Women Who Use Drugs Need Gender-Specific Services

[Jabberwocky]

Women Who Use Drugs Need Gender-Specific Services—My Own Life Proves It

Women’s health is an essential piece of harm reduction and drug-user health. Last week’s news that Vancouver is planning a supervised injection facility just for women is inspiring. But far too often, we lump services together and fail to see the importance of specific programming for women who use drugs.

Sadly, most people just don’t know much about the hidden experiences of drug-using women. But everyone has an opinion.

Women who use drugs are especially demonized—the “addicted mother” is a stereotype hated by virtually everyone. Yet due to power imbalances, sexual assault and other forms of abuse, gender-based stigma and, in some cases, physiological or biological susceptibility, women who use drugs are in many ways at an increased risk of disease and harm compared with men, and therefore need tailored help.

It is unacceptable that in many communities, no services exist that women can count on to guide and support them in their drug use, decision-making and living. To help shed light on the importance of gender-specific programs, I want to share a small piece of my life with you.

I have experienced three pregnancies in my life, and I was using drugs—different kinds, and in different ways—when I found out about each of them. Our society understands drug use as a one-way trajectory from gateway to chaotic or addictive use. That is not my story.

From the age of 13, drug use has been a part of my life, but the kind of drugs I use, the way I use them, and the rapidity of consumption is not at all a one-way path. Rather, it is usually related to: the pace at which my partner uses and the pace he accepts my use; housing stability; external stressors like court dates; the strength of my connection to my family, my community and my friends; and my overall mental health.

The reproductive decisions women often have to make have major repercussions. These decisions should not to be made lightly, or without a firm understanding of options and available resources.

But there was no group or service I felt like I could turn to for help. No one I could trust. None of my pregnancies were planned and none resembled what you might think of when you think of pregnancy. No balloons, family pictures, showers—instead, for me, pregnancy represented loss and hardship.

My first pregnancy occurred when I was 16. I was running with a group of Grateful Dead-following hippies. We smoked pot, drank alcohol, ate hallucinogens and occasionally dabbled in cocaine. After much pressure from my then-boyfriend’s mother, I made the decision to have an abortion. I was not able to cope with this decision, and was too embarrassed to talk to anyone. I moved out of my parents’ house the day I had the abortion and did not move back in.

And I handled the emotional turmoil the way I always handle difficult situations: with heavy and chaotic drug use. I began smoking crack, taking handfuls of prescription pills and drinking heavily. Having no support and no idea how to handle such a decision, I depended on the only real coping skill I had.

I went through over a year of destructive and chaotic drug use, sexual risk-taking and intense self-hatred. One thing that is consistent in my life is negative self-talk and an overwhelming belief that I am not good enough and never will be. Constant negative thinking and obsessive negative thoughts are one of the reasons I use drugs: Doing so, for me, reduces the unbearable negative noise.

***

Aged 21, I again became pregnant, this time with a biracial child (I am white). This did not go over well in my family here in Greensboro, North Carolina. At the time I smoked crack, drank alcohol and used prescription pain pills. When my family disowned me, I lost their emotional and financial help, and with all of the stress and my inability to cope, I quickly became homeless. Life was then stressful in ways I had never before dealt with.

For the first time in my life, I became a victim of physical abuse. The stress of our situation and my emotional turmoil was more than my husband could cope with. Being hit by the man I loved was beyond comprehension for me. I felt the world was against me. What was wrong with me?

I just remember wanting to die. Many women are abused for the first time in their lives when they are pregnant. And in many ways, pregnancy can be the most dangerous time in a woman’s life. Women with mental illness often use drugs to cope and they are also at increased risk for postpartum depression.

After having a baby, things became even more difficult. With the help of his family we were able to secure housing, but the abuse continued and I was not able to stop using. My husband’s use escalated and he began experiencing cocaine psychosis. He was extremely paranoid and often paced around the house with a shotgun, loaded and ready.

He thought I was the FBI working undercover. He would shut the electricity down and we would sit in silence for hours. He thought the TV was sending messages.

