A scoping review of Aotearoa New Zealand women's experiences of substance use, alcohol and drug services





Substance use, parenting, pregnancy, addiction, treatment, rehabilitation


INTRODUCTION: The experiences with healthcare services of women who use substances (WWUS)—especially when pregnant or parenting—are largely missing from research in Aotearoa. This scoping review was conducted to inform doctoral research on a new, integrated parenting and substance-use residential-treatment facility in Auckland: Te Whare Taonga.

APPROACH: Two objectives of the review were to: 1) collate insights from experiences of women who use substances; and 2) synthesise strengths and weaknesses within current healthcare and alcohol or other drug (AOD) services to understand what works to support WWUS, particularly those who are pregnant or parenting. Peer-reviewed studies, grey literature, and theses published between 1992–2022 exploring the perspectives and views of WWUS and their experiences of substance use, healthcare services, and AOD-treatment providers in Aotearoa New Zealand, were scoped in multiple databases.

FINDINGS: The review evidenced a need for gender-specific or gender-sensitive services that are non-stigmatising, accessible to pregnant or parenting women, and culturally appropriate. Holistic care tailored to individual need was considered important. Barriers to treatment included stigma, wait times, negative experiences of healthcare workers, and a lack of appropriate services to meet women’s needs.

CONCLUSIONS: There is a lack of AOD services available to WWUS, and, subsequently, research is limited. However, the findings provide an understanding of how healthcare and treatment providers, social workers, whānau (extended family, family group, can include friends with no kinship ties), community, and funders can provide informed and empathetic support to WWUS, including those who are pregnant and parenting.

Author Biography

Suzette Claire Jackson, University of Auckland

Suzette Jackson (Te Ātiawa, Taranaki; MSW) is currently working on her PhD through the University of Auckland, is a registered social worker, and works part-time as a community counsellor in the addictions field.


Adams, Z. M., Ginapp, C. M., Price, C. R., Qin, Y., Madden, L. M., Yonkers, K., & Meyer, J. P. (2021). “A good mother”: Impact of motherhood identity on women’s substance use and engagement in treatment across the lifespan. Journal of Substance Abuse Treatment, 130, 108474–108474. https://doi.org/10.1016/j. jsat.2021.108474

Alcohol Healthwatch. (2020). Evidence-based alcohol policies: Building a fairer and healthier future for Aotearoa New Zealand. https://www.ahw.org.nz/Portals/5/Resources/Briefing%20papers/2021/ Evidence-based%20alcohol%20policies-Alcohol%20 Healthwatch%20Nov%202020.pdf

Ball, J., Crossin, R., Boden, J., Crengle, S., & Edwards, R. (2022). Long-term trends in adolescent alcohol, tobacco and cannabis use and emerging substance use issues in Aotearoa New Zealand. Journal of the Royal Society of New Zealand, 52(4), 450–471. https://doi.org/10.1080/03036758.2022.2060266

Ballantyne, N., Beddoe, L., Hay, K., Maidment, J., Walker, S., & Ngan, L. (2019. Enhancing the readiness to practise of newly qualified social workers in Aotearoa New Zealand (Enhance R2R). Ako Aotearoa. https://ako.ac.nz/ knowledge-centre/enhancing-the-readiness-to-practise- of-newly-qualified-social-workers/report-on-phase-one- the-social-work-curriculum/

Brady, K. T., & Randall, C. L. (1999). Gender differences in substance use disorders. Psychiatric Clinics of North America, 22(2), 241–252.

Chan, C., & Moriarty, H. (2010). A special type of “hard- to-reach” patient: Experiences of pregnant women on methadone. Journal of Primary Health Care, 2(1), 61–69. https://doi.org/10.1071/hc10061

Chou, J. L., Pierce, K. J., Pennington, L. B., Seiler, R., Michael, J., Mc Namara, D., & Zand, D. (2018). Social support, family empowerment, substance use, and perceived parenting competency during pregnancy for women with substance use disorders. Substance Use & Misuse, 53(13), 2250–2256. https://doi.org/10.1080/1082 6084.2018.1467456

Clifford, B., Van Gordon, K., Magee, F., Malone, V., Siefried, K. J., Graham, D., & Ezard, N. (2023). “There’s a big tag on my head”: Exploring barriers to treatment seeking with women who use methamphetamine in Sydney, Australia. BMC Health Services Research, 23(1), 162–171. https://doi.org/10.1186/s12913-023-09125-z

Conroy, J. M. (2018). A gendered difference? Female experience of drug and alcohol treatment in New Zealand [Unpublished master’s thesis]. Victoria University of Wellington.

