Drug Abuse

The Epidemiology of Opiate Addiction in the United States

Chapter 13

The Female Opiate Addict

CARL D. CHAMBERS, R. KENT HINESLEY, AND MARY MOLDESTAD
Note: The original version of this chapter was published in The International Journal of the Addictions, 5, 1970, under the title "Narcotic Addiction in Females: A Race Comparison."

Introduction

FEMALE opiate addicts were first accepted for treatment at the Lexington Hospital in July, 1941. With the exception of 109 female addicts treated at Fort Worth (1947-1952 ), all female addicts have received their treatment at the Lexington facility. From 1941 through 1965 there were 14,866 female admissions. These 1,866 female admissions represent 16.5 percent of thetotal admissions to the two hospitals (1935-1965 ) and 18.0 percent of the admissions which occurred during the period when females were being admitted (1941-1965 ) . Researchers have largely ignored or otherwise omitted female addicts from their analyses. The size of this previously ill-defined population necessitated its study. Extensive clinical involvement of the authors with females undergoing medical and psychiatric treatment for their addictions produced an awareness of multiple race-associated differences among female addicts. This involvement, therefore, produced the frame of reference for the study. This report was designed to provide comprehensive source data on female opiate addicts through a controlled race comparison.

Subjects and Design

From June through December of 1965 there were 168 females admitted to the hospital at Lexington. The racial distribution of these females was 66.1 percent white and 33.9 percent Negro.The mean age of the white females was 37.0 years and that of the Negroes, 30.4 years. The current report is a statistical analysis of the 168 consecutively admitted female addicts.

The hospital records for the 168 subjects included data with respect to medical history, various aspects of their addiction histories, employment, criminal history, personal and family information, as well as varied clinical and administrative notes and documents. In order to supplement this data each of the subjects was individually interviewed by members of the Social Science stag.

The study was designed to ascertain any significant differences between the white and the Negro addicts. With race as the independent variable, the dependent variables were grouped into three interrelated categories: (a) social characteristics, (b) addiction characteristics, and (c) other deviancy characteristics.

Social Characteristics

Residence
Utilizing U.S. Census definitions of regions, these female addicts had primarily resided in three geographical areas. Most, 91.1 percent, had been admitted from the South, North Central, and Middle Atlantic regions.There were significant racial differences in the number o f patient contributions from these regional areas. The South contributed 50,5 percent of all of the white addicts but only 14.0 percent of the Negro addicts. The North Central region, however, contributed 50.9 percent of the Negro addicts but only 20.7 percent of the white addicts. The Middle Atlantic region, the third major contributor, contributed 17.1 percent of the white and 31.6 percent of the Negro addicts. The remaining Negro addicts ( 3.5%) had resided in the Pacific region. The remaining white addicts were distributed as follows: 2.7 percent from the Pacific region, 4.5 percent from the Mountain region, .9 percent from the New England region, and 3.6 percent had resided in Puerto Rico.' Thus, the Southern region contributed the largest number of white addicts, while most Negro addicts had resided in the North Central region.

Residence in a Standard Metropolitan Statistical Area (SMSA) was also significantly associated with the race variable ( Table I3-I ) . All of the Negro but only 78.4 percent of the white addicts reported metropolitan residences.

Father's Occupation

A variety of social backgrounds were reported. Thus, 20.9 percent of these female addicts reported that their fathers had performed professional-managerial roles, 5.0 percent had fathers in the clerical-sales fields, 39.6 percent had been in operative craftsman jobs, 10.8 percent had been farmers, and 23.7 percenthad been service workers or laborers? Collapsing these occupational categories, 25.9 percent of the fathers had worked in whitecollar roles, and 74.1 percent had been blue-collar workers.There was a significant difference between the races in the occupations they reported for their fathers. White addicts more frequently reported their fathers had been white-collar workers (Table 13-I ) .

Childhood Home Situation

The majority of these female addicts ( 54.8% ) had been reared in a home which had been broken prior to age sixteen. The race differences were significant. Being reared in a broken home was more frequently found among the Negro addicts. While 45.9 percent of the white addicts had been reared in broken homes, 71.9 percent of the Negro addicts reported this social disadvantage .3

An even greater majority of these female addicts (57.7%) reported that their mothers had pursued occupational roles outside of the home. As would be expected from a higher incidence of broken homes,the Negro addicts significantly more often than white addicts had mothers who had worked outside the home.