I was terrified. I worked and did all the housework, while he either went out to clubs and cheated on me or stayed home and interrogated me about the paranoid delusions he was having. I feared for my daughter’s safety and my own.

Then one evening, my husband reported a pain in his kidney and went to the hospital. He ended up having a rare form of cancer and he died very quickly. I had a terrible time dealing with my confused feelings over his death.

***

Five years later, my third pregnancy came as a complete surprise. I was on Depo-Provera (birth control), and I rarely had a period during this time in my life—a time when I continued to use drugs, but in a more normalized way.

I did not realize that many women who use opioids stop having their periods. No one really talks about this.

And things had been going pretty well for me: I had re-enrolled in school; my drug use had stabilized; my family relationships were growing more positive.

Then, boom!

This time, once I found out, I was already five months pregnant and had had no idea. As soon as I told my family, I was disowned again. Since I was already five months pregnant, I had no choices about what to do.

I totally lost it. Meanwhile the father of the child became increasingly abusive and difficult. (After I was physically abused by my husband, I spent the next 10 years with abusive men; it became a pattern for me. I seemed to somehow unconsciously pick abusive partners.)

Upon finding out we were having a baby, he immediately began selling drugs so we would have money to pay for the baby. I dropped out of school because there was no way to finish, and I ended up giving birth about a month early.

I have never felt so crazy in my life. This pregnancy ended with postpartum psychosis and my inability to care for myself or either of my children.

I left the man and the child.

Broken, alone and confused, I spun into the arms of the most abusive and by far the sickest man I have had in my life.

Women who use drugs are often influenced by their drug-using partners. My past boyfriends introduced me to drugs, and I was very dependent upon the men I was with to show me how to use and what to use. I always depended on the men I was with to make my shots, inject me and help me get high.

But the man I was with next was different. He sold drugs but did not use them. He was truly dangerous. He was addicted to power and money. I worked for him and sold cocaine for him.

After I realized how dangerous he really was, I tried to quit. I begged to leave. I even paid him large amounts of money so that I could stop working for him. He would take the money and agree to leave me alone, but the next day he would come barging into wherever I was, and he would beat me, humiliate me and rape me.

Like so many women who use drugs, I did not consider the police as an option for help. You can’t call the police if you are a criminal, and if you are working for a criminal you never call or threaten to call the police.

Rape, abuse and terror were my life. By this point, any semblance of self-respect I had was gone. I was completely stuck. I could not leave him because I was so addicted and completely financially dependent on him. I drove his car, lived in his house, and sold his drugs. He was how I survived. This was what he liked. He wanted me to need him to the extent that he had complete power over me.

The pain of my life exacerbated my drug use. Now I felt like I was using combinations of heroin and cocaine just to survive. I had a terrible time hitting my veins; like many women, I have very small veins. I did not know how to protect myself from hepatitis C, or overdose. I regularly let other people make my shots and inject me because I had such a hard time doing it myself.

Too many women have men inject them and fix their shots. They report there is a certain intimacy to having your man inject you. But we need services to help women learn how to take care of themselves and their own health—this is so important.

Looking back, I’m lucky to be alive. By 28, I had hepatitis C and a MRSA staph infection in my blood. I could barely walk. My legs had huge abscesses on them and my arms were blistered with track-marks.

I showed up in an emergency room, ashamed and terrified, and said, “Please help me.” Doing so didn’t mean that things went happily ever after, but it did wind up being a good move.

This is just a snapshot of my life. One woman, one experience.

***

There were so many times and places where, had there been the right kind of help available, I would have benefited from it. Had anyone been willing to listen or counsel me about safer use or shared harm reduction strategies and techniques,it could have changed everything. We must stop believing that there is nothing we can do for people until they stop using. This is simply not true. There are so many places we can intervene. We need pragmatic,solutions that accept the reality that not all people are able or willing to be 100-percent abstinent.

