The governance of female drug users

Front matter

— Women’ S PES 21 drug s

NATASHA DU ROSE

THE GOVERNANCE OF FEMALE DRUG USERS Women’s experiences of drug policy

Contents

Acknowledgements iv About the author v Introduction 1 Part One 15 one Research context 17 two Political context 43 Part Two 61 three Prohibition 67 four Medicalisation 91 five Welfarisation 117 Part Three 137 six Psychosocial accounts 151 seven Social stories 203 Conclusion 269 Appendix: Research methods 277 Bibliography 279

Index 341

Acknowledgements

Part One

Part One of the book begins from the premise that objects of government are discursively constructed. The meaning of female illicit drug use is not self-evident or an objective entity but is constructed in different discourses (e.g. prohibition, medical or welfare) and takes different forms. Drawing on Foucault’s concepts of discourse and governmentality, the ‘problem’ of women’s illicit drug use is understood as a realm brought into existence by government itself. As Foucault (1972) [1969] argues, discourses are formed by ‘systems of dispersion’ or ‘forms of division’ (Foucault 1972, [1969] p. 37) which ‘systematically form the objects of which they speak’ (Foucault 1972, p. 49). It is assumed that in order to gain an understanding of how women who use illicit drugs are governed, it is necessary to examine the discourses that define, categorise and differentiate them from others. It is these discourses that help to identify women’s illicit drug use as a ‘social problem’ and make women who use illicit drugs amenable to governmental intervention and regulation.

This approach permits an analysis of illicit drug use and female (and male) illicit drug users that does not presume a chronological development of ideas advancing closer to the truth. Rather, it is one that allows for the exploration of the underlying points of differentiation, exclusion and contradiction in constructions of drug use and female users, as well as some of the material effects of these structuring principles. The accuracy and validity of particular constructions of drug taking and female drug users is not questioned. Rather, the underlying demarcations that condition the different constructions of drug use and women drug users are located. In this process, the space is revealed for alternative understandings of drug use and women’s constructions of resistant identities.

Part One is comprised of two chapters investigating “authoritative discourse’ on female illicit drug use. Academic and drug policy discourses are understood as ‘authoritative discourses’ which construct and situate female drug users identities in particular ways. These discourses produce a particular network of material relations which involve the production of various material effects on the lives of female illicit drug users (i.e. their subjection to various forms of state intervention).

Chapter One analyses the various constructions of women drug users in academic discourse. It does not call into question the validity or accuracy of previous explanations of women’s illicit drug use. Instead the different ways their illicit drug use has been made sense of and the different subject positions made available to them within academic discourse are traced. Academic discourse is understood as an authoritative discourse comprised of ‘experts’ with ‘scientific’ knowledge who help to inform and shape current drug policy. The assumption is that ‘scientific’ data is often used as a framework for social policies, and therefore how questions are framed within academic research has social consequences. An examination of early constructions of women drug users in academic discourse, for instance, as pathological and as bad mothers, is important as such constructions prevail in the formation of policy and in the governance of female drug use.

Chapter Two provides an overview of the key ‘political rationalities’ or ‘government mentalities’ underpinning contemporary drug policies in the UK, US and Canada. It investigates the political context conditioning the various techniques and procedures shaping and regulating female drug users. Prohibition, neoliberalism and riskmanagement are identified as central rationalities guiding contemporary drug policies and their impact on the ways female drug users are governed is considered.

ONE

This chapter discusses the research context in which this book is located, including the traditional inclination to view women’s drug use as peripheral or pathological. It examines feminist work on female drug use and how this has challenged traditional understandings of female users. It concludes with a discussion of the contribution this book will make. This chapter investigates the various ways female illicit drug use has been made sense of and the different ways female users have been constructed within academic discourse. It explores how different explanations of women’s illicit drug use have shaped the meaning of it in different ways and how the subject position ofa female illicit drug user is continuously being modified and transformed as new and different explanations emerge in the chain of knowledge about it.

