Women using alcohol and other drugs
Dorothy Broom & Adele Stevens, women's studies program Australian National University
In introducing a discussion of topics that are formulated as "women and ....", it is customary to note that previous _ r4;earch concerning the second of the two terms has typically failed to consider how women’s lives differ from men’s. Whether it be women and the law, women and fiction, women and the city ... the list is endless, and while the story differs in the details, the plot is much the same: the study of human life has, until recently, been the study of men’s lives, and much of what has been said about the law, fiction, and the city is really only relevant to men’s experiences of the law, fiction, and the city. Indeed, sometimes it is even limited to men drawn from specific racial and class locations, and the story of humanity has been not simply incomplete, but distorted by its failure to consider the diversity of human lives.
The contemporary women’s movement has identified these omissions and distortions, and has undertaken the task of enlarging our understanding by engaging research that not only throws the spotlight on actors previously consigned to darkness, but raises questions about the most fundamental assumptions and categories of social thought: rationality, the state, the self, the body, the social contract, the periods of history. In some areas, such research has been going on for a decade or two, and vigorous new discourses are being generated. In women’s health, discussions of the world of work and the family there is now a substantial and diverse literature, and social institutions are beginning to alter their own procedures to take account of it. For example, equal opportunity policies, women’s refuges and women’s health centres all represent responses by organisations and the state to new feminist analysis and the claims arising out of it. However, other areas have been slower to develop either scholarship or policies that show the imprint of this new force in contemporary social thought. Alcohol and other drug use is one such area.
Until the 1970s, most studies of alcohol and other drug use were conducted among males (this omission is documented by writers such as Wilsnack and Beckman, 1984; Reed, 1987). Some studies ignored women entirely; others included women but ignored gender, simply lumping men and women together in the analysis. A review of the literature in 1970 showed that only 28 English language studies of alcoholic women had been published between 1929 and 1970 (Sandmaier quoted in Wilsnack and Beckman, 1984: ix). Congruent with the limited empirical research on women, theories of addiction and treatment have also ignored women. The typical alcoholic or drug addict was assumed to be male, and services were developed to address alcohol and other drug problems so conceptualised.
Initially, researchers tended to simply add women into studies that remained otherwise unchanged. Studies that include women at least permit empirical documentation of sex differences in rates of alcohol and other drug use, and they have shown that women are less likely than men to use illicit substances, alcohol or tobacco, but more likely to take prescribed drugs. However, without revising the conceptual models that both direct and arise out of empirical research, the new studies could add little to our understanding of how gender figures in alcohol and other drug use, abuse, or treatment. Data divided into two categories do not explain how the members of those categories are socially produced as gendered, nor do such data necessarily reveal gender differences in the social production or social meanings of drug use.
In the 1980s, the first studies appeared that placed women and gender squarely centre-stage (for example, Fillmore, 1984; Hamilton, 1989; a special issue of the Journal of Social Issues, Vol. 38, No. 2, 1982). These studies identified the previous neglect of women in the literature, and showed that workers in the field-including researchers therapists, and the police-have tended to share the lay view that women with drug or alcohol problems were somehow "worse" thE men with the same problems. Women who al problem drinkers or use illicit drugs have been construed socially as different or more abnormal than men who engage in the same behaviour. Considering norms of appropriate femininity and masculinity, it becomes apparent that an addicted or alcoholic woman is doubly deviant: she has transgressed not only the law or general social convention, but she has specifically violated the norms of being a " good woman." Her drinking and drug use opens her to suspicion of sexual promiscuity or prostitution and incompetence as a mother and wife. Addiction or alcoholism among males, by contrast, is more or less accepted as a "social fact" (Fillmore, 1984) of masculine excess. In women, such problems are viewed as profound threats to the social order.
The social expectation that intoxication is permissible for men but not women has a long history in Australia where, since the establishment of white settlement in the l9th century, sexual stereotypes have had it that respectable women must function as "God’s police," imposing restraint, civilisation and decorum on men who would otherwise, naturally, behave in barbaric, antisocial ways (Summers, 1975). Traditionally, Australian public bars excluded entry to all women except prostitutes and barmaids, and later admitted women only to segregated "ladies lounges" where they would be protected from the heavy drinking and masculine misbehaviour of the main bar. Because of the poverty and violence associated with alcoholism, some colonial Australian women took up the cause of temperance, as American women did. These historical conventions have kept Australian women’s use of alcohol and illicit drugs markedly lower than men’s (Lennane, 1987). The inhibition arises, however, not from the properties of the drugs, or even from the drugs themselves, but from their social definition. For example, during the 1890s, the majority of consumers of opiate-based patent medicines were women, whereas once these substances became illegal, the sex ratio was reversed (Stevens, forthcoming). Apparently women may use substances for medicinal purposes, but not for recreation. As Erickson and Murray have observed, women’s use of prescription medication ... is not viewed with the alarm and disapproval that accompanies women’s lower levels of us of alcohol and illicit drugs (1989). The concern attending women’s alcohol and other drug use has tended to emphasise not the welfare of the women themselves, but the dangers that drug using women pose to their children and families, and to civil society more generally.