Women who want help for substance use issues are often too afraid to look for help—and when they do feel they can reach out, there is often very little to reach out for. There are not many drug treatment centers or support groups where child care services are available, for example. And the treatment centers that are available for both mother and child are almost always faith-based, with a 12-step component—not necessarily helpful for many women. I have never seen one that allows mothers to be on medication-assisted treatment.

Women are afraid of people knowing about their struggles with drugs—and we have reason to be.

It is not safe to tell anyone you are a mother who uses drugs. Child Protective Services is notorious for being overly aggressive and disagreeable to women who are caught up in the system because of drug use. I have never heard a CPS-involved woman report that it felt like she had a team working to improve her and her child’s life; many report CPS involvement as feeling like punishment.

The hurdles and dangers placed in front of women drug users are so severe that many simply give up and give in. We have to stop punishing women and start providing services—harm reduction, treatment and other forms of support—that are built around what we know about the specific difficulties and barriers that women face.

http://theinfluence.org/women-who-use-drugs-need-gender-specific-services-my-own-life-proves-it/

Outstanding article.

 

[Moreaux]

Interesting article. I think there are many aspects of recovery that are gender specific as I have found many times interacting with men on this site they have aspects of recovery that I absolutely cannot relate to and have to ask my husband his opinions...

 

[pharmacybandit]

Very interesting. Thanks for the read.

 

[herbavore]

My brother abandoned his kids during his active addiction and he has terrible guilt and remorse for that; but even he used to tell me, after having spent years in recovery groups, that the guilt he lived with could only be described as a fraction of what he saw mothers living with.

 

[pharmacybandit]

I smoked a cigarette while I was still nursing and I feel guilty about it to this day. I'm not even a smoker, but I was having bad anxiety and needed to calm down. I feel terrible about it and obviously one solitary cigarette did not affect my healthy babies. I cannot even imagine he guilt felt by women who were in active addiction while pregnant(or nursing)-- when I think about how I imagine myself feeling, it breaks my heart into a thousand pieces and then some. My heart goes out to those women. It says a lot about addiction because no woman would WANT to harm their unborn child, so for that need to outweigh that instinctual protection of your child, that's heavy.

 

[Burnt Offerings]

Female addicts definitely have it worse in certain ways than male addicts do. I witnessed that 1st hand. More predatory sexual behavior towards them for sure (which mirrors the situation in society generally-speaking but drug use often just adds an additional layer of violence and desperation)

 

[starting_over]

Hmm I never really gave this much thought, thanks for the article OP.

 

[Pembroke]

I think that a lot of this has to do with the fact that, at least in the US, women's bodies are treated as public property in ways that the bodies of men are not; this is especially true during pregnancy and motherhood. People feel empowered to comment on and criticize women in ways that they simply wouldn't a male, and both men and women have an inherently perceived expertise on the bodies of women.

A case in point that I encountered recently: A woman with whom I am acquainted recently gave birth to a son. It was a traumatic birth ending a series of traumatic births: her first son was stillborn at full term in one of those tragic cases where they'll never know what happened, only that he had a heartbeat at a 36 week checkup and two days later he was dead; she gave birth to a daughter two years later, a child with moderately significant chromosomal abnormalities, necessitating an early and emergent cesarean and weeks in the NICU; and then finally her new baby boy, born via another emergent cesarean with major maternal complications resulting in massive blood loss, broken ribs, removal of her spleen (which had ruptured), and an emergency hysterectomy with unilateral salpingo-oophorectomy. After several days in the ICU, another 10 days or so in acute care / short stay hospitalization, she came home and finally got to be with her new son. She is currently prescribed Percocet 10/325s. The day after she came home I was visiting with a friend of mine who is this woman's neighbor, and my friend's daughter-in-law was also visiting. She (the DIL) demanded that the woman's husband bring his wife and the baby over to visit. This DIL has 15 years experience as a lay caregiver, but no formal medical training. Even so, she felt informed enough and empowered to immediately tell this poor woman, one day home with her 3-week old baby and stapled from her sternal notch to her pubic bone, "You better stop taking those percocets! Breastfeeding is just too important at this stage and you'll never forgive yourself if you get that baby hooked on drugs or if you overdose him! It's not like you can have any more!"