Traditionally, research on illicit drug use focused on male users, and women were ignored or seen as peripheral to predominantly male worlds of drug usage (File, 1976; Marsh, 1982; Jeffries, 1983; Gomberg, 1986). When the issue of female illicit drug use was focused on, the bulk of the research was concerned with women’s deviation from traditional gender roles, pregnancy and motherhood (Rosenbaum, 1997). Early studies that did include women were predominantly medical, psychiatric and psychological, and based on women in treatment (Rosenbaum, 1981). Women were considered as a subset of a larger male population or compared with male users (Taylor, 1993). Within this literature female users were constructed as more deviant, ‘sicker’, passive and emotionally and psychologically disordered than male users and ‘normal’ women (Rosenbaum, 1981 1997; Taylor, 1993). By the 1970s a growing body of research, mostly from the US, began to appear on the physiological effects of women’s illicit drug use on the foetus and newborn, and the ‘management’ of the pregnant user.

Baby vessels and bad mothers

The effect of women’s illicit drug use on reproduction and childrearing largely dominated academic discourse on female illicit drug use in the 1960s and 1970s, and still continues to thrive, emerging from the clinical fields of obstetrics (see, for example, Naeye et al, 1973, 1976; Fraser, 1976; Kandall et al, 1976; Wilson et al, 1979; Lutiger et al, 1991; Mathias, 1992; Hepburn, 1993) and psychiatry and psychology (see, for example, Densen-Gerber et al, 1972; Carr et al, 1975; Pagliaro and Pagliaro, 1999). Within such studies, women users were considered predominantly in terms of their biology as bearers of children or as mothers. Female users were regarded as the ‘independent variable’, as the source of the problem under investigation. Constructed as ‘baby vessels’ and ‘bad mothers’, female users were positioned as irresponsible, selfish, indifferent to the needs of their foetuses and children, and incapable of bringing healthy children into society.

In early obstetrics studies on pregnant drug-using women, the needs of the woman and foetus were assumed to be in conflict. The analysis tended to be largely asocial, with no reference to confounding influences on foetal outcomes such as the mother’s socioeconomic status, nutrition, health, alcohol and tobacco use, mental health, support networks, work stress or presence of an abusive relationship (see, for example, Kandall et al, 1976; Philips, 1986; Mathias, 1992; Hepburn, 1993). For example, an early UK study conducted by Fraser (1976) reports on 32 pregnancies in 29 women addicted to heroin or methadone over eight years in one obstetric department. The focus of the article is the effect of the mother’s drug use on the unborn foetus. Fraser states that the women were all under 30, white and British, and that most of them had drug-addicted partners. The only other information provided about the women is on the medical complications of their pregnancies and their attendance at the antenatal clinic. Typically, they are characterised as antagonistic and uncooperative. Fraser (1976, pp 897-8) reports:

Regrettably, the drug addict is notoriously uncooperative. Only 9 patients consented to admission and some of these discharged themselves.... Considerable tolerance is required towards these patients, who are antagonistic to society, who all too readily ignore advice, and who encourage potentially disastrous consequences for themselves and their children.

The ‘bad’ behaviour of the pregnant drug user is attributed to her craving for her drug of choice. Mothering becomes a matter of alternating ‘love and indifference’ for female illicit drug users, due to their ‘ever increasing urge for drug relief’ (Fraser, 1976, p 899). In such studies, sole responsibility for foetal wellbeing and children was seen as with pregnant or female drug users (that is, not with fathers or wider society).

In 1985 a case study by Ira Chasnoff in the US, which reported the damaging effects of cocaine use during pregnancy, set off a massive media response and a subsequent moral panic about an epidemic of ‘crack babies’ in the US (Coffin, 1996; Rosenbaum, 1997). By the late 1980s the government had stepped in, with nearly half the states in the US hoping to solve the ‘problem’ of drug use in pregnancy through prosecution (Rosenbaum, 1997). Due to the “criminalisation of pregnancy’, research on female drug use in the 1980s and 1990s in the US continued to be dominated by a concern with pregnancy and motherhood, particularly in relation to crack use. In contrast, in the UK and Canada in the 1980s, there was no corresponding moral panic, and pregnant female illicit drug users did not face the threat of prosecution for using drugs while pregnant. However, the US literature served as a source of scientific knowledge and a reference frame for practitioners in the UK and Canada, and pregnant female users were subjected to increased intervention into their lives (Waldby, 1988; Klee, 2002). Many heroin and/or crack-using women lost custody of their children as they were viewed as ‘unfit mothers’ (Klee, 2002).

