Drug Abuse

Chapter four Four survival strategies

4.1 Introduction

In chapter two it was shown how addiction could be seen as a perversion, as a coping strategy - albeit an ineffective one - for dealing with childhood traumas and gender pathologies.

Summarizing chapter two it may be said that a woman might continue her drug use for various reasons: she may wish to compensate herself for childhood cruelty, neglect, poor parenting, for the lack of warmth, the never completed union, the never reached intimacy with her mother; she may stage a performance of 'the fallen woman', the outcast of society. Behind the act of the independent 'fallen woman' might be hidden the dependent wish to be taken care of. By acting out the 'fallen woman'- script she takes her enraged revenge on society and at the same time, by taking drugs, she provides herself with a substitute for the perfect mother or the perfect lover.

The above explanation of female drug-use, based on the data from Kaplan's framework (1991) is a general explanation of mental illness within a social context. As Brinkgreve (1992) points out, a gap exists between general, more or less sociological explanations and individual symptoms. In order to explain the different kinds of perversions - anorexia, kleptomania, extreme dependency and self-mutilation - Kaplan refers to individual history and individual childhood traumas.

Kaplan's general framework contributes considerably to an understanding of female drug-use. The next step could be to examine whether or not it is possible not only to generalize and systematize the strategies that enlist social gender stereotypes to survive gender pathology and childhood traumas into different kind of perversions, but also to identify the typical gender identity conflicts and accompanying conflict-solving strategies within one perversion. Two important types of gender identity conflicts occur in women's life that could be related to female drug-use: the conflict of whether or not to adapt to social gender stereotypes and the conflict of whether or not one is in control of one's life. These gender identity conflicts might result in any one of four strategies, as the following section will illustrate.

4.2 Survival strategies' model

One conflict is about adaptation to social gender stereotypes. Some researchers (Rosenbaum, 1981) argue that female drug-users uphold traditional sex-role stereotypes by identifying with their male partner and upholding the social expectations that they should share his important life activities with him. Others (Chein, Gerard, Lee and Rosenfeld, 1964) presume that female drug-users deny their passive natures by using drugs. Female drug-users reject their femininity (Perry, 1979). Ettore, 1992, points out that female drug-use could be an indication of a trend towards social equality of women. In the present study, we will investigate whether or not the problem-solving strategies characteristic of female drug-users' reflect traditional female gender stereotypes and whether they imply an inward (the introverted variant) or outward direction of energy and aggression (the extroverted variant).

The other conflict is about social gender expectations of being 'in control'. According to social expectations, women ought to be in control of the domestic/female sphere: they deal with children and household chores; they should act in a caring way towards their men. Ettore (1992) supposes that for any woman the social expectation is that she will behave in a traditional, i.e a dependent way. Ettore goes on to say that there is nevertheless an incompatibility between the social expectation for women to be dependent and the need for all women to be 'in control'. Female drug-users defy the social expectation of being 'in control'. In the public's view, female drug-users are seen as having 'lost control' in their domestic situation. They are seen as bad mothers, uncaring towards their children and irresponsible as wives, failing to consider the needs of their husbands.

Some female drug-users refute this view of having 'lost control' by exerting control over the way the public perceives them. They control their public image by being cold, tough, aggressive and manipulative; through using their body, their sexuality as an instrument for obtaining money and gaining control over men, obtaining dominance and power. This variant is called 'control'

Other female drug-users give up the struggle, are demoralized and comply to the public image of having 'lost control'. This variant is called 'avoidance'.

The contrasts in variants yield the following diagram:

	Introvert	Extravert
Avoidance	Anaesthesia (1)	Flash, kick (2)
Control	Submission (3)	Performance (4)

figure 4.1 Four survival strategies.

I will investigate below whether or not it is possible to apply this model to the individual life-histories of the research subjects and to the data of the semi-structured interview.

4.3 Research subjects' survival strategies

I discovered that 'anaesthesia', the first survival strategy, could be used to categorize the cases of drug-use as self-medication. Characteristic of this strategy is the fact that the research subject does not take drugs for pleasure, or because she is curious about hard drugs, but because she is anxious to avoid responsibility and negative emotions or to reduce psychiatric symptoms such as hallucinations and delusions. Women who use drugs to anaesthetize their feelings seem to experience themselves as victims: victims of violence, of an unhappy childhood, of society. They turn their energy and aggression inwards.