Just sit with that for a minute. We're talking about a young woman, not quite 30 years old, who in the past eight years has lost a son, nearly lost a daughter, and very nearly lost her life 20 days prior while giving birth to a son, and who has been thrust into menopause at 29 years of age. "It's not like you can have anymore (implied: if you kill this one)!" What the actual fuck?

Needless to say, I was livid. I don't usually argue with people, but in that moment I lost my shit. Any clinician who is cross-trained in obstetrics and chronic pain management will tell you that most opioid medications that are expressed in breastmilk are actually expressed at a rate far below 1%. Unfortunately, few doctors are cross trained in those areas, but do a little research and you'll see the numbers hold out - particularly if we are talking about the short-term, oral ingestion of pharmaceutical opioids at therapeutic doses. The risks in this case were very low, and that's assuming that the woman even had the option of breastfeeding (or if she chose to breastfeed, which is no one's place to comment on with exception to the patient and her care team, but that's yet another issue) to begin with! The level of trauma inflicted upon her body during the delivery, followed by roughly 3 weeks of not breastfeeding due to her physical condition, and with all of the interventions done to her body during that time, I somehow doubt that breastfeeding is an option. But even that isn't really the point. The point is that this woman has a doctor and that doctor went to medical school, specialized in high risk pregnancy and highly complicated deliveries, held this woman together with what might analogously be called duct tape and prayers, cared for her for 20 days, released her with a prescription for a fairly mild opiate pain killer (mild when viewed in consideration of all that happened to this woman's body), and, presumably, discussed the risks and benefits of taking this medication during the postpartum period. She does not need a caregiver with a big mouth telling her a damn thing about her baby, her body, or her care.

Some might say that the above story has little to do with addiction as a woman's issue, but I would beg to differ. After all, what this boils down to is a person who thinks they have the authority to comment upon/judge what a woman is putting into her body specifically because that woman happens to have given birth recently. If that sort of commentary is acceptable - and let's be honest, though this situation is to the extreme, it is not uncommon at all for a woman to be lectured after being given prescription drugs during the pre- and peri-natal period - then image what it must be like for an addict. Addicts are already viewed as "selfish" and as "choosing to put substances in their bodies without reason", so the judgement is that much more severe and the scorn that is visited upon them is issued openly and with the approval of others.

I am a chronic pain patient and have been on Dilaudid for years. I am unable to bear children, but if I could I would most likely continue to use the Dilaudid during the course of my pregnancy, though I would like to think I would be strong enough to limit my doses. I would, of course, remain under the care of my anesthesia team and would be treated by a high-risk perinatologist, and those doctors would be expected to work closely with one another. And I know that I would feel like shit when my baby was placed on opiates at birth to begin the slow tapering process needed to ease an infant through withdrawal from these drugs. The guilt would be emmense and it's not something I ever plan to do. But honestly, if I found myself in that position, the vast majority of people in my life would not know I was pregnant until after the baby was born. I'm introverted enough that I go months without seeing people anyway, so it wouldn't be that hard. But it's profoundly sad to me that I would have to do that because of how harshly people would judge me, people with no real education on the actual risk and impact of drug use during pregnancy, people who still believe the myth of the crack baby (reality: yes, a lot of them were born addicted and went through withdrawals... but the long term effects were eventually found to be minimal. The worst complications and long-term effects were actually linked to poverty, malnutrition, lack of prenatal care, and low birthweight; the prevalence of these issues in so-called "crack babies" is approximately equivalent to babies born into poverty, with or without the addition of neonatal drug abuse. Seriously. Read up on it before you come at somebody with that shit.), and they're generally the same people who encourage pregnant women to stop taking prescribed psych meds, as well. These same people would encourage women to accept the risks associated with medications for high blood pressure, diabetes, and a host of other illnesses, as though treating physical pain and mental illness is somehow optional in a way that treating that stuff is not. If you feel that way, then you can fuck right off anyway.