Negro mothers would appear to have to work outside the home regardless of intactness of the family unit. Among Negro addicts who had been reared in broken homes, 82.7 percent had working mothers, as did 89.3 percent of the Negroes from intact families. Among white addicts, however, intactness of the family did appear to affect the incidence of having a mother working outside of the home. Only 28.4 percent of the intact families but 73.0 percent of the broken families had a working mother. Thus, at a statistically significant level the Negro addicts had more often been reared in broken homes, and regardless of the intactness of the familial home, their mothers usually had worked outside ofthe home.

Formal Education

The amount of completed formal education among these female addicts was not associated with race ( Table13-I ) . The median years of education was10.8 for the white addicts and 10.9 for the Negro addicts. Termination of education prior to completion of high school was prevalent in both races, with66.7 percent of the Negroes and61.3 percent of the whites not completing high school. Still,16.2 percent of the white and8.8 percent of the Negro addicts did pursue formal education beyond high school. Nine percent of the whites and1.8 percent of the Negroes were college graduates.

Of the eleven female addicts with college educations, seven were nurses, and the others had completed degrees in home economics, political science, psychology, and social work. Three of the white addicts had pursued their educations through at least one year of graduate school-an MSW social worker, one of the registered nurses, and the home economist.

Among the sixty-eight white school "dropouts," eighteen had sought vocational education, and fourteen had completed their vocational programs. Among the thirty-eight Negroes who had not completed high school, eight began vocational training programs, but only three completed these programs. Vocational programs to prepare for jobs in business or as beauticians were the most popular with77.0 percent of those seeking vocational skills choosing these two programs.

 

Marital Status

In this addict population 11.9 percent had never been married,64.3 percent had marriages they considered to be intact, and23.8 percent had been married but were divorced, separated, orwidowed.6 With the white addicts having a mean age of 37.0 years and the Negroes30.4 years, the low incidence of single status was not unexpected.

There were significant race differences in the addicts' marital status ( Table 13-I ) . White addicts more frequently reported they had never been married and more frequently reported marriages which had been broken. Although the Negro addicts more frequently reported their marriages as being intact, these marriages were more frequently common-law rather than legal marriages."

Subjects' Occupational Status

Data pertinent to each addict's occupational history was available for two time periods: the dominant occupational status or means of support since the time formal education was terminated and the major means of support for the six-month time period immediately preceding hospitalization. Grouping the subjects into three categories-legally employed, illegally employed, and dependent-produced significant race differences for both time periods ( Table13-I ) .

For the dominant time period, 16.6 percent of these addicts reported legal occupations,43.5 percent reported illegal activities as the major means of financial support, and 39.9 percent reported they had been financially dependent upon spouses, other family members, or various social welfare programs. The Negroes were almost twice as likely to have engaged in illegal activities and only half as likely to have been in the dependent category.

During the six months prior to hospitalization,20.5 percent of these addicts reported their primary means of support was a legal occupation,44.7 percent indicated engagement in illegal activities, and34.8 percent reported themselves as financially dependent. The race differences were even more marked during this time period. The Negro addicts were more than twice as often engaged in illegal activities and only a third as often reported themselves in the dependent category. Thus, among the white addicts the primary means of support after leaving school and for the six-month time period prior to hospitalization was one of dependence, while among Negro addicts, engagement in illegal activities was the most common for both time periods.

Addiction Characteristics

Onset Situation

The age at which narcotics was fast used and the situational contexts of this onset were both significantly associated with race. These female addicts had a mean onset age of 25.9 years, and most (57.9) indicated they had received their first narcotic from a friend ( Table 13-II ) . This interchange was reported as occurring within a social context for "kicks" or "out of curiosity" and predominantly involved one of the illegally manufactured or distributed drugs. A second group, 31.1 percent of the addicts, reported-that their initial exposure occurred within a medical or quasi-medical context, with the drug being one which had been legally manufactured and purchased through a physician or drugstore. The remaining 11.0 percent reported their first narcotic, usually one of the illegally manufactured drugs, had been provided by a family member who was an addict. Within this latter group, most, 77.8 percent, reported they had been addicted by their husbands.

The white addicts had a mean onset age of 27.4 years and most frequently reported medical or quasi-medical rationale. The Negro addicts, however, had a mean onset age of 21.3 years, and the most prevalent onset situation reported involved peers within a social context.

Drugs Used

Among the Negroes, heroin was overwhelmingly the first opiate used, the opiate which was currently being used, the drug which the addicts preferred to use, and the drug which they used most frequently. Heroin use by white addicts was significantly lower in each of these four categories ( Table 13-II ) .