The second strategy 'flash, high' is also employed to avoid feelings, but is the opposite of 'anaesthesia' because it is precisely those feelings of anaesthesia, emptiness and boredom the research subject is trying to avoid: the flash or kick disrupts the anaesthetized feelings. The flash is similar to the kick of the kleptomaniac woman, whose stealing disrupts her feelings of alienation. This 'flash' category includes motives such as curiosity and being in need of a 'kick'. The research subjects who apply this strategy are more inclined to direct their energy and aggression outwards, and strive more for their own enjoyment. Since they are 'in control' of their own pleasure they can, as a consequence, refute the image of women as passive beings, dependent for pleasure on men and children.

The third survival strategy 'submission' shows introverted energy in conjunction with subjection to another's control. Kaplan's 'Horigkeitsscript' (1991) is an example of this strategy. Also classified under this strategy are the problems with leaving home and the symbiotic union with mother mentioned earlier.

The last strategy, the strategy of 'performance' concerns the opposite of submission: the research subject makes an masquerade of herself as the 'fallen woman', she plays the role of outcast of society as a stage performance. Behind this acting-out she is able to hide her feelings of vulnerability, of longing for a symbiotic union with mother and of longing to be taken care of.

Analyzing and categorizing the data of the semi-structured interview [the interview is featured in appendix two and contains questions about background to crisis; lenght of crisis; former attempts to solve crisis and the reasons why these attempts failed] into survival strategies resulted in the following distribution of coping or survival strategies (see figure 4.2). Two strategies, 'submission' and 'performance' could only be found in combination with the 'anaesthesia strategy' or the 'flash strategy'. The category 'other strategies' consists of strategy three (one research subject), strategy four (one research subject), a combination of strategy four and one and strategies unknown (two research subjects).

It is evident that 'anaesthesia' and 'anaesthesia in combination with submission' are the most common survival strategies. The more rebellious strategies, the flash strategy and the performance strategy are adopted by one quarter of the research subjects. The majority of the research subjects uphold traditional sex role stereotypes by identifying with a submissive and dependent image of women. The implication of above results is that the treatment of gender identity problems is an essential element in the treatment of women who use drugs.

I will explain below the four main survival strategies with some illustrations from the research subjects' case-material. It must be kept in mind that the present subjects show combinations of these strategies.

Anaesthesia as a survival strategy for childhood traumas

In the case of anaesthesia, the main functions of drug-use are:

-   to anaesthetize unbearable, painful feelings of fear, anxiety, confusion and depression; the drugs are used as self-medication

-   to escape, to cope with or offer a solution to gender identity problems

-   to reduce tension

Research subjects report that they cannot live with their mental pain, they cannot cope with their feelings, thoughts and emotions and have to anaesthetize them.

The following example illustrates this strategy. From the moment Nancy awakes she uses drugs. What does she think when she wakes up? Her inner dialogue goes as follows:

-   I'm feeling miserable, as if I have not slept at all; everything hurts, it's too much for me, I can't stand this feeling of sickness

-   Do I have to get up? Why are they waking me up? I know it's awful, but, yes, I have to get up, my son needs me

-   I have got my son, so I have to care for him. It is my last chance. If I don't care for him, he'll end up in foster care, just like the other children. I won't let that happen again. If that happens, then I've lost everything, my husband and my children and what's to stop me killing myself? Nothing

-    Too many things surfacing from the past, all those awful thoughts about incest, I will never escape those memories. Nobody has as many problems as I do. I always seem to feel sick, to have lost my energy and never know what to do. I feel rotten, worthless, I can't stand it anymore, it would be better if I wasn't alive anymore.

Nancy feels depressed and takes tranquillizers as self-medication in order to avoid her feelings and to enable her to care for her eight month old baby.

