The specifities of female drug addiction
Female use and abuse of drugs has been studied for only a short time. Its connections with violence, the fact that is rarely brought into the open, and its highly negative social image have served as convincing arguments for developing programmes specifically targeting women.
The results of etiotogical studies have shown that having undergone sexual violence, especially during childhood, is closely correlated with the consumption of heroin, cocaine and alcohol.
In the United States, eighteen States have passed laws against pregnant crack or cocaine users. These women run the risk of having their children taken away from them either temporarily or for good, and in South Carolina, of being sentenced to prison for up to 10 years (1). Drug use is stigmatised in all societies, but it is frowned upon even more when the user is a woman. It has been estimated for example that 9 out of 10 women go on living with alcoholic partners, whereas only 1 out of 10 men do so (2). Women have no choice but to hide their addiction. To declare it openly is to sign a social death warrant, and sometimes actually leads to physical death: many women questioned at treatment centres admitted that they had made suicide attempts (3). Men presumably feel less guilt about their addiction than women, and are able to maintain higher levels self-esteem because they are more able to blame their drug abuse on external causes. The medicalisation of women's lives (2) also explains why no one ever notices they are taking drugs. Although they take fewer hard drugs (there is only 1 woman hard drug abuser for every 3 men) and alcohol (there is only 1 woman alcohol abuser for every 2 men), physicians prescribe three times more benzodiazepines* for female patients, thus causing further addiction while confining this "normalised", medically-prescribed consumption to the secrecy of private life.
The fact that women are blatantly in the minority among the patients attending specialised centres seems to be due to their role as mothers. Between 18% and 75% of all the women undergoing treatment have at least one child (4) and are afraid that they will be accused of being irresponsible mothers. They also often have the impression that they are being inspected more than they are being helped (5). One of the arguments put forward to justify setting up centres equipped with child minding facilities is that it is harder for women to talk about the violence to which they have subjected when men are present. The results of etiological studies (3) have shown that the fact of having undergone sexual violence, especially during childhood, is closely correlated with the abuse of heroin, cocaine and alcohol. On the world-wide scale, physical and sexual violence results in the death or mutilation of more women aged between 15 and 44 than cancer, malaria, road accidents and even war. Given this context, female drug abuse might be regarded as a kind of survival strategy.
Surveys carried out in Germany, France and Ireland have indicated that HIV and HVC are on the uprise among female drug consumers (6). This would seem to result from greater risk-taking with injections and unsafe sex. The trend is attributable to the fact that women have less scope to negotiate whether a sexual partner is going to wear a condom or not, while being at the same time more susceptible to all sexually transmitted diseases, including HIV infection. Their sexual organs are more accessible to the virus, and have a more sensitive and more easily damaged surface. Women are usually initiated to drug use by a partner or a member of their family (siblings or elders), whereas men are usually initiated by peers. Female users of hard drugs such as heroin, cocaine and crack, are forced to seek the protection of a partner from street violence: the authors of several studies have reported that drug-consuming couples frequently share their syringes and forego the use of condoms. Since illegal drugs such as cocaine, crack and heroin are expensive, women sometimes barter a dose in exchange for sex, and this leads them into prostitution. According to the latest European studies, 60% of all the women who consume hard drugs go in for prostitution. The risk that these women may contaminate their customers with infectious diseases has always been a cause for concern and has been one of the reasons for the development of harm reduction programmes for prostitutes as well as schemes for treating female drug abusers. A number of local low threshold Outreach projects have been set up in Europe for women, which provide shelter, information and practical advice about safe sex and reducing the risks associated with drug consumption. Mutual aid groups such as Mainline in Amsterdam give women access to various services and activities designed to bolster their self-esteem, such as hairdressers, theatrical activities -and self-defence.
2 Anne-Catherine Menétrey, Alcool et toxicomanies: "Faut-il une approche spécifique scion le sexe?" Lausanne: Dépendances n°ll, ISPA/GREAT 2000.
3 Council of Europe, Pompidou Group. Women and drugs. The accent on prevention. Proceedings of the Bonn Symposium, 6-7 October 1995. Strasbourg, Council of Europe, 1997.
4 "Lee Canadiennes et Fusage d'alcool de tabac et d'autres drogues." ARF: Toronto, ed. 96. http://fano.arf.org
5 The "Femmes, dépendances" forum is a group that brings together women from all over French-speaking Switzerland, who are interested in addiction-related issues within a gender context. Under the auspices of the ISPA, also cf. "Points de vue sur lee toxicodépendances des femmes en Suisse romande, Enquête sur la demande et I'offre d'aide spécialement destinée aux femmes". Lausanne, 1998.
6 Annual report of the OEDT 2000.
OFSP (1998) °II faut des offres spécifiques pour les femmes et tenant compte de leurs besoins particuliere, car..." An explanation of the issue intended for associations and authorities, specialists and male and female politicians interested in drugrelated interventions.
Ernst M.L., et al. "Au féminin, s'il vous plait ! Promotion des offres de prise en charge `à has seuil' pour les femmes toxicodépendantes." Berne, OFSP, 2000
A TRANS-NATIONAL SURVEY ON EUROPEAN WOMEN
At the request of the European Commission, the European Institute for research on risk factors in childhood and adolescence (IREFREA) has launched a vast survey on drug dependence among women. In 2000, the network set up for this purpose in Germany, Spain, France, Italy and Portugal published its first findings, entitled "Women drug abuse in Europe: gender identity", based on interviews with female heroin addicts undergoing treatment. This book addresses two main questions, which can be summed up as follows: what effects do drug abuse and childbirth have on the development of women's sense of identity? The risk factors involved and some specific preventive strategies are presented in the form of a practical handbook for people dealing with drug abuse problems. A more complete version of this report will become available shortly.
These findings can be consulted directly in French and English at the following website: www.irefrea.org