Crossin, R., Cleland, L., Wilkins, C., Rychert, M., Adamson, S., Potiki, T., Pomerleau, A. C., MacDonald, B., Faletanoai, D., Hutton, F., Noller, G., Lambie, I., Sheridan, J. L., George, J., Mercier, K., Maynard, K., Leonard, L., Walsh, P., Ponton, R., ... Boden, J. (2023). The New Zealand drug harms ranking study: A multi-criteria decision analysis. Journal of Psychopharmacology. https://doi. org/10.1177/02698811231182012

Department of Internal Affairs. (2019). Oranga Tāngata, Oranga Whānau: A kaupapa Māori analysis of consultation with Māori for the government inquiry into mental health and addiction. https://mentalhealth.inquiry. govt.nz/assets/Uploads/Summary-of-submissions-featuring-Maori-voice.pdf

Escañuela Sánchez, T., Matvienko-Sikar, K., Linehan, L., O’Donoghue, K., Byrne, M., & Meaney, S. (2022). Facilitators and barriers to substance-free pregnancies in high-income countries: A meta-synthesis of qualitative research. Women and Birth: Journal of the Australian College of Midwives, 35(2), 99–110. https://doi.org/10.1016/j.wombi.2021.04.010

Forray, A., Merry, B., Lin, H., Ruger, J. P., & Yonkers, K. A. (2015). Perinatal substance use: A prospective evaluation of abstinence and relapse. Drug and Alcohol Dependence, 150, 147–155. https://doi.org/10.1016/j. drugalcdep.2015.02.027

Frazer, Z., McConnell, K., & Jansson, L. M. (2019). Treatment for substance use disorders in pregnant women: Motivators and barriers. Drug and Alcohol Dependence, 205, 107652–107652. https://doi. org/10.1016/j.drugalcdep.2019.107652

Gibson, K., & Hutton, F. (2021). Women who inject drugs (WWID): Stigma, gender and barriers to needle exchange programmes (NEPs). Contemporary Drug Problems, 48(3), 276–296. https://doi. org/10.1177/00914509211035242

Gray, J., & Nosa, V. (2009). Tau Fifine Fiafia: The binge drinking behaviours of nine New Zealand born Niuean women living in Auckland. Pacific Health Dialog, 15(1), 104–111.

Handa, K. (2006). Methamphetamine use in pregnancy: A qualitative study of New Zealand women and health clinics [Unpublished doctoral dissertation]. University of Auckland.

Heimdahl, K., & Karlsson, P. (2016). Psychosocial interventions for substance-abusing parents and their young children: A scoping review. Addiction Research & Theory, 24(3), 236–247. https://doi.org/10.3109/160663 59.2015.1118064

Hipkins, C. (2023, March 13). Freeing up more government bandwidth and money to focus on the cost of living. Beehive.govt.nz https://www.beehive.govt.nz/release/ freeing-more-government-bandwidth-and-money-focus-cost-living

Jansson, L. M., & Velez, M. (2012). Neonatal abstinence syndrome. Current Opinion in Pediatrics, 24(2), 252–258. https://journals.lww.com/co-pediatrics/ Fulltext/2012/04000/Neonatal_abstinence_syndrome.19. aspx

Malatest International. (2022). Evaluation report: Pregnancy and parenting services. https://www.health.govt.nz/ publication/evaluation-report-pregnancy-and-parenting- services

Marcellus, L. (2017). A grounded theory of mothering in the early years for women recovering from substance use. Journal of Family Nursing, 23(3), 341–365. https://doi.org/10.1177/1074840717709366

McCrone, J. (2008, April 12). The demon P. The Press. https://www.stuff.co.nz/the-press/christchurch- life/361020/The-demon-P

McFadden, M., Bellamore, L., & MacDonald, B. (2021). The New Zealand Illicit Drug Harm Index 2020: Research report. https://www.health.govt.nz/system/ files/documents/publications/the_nz_illicit_drug_harm_ index_2020_2_dec.pdf

Milic, J., Glisic, M., Voortman, T., Borba, L. P., Asllanaj, E., Rojas, L. Z., Troup, J., Kiefte-de Jong, J. C., van Beeck, E., Muka, T., & Franco, O. H. (2018). Menopause, ageing, and alcohol use disorders in women. Maturitas, 111, 100–109. https://doi. org/10.1016/j.maturitas.2018.03.006

Milligan, K., Niccols, A., Sword, W., Thabane, L., Henderson, J., Smith, A., & Liu, J. (2010). Maternal substance use and integrated treatment programs for women with substance abuse issues and their children: A meta-analysis. Substance Abuse Treatment, Prevention, and Policy, 5(1), 1–14.

