Over the past decade there has been a greater focus on the needs of women who are using substances problematically, with consideration within the policy, research and intervention fields, both in Ireland and internationally (Mutatayi et al., 2022; Morton et al., 2020). This has included an analysis of gender and Irish drug policy (Morton et al., 2020; Windle & Cronin, 2025), involvement in international projects and publications such as the Pompidou Group Gender and Drug Policies Handbook, (Mutatayi et al., 2025) and showcasing of good practice and innovation in relation to women’s pathways into treatment, innovation in intervention, complexity and intersectionality, and trauma and domestic violence (Giacomello, 2022; Mutatayi et al., 2022). The recently published draft new National Drug Strategy includes gender mainstreaming as a core principle in terms of responses and interventions, as well as a key action to address intersectionality issues for women including domestic violence (Department of Health, 2026).

Important gender differences in both patterns of substance use and access to treatment have been highlighted and debated (Greene et al., 2023; Grella & Lovinger, 2011). Historically, substance use has been described as more prevalent among men than women, particularly alcohol and illegal substance use (Thibaut & Jhanwar, 2020). Recently an array of Irish literature has illustrated gender distinctions with respect to substance use trajectories arguing a clear connection between childhood trauma, domestic violence, abuse, parental drug use, poverty and bereavement/loss and later substance use initiation pathways (Morton et al., 2023; Ivers et al., 2021) as well as participative methodologies to explore women’s experiences (McCullough et al., 2025) and the importance of culturally appropriate responses (Comiskey & O’Neill, 2026). This paper emanates from discussion between community based organisations and service providers about how to proceed in developing and enacting gender transformative responses in the context of community interventions and practices.

The intention was to provide a theoretical basis for a gender transformative approach, together with a practical summary of the recommendations published to date on responding effectively to women using substances in Ireland. We summarise and categorise the key recommendations with a view to providing guidance to services, practitioners, funders and policy makers in regard to women and substance use responses. Additionally, this is undertaken from the position of exploring and clarifying the attributes of any responses that may ensure a transformative impact.