Gender-responsive addiction treatment: Centering women’s voices to advance trauma-informed and transformative care

Background. Women with substance use disorders face distinct and compounding barriers to addiction treatment, including trauma histories, caregiving responsibilities, stigma, and structural inequality. Despite increased interest in gender-responsive treatment, few studies centre women’s lived experiences to inform trauma-informed and transformative care. Methods. This qualitative study draws on in-depth interviews with 60 women engaged in alcohol and drug services across Belgium, including women-only as well as mixed-gender programmes. Data were analysed using conventional content analysis to identify key themes related to gender-responsive and trauma-informed care. Results. Five core themes emerged: (1) safety - emotional, relational, and environmental - as a foundation for recovery; (2) nuanced preferences for women-only versus mixed-gender settings; (3) the importance of peer support and lived experience in fostering trust and motivation; (4) the need for holistic, person-centred, and body-aware treatment; and (5) comprehensive care that respects women’s social roles and realities. Women emphasized that meaningful recovery extends beyond abstinence to dignity, connection, and systemic support. Conclusion. Gender-responsive alcohol and drug treatment goes beyond mere adaptation to transformation of power, practice and purpose. Centering women’s voices reveals the need for flexible, trauma-informed, and structurally aware care that addresses both individual recovery and the social conditions that shape it.