The drug-using careers of these female addicts frequently included the smoking of marihuana. A history of marihuana smoking was reported by 48.8 percent of the 168 addicts. Ahistory of marihuana smoking was significantly associated with race ( Table 13-II). Negro opiate addicts more frequently reported that they were also marihuana users. Neither the extent of marihuana use nor the time at which the first marihuana experimentation occurred were, however, associated with the race of the users. Most of the marihuana users, 78.0 percent, indicated their first marihuana use preceded all other drug use. This introduction sequence was true of 69.8 percent of the whites and 87.2 percent of the Negroes who reported marihuana histories. Most of the marihuana users reported that their use of this drug was transitory in nature, with only 18.6 percent of the white users and 12.8 percent of the Negro users reporting they had smoked marihuana continuously throughout their drug careers.

Regardless of race, marihuana use was significantly associated with heroin use. For example, 72.1 percent of the white and 89.7 percent of the Negro marihuana users also reported they were heroin users. There was, however, a significant race difference in heroin use among those who did not smoke marihuana. Of the Negroes who did not smoke marihuana,83.3 percent did use heroin, but only 11.8 percent of the whites who did not smoke marihuana reported ony heroin use.' Thus, at a significant level Negro females were found to be heroin users whether or not they had also used marihuana, but the whites were not.

These female opiate addicts also reported extensive use of sedative-hypnotics, usually barbiturates, with 67.3 percent of the subjects indicating sedative-hypnotic use as part of their drug histories. Although the differences were not significant, the white addicts more frequently reported histories of sedative-hypnotic use than Negro addicts.

Method o f Administering Drugs

The method utilized to administer drugs was related to race ( Table 13-II ) . Although intravenous injections were most frequently reported by addicts of both races, Negroes significantly more often reported this method.

Racial differences in the method of drug administration can be attributed in part to the racial differences noted in the type of drugs being taken. The data indicate an association between the drug used and the method of administration. For example, 91.0 percent of all heroin users were using the intravenous technique. Controlling for race, 87.7 percent of the Negroes were current heroin users, and 88.0 percent of these heroin users were using the drug intravenously. Only 35.1 percent of the whites were heroin users, but 94.9 percent of these heroin users were using intravenously. By contrast, of the subjects reporting the use of the oral method, 97.1 percent were white addicts, and these were primarily codeine or paregoric users. Among those who utilized intramuscular or subcutaneous techniques, 77.8 percent were white addicts, and these were primarily Demerol, Dilaudid,or morphine users.

Source of Drugs

Where these female addicts secured their drug supplies was significantly related to the race o f the addict ( Table 13-II ) . Although most of the addicts ( 60.1 ) were purchasing their drugs from illicit underworld sources ( pushers ) , the Negroes were more likely to have been securing drugs from these illicit sources than were the white addicts. The majority of the whites chose, or were able, to secure their drugs from legitimate sources-doctors and drugstores -even though the techniques utilized to secure the cooperation may have been fraudulent, deceitful, or illegal. A small number of addicts, by virtue of being in the nursing profession, had access to narcotics and were stealing their drugs from these medical supplies.

The drug and the source of its purchase are related. As a legal market does not exist, all of the heroin users had to secure these drugs from underworld sources. Addicts, regardless of race, who used the legally manufactured and distributed drugs, usually secured their drugs from legitimate sources. For example, 86.1 percent of the whites and 85.7 percent of the Negroes addicted to the legally manufactured drugs purchased them from legitimate sources.

Previous Cures for Drug Addiction

These female subjects were neither novice drug users nor uninitiated in the treatment of drug addiction ( Table 13-III ) . These addicts had been using drugs an average of 8.9 years and most ( 59.5% ) had previously been "cured" of their addictions.g Although for 40.5 percent of these addicts the current treatment process was the first they had undergone, they were not novice drug users. The subjects had been using drugs an average of 6.0 years. Race was not associated with the duration of drug use. The white addicts had been using drugs an average of 8.8 years and the Negroes for an average of 9.1 years.

Race was not associated with having experienced an addictioncure. Of the white addicts 56.5 percent had experienced a prior cure, and 59.6 percent of the Negroes had likewise undergone this process. Race was not associated with place of prior treatment. Most of the addicts with histories of prior cures had experienced this treatment process at the Lexington Hospital. Only 26.0 percent had received addiction treatment which did not include a federal in-patient psychiatric facility.