In the discourse on women’s drug use, taking drugs prescribed by the doctor to control the ‘condition’ of pregnancy or postnatal depression is constructed as responsible and a sign of a ‘normal’ woman. However, taking or ‘self-prescribing’ drugs while pregnant or when mothering is taken as a sign of irresponsible, uncaring behaviour and abnormality. Furthermore, since many pregnancies are unplanned, it is likely that women will have taken drugs before knowing they were pregnant, but the same attention is not given to pregnant women who have taken medication for chronic illnesses such as anticonvulsants or antidepressants (Boyd, 2004). As Siney (1995) argues, in discourse on pregnant drug users, if a woman is dependent on illicit drugs, her physical and psychological dependence is viewed as a matter of choice, and if she does not stop taking these drugs, then apparently she thinks the wellbeing of her baby is less important than her own.

The US Office of National Drug Control Policy (ONDCP) (2014) cite the National Institute on Drug Abuse (NIDA) for the official line on the prenatal effects of illicit drugs. NIDA list premature delivery, low birth weight, smaller head circumference and shorter length as some of the effects of prenatal cocaine use (NIDA, 2011). Also according to NIDA, heroin use during pregnancy is associated with low birth weight; methamphetamines with premature delivery, placental abruption, fetal growth retardation, and heart and brain abnormalities; and marijuana with altered responses to visual stimuli, increased tremulousness and a high pitched cry (NIDA, 2005). NIDA concede that although these effects are documented by numerous scientific studies, it is difficult to establish the specific harms caused by any one drug due to the many confounding factors, especially the use of other drugs, that have an impact on maternal, fetal and child outcomes (NIDA, 2011). Furthermore, alcohol and tobacco, which are legal drugs, arguably put the foetus at a greater risk than illegal drugs.

Existing research shows that while using illicit drugs cannot be seen as ‘safe’, no scientific basis exists for concluding that exposure will inevitably cause harm. A foetus may be exposed to a particular drug in utero, but this does not mean it will be harmed by the exposure (NAPW, 2010). The response to pregnant illegal drug users is guided not by toxicity, on scientific accuracy, but by the social meaning of the drugs. Recent research highlights the multiple determinants of poor maternal outcomes, including the amount and number of all drugs used, poverty, poor nutrition, homelessness, lack of prenatal care, domestic violence and other health conditions (NIDA, 2011, 2012). These can all interact to have an impact on birth outcomes. To isolate the impact of exposure to any one drug from the combined effects of all confounding variables is not easily achieved. Controlling for the eftects of other substances used during pregnancy is nearly impossible as subjects typically use other illegal and legal drugs during pregnancy (Singer et al, 2002a).

It is now acknowledged that concerns that crack babies would never function in society and become a ‘biological underclass’ (Hopkins, 1989) were unfounded (Leshner, 1999), and that there is no actual condition, syndrome or disorder that can be termed ‘crack baby’ (Arendt et al, 2004). However, assumptions about the pregnant female illicit drug user and the supposed effects of illicit drug use on the foetus continue to underpin the criminalisation of pregnancy in the US, and to have an impact on the treatment of pregnant female users in Canada and the UK. The behaviour of female users is viewed as posing a threat to public health and as evidence for the justification of various punitive forms of state intervention, including mandatory ‘treatment’, the loss of child custody, and incarceration (Boyd, 2004)

(This issue is discussed in detail in Part Two of this book. See Chapter Three, pp 81—86 and Chapter Five, pp 131—136).

