Gender Related Mechanisms Put in Place for the Treatment of Alcohol and Drug Addiction Patients in Mathari National Teaching and Referral Hospital, Kenya
DOI:
https://doi.org/10.53819/81018102t5427Abstract
Drug addiction affects every demographic, but individual experiences of treatment vary considerably by gender, making it essential to understand the gender dynamics encountered by patients receiving alcohol and drug addiction treatment services. This study focused on Mathari National Teaching and Referral Hospital, the largest government rehabilitation facility in Kenya, which has a mission to treat, educate, and conduct research on alcohol and drug addiction. The specific objective of the study was to examine the gender-related mechanisms put in place for the treatment of alcohol and drug addiction patients at the hospital, with particular attention to gender bias during admission, enrolment criteria and admission duration, and gender-based separation during enrolment. The Feminist Theory on Equality and Reason, advanced by Mary Wollstonecraft, served as the foundation of the study, providing an analytical lens for examining how institutional mechanisms, though formally gender-neutral, can produce systematically inequitable experiences for male and female patients. A mixed-methods research design was employed to gather both quantitative and qualitative data. The study drew on a sample of 255 respondents, with 232 patients completing the questionnaire, alongside 10 key informant interviews with hospital staff, selected through stratified systematic random sampling. A questionnaire and an interview guide were used for data collection. Quantitative data were analyzed using descriptive and inferential statistics with the aid of SPSS version 23, while qualitative data were analyzed thematically, with verbatim quotes used to enrich the results. The findings revealed that although gender-related mechanisms existed at the hospital, they were unevenly implemented. Women were more than twice as likely to experience gender bias during admission, faced longer admission waiting times, and had reduced access to gender-segregated treatment spaces, and these upstream disparities translated into weaker treatment outcomes including lower comfort with treatment and poorer social reintegration. The study concluded that gender-related mechanisms existed more in principle than in practice and that meaningful equity required deliberate restructuring of admission protocols, resource allocation, and institutional accountability. Recommendations included standardizing admission protocols, expanding female-specific treatment spaces, introducing binding gender-responsive accreditation standards through the Ministry of Health and NACADA, and strengthening post-discharge aftercare to close the social reintegration gap experienced by female patients.
Keywords: Gender Related Mechanisms, Treatment, Alcohol and Drug Addiction, Patients, Mathari National Teaching and Referral Hospital, Kenya
References
Amaro, H., Raj, A., Vega, R. R., Mangione, T. W., & Perez, L. N. (2016). Racial/ethnic disparities in the HIV and substance abuse epidemics: Communities responding to the need. Public Health Reports, 116(5), 434–448. https://doi.org/10.1016/S0033-3549(04)50072-9
Baruch, Y., & Holtom, B. C. (2018). Survey response rate levels and trends in organizational research. Human Relations, 61(8), 1139–1160. https://doi.org/10.1177/0018726708094863
Bocelli, L. (2016). Gender disparities in substance abuse treatment enrolment. European Journal of Substance Use, 21(3), 145–160.
Brady, K. T., & Randall, C. L. (2019). Gender differences in substance use disorders. Psychiatric Clinics of North America, 22(2), 241–252. https://doi.org/10.1016/S0193-953X(05)70074-5
Budambula, N. L. M. (2018). Socio-demographic and sexual practices associated with HIV infection in Kenyan injection and non-injection drug users. BMC Public Health, 18(1), 1–10. https://doi.org/10.1186/s12889-018-5100-y
Chesang, R. K. (2013). Drug abuse among the youth in Kenya. International Journal of Scientific & Technology Research, 2(6), 126–131.
Constitution of Kenya. (2010). The Constitution of Kenya. Government Printer.