Admission Status at the Lexington Hospital

In this sample 56.0 percent of the subjects were experiencing their first admission to the Lexington facility. There was no significant difference between the races in this regard, with 58.6 percent of the white and 50.9 percent of the Negro addicts being admitted to the hospital for the first time. It was found, however, that there was a significant racial difference concerning the mechanisms whereby the addicts were admitted to the hospital and therefore, the degree of control the patient retained over her length of stay in the hospital. Of the white subjects 91.0 percent had voluntarily sought admittance and therefore retained the prerogative of requesting discharge at any time during hospitalization. Of the Negro subjects 68.4 percent were voluntary patients. The remaining 9.0 percent of the white and 31.6 percent of the Negro addicts had been sent to the hospital through various federal courts and prison mechanisms to be incarcerated for specific periods of time ranging from one to ten years.9

Although female addicts from both races were more likely to be volunteers than prisoner patients, white subjects were significantly more likely to be volunteer patients. This was true regardless of whether the addicts were first admissions or readmissions. Among the first admission patients, 90.8 percent of the whites but only 72.4 percent of the Negroes were voluntary patients, and among the subjects being readmitted to the hospital, 91.3 percent of the whites but only 64.3 percent of the Negroes were voluntary admissions."

Other Deviancy Characteristics


Addicts as Sellers o f Drugs

Within this population of female addicts 25.0 percent reported they had been sellers as well as users of narcotics. Among those addicts who were also "pushers," 73.2 percent indicated that the sale of drugs had, at some time during their careers, been a primary means of support. The selling of drugs did not carry the arrest potential one might expect. Only 31.0 percent of the "pushers" had experienced an arrest for their drug sales.

Race and the selling o f drubs were associated. At a statistically significant level Negroes more frequently than white addicts reported they had been "pushers" ( Table 13-IV). Race differences, however, did disappear among the drug sellers. Regardless of race, most "pushers" supported themselves through this means rather than only supplementing their incomes. In addition, being arrested for the selling of narcotics was not associated with race.

Addicts as Prostitutes

Prostitution was a common means of obtaining money among these addicts, with 47.0 percent reporting such histories. Among those with histories of prostitution, 78.7 percent indicated this behavior had, at some time during their careers, been a primary means of support. The risk of arrest for prostitution was high, with 51.9 percent of those admitting to prostitution reporting specific arrests for this activity.

Race and prostitution were associated. Negroes more frequently reported they had been prostitutes. As was reported above among the sellers of drugs, most prostitutes, regardless of race, engaged in this activity for primary rather than supplementary financial support. Also, being arrested for prostitution was not associated with race.

At least in this population of female addicts, most did not engage in either the selling of drugs or prostitution. At a significant level, however, Negroes more frequently than white females engaged in these behaviors.

Addicts as Labeled Criminals

Less than one-third ( 30.4b ) of this female addict population had arrived at the current stage of their lives without having been arrested.Having an arrest record was, however, associated with race. While 91.2 percent of the Negro addicts reported having been arrested, only58.6 percent of the whites reported this history. Race was not associated with the type of arrest. Among those addicts with arrests, being arrested prior to age eighteen, being arrested on specific narcotic charges, and being arrested for prostitution were not associated with the race of the person being arrested. A mean age comparison of first arrest and a comparison of the mean number of arrests failed to elicit any significant differences between the races.

Although Negroes more frequently reported their arrests led to incarceration and the whites who were incarcerated had on the average spent longer periods incarcerated, neither difference was statistically significant.

It should be noted that among the female addicts with arrest histories,30.8 percent had been arrested prior to their first use of drugs and 21.4 percent of all the addicts had arrest histories preceding drug use.

Addicts as Labeled Psychiatric Deviants

Formally diagnosed psychiatric deviancies were recorded for 54.2 percent of these subjects." Race was not a significant factor in whether a psychiatric label was recorded, but being labeled with a certain disorder was associated with race ( Table 13-V ) . Regardless of race, the various personality disturbances were most frequently diagnosed. Significantly, however, white addicts were most frequently labeled as having personality pattern disorders, while Negroes were most frequently diagnosed as having personality trait disorders. Negro addicts were labeled sociopathicthree times more often than white addicts."

 

Summary and Conclusion

The independent character of race in the life career of168 female narcotic addicts has been demonstrated. Significant race differences were found in each of the three areas where dependent variables were analyzed.

1. In the area of social characteristics it was found that Negro addicts were more likely to have been reared in a broken home, to have been reared in a home where the mother pursued an occupational role outside of the home, and to have had fathers whose occupational roles were classified as being blue collar. They did not, however, differ from whites in the amount of education attained. In addition, the Negro addicts were more often SMSA residents from regions outside of the South, and they reported that they had supported themselves through illegal activities. Negro females more often supported themselves through illegal activities even though Negroes significantly more often reported an intact marriage. A comparison of mean ages at the time of hospitalization indicated that the Negro addicts were a considerably younger group than the white addicts.