A closely related strand of academic discourse is concerned with the effects of women’s illicit drug use on mothering and childrearing, and comes from the fields of psychiatry and psychology. The focus is on the children of drug-using women, and the women feature as the source of the problem under investigation (see, for example, Cregler and Mark, 1986; Deren, 1986; Regan et al, 1987; Famularo et al, 1989; Bays, 1990; Staples, 1990; Kelley, 1992; Krutilla, 1993; Leifer et al, 1993; Muller et al, 1994; Egami et al, 1996; Pagliaro and Pagliaro, 1999). Maternal drug use is constructed as causing psychological deprivation, separation, loss and abandonment, physical abuse and neglect, murder, academic failure and pain and suffering for the next generation. Female users are situated as ‘unfit’ mothers and therefore ‘abnormal’ women. For example, in Substance use among women, Pagliaro and Pagliaro (1999, p 87) state:

If... substance abuse kills the heart and murders the soul, it is no more apparent than in the context of the effects of substance use upon mothering and child rearing.

They then cite a number of studies, seeking to provide evidence that drug-using mothers are incapable, indifferent, neglectful and selfish. The following is an excerpt from a life history conducted with a 28-year-old crack cocaine-using woman:

As she got more addicted to crack, she developed an attitude about her kids that she describes as “hey, get the fuck out of here.” She wanted them away from her. She said, “Drugs keep you from loving the people who you love, you only love the drugs...” (Woodhouse, 1992, quoted in Pagliaro and Pagliaro, 1999, p 87)

Issues of separation, loss and abandonment, physical abuse and neglect of children are all attributed to maternal drug use (see, for example, Famularo et al, 1989; Bays, 1990; Kelley, 1992; Leifer et al, 1993; Muller et al, 1994; Egami et al, 1996; Pagliaro and Pagliaro, 1999). Female users are judged ‘inadequate’ mothers, so dependent on their drug of choice that they are incapable of thinking or caring about anything else. Brooks et al (1994, p 204) assert, ‘Addiction prevents a mother from responding to her infant’s needs; her primary focus is on her drug of choice, not on her child’ Carr (1975, p 70) argues,

‘although the mother may be physically present, she remains a distant, non-nurturing figure to the child psychologically’ Female users are deemed incapable of establishing a ‘normal’ maternal infant bond with their newborns (see, for example, Densen-Gerber et al, 1972). This is often explained as due to the likelihood of having psychological problems and having received bad mothering in their childhoods (see, for example, Carr, 1975).

Concern was raised about the long-term psychological, developmental and behavioural effects that drug use could have on the children of drug-using mothers, who, it was argued, were destined to become the ‘problem individuals’ of the next generation (Fontana, 1971). Densen- Gerber et al (1972) asserted that psychopathology and sociopathy would be passed to the next generation. Carr (1975, p 66) stated:

. those children whose mothers are drug dependent .. represent an extremely “high-risk” group in terms of developmental, behavioural and psychological problems ... these children will be disproportionately represented in future groups of addicts, criminals, the mentally retarded and persons requiring the aid of mental health or other social services.

Pagliaro and Pagliaro (1999) argue that a mother’s substance use may lead to the pain and suffering of their children, depression and suicide for those children in adulthood, and even give rise to another generation of substance users. Furthermore, they propose, maternal drug use could have long-term negative effects on the cognitive and academic performance of children.

Female users were not only constituted as threatening the wellbeing of individual children, there was also concern about how this may lead to a threat to public health. Thus, for example, Carr (1975, pp 73-4) argued:

. in terms of long term cost to the individual and to society, children raised by drug-dependent mothers may be a more serious social and public health hazard than leukaemia or poliomyelitis.

To prevent this problem from reaching ‘epidemic proportions’ (Carr,

1975, p 77), it was claimed that coercive state intervention was required in the form of mandatory treatment or removal of the child from the mother’s custody (Densen-Gerber et al, 1972; Densen-Gerber and Rohrs, 1973; Carr, 1975; Kelley, 1992).