In recent decades, concern has grown regarding women’s use of alcohol (Wodak, 1990), nicotine (Jacobsen, 1986), and prescribed drugs (Cooperstock, 1978; Mant, Broom and Duncan-Jones, 1983). This concern arises from the recognition that these licit drugs are used by far more women. And hence cause more harm, than illicit drugs. It may also be stimulated by the cultural belief that any use of drugs by women is more likely to be defined as abuse than similar use by men. so awareness that women are using these substance is almost automatically construed as a social problem. The increased concern is related to a suspicion that women may be more susceptible than men (or susceptible at lower levels) to the harm caused by various substances (Dunne, 1988).
This is an area in much need of thorough investigation.
In Australia, the state has been a key actor in both research and intervention in alcohol and other drug problems, perhaps more so than in some other countries where private and philanthropic organisations have played a larger part. Indeed, Australian governments have figured centrally in defining and addressing many social problems, including economic inequality, social justice, and ill health. As Sara Dowse put it in a classic essay, "despite my scepticism about the so-called democratic process of government and my philosophical abhorrence of the modern capitalist state, when I want something done I look to just that arena. My expectations are low, but my directions are clear." (Dowse, 1984: 139).
In the last decade and a half, Australian women have been successful in making claims on the state for services that address their special needs. Since 1974, more that 40 women’s health centres (Broom, in press) and over 300 women’s refuges (Department of Community Services and Health, 1990: statistical supplement 57) have opened in metropolitan areas and country towns, and most of these have at some stage been partly or fully government funded.
A major initiative of the Commonwealth government has been the creation in 1985 of a National Campaign Against Drug Abuse (NCADA) which allocates funding for treatment, law enforcement, research, and health education campaigns (Brown et al., 1988). Women are a "target group" identified by the Campaign, and much of the Australian research on women’s drug problems has been funded (at least in part) under this program (for example, see Waldby, 1988; Cormack and Smith, 1986 and 1988). Services directed toward women have also benefited from NCADA’s priorities; in some instances, groups that had sought for years to address women’s special needs on limited or no funding finally obtained financial support as a result of increased government allocations (Murray, 1990).
To what extent have these studies and services been informed by feminist perspectives? In the past, attention to wome within the field has frequently actually reinforced women’s subordinate status rather than questioning it. However, some recent Australian work has begun to develop in new directions. One key element in a feminist perspective is the consideration of women not as a homogeneous category, but as a diverse group. For example, Aboriginal women have particularly intense and culturally specific problems related to alcohol.
"Their own use of alcohol or the fact of living in a community where alcohol use permeates the fabric of daily life, have been factors which exacerbate the myriad other difficulties experienced by Aboriginal women...in their disadvantaged position in Australian society "(Brady, 1989:12).
European colonisation has been immensely destructive of Aboriginal self-sufficiency, and at the same time, has replace traditional use of "softer" drugs such as pitju with much more harmful substances and patterns of use (Hume, 1989: 41). Ferrence has suggested that targeting prevention programs to specific subgroups is likely to yield better results. She suggests young single women, divorced and separated women and depressed women are all at special risk and would benefit from prevention designed to meet their particular needs (1984).
Feminist research and services also consider carefully the way social beliefs about gender influence women’s experience of drug use and treatment. For example, Waldby (1988) has explored the professional presumption that addicted women cannot make good mothers, and the resulting concentration on the welfare of the foetus/infant at the expense of the mother who
"... is regarded as the cause of her infant’s medical problems and as the primary obstacle to the care of the child in utero, rather than as a subject worthy of attention in her own right. The interests of mother and child are posed as antithetical, and as the ‘innocent’ party the child’s interests are granted priority". (Waldby, 1988: 82).
These patterns interfere with the relationships between the mother and child and alienate women from treatment facilities, creating a self-fuUfilling prophecy in which addicted women are defined as incompetent mothers and are subjected to experiences which deprive them of their competence.
Another example of a study informed by feminist theory is Pilkinton’s (forthcoming) consideration of gender differences in recreational cocaine use. She found that men’s and women’s patterns of cocaine use differed along lines that conformed to their different social positions, including heterosexual relationships. Women were more likely than men to refrain from using cocaine if they felt it would interfere with their work or family responsibilities. They also tended to acquire the drug as a gift, whereas men were more likely to buy their supplies.