2. In the area o f addiction. characteristics it was found that Negro addicts had been introduced to an illicit drug subculture through the use of marihuana, had first experimented with opiates in the company of their peers, had used heroin as their first opiate, preferred to use heroin above all other drugs, used heroin more frequently than any other drug, and were currently addicted to heroin which had been purchased from pushers and administered by intravenous injection. White addicts, on the other hand, characteristically did not use marihuana, most frequently attributed initial opiate use to medical or quasi-medical factors, and used and preferred the legally manufactured. drugs which had been purchased or obtained from such legal sources as doctors or drugstores. As with the Negro addicts the most prevalent method of administering drugs was the intravenous technique. In both races the majority used sedative-hypnotics in addition to opiates.

A majority of the patients admitted to having undergone previous "cures" for their addictions. Among those patients with previous "cures," most had experienced this treatment at the Lexington Hospital. Race did not significantly differentiate between those subjects with previous "cures" and those without or between those treated at Lexington and those treated elsewhere.

Most patients of both races were being admitted for the first time and as voluntary patients. Negroes were, however, at a statistically significant level more often admitted as prisoner patients regardless of whether they were first admission or readmission patients.

3. It was anticipated that known narcotic addicts would also have histories o f other deviances. Almost 25 percent of these addicts admitted to selling narcotics, almost 50 percent admitted to being prostitutes, almost 25 percent had arrest records as adolescents, and 21 percent had arrest records which predated their first use of drugs.

There were statistically significant racial differences among narcotics pushers and prostitutes, with Negro addicts more frequently engaging in these deviancies. Negro addicts were also more likely to have combined the two illegal activities than were whites. White addicts were less likely than Negroes to have engaged in either activity.

As would be expected, arrests were prevalent among those who sold narcotics or engaged in prostitution as a means of financial support. At least among these addicts, engaging in prostitution carried a higher risk of detection and arrest than did the selling of narcotics. Arrests for both were more frequently characteristic of the Negro addicts.

These female addicts were most frequently diagnosed as having personality disorders. Race and diagnosis were associated. White females were predominantly diagnosed as having either personality pattern or trait disorders, while Negro females were diagnosed as having personality trait disorders or sociopathic disturbances.

This study has demonstrated the necessity of considering race as an important variable in any attempt to formalize a theoretical frame of reference for addiction among females or in any attempt to construct a typology of female narcotic addicts. Negroes and whites have been shown to differ significantly in childhood home status, occupational status, conjugal home status, and regional area of residence. The racial differences were also significant with respect to how they became addicted, what drugs were used, method of administration, and how the drugs were obtained. The two races also differed on what other deviancies were evident in their life spaces.

 

1. A chi-square comparison indicated a significant racial difference by region: X' - 33.00; 6 d.f.; P - <.001.

2. The father's occupation distribution was calculated only for those 139 subjects who reported these occupations.

3. The incidence of broken homes among the female addicts of both races appears to exceed that which would be expected within their base populations. Indicative of this excess, although not strictly comparable statistics, the 1980 U. S. Census of Population ( Social and Economic Characteristics PC [1)-[Cl Table 79, p.210 ) reported 10.0 percent of the white and 33.7 percent of Negro populations under age eighteen living in households where one or both parents were absent.

4. Two of the fourteen white dropouts who completed vocational programs were beauticians trained during penal incarcerations. Three of the five Negroes who completed vocational programs were so trained in prisons as a seamstress, a nurse's aide, and a business machine operator.

5. For the purpose of ascertaining marital status, a common-law relationship of one year duration was tabulated as a marriage. Of the 108 marriages, 45 ( 41.7 ) were common-law relationships.

6. Among Negro addicts reporting an intact marriage, 59.8 percent reported them to be common-law relationships of at least one year duration. This differed significantly from the white addicts, with only 27.9 percent reporting commonlaw marriages ( X' = 9.71; P - [.Ol ).

7. The significant difference was X' - 33.65; P - [.001.

8. "Cure" as used here corresponds to the patients' argot of having been formally withdrawn or detoxified ( e.g. hospital, jail) but does not include those times when they might have withdrawn themselves.

9. A chi-square comparison indicated this racial difference was significant: X' - 12.24; P - <.001.

10. The chi-square racial comparison for first admission patients who were also voluntary patients was X' - 3.98; P - <.OS; the same comparison among the readmissions was X' - 6.62; P - <.02.

11. The 45.8 percent who did not receive psychiatric evaluations were volunteers who left the hospital against medical advice before such evaluations could be completed.

12. The racial difference in the receiving of sociopathic labels was significant: X' - 8.29; P - <.02.

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