Degenhardt, L., Charlson, F., Ferrari, A., Santomauro, D., Erskine, H., Mantilla-Herrara, A., Whiteford, H., Leung, J., Naghavi, M., Griswold, M., Rehm, J., Hall, W., Sartorius, B., Scott, J., Vollset, S. E., Knudsen, A. K., Haro, J. M., Patton, G., Kopec, J., … Vos, T. (2021). The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. The Lancet Psychiatry, 5(12), 987–1012. https://doi.org/10.1016/S2215-0366(18)30337-7
Degenhardt, L., Peacock, A., Colledge, S., Leung, J., Grebely, J., Vickerman, P., Stone, J., Cunningham, E. B., Trickey, A., Dumchev, K., Lynskey, M., Griffiths, P., Mattick, R. P., Hickman, M., & Larney, S. (2016). Global patterns of opioid use and dependence: Harms to populations, interventions, and future action. The Lancet, 394(10208), 1560–1579. https://doi.org/10.1016/S0140-6736(19)32229-9
El Hayek, S., Foad, W., De Filippis, R., Ghosh, A., Koukach, N., Mahgoub Mohammed Khier, A., Pant, S. B., Padilla, V. S. R., Ramalho, R., & Shalbafan, M. (2024). Stigma toward substance use disorders: A multinational perspective and call for action. Frontiers in Psychiatry, 15, 1295818.
Ens, T. A., Seneviratne, C. C., Jones, C., & King-Shier, K. M. (2021). Factors influencing medication adherence in South Asian people with cardiac disorders: An ethnographic study. International Journal of Nursing Studies, 50(11), 1472–1481. https://doi.org/10.1016/j.ijnurstu.2014.02.015
Erica, J., Johnson, M., & Patel, S. (2021). Implementing gender-responsive strategies in addiction treatment: A systematic review. Journal of Substance Abuse Treatment, 127, 108–118.
European Monitoring Centre for Drugs and Drug Addiction. (2018). European drug report 2018: Trends and developments. Publications Office of the European Union.
Finke, L. (2018). Feminist theory, women's writing. Cornell University Press. https://doi.org/10.7591/9781501726255
Fisher, A. A., Laing, J. E., Stoeckel, J. E., & Townsend, J. W. (1998). Handbook for family planning operations research design (2nd ed.). Population Council.
Gouse, H., Magidson, J. F., Burnhams, W., Remmert, J. E., Myers, B., Joska, J. A., & Carrico, A. W. (2016). Implementation of cognitive-behavioural therapy for substance use disorders in South Africa. Substance Abuse Treatment, Prevention, and Policy, 11(1), 1–9. https://doi.org/10.1371/journal.pone.0147900
Green, C. A. (2016). Gender and use of substance abuse treatment services. Alcohol Research & Health, 29(1), 55–62.
Grella, C. E., & Joshi, V. (2019). Gender differences in drug treatment outcomes. Addictive Behaviors, 24(6), 837–851.
Health Act, No. 21 of 2017. (2017). The Health Act. Government Printer.
Houghton, S., & Roche, A. M. (2014). Men and substance use: Addressing masculine norms in treatment. International Journal of Drug Policy, 25(3), 430–437.
Hvidberg, L., Jensen, M., & Peterson, T. (2023). Gender disparities in healthcare delivery: A contemporary analysis. Journal of Health Services Research, 28(4), 245–258.
Jansson, L. M., Spencer, N., McConnell, K., Velez, M., Tuten, M., Harrow, C. A., & Huestis, M. A. (2016). Maternal buprenorphine maintenance and lactation. Journal of Human Lactation, 32(4), 675–681. https://doi.org/10.1177/0890334416663198
Kabore, I., Bloem, J., Etheredge, G., Obiero, W., Wanless, S., Doykos, P., Ntsekhe, P., Mtshali, N., Afrikaner, E., Sayed, R., Bostwelelo, J., Hani, A., Moshabesha, T., Motlhabane, T., Shongwe, E., Mtshali, P., Matinyenya, B., Jansen, N., Chibi, B., Mbongwe, B., & Tiam, A. (2016). The effect of community-based support services on clinical efficacy and health-related quality of life in HIV/AIDS patients. AIDS Patient Care and STDs, 24(9), 581–594. https://doi.org/10.1089/apc.2009.0307
LaFave, L. M., & Echols, L. D. (2016). An argument for choice: An alternative women's treatment program. Journal of Substance Abuse Treatment, 16(4), 345–352. https://doi.org/10.1016/S0740-5472(98)00051-8
Langton, L. (2012). Use of victim service agencies by victims of serious violent crime, 1993–2009. Bureau of Justice Statistics.
Lugones, M., Spelman, E. V., Kolmar, W. K., & Bartkowski, F. (2005). Feminist theory: A reader. McGraw-Hill.