This study is congruent with American research that identifies sex differences in th, personal histories of heroin users (Binion, 1982). It also fits with Sargent’s (1989) research in London, Sydney and Amsterdam which revealed a sexual division of labour in the drug scene. Women were prostitutes anc couriers, while men occupied the high prestige positions as dealers, a pattern whicl parallells the division in straight society. These studies demonstrate the need for further research that considers the way women’s social lives shape and inform their drug use and problems.
Just as good research must be gendered it is to promote understanding of all drug users, adequate treatment programs must also be gender sensitive. A few such progran now exist in Australia. The Women’s Addiction Recovery Service in the ACT developed its approach and its activities out o a long and ongoing process of interaction wit: the client population (Enright, forthcoming). There is debate about the appropriateness of women-only services (Hamilton, 1989:33), bu there is no doubting that the bulk of services supposedly designed for both sexes have actually been inappropriate for women and have contributed to women’s under representation in treatment (Reed, 1987;
Cormack and Smith, 1988). Few treatment programs have included child care, thus excluding many women with responsibilities for growing children. American research shows that women are attracted to agencies that included treatment for children (Beckman and Kocel, 1982), and an Australiar residential program with child care shows unusually high rates of use by women (Blatch 1990). Women have also been fearful that they would lose custody of their children if they sought treatment, a well-founded fear in view of the stereotype that drug affected women cannot be good mothers.
Traditional services have relied on the medical model which presumed that drug abuse was a symptom of an individual’s genetic or environmental defects. They have largely ignored the non-pathological social factors that influence drug use, and they have ignored entirely the differential factors that influence women’s drug use. For example, workers in the field are now convinced that many drug affected women have been subjected to childhood sexual abuse and other forms of violence. Expecting such women to recover in residential situations where they must live and work with men is manifestly unrealistic. On the other hand, it is not difficult to understand the resistance to acknowledging the violent backgrounds of women addicts, as it shifts the blame away from the "fallen woman ," and raises questions about male violence and the dangers to women and children in the family home.
Gender sensitive services recognise that women are typically deprived of access to power and self-determination, and that their drug use is likely to be shaped by women’s comparative powerlessness. Consequently, appropriate treatment programs must contribute to empowerment if they are to be effective in the long term. Related to empowerment is the notion that abstinence is not the only valid treatment goal; "control over substance abuse and personal empowerment are equally valid" (Stewart ar Briggs, 1990). In some circles, increasing emphasis is being placed on harm reduction as the objective. The evidence that women often modify their use patterns for the benef of colleagues or children suggests that harn reduction can be an appropriate and realistic strategy for some women, and that support i achieving it would be constructive. In light o the AlDs crisis, such approaches become all the more compelling.
Perhaps one of the most significant contributions a feminist perspective can add to understanding and treatment of women’s alcohol and other drug problems is an appreciation of the complexities and contradictions that bear on the issues. For example, women’s social and psychological dependency, are clearly important factors in how and when drugs become problems (Ettorre, l 989: 596) . Writers such as Jacobse (1989) have stressed women’s use of drugs as a means of coping with sexual oppression and the depression that it produces. According to this view, women’s drug problems are symptoms of the destructiveness of conforming to social norms. On the other hand, because it contradicts the standards of acceptable femininity, women’s recreational use of alcohol and other drugs may serve as form of resistance to social norms. In these cases, women may choose to flaunt conventional femininity by seeking out pleasurable behaviours that are normally prohibited to women. These alternatives are not "opposites". Instead, they are two aspects of the same logic: a logic that connects women’s alcohol and other drug use to women’s social relationships and the social structures that govern them.
Beckman, Linda J. and Katherine M. Kocel 1982 The treatment-delivery system and alcohol abuse in women. Journal of Social Issues 38 (2):1390151 .
Binion, Victoria Jackson 1982 Sex di¤erences in socialization and family dynamics ot male and female heroin users. Journal of Social Issues 38 (2): 43- 57.
Blatch, Lynne 1990 Women and TCs - a family approach to treatment. Paper presented at the World Federation of Therapeutic Communities Conference Athens, September.
Brady, Maggie 1989 Alcohol use and its effects upon Aboriginal women. Seminar: Alcohol and Crime, 4-¢ April, Australian Institue of Criminology, Canberra.
Broom, Dorothy H. 1991 Damned If We Do: Contradictions in Women s Health Care Sydney: Allen & Unwin (in press).