The findings of these clinical works were translated into policies that have resulted in millions of illicit drug-dependent women losing their children. It was assumed that women who consume illicit drugs are ‘bad’, ‘unnatural’ mothers, and are solely responsible for the wellbeing of their foetuses and children. They are constructed as victims of the addictive properties of drugs, over-determined by a compulsive dependence. This compulsion is supposedly so powerful that a mother will have no concern for her foetus or love for her child. Feminist studies have challenged claims made in traditional research about female users as ‘unfit mothers’, and claimed that many drug-using women show themselves to be loving mothers with parenting skills paralleling those of non-drug-using women, and many more are able to thrive as mothers with appropriate support (see, for example, Colten, 1980, 1982; Boyd, 1999; Baker and Carson, 1999; Campbell, 1999; Klee, 2002).

Psychopathological and emotionally disturbed women

Traditional research focusing on women’s illicit drug use, other than in terms of their reproduction and social roles as mothers, has been primarily psychiatric or psychological in orientation. Since the 1960s, both in Europe and the US, medical and sociological discourse constituted women who use illicit drugs as psychopathological and/ or neurotic (see, for example, Chein et al, 1964; Ellinwood et al, 1966; D’Orban, 1970; Densen-Gerber et al, 1972; de Leon, 1974; Levy and Doyle, 1974; Polit et al, 1976; Colten, 1977; Christmas, 1978; Cuskey, 1982; Gossop, 1986; Women 2000, 1987). Personality or character disorders were a common diagnosis for female users, followed by neurosis, psychosis and sociopathy (see, for example, Chein et al, 1964; Ellinwood et al, 1966; Hall, 1968; D’Orban, 1970; Cuskey, 1972; Densen-Gerber et al, 1972; Ross and Berzins, 1974).

In early studies of female drug users, the psychopathology attributed to them was frequently constructed as a response to a disturbed and abnormal family background (see, for example, Chein et al, 1964; Ellinwood et al, 1966; D’Orban, 1970; Carr, 1975; Cuskey, 1982) or a broken home (see, for example, Chambers et al, 1970; D’Orban, 1970; Barr et al, 1973; Binion, 1977). Chein et al (1964, p 313) asserted that female addicts develop their “psychopathology and difficulties through immersion in a malignant family environment’ Female users’ psychopathology was also often constituted as a response to an inability to adjust to various social institutions including school, work and marriage. D’Orban (1970) asserted that educational failure, premature school leaving, an inability to hold down jobs and ‘unstable drifting’ were all prominent features in the lives of the women in his study. However, the co-occurrence of family issues, psychological problems and drug use doesn’t necessarily indicate that the drug use or psychological issues were caused by family problems; rather, a range of wider social factors are likely to have contributed to both. Furthermore, the co-occurrence of drug use and a lack of engagement with social institutions, such as education and work, may indicate a lifestyle choice rather than psychopathology.

The subjects chosen for the studies discussed in the early literature were women in treatment. However, women in treatment are likely to comprise of a very specific group of illicit drug-using women, with a range of needs, who do not represent the wider population of female drug users (Taylor, 1993). Reports of female illicit drug users as pathological and emotionally disturbed do not address the positive functions drug taking may serve in their lives (for example, for pleasure or for blocking out pain), or consider the wider social contexts in which women move and make choices. Such accounts therefore served to provide a skewed view of female users.

Early academic discourse on illicit drug use generally constructed women as more pathological and emotionally disturbed than their male counterparts (see, for example, D’Orban, 1970; Densen-Gerber et al, 1972; de Leon, 1974; Christmas, 1978; Cuskey, 1982; Gossop, 1986). Discourse on female illicit drug use is replete with observations that women who use illicit drugs are more emotional, dependent, demanding, needy, anxious and depressed than male users (see, for example, Chein et al, 1964; Ellinwood et al, 1966; Colten, 1977). For instance, in Women 2000 (1987), a report on an international conference on women and drug abuse, it is asserted that “drug-abusing’ women are likely to have higher levels of depression and anxiety and lower levels of self-esteem than male drug users. However, culturally, women have tended to be viewed as sicker, more emotional, excessively dependent, more depressed and needy than men. What is appropriate ‘feminine’ behaviour for women is close to a number of ‘neurotic illnesses’ often called the ‘worried well’, for which legal drugs are readily prescribed. Hence, it might be argued that the only thing distinguishing the construction of female illicit drug users from non-using ‘normal’ women is that they take illegal drugs. Drugs prescribed by those with the medical authority to serve a normalising function are constructed as socially necessary, but are constructed as signalling a lack of normality when self-administered.

