that we can understand the data that we are collecting. Thank you. Thank you Christina. There is another question that can be for everyone I would start maybe with Christiana. So it's Maria Rivera ask if I like to know your opinion on about legal drug use tranquilizer sedatives and women, not related to experimentation or try trauma. Maria, Christina if you want to comment you presented this in you. Okay, so you asked me to comment because I was looking at over medication of women, like 100 years ago with morphine and other drugs and this was something that I was exploring during a historical analysis of women who use drugs in Portugal. And there is this trend. And actually when looking at contemporary data, at least in Portugal but I think we can find it also in other countries for example in Spain but also others that, you know, there are higher levels of women using prescription pharmacists and on the other way around. Also, there are more, more, you know, higher rates of women using you know prescription opioids for example, or other opioids rather than heroin. So this is interesting because again shows these demonstrates this connection or this link between women and, you know, legal or more socially accepted markets. And, and also it, it shows that possibly not, you know, because you are asking specifically not only regarding the trauma experiences. But I think, for example, women nowadays have a lot of mental load that is related with the work life and also with the maternity rules and all these, you know, overlapping of expectations and rules they have. And possibly, and possibly this, this is also a cause for searching for more, you know, mental health care and consequently to have a medication. So, this is something that is very clear. The connection of women, for example, with alcohol, the bacon also with psychopharmacy, and growingly with cannabis. And in order to have a gender perspective on drug use I think we need to redefine what do we mean my drugs and looking not only for the listed markets, but only for the other ones because probably there, women are not a minority. So I would just say this. Thank you, Cristiana. I don't know if Judy or Sarah want to add anything on this. Yes, I think if we just add to Christina's point, I think, you know, looking at the 1950s, there was definitely this, you know, overtreatment and this biomedical, you know, everything will be fixed with a pill but I think that was also part of like not being able to accept difference, you know, and I think also back then there was a lot more constraints on women overall and much more strict kind of gender norms and if women were outside of their place, then it was this sense, you know, they then need to see a doctor who's medicated. And yes, I think, you know, things have changed over time but I just think it also shows, you know, the damage of, you know, very strict gender norms and hierarchies and also that you know things can't just be fixed necessarily always with a pill or the biomedical approach. Thank you, Judy. Now, I think there is another question that we move on intervention so John is Bennett asked, based on the presentation with professional training in the drug field benefit from a stronger gender equality orientation I don't know if Sarah do you want to reply. I can start the response to that perhaps the others. I think this goes back to the points that all of us were making but I think both Judy and I were reiterating these around the kind of patriarchal systems that have developed over time around both understanding drug markets but also responding to the impacts for women that's very embedded there's fantastic innovation in different jurisdictions. We've all worked with fantastic projects that are doing fantastic work but that hasn't been mainstreamed so of course the question becomes as john says, how do we start to systemize that that change. Yeah. Yes, Christina. Yes, I think training is the first step because our university degrees and most of you know the specialized training in drug drugs and drug addiction don't have you know really gender transversal in their curriculum so for sure that the access to gender equality training on gender mainstreaming and also the connection between you know gender and drugs is very relevant in this way to to change you know the practices or at least to begin to create a bigger understanding of what what means you know or the, the, the relevance of, you know the fact that drugs and drug use behaviors are not neutral they are influenced by you know social structures that are asymmetric so for sure we need to bring in contact with these contacts and build understanding on on them to increase the way we work. And just to connect with my presentation because I was hearing my colleagues and I think I didn't finalize it with with kind of recommendations or things to do. So talking about youth and young young women, probably this group is more, they connect more with prevention, probably, and harm reduction. And I came from the harm reduction fields, specifically nightlife environments and most of the interventions are gender neutral also. So for sure, we need, we are learning how to do it, we are learning how to consider gender. So we have to connect you know with the feminist theories and queer theories and you know, try to have another lens to analyze the behaviors we want to, you know, we are working on so probably I will. Thank you. Thank you, Cristiana. And I think we can take maybe a last question. Does have from Mary Millett does having men working with women in a dictionary for patriarchy. That's, she said for for Judy. Well, yes, I think when you know we've looked at how to make harm reduction services and treatment services more gender sensitive there's definitely recommendations for, you know, hiring more women and especially peer workers I think there is that element always more comfortable like speaking to someone that's more like you. And, yeah, I say also said before the treatment system can be experienced as very patriarchal so there is, you know, already that lack of an established trust with the patriarchal system but then you know with, if you're mainly engaging with a male doctor or other professional, but that's not to say that, you know, men working within the system like shouldn't also be sensitized and be able