Women who inject drugs (WID) are highly marginalized and stigmatized and experience ongoing discrimination in Georgia. Few opportunities exist for WID to receive publicly funded treatment for substance use disorders. The IMEDI (Investigating Methods for Enhancing Development in Individuals) project was developed in response to the need for women-specific and women-centered treatment services. This paper described our approach to understanding the Georgian culture—and WID within that culture—so that we could integrate two interventions for substance use found effective in other Western and non-Western cultures and to outline how we refined and adapted our integrated intervention to yield a comprehensive women-centered intervention for substance use. Reinforcement Based Treatment (RBT) and the Women’s CoOp (WC) were adapted and refined based on in-depth interviews with WID () and providers of health services () to such women and focus groups [2 with WID () and 2 with health service providers ()]. The resulting comprehensive women-centered intervention, RBT+WC, was then pretested and further refined in a sample of 20？WID. Results indicated positive pre-post changes in urine screening results and perceived needs for both RBT+WC and a case management control condition. The approach to treatment adaptation and the revised elements of RBT+WC are presented and discussed. 1. Background and Aims Injection-drug-using individuals are highly marginalized, highly stigmatized, and are at increased risk for STIs, HCV, and HIV worldwide [1]. Women who inject drugs (WID) experience this same marginalization, stigmatization, and increased risk for disease—without any recognition for the need for research and service delivery focused on their unique needs [1]. WID in Georgia are likewise highly marginalized and stigmatized and experience ongoing discrimination in Georgia. Although they represent up to 10% of the adult substance-using population [2, 3], only 1–5% of drug-related service beneficiaries are women [4, 5]. The World Health Organization [1] has recently called for worldwide efforts to provide treatment services for women to meet their unique needs, including physical abuse and violence. Women in Georgia who use illicit substances commonly experience emotional abuse, physical aggression, and sexual violence [6]. Such violations are rooted in social norms and traditions and a cultural environment that supports asymmetry in gender roles and places restrictions on women’s freedom and independence [7]. Recent economic problems in Georgia have facilitated women’s rise
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