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In June 2016, UNICRI carried out a survey to explore the level of gender mainstreaming in the working agenda of substance use treatment centres in Italy. Gender responsive approaches are relatively new in the substance use field, although many studies highlight barriers to women's access to substance use services. The aim of this exploratory study was to investigate to what extent a gender responsive approach is applied in the Italian substance use treatment services and to explore the professionals’ opinions regarding the advantages and the challenges of applying such approach. The majority of professionals recognize the importance of including a gender responsive approach in their working agenda, and the need for specific training. Overall, the gender-responsive approaches are limited to pregnant women and mothers. A subset considered this approach counterproductive as compared to individualized treatment options. Results seem to indicate a general lack of understanding and awareness among professionals about the potentials of applying gender responsive approaches and about the social, economic and cultural factors that determine health inequalities and influence women's access to services. A reductionistic interpretation of the gender responsive approach seems to prevail, which limits women’s needs to those of pregnant women and mothers and does not take into account the role previous trauma and violence experiences might have on drug use in women.