to, you know, also be gender sensitive in the way that they approach women and understand issues more I think we all you know also agree that being the, you know, redefine masculinity is, you know, is also and gender equality is also about like sensitizing men to be better as well. So yes I think you know it can be complex but I think yes a lot of the time, you know, making sure that we're hiring women and women in all their diversity, you know, does help. Thank you Judy maybe we have time for the last question Marka. Yes, there is one more question on on the services for for drug users and people will use drugs by Greece. I'm really interested to discuss in which ways we could change the way intervention is given to women. If I can add something from my side I liked this mention of diversity. I think the objective here is to help people to be helpful altogether because it's not one way direction only, and probably to take more and more into consideration the characteristics of individuals rather than fostering a kind of an adversion between between the two main genders. But I leave the discussion to you about what can be practically beyond what you said already be done to make the services more welcoming gender differences. I want to maybe go back to Sarah. I'd love to answer that one. I'll start the thread. I just noticed there's another question in the chat as well about, you know, this is this is a parallel around kind of pregnancy and motherhood and what can we do around responding to women so I put both of those in together. One of the other things is that we know is that women often you don't pitch up to the service that we expect them to. So, very often if substance use is the major issue it's the domestic violence service that they may pitch up to or go to. And there's really interesting research that shows that women actually go to the service that responds to what they feel is the biggest risk in their lives so we may think it's their substance use but for them it could be the domestic violence or their health association with their pregnancy or. So I think one of the things we need to do is normalize substance use whatever service we're providing and know the interrelationships. I think some of the biggest changes we've seen an innovation is the wide range of start services starting to normalize and routinely inquire about women substance use and accepting its functionality in all its forms. The other things that we've found kind of in research is that trust is the key thing in all services and women specific services or services where women can feel very safe where safety is prioritized and that that is really attended to. So I might pass over to some of the others because I know they'll have comments too. Yeah. Christiana. Yes, I would like to compliment what Sarah just said with this idea that we have applied in Cosmic Air, growingly that is the concept of collaborative networks. And by design mean to create intentional bridges between those who are working in the gender field. For example, we are planning an intervention in a large scale event next month, next month between, you know, Cosmic Air that is specializing in harm reduction in nightlife events. And also, you know, a rape crisis center in Portugal and another organization specializing in date violence. So through this connection we can create, you know, a really, really gender responsive collaboration, you know, to, to, you know, to, to capitalize let's say from the specialization of each partner to build comprehension on this field. And we did it also with other topics. For example, now we want also to create a collaborative network with organizations working in the sexual health fields, mental health and also gender diversity to try to create also, you know, a harm reduction collaborative effort to respond to the needs of queer transgender and non binary people who use drugs also here in Portland Lisbon so just wanted to add that this collaborative effort between areas that are always separated. And just to finalize, because we also find a lot of stigma and prejudices towards drug use in the gender field, at least in my experience, there are, you know, also bias that because we are talking about two social constructions trucks and gender. So the other area has also their, their, their own, you know, biases towards trucks. Thank you Cristiana I think we arrived to the end would like just to inform me was already put in the chat that we are organizing a side event, thanks Alessandra on the 22nd of November. This is an event that is organized in cooperation with the pump to the group of the council or Europe, Europe and the Portuguese secret. And at the margin of at side as a side event as I say the registration are open is there is no registration fee for this event. I would like to mention this event is the result of a work of a group that is I mentioned before the European group on gender and drugs that was set up around three years ago. And then the past edition edition of Lisbon Addiction and include the several experts from European countries working on gender and drugs and several institutions including a unique group of the Council of Europe us and expert from different countries and we have really the objective to try to include him in a more systematic way as a gender perspective in the drug field. So if you want to subscribe you have time until end of September. I give the floor back to Marica for the conclusion. Thanks. Thank you very much. We also we are receiving a lot of positive remarks from our public, which is always very good to see. Also thank you everybody. Nothing to add you made already very good conclusions and Alexis announced before he wasn't able to be with us and we prefer to do without conclusions. But I will just launch a quick poll for people to answer about their opinion and how we can improve the webinars. If you don't need to remain connected we will remain connect a little bit more and then we will circulate news about the next webinars. Thank you Linda. Thank you Marco. Thank you. Thank you all the speakers. Thank you all the public that makes our webinars so interesting. Thank you very much. During the webinar a lot of resources were shared in the chat. We collect all of them and we will definitely consider and reshare with our public. Thank you very much everybody.