Explanations for female illicit drug users’ greater propensity for psychological and emotional disturbance are diverse, but basically fall into two categories. One constitutes the problem as inherent in the women themselves. For example, as women’s use of illicit drugs represents a greater departure from traditional sex roles than men’s, the female drug user is ‘sicker’ than the male (see, for example, Margulies, 1972; Kaufman, 1984). The other argues that women receive greater maltreatment from society, and consequently have more about which to complain (see, for example, Colten, 1977; Mondanaro, 1989; Ettorre, 1992). Maltreated, victimised and abused women are believed to use illicit drugs as a coping mechanism for emotional trauma and/ or impaired self-esteem (see, for example, Suffet and Brotman, 1976; Hser et al, 1987a, 1987b; Mondanaro, 1989; Reed, 1991; Russel and Wilsnack, 1991). This thesis is known as the drug use as ‘self-medication’ hypothesis.

In terms of women’s drug use involving a departure from gender roles, in traditional research female users were more likely than males to be constructed as ‘sexually maladjusted’ (Chein et al, 1964; Ellinwood et al, 1966; D’Orban, 1970; Barr et al, 1973). ‘Normal’ psychological adjustment meant behaving within prescribed gender norms. High incidence of out-of wedlock pregnancies, never married, homosexual, separated or divorced women were noted (Chein et al, 1964; Ellinwood et al, 1966; D’Orban, 1970; Barr et al, 1973). Female users were generally thought to have problems with sexual identity (Cuskey, 1982). Feminists thus argue that traditional drug theory constructs female drug use as a deviation from ‘normal’ femininity (see, for example, Ettorre, 1992; Rosenbaum, 1981, 1997). For example, Rosenbaum (1997, p 1) argues:

Historically women’s drug use has been defined as problematic when their traditional gender roles were violated or abandoned, therefore jeopardised.

While feminists have challenged the construction of female illicit drug users as psychologically disordered (see, for example, Rosenbaum, 1981; Taylor, 1993), the notion of women illicit drug users as neurotic is still very much alive in relation to the drug use as ‘self-medication’ hypothesis. The proponents of this hypothesis, including some feminists, assert that illicit drug use serves as a coping mechanism for women experiencing psychological and emotional problems and/or situational stresses (see, for example, Mondanaro, 1989; Russel and Wilsnack, 1991). Feminist versions of this discourse draw attention to the ways in which factors such as low esteem and depression ‘relate to the general lot of women in society’ (Maher, 1997, p 5). For example, Mondanaro (1989, pp 2-3) argues:

The legacy of growing up female in a society that undervalues and denigrates the role of women is a low sense of self-esteem, high levels of depression and anxiety, and a sense of powerlessness. Learned helplessness is another result of the daily confrontation with the dominant culture.... All these characteristics act in concert to immobilize many chemically dependent women.

Research indicates a disproportionate number of female dependent drug users have experiences of sexual abuse, rape and trauma (see, for example, Najavits et al, 1997; Welle et al, 1998; Hawke et al, 2000; Pettinati et al, 2000; Gilbert et al, 2001; Neaigus, 2001; Becker and Duffy, 2002; Agrawal et al, 2005; Brady and Ashley, 2005). Research also shows a high incidence of sexual abuse histories in illicit drug or alcohol-using women in treatment (see, for example, Miller et al, 1987; Russell, 1983; Harrison, 1989; Mondanaro, 1989; Hurley, 1991; Reed, 1991). Some studies have suggested that as many as 75 per cent of women in treatment for alcohol or drug problems have histories of childhood sexual abuse or incest (see, for example, Miller et al, 1987; Mondanaro, 1989; Reed, 1991).