The data from the semi-structured interview showed that the research subjects in the present study named a total of 82 reasons for continuing their addiction. These reasons were almost always expressions of the 'anaesthesia strategy'. They wanted to escape unbearable and painful feelings. Precisely what are the events that these women wish to avoid? Quite astonishingly, almost 60% of these events are related to her sex as a woman. The distribution of these events is shown (figure 4.3):

For ease of understanding it is important to note that I have included the loss of contact with a child as a sex-linked event, because the meaning of such an event is very sexspecific: the child motivates the female drug-user to stay alive and to control her druguse. If contact is broken, all reasons for staying alive and controlling the drug-use disappear. She feels she has failed as a mother, and for this reason she no longer has any reason to live. The other reasons or events which prompted continued drug-use were not linked so strongly to sex. In order of importance they were as follows: homelessness (14), grief over the death of important persons which never had been dealt with (7), relationship problems (7), disrupted relationships with the family (7) and being HIV-positive (2).

The flash strategy

The flash strategy is meant to disrupt feelings of alienation or anaesthesia, to bring pleasure, to enhance or liberate (sexual) feelings, to improve sexual functioning and to increase the capacity to endure prostitution.

I will illustrate the flash strategy by taking the example of Deborah, a forty year old woman of Surinam Hindustani origin. She was referred to the VKC by her physician after a suicide attempt.

Deborah

Deborah, mother of three children, is addicted to heroine and cocaine and has been using drugs for the past ten years. She started taking drugs out of curiosity taking them from her ex-husband. For years her drug-use was controlled; she only used drugs in the evenings and at night and was able to continue caring for her children.

Deborah's problems started when she came into contact with the police. She was dealing in drugs and the police had recently raided her house in search of drugs and arrested her. After her arrest she went downhill. Her illusion of control was shattered and she tried to kill herself with sleeping-tablets.

Deborah is also an example of strategy four, the stage performance strategy. She is the queen of the women drug-users. She dresses herself beautifully, moves like a fashion model and is in good health. She has a great deal of pride and has never been involved in prostitution. She became a drug dealer because she made a better job of it than her husband. Speaking about her beginnings as a drug-dealer she says:

"Actually it was my husband, who was the drug dealer, but he always made a mess of it. There was always money missing, so I threw him out of the house. I said to him: this is my house and from now on I'm going to do things my way. Then I took over the business. It's been flourishing for a few years now".

Deborah has identified with a male sex-role, and she is better at it than a male. When she was young, her mother always said: "Learn a trade, don't become like me." Deborah is the most highly educated of all the research subjects. She was unlucky because after her arrival in Holland, she found it impossible to get a job which suited her level of education. She said that the only job she could get was as a cleaner. She worked as a cleaner until she took over her husband's business.

Deborah would like to advocate 'controlled' drug-use. Her dream for the future consists of being the manager of a clothing boutique and using drugs only incidentally for pleasure.

The submission strategy

The submission strategy is employed in order to avoid having to take control of one's own life, to banish feelings of loneliness or of loss as a consequence of broken contacts with family, and to avoid fears of abandonment (by a peer group, husband or boyfriend). The submission strategy often goes hand in hand with strategy one, the anaesthesia strategy. The familiar pattern of submission, of dependency is present in almost every case since, with one or two exceptions, every woman becomes addicted through a supplying, addicted boyfriend. One question we may ask ourselves is what exactly the advantage is for the boyfriend whose girlfriend is also addicted. The advantage lies in the fact that if his girlfriend is hooked, the boyfriend can easily persuade her to get involved in prostitution, She can then earn money for two, for his and for her drugs. The case related below is a good illustration of this.

Christa

Christa, a twenty-six year old German-Italian is residing illegally in The Netherlands. She was referred to the Women's Crisis Centre because she is suffering from some somatic problems: she has a broken leg and is in need of rest. She is homeless, so the Women's Crisis Centre is the only place she can stay and get some rest.

Christa grew up with two sisters, an Italian father and a German mother. Her father worked as an engineer. Both parents thought that their marriage was the biggest mistake in their life and divorced when Christa was fourteen years old. According to Christa her Italian father is authoritarian, selfish and manipulative. Her mother is quiet and also selfish.