I should probably stop ranting. This is a topic I'm passionate about, which you probably couldn't tell, right? I just really feel that more women would escape their demons if they were made to feel valued and supported instead of being treated like they're Hitler for struggling. More mothers would get help, of this I am sure, if they would get empathy and help instead of a referral to CPS and the likelihood of having their children taken from them.

 

[Jabberwocky]

Thank you for that Pembroke. I'm glad you wrote you posted that

 

[Pembroke]

Thank you for that Pembroke. I'm glad you wrote you posted that

I hope you found it helpful. I fully believe that more women would recover from addiction, and particularly women with children, if we would support them as opposed to shaming and punishing them.

My view on women who use drugs while pregnant is this: so you did drugs while you were pregnant? Okay. How does you punishing yourself and beating yourself up for that today help you be a stronger woman, a better person, or a more competent parent. If it doesn't, then you must put it behind you. I know it's hard, especially in a world that wants to make you feel like shit because of it; it's even harder if your child has ANY chronic physical, mental, or neurobehavioral issue, because the world will try to make you believe it is related to that drug use whether it is or not. And if you did do drugs and it did cause long term problems... does punishing yourself for it help your child and support you in helping them build the life skills they will be need to live with their condition(s)? Probably not. If anything, carrying that baggage makes you more likely to relapse TODAY, which hurts your child TODAY. So you messed up before? So what? If you overcame that monster, then you are showing that child every day what it means to fight, to be strong, and to go on in spite of obstacles. That sounds like a damn fine parent to me.

Women bear a disproportionate share of the work of relationships, of the consequences of sex, of child rearing, and even if the ravages of addiction. We're typically smaller and our bodies are different. That has an impact, a huge one, on our options for getting out of bad situations. Women who have children young are less likely to complete their education and hold gainful employment than their male counterparts, who suffer fewer consequences of early parenthood. And what's more, women are judged more harshly for their parenting choices than men. A man can do drugs for a whole pregnancy, disappear for years, and if he shows up ten years later and pays his child support he is somehow a "good guy" and gets credit for "trying"; if that same child had asthma and the mother smoked a cigarette a day during her pregnancy, she always has that asterisk by her title of Mother. She's a Mom*.

All of these things have bearing on how women recover from addiction - or if they don't. It is indisputable hat women need gender-specific care when recovering from addiction, poverty, trauma, participation in violence, and more.

Much of my focus is on motherhood because the OP so heavily focuses on motherhood, but even in the absence of children, women often need more support and gender-specific counseling and treatment. A female addict is significantly more likely to have experienced sexual violence in relation to her drug use, and is often left struggling with "in relation to" vs "caused by" thinking - which leaves them with undeserved perpetrator or collaborator guilt. They're more likely to have physical damage in the form of infertility, STIs, PID, and a ton of other scars, physical and mental. I truly wish more programs had a better understanding of the special needs of women recovering from trauma... and let's be real, I don't know of an addict who isn't recovering from trauma.

Whatever guilt you find yourself carrying, toothpastedog, I hope you are able to overcome it. You are getting better every day. You are worthy, you are strong, and you are enough. You can't change the past, but you can control how your past impacts your future.

 

[Pembroke]

Oh, and a word to moms who learn of a pregnancy halfway through their second trimester and in the throes of addiction:

If you are addicted to street drugs, you are made to get clean. If you are addicted to prescribed and legally obtained pharmaceuticals... your addiction is managed.

It is nearly universally accepted that the risks of suddenly stopping drugs late in a pregnancy aware far greater for mom AND baby than following harm reduction protocols and reducing - not eliminating, but reducing - the overall intake of drugs. If you fought on your own, still took enough drugs to get you through kicking, and carried to term; you did EXACTLY what a high-risk perinatologist would have wanted you to do. Withdrawing during critical developmental periods in the third trimester is worse for a developing fetus than managing your addiction and letting the resulting newborn go through medically supported withdrawal after birth. Don't beat yourself up just because no one was there to tell you you were doing the right thing and the best you could. Focus that energy on being a great parent today.