Milligan, K., Usher, A. M., & Urbanoski, K. A. (2017). Supporting pregnant and parenting women with substance-related problems by addressing emotion regulation and executive function needs. Addiction Research & Theory, 25(3), 251–261. https://doi.org/10.1 080/16066359.2016.1259617

Mitchell, M. M., Severtson, S. G., & Latimer, W. W. (2008). Pregnancy and race/ethnicity as predictors of motivation for drug treatment. The American Journal of Drug and Alcohol Abuse, 34(4), 397–404. https://doi.org/10.1080/00952990802082172

Morrison, B., Hamilton, K., & Lyndon-Tonga, L. (2021). “It’s the right path for me”: Findings from an aromatawai of Te Ira Wāhine. Practice: The New Zealand Corrections Journal, 8(1), 32–37.

Mukherjee, R. (2019). FASD: The current situation in the UK. Advances in Dual Diagnosis, 12(1/2), 1–5. https://doi. org/10.1108/ADD-02-2019-040

Nelson, A. (2022). The Nīkau Practice framework: A focused framework for social work practice with substance

use in Aotearoa New Zealand [Unpublished doctoral dissertation]. University of Auckland.

New Zealand Drug Foundation. (2020). State of the nation 2020: A stocktake of how New Zealand

is dealing with the issue of drugs. https://www. drugfoundation.org.nz/assets/uploads/State-of-the- Nation-2020-WEB2.pdf

New Zealand Drug Foundation. (2022a). Drugs in NZ – An overview. https://www.drugfoundation.org.nz/policy-and- advocacy/drugs-in-nz-an-overview/

New Zealand Drug Foundation. (2022b). State of the nation 2022. https://www.drugfoundation.org.nz/policy-and- advocacy/state-of-the-nation-2022/

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., . . . Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. https://www.bmj.com/content/372/bmj.n71

Paris, R., Herriott, A. L., Maru, M., Hacking, S. E., & Sommer, A. R. (2020). Secrecy versus disclosure: Women with substance use disorders share experiences in help seeking during pregnancy. Maternal and Child Health Journal, 24(11), 1396–1403. https://doi.org/10.1007/ s10995-020-03006-1

Parsonage, P. (2015). Waitemata ̄ DHB CADS Pregnancy and Parenting Service: Process evaluation. Health Promotion Agency.

Paschen-Wolff, M. M., Kidd, J. D., & Paine, E. A. (2023). The state of the research on opioid outcomes among lesbian, gay, bisexual, transgender, queer, and other sexuality- and gender-diverse populations: A scoping review. LGBT Health, 10(1), 1–17. https://doi.org/10.1089/ lgbt.2022.0036

Pedersen, M. (2019). “Feels a bit naughty when you’re a mum”: Alcohol use amongst mothers with preschool children (Unpublished doctoral dissertation]. Massey University. Massey Research Online. http://hdl.handle. net/10179/15706

Polak, K., Haug, N. A., Drachenberg, H. E., & Svikis,

D. S. (2015). Gender considerations in addiction: Implications for treatment. Current Treatment Options in Psychiatry, 2, 326–338. https://doi.org/10.1007/s40501- 015-0054-5

Pollock, D., Davies, E. L., Peters, M. D. J., Tricco, A., Alexander, L., McInerney, P., Godfrey, C. M., Khalil, H., & Munn, Z. (2021). Undertaking a scoping review: A practical guide for nursing and midwifery students, clinicians, researchers, and academics. Journal of Advanced Nursing, 77, 2102–2113. https://doi.org/10.1111/jan.14743

Proulx, D., & Fantasia, H. C. (2020). The lived experience of postpartum women attending outpatient substance treatment for opioid or heroin use. Journal of Midwifery & Women’s Health, 66(2), 211–217. https://doi. org/10.1111/jmwh.13165

Ramsay, A. J. (2014). Drunk feminine bodies: An exploration of young women’s embodied experiences of intoxication [Unpublished doctoral dissertation]. Massey University. Massey Research Online. http://hdl.handle. net/10179/6724

Rankine, J., Gregory, A., Tonks, A., & Thompson-Evans, T. P. (2013). Women and alcohol in Aotearoa/New Zealand: Te waipiro me ngā wāhine i Aotearoa. Alcohol Healthwatch and Women’s Health Action.

Reed, C. (2019, May 11). Fighting the demon. Inside New Zealand’s meth crisis. New Zealand Herald. https://www.nzherald.co.nz/indepth/national/new- zealands-fight-against-methamphetamine/

Salmon, J. (2008). Fetal alcohol spectrum disorder: New Zealand birth mothers’ experiences. Canadian Journal of Population Therapeutics and Clinical Pharmacology, 15(2), e191–e213.