Mburu, G., Ayon, S., Tsai, A. C., Ndimbii, J., Wang, B., Strathdee, S., & Seeley, J. (2018). Who has ever loved a drug addict? It's a lie. They think a 'teja' is a bad person: Multiple stigmas faced by women who inject drugs in coastal Kenya. Harm Reduction Journal, 15(1), 29.https://doi.org/10.1186/s12954-018-0235-9
Mokaya, A. G. (2016). Determinants of drug abuse among women in Nairobi County, Kenya (Master's thesis). University of Nairobi.
Mugisha, F., Arinaitwe-Mugisha, J., & Hagembe, B. O. N. (2017). Alcohol, substance and drug use among urban slum adolescents in Nairobi, Kenya. Cities, 20(4), 231–240. https://doi.org/10.1016/S0264-2751(03)00034-9
Muthuri, J. N., & Arasa, J. N. (2017). Gender differences in substance use problems in Kenya. Journal of African Studies and Development, 9(5), 56–63.
Mutindi, M. (2016). Barriers to treatment access for women with substance use disorders in Kenya. African Journal of Alcohol and Drug Abuse, 1(1), 12–24.
Muturi, N. (2016). Communication indicators and the HIV/AIDS epidemic in rural Central Kenya. African Journal of AIDS Research, 4(1), 15–24.
Nairobi City County Government. (2018). Nairobi City County government annual report. Nairobi City County.
National Authority for the Campaign against Alcohol and Drug Abuse. (2017). NACADA strategic plan. NACADA.
National Authority for the Campaign against Alcohol and Drug Abuse. (2022). Status of drugs and substance use in Kenya. NACADA.
National Survey on Drug Use and Health. (2019). Results from the 2019 National Survey on Drug Use and Health: Detailed tables. Substance Abuse and Mental Health Services Administration.
Ndegwa, S., Munene, A., & Oladipo, R. (2017). Factors influencing alcohol use among university students in a Kenyan university. African Journal of Clinical Psychology, 1(1), 102–117.
Nugroho, A., Aminah, S., & Faisal, R. (2021). Gender-sensitive practices in addiction treatment: Implementation challenges and outcomes. International Journal of Drug Policy, 89, 103–112.
Odejide, O. A. (2016). Status of drug use/abuse in Africa: A review. International Journal of Mental Health and Addiction, 4(2), 87–102. https://doi.org/10.1007/s11469-006-9015-y
Pesce, R. C., van Veen, T., & Giltay, E. J. (2016). Gender-responsive treatment programmes for women with substance use disorders. European Addiction Research, 22(4), 196–205.
Possick, C., & Itzick, M. (2018). Women's experience of drug abuse treatment: A review. Journal of Social Work Practice in the Addictions, 18(3), 245–263.
Price, J., & Shildrick, M. (2017). Feminist theory and the body: A reader. Routledge. https://doi.org/10.4324/9781315094106
Richie, B. E. (2018). Compelled to crime: The gender entrapment of Black battered women. Routledge. https://doi.org/10.4324/9781315656557
Rizzo, D. N., Wong, E. C., Collins, R. L., Pedersen, E. R., Dong, L., & Troxel, W. M. (2022). Barriers to treatment for substance use among women at risk in the United States: A scoping review. Substance Abuse Treatment, Prevention, and Policy, 17(1), 48.
Schamp, J., Simonis, S., Roets, G., Van Havere, T., Gremeaux, L., & Vanderplasschen, W. (2021). The role of gender in perceived barriers to and facilitators of substance use disorder treatment for women in Flanders, Belgium. Frontiers in Psychiatry, 12, 688323.
Schuch, J. J. J., & De Jonge, P. (2018). Gender differences in the effectiveness of treatment for substance use disorders in the Netherlands. Drug and Alcohol Dependence, 186, 1–8.
Tuchman, E. (2011). Women and addiction: The importance of gender issues in substance abuse research. Journal of Addictive Diseases, 29(2), 127–138. https://doi.org/10.1080/10550881003684582
Van der Meer, C. A. I., Bakker, A., & Olff, M. (2017). The role of female staff in gender-sensitive addiction treatment. European Journal of Psychotraumatology, 8(Suppl 5), 1375338.
Vicente, J., & Wiessing, L. (2017). Gender differences in adolescent substance use in Europe. Drugs: Education, Prevention and Policy, 24(5), 385–392.
World Health Organization. (2023). Global status report on alcohol and health and treatment of substance use disorders. World Health Organization.
