A case study from the West Midlands reveals that the British From Harm to Hope drugs strategy lacks gender responsiveness. Researchers used qualitative methods, including interviews and focus groups, to explore drug and alcohol treatment issues affecting women. The study involved 28 female service users and 17 practitioners from the women’s sector, along with nine frontline professionals who participated in an online world café to gather insights. Findings indicate that many women using illicit drugs face trauma and mental health challenges linked to adverse childhood experiences, child removals, domestic abuse, and interactions with the criminal justice system. The study emphasizes the need for public health policies to more effectively address women’s substance use, mental health, and the effects of abuse and violence throughout their lives. Recommendations include improving drug and alcohol services and enhancing referral pathways to support domestic violence and mental health services. The research highlights the importance of developing tailored strategies to better serve women’s health needs in the context of substance use.