Schamp, J., Simonis, S., Roets, G., Van Havere, T., Gremeaux, L., & Vanderplasschen, W. (2021). Women’s views on barriers and facilitators for seeking alcohol and drug treatment in Belgium. Nordisk Alkohol & Narkotikatidskrift, 38(2), 175–189. https://doi. org/10.1177/1455072520964612

Seitz, N. N., Lochbühler, K., Atzendorf, J., Rauschert, C., Pfeiffer-Gerschel, T., & Kraus, L. (2019). Trends In substance use and related disorders: Analysis of the Epidemiological Survey of Substance Abuse 1995 to 2018. Deutsches Ärzteblatt International, 116(35–36), 585–591. https://doi.org/10.3238/arztebl.2019.0585

Shahram, S. Z., Bottorff, J. L., Kurtz, D. L., Oelke, N. D., Thomas, V., Spittal, P. M., & Cedar Project Partnership. (2017). Understanding the life histories of pregnant- involved young Aboriginal women with substance use experiences in three Canadian cities. Qualitative Health Research, 27(2), 249–259. https://doi. org/10.1177/1049732316657812

Spirrett, T. (1997). Women’s discourse concerning relapse during methadone treatment: A feminist poststructuralist analysis [Unpublished doctoral thesis]. University of Auckland.

Streatfield, B. (2022). Young women’s recreational drug use in Aotearoa [Unpublished master’s thesis]. Te Herenga Waka-Victoria University of Wellington. Victoria University of Wellington online. https://doi.org/10.26686/ wgtn.21213665

Stuart, K. (2009). Trading off: A grounded theory on how Māori women negotiate drinking alcohol during pregnancy [Unpublished doctoral dissertation]. Massey University. Massey Research Online. http://hdl.handle. net/10179/1211

Suntai, Z. (2021). Substance use among women who are pregnant: Examining treatment completion by race and ethnicity. Journal of Substance Abuse Treatment, 131, 108437. https://doi.org/https://doi.org/10.1016/j. jsat.2021.108437

Thomas, R., & Mukherjee, R. (2019). Exploring the experiences of birth mothers whose children have been diagnosed with fetal alcohol spectrum disorders: A qualitative study. Advances in Dual Diagnosis, 12(1), 27–35. https://doi.org/10.1108/ADD-10-2018-0014

Towers, A., Sheridan, J., Newcombe, D., & Szabó, Á. (2018). New Zealanders’ alcohol consumption patterns across the lifespan. Health Promotion Agency. https://www. hpa.org.nz/research-library/research-publications/new- zealanders’-alcohol-consumption-patterns-across-the- lifespan

Tricco, A. C., Lillie, E., Zarin, W., O’Brien, K. K., Colquhoun, H., Levac, D., Moher, D., Peters, M. D. J., Horsley, T., Weeks, L., Hempel, S., Akl, E. A., Chang, C., McGowan, J., Stewart, L., Hartling, L., Aldcroft, A., Wilson, M. G., Garritty, C., . . . Straus, S. E. (2018). PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Annals of Internal Medicine, 169(7), 467–473. https://doi.org/10.7326/M18-0850

United Nations Office on Drugs and Crime. (2015). World Drug Report 2015. https://www.unodc.org/documents/ wdr2015/World_Drug_Report_2015.pdf

Vaughan, T. (1996). Public shame private problem: The role of partners in the recovery of women with alcohol abuse [Unpublished doctoral dissertation]. University of Auckland.

Waitematā DHB. (2017). Waitematā DHB CADs Pregnancy and Parenting Service (PPS): Outcome evaluation report.

Weber, A., Miskle, B., Lynch, A., Arndt, S., & Acion, L. (2021). Substance use in pregnancy: Identifying stigma and improving care. Substance Abuse and Rehabilitation, 12, 105–121. https://doi.org/10.2147/ SAR.S319180

Wells, E. A., Kristman-Valente, A. N., Peavy, K. M., & Jackson, T. R. (2013). Social workers and delivery of evidence-based psychosocial treatments for substance use disorders. Social Work in Public Health, 28(3–4), 279–301. https://doi.org/10.1080/19371918.2013.759033

Wilke, D. J., Kamata, A., & Cash, S. J. (2005). Modeling treatment motivation in substance-abusing women with children. Child Abuse & Neglect, 29(11), 1313–1323. https://doi.org/10.1016/j.chiabu.2005.05.002

Wood, M. (2010). Towards self-forgiveness and self- worth: Journeys of birth mothers of children with FASD [Unpublished doctoral dissertation]. University of Saskatchewan. http://hdl.handle.net/10388/etd- 09192010-174632




How to Cite

Jackson, S. C., Chubb, L. A., & de Haan, I. (2023). A scoping review of Aotearoa New Zealand women’s experiences of substance use, alcohol and drug services. Aotearoa New Zealand Social Work, 35(3), 58–75. https://doi.org/10.11157/anzswj-vol35iss3id1060



Original Articles