Brown, H., M. Hamilton, D. Macdonald, M. Miller and E. Stephensen 1988 Report of the Task force on Evaluation, Natlonal Campaign Against Drug Abuse i985-1988 Canberra: Department of Community Services and Health.
Cooperstock, Ruth 1978 Sex differences in psychotropic drug use. Social Science and Medicine 12: 176-186.
Cormack, Simone and Helen Smit 1986 and 1988 Services for Women wlth Drug and Alcohol Related Problems in South Australia (2 Volumes) Adelaide: Drug and Alcohol Senvices Council Monitoring, Evaluation and Research Unit.
Department of Community Services and Health 1990 Annual Report of the Department ot Community Services and Health 1989-90 Canberra: AGPS.
Dowse, Sara 1984 The bureaucrat as usurer. In Dorothy H. Broom (ed), Untinished Business: Soci Justice tor Women in Australia Sydney: George Allen & Unwin
Dunne, Frances 1988 Are women more easily damaged by alcohol than men? British Journal of AddicUon 83:1135-1136.
Enright, Lyn, forthcoming Women s Addiction Recovery Service: a community development model. Dorothy Broom (ed), Women s Alcohol and Drug Ut : Australian teminist perspectives Canberra:
Australian Council of Alcohol and Other Drug Associations.
Erickson, Patricia G. and Glenn F Murray 1989 Sex diherences in cocaine use and experiences: a double standard revived? American Journal of Drug and Alcohol Abuse 15 (2).
Ettorre, Betsy 1989 Women and substance use/abus towards a leminist perspective or how to make dust ‘l! Women s Studies International Forum 12: 593-602.
Ferrence, Roberta G. 1984 Prevention ol alcohol problems in women. In Sharon C. Wilsnack and Lind J. Beckman (eds) Alcohol Problems in Women Nez York: The Guilford Press. Pp. 413-442.
Fillmore, Kaye Middleton 1984 When angels fall: women s drinking as cultural preoccupation and as reality. In Sharon C. Wilsnack and Linda J. Beckman (eds) Alcohol Problems in Women New fork: The Guilford Press. Pp. 7-36.
Hamilton, Margaret 1989 My story: reflections from a worker in this field since the late 1960s. In Proceedings ot the Natlonal Conference on Women: Alcohol and Other Drugs Adelaide: Drug and Alcohol Senvices Council of South Australia. Pp. 23-39.
Humes, Glenda 1989 The situation in the Aboriginal Community. In Proceedings ot the National Conference on Women: Alcohol and Other Drugs Adelaide: Drug and Alcohol Senvices Council of South Australia. Pp. 4’-47.
Jacobsen, Bobbi 1986 Beating the Ladykillers London: Pluto Press.
Lennane, J. 1987 Women alcohol and drugs. Proceedings of Autumn School ot Studies on Alcohol and Drugs Sydney: St. Vinoent s Hospital.
Mant, Andrea, Dorothy Broom and Paul Duncan-Jones 1983 The path to prescription Social Psychiatry 18:
Murray, Robin 1990 Jarrah house. In Proceedings of the Third Winter School in the Sun Conference Brisbane: Alcohol and Drug Foundation of Queensland Pp. 319-328.
Pilkinton, Nicola lorthcoming Recreational cocaine use. In Dorothy Broom (ed), Women s Alcohol and Drug Use: Australian feminist perspectives Canberra: Australian Council of Alcohol and Other Drug Associations
Reed, Beth Glover 1987 Developing women-sensitive drug dependence treatment services. Journal of Psychoactive Drugs 19 (2): 151-164.
Sargent, Margaret 1989 Power relations theory: women s social position, their downfall and their healing. Paper presented at the National Conference on Women, Alcohol and Other Drugs, Adelaide.
Stevens, Adele forthcoming Illicit drug use among women. In Dorothy Broom (ed), Women s Alcohol and Drug Use: Australtan teminist perspectives Canberra: Australian Council of Alcohol and Other Drug Associations.
Stewart, Jan and Vikki Briggs 1990 Evaluation ol a specialist drug and alcohol treatment service for women. Centre Lines No 3 (National Drug and Alcohol Research Centre, Sydney).
Summers, Anne 1976 Damned Whores and God s Police Harmondsworth: Penguin.
Waldby, Cathy 1988 Motherlng and AddicUon:
Women with Children in Methadone Programs National Campaign Against Drug Abuse Monograph Series No .4 Canberra: AGPS.
Wilsnack, Sharon C. and Linda J. Beckman (eds) 1984 Alcohol Problems In Women New York: The Guilford Press.
Wodak, Alex 1990 Alcohol and women s health: a cause for concern? Health right 9 (3): 17-22.