Studies investigating the relationship between childhood sexual abuse and drug use have suggested that substance use may serve the purpose of enabling sexual abuse survivors to cope with the symptoms of post-traumatic stress syndrome (Root, 1989), numb emotional pain and/or block out flashbacks (Blume, 1990b), create a sense of aliveness when survivors feel dead inside (Blume, 1990b), socialise with minimal interpersonal closeness (Singer et al, 1989) and enhance feelings of self-esteem (Russell and Wilsnack, 1991). In most studies, drug use thus serves as ‘self-medication’ for the symptoms of abuse, the negative effects of which are preferable to the symptoms of abuse such as depression, anxiety or post-traumatic stress syndrome (see, for example, Root, 1989; Blume, 1990b). However, Russell and Wilsnack (1991) offer a more complex ‘vicious cycle causation’ model, more specific to the use of crack cocaine, according to which the negative experiences of childhood abuse are thought to impair self-esteem, which is enhanced with the use of crack.

Female users have been constituted as more pathological and emotionally disturbed than men, and more recently as victimised and abused women who use illicit drugs as a coping mechanism for emotional trauma and/or impaired self-esteem. Both constructions give authority to policies and practices that responsibilise female users for their drug problems and situate them as a special case requiring special treatment and as intractable, difficult service users (See Chapter Four, pp 109-116). While there may be some female dependent users with psychological and emotional issues, the majority will not see themselves as psychologically disordered. Furthermore, those who do may not view this or even their drug use as the most pressing problem in their lives. While it has been estimated that at least one in three females (as opposed to one in six males) will have survived some form of sexual abuse before reaching the age of 18 (Black et al, 2011), this would indicate that the prevalence of drug use has been seriously under-estimated (Maher, 1997). While there is some evidence from research drawing from the accounts of female users themselves that illicit drug use is used to block out memories of childhood abuse, such studies typically fail to explore the contribution that other factors such as socioeconomic status, peer groups, proximity to drug cultures and social relationships may have. Finally, constructions of female users as victims of abuse or the pharmacology of drugs fail to take account of women’s agency.

Polluted and polluting women

Another strand of academic discourse on women’s illicit drug use emerged in response to the advent of the HIV/AIDS pandemic of the 1980s. In the 1980s illicit drug users became the target of a number of ‘moral panics’ (McGrath, 1993, p 158). Drug users, intravenous drug users in particular, were identified by the media, politicians and medical professionals as among one of the main groups of individuals defined as at ‘high risk’ of contracting and infecting others with HIV/AIDS. Female drug users were targeted as a result not only of their drug use, but also their sexual behaviour. They were constituted as immoral, diseased women and/or prostitutes who threatened to contaminate and pollute the general populace. One strand of this discourse emerging from the US focused on crack, and constructed female users as capable of doing anything to feed their addiction. Female users were also situated as primarily responsible for the sexual health and moral standards of communities.

In the light of the HIV/AIDS and crack epidemics in the 1980s and 1990s, numerous studies were conducted documenting the risky sexual behaviours of female illicit drug users (see, for example, Mondanaro, 1987; Kinnel, 1989; Plant et al, 1989; Worth, 1989; Corby et al, 1991; Inciardi et al, 1993; Gossop et al, 1995). Women who use illicit drugs were frequently conflated with prostitutes — another group deemed as ‘high risk’. In the US researchers began to focus on ‘sex for crack’ exchanges and the impact of crack on sexual behaviour (see, for example, Siegal et al, 1992; Edlin et al, 1994; Inciardi, 1995; Jones et al, 1998). With the rise of crack use in the UK and other European countries, this association migrated (see, for example, Mondanaro, 1987; Cohen et al, 1989; Worth, 1989; Feucht et al, 1990; Lewis and Watters, 1991; Schilling et al, 1991; McKeganey et al, 1992; Klee, 1993, 1996; Brown and Weissman, 1994; Rhodes et al, 1994; Gossop et al, 1995; Fortenberry et al, 1997; Stevens et al, 1998). Female users were constituted as ‘polluted’ and ‘polluting’, as carriers of medical and moral disease, posing a threat to the moral fabric and public health of the majority.