Christa started using drugs when her younger sister died of leukaemia at the age of seventeen. It took her sister two years to die. Christa felt she failed to keep her sister alive and at the same time failed to get her Italian boyfriend to quit drugs. He refused to stop and so, in order to keep the relationship alive and so avoid another loss, she joined him, depending on him in her drug-use. He set the shots in her arms, she was unable to do it for herself. After finishing their nine year relationship she went to Holland and got a new boyfriend. Again Christa says she would like to quit using drugs, but she gives her boyfriend heroine, to keep him happy. She has turned to prostitution in order to buy drugs for them both.

The performance strategy: masquerading as the fallen women

Women drug-users would rather act out a perverse script of being a 'vicious and deprived sinner', lost for humanity, the scum of society than be seen as extremely vulnerable. They restore a magical sense of power and control by taking the process of self-destruction and mutilation into their own hand. A pregnant example of this strategy is the following case-history.

Karen

Karen, a 27 year-old German, was referred to the Women Crisis Centre because she was suffering from pneumonia. Her treatment goal is repatriation to Germany.

Karen's stepfather beat her up until she was fourteen years old. At that age she was placed at a boarding school. She has completed pre-university education. Karen has a daughter of six who is taken care of by her parents-in-law. Recently, her husband and she divorced and she came to Holland with her boyfriend. They had made plans to commit suicide by taking a overdose in Amsterdam. Her boyfriend is suffering from Aids. Karen is not only suicidal, she also hopes to get Aids from her friend or a baby. She takes no precautionary measures when she and her boyfriend have sexual intercourse. There follows below a reproduction of some parts of a conversation I have had with her. 'T' stands for therapist, 'K' for Karen.

T:   Your behaviour seems to me to be very risky. Aren't you afraid of becoming HIVinfected?

K:   It's not so risky.

T:   Would you take the same risks if you had a baby by your boyfriend?

K:   (hesitant) I would be more careful, the child would need me, what would become of the child if I died too?

T:   (confronting) Do you see the way you think? You always put other people first, your boyfriend, your baby ...

K:   I don't care about myself. I'm not important. I wouldn't mind if I died. That's just the way I am. I don't see any alternatives.

T:   Why not?

K:   Ever since I was a child I have been brought up with the idea that I am no good, that I am bad. There comes a time when you start to believe it yourself. And if on top of that you're a junkie and a prostitute into the bargain, then society makes you want to puke. It stigmatizes you. I stand in front of the mirror and think: "Was bin ich? Ich bin Scheisse, a junkie."

T:   Don't you want to change that?

K:   When I was with my boyfriend in Germany, I used to feel better about myself. I had a bit more self-esteem. But since we've been in Amsterdam I've lost all positive self-regard. Maybe, if I go into treatment in Germany I'll feel a bit better about myself. But now, I can't say that I'm going into treatment to help myself, because I won't do it for myself. No, I am going into treatment to be a better person for my boyfriend and my baby.

My interpretation is that Karen identifies with society's view of her as a heroine prostitute. She likes being in control, so she exaggerates, she is more self-destructive than even society imagines her to be. Her self-destruction puts the blame on society. It is as if her sick habits, her sick body scream: "it is society's neglect, society's rejection that's done this to me. I am innocent, but society has made a victim of me, an outcast, a pariah. I'm going to die because society and my parents don't care. For them, for my parents, I am less than nobody."

4.4 Discussion

Some drug researchers (Chein, Gerard, Lee and Rosenfeld, 1964) have argued that female drug-users deny their passive natures by using drugs. The female drug-user is tough, manipulative, aggressive, cold and hard. She has adopted an independent, if not rebellious survival strategy that includes the use of illicit drugs. Drug-use could be seen as an indication of a recent trend towards social equality for women (Ettore, 1992). Although this is an interesting observation, the above survival strategies show that the rebellious strategy only fits a part of the research subjects: those that use the flash strategy and performance strategy (see figure 4.2).

The majority of the research subjects (33 female drug-users) upholds traditional sex role stereotypes by identifying with a submissive, dependent and introverted survival strategy. In society's eyes this group of women has failed as women and as mothers. Female drug-users have often identified with this view and are demoralized as a consequence. They do not offer any resistance to society's view of them, do not seek help as a consequence.

Regardless of the extent to which female drug-users are rebellious, they nevertheless show both sides of the same coin: they are caught in a web of conflicting gender identities and are unable to develop autonomy.