Impact of case management on rural women's quality of life and substance use.

INTRODUCTION: It is widely accepted that women experience drug dependency in different ways from men, including a greater sense of social stigma, higher levels of shame and self-blame, and higher rates of psychological co-morbidity. There is also evidence that women's experience of substance dependency may be negatively affected by living in a rural area. Recognising the complex needs of rural drug dependent women, a community-based case management model (known as WRAP--women's referral and access program) was developed, which adopted a holistic approach and aimed to address the physical, social and psychological dimensions of women's lives. This article reports a study to determine if this model was effective in meeting the women's broader support needs; and specifically whether it improved women's quality of life, health and social circumstances.

METHODS: Women were assessed at baseline, 3 and 6 months, using a semi-structured interview, the WHO Quality of Life brief version (WHOQoL-BREF), Rosenberg Self-Esteem Scale, and the Brief Treatment Outcome Measure (BTOM).

RESULTS: Sixty-three women were recruited to case management. After 6 months, 62% of women recruited remained in case management, with older women and those with better self-reported health status at recruitment more likely to do so. Consistent with women's subjective experience, there were significant improvements in self-esteem; the psychological domain of the WHOQoL-BREF; severity of dependence, psychological wellbeing and social functioning (BTOM); with reductions in drug dependency and drug use. The model, linking women with services and some direct service provision, was generally well accepted by women.

CONCLUSION: The WRAP case management model, with its holistic approach and focus on improving women's quality of life rather than on reducing drug use per se and/or trying to move women into drug treatment, was successful. The model is well suited to implementation within the constraints of a rural setting. There is strong evidence for improvement in many areas of women's lives over a 6 month period of case management, and a trend towards continued improvement beyond 3 months of case management in some areas. For women, the success of case management was a result of the consistency and continuity provided by having one person who provided much needed support and assistance.