Substance abuse patterns in Rosa Lee's family: a case study

Rosa Lee

Of all the individuals examined in Leon Dash's Rosa Lee: a Mother and Her Family in Urban America, Patty is perhaps the most difficult case in terms of treatment and recovery from her drug problem. More than any other single factor, Patty's environment, both in her adulthood and in her childhood, has contributed to her drug dependency. The bond between Rosa Lee and her daughter is so strong that it has resulted in them choosing similar life paths. Dash repeated relays the idea that Patty's single most important goal throughout her childhood was to be like her mother. Rosa states, "She was just doing what she had seen me do and wanted to imitate me. She's been like that her whole life," (Dash 181). Patty's childhood was far from what most people would consider healthy, psychologically, yet rather than acting out in other potentially more aggressive ways, Patty chose to emulate her mother and stay as close to her as possible. Unfortunately, emulating Rosa Lee clearly led to other troubles -- including drug abuse. From this point-of-view, it should be understood that the most essential tactic in treating an individual like Patty would be the complete removal from her current social environment.

In many cases, and certainly in Patty's case, the dynamics of family life contribute most significantly to the subject's addictive behavior: "Even though its values are largely shaped by the surrounding subculture, the family plays an integral role in shaping the attitudes of its members toward drug abuse," (Schlaadt 12). Typically, family settings within which drug abuse is common or accepted facilitate the spread of that practice to other family members. This was clearly the case in Patty's introduction to heroin. Patty was first exposed to the drug by watching her brother and his girlfriend while hiding in his closet: "After Ronnie pushed the liquid into his vein, she watcher her brother's worried frown change into a look of pleasure.... Ronnie refused to inject her that day. But, Patty told me, 'I knew then, "Well, I'm gonna try that one day,"" (Dash 186). One of the major problems with being introduced to such a serious drug at a young age is that the pain and suffering associated with growing-up in a drug abusing household does not simply end with childhood: "If these children survive, it follows them, particularly if they are girls, into their own adulthood. For example, many of these girls will, themselves, resort to substance abuse in adulthood," (Pagliaro 94). Depression is another major result of such a childhood. This effect can manifest itself in further drug use, or even in attempted suicide.

Studies have indicated that children raised by mothers who are substance abusers are adversely affected cognitively, as well as physically and emotionally: "Starting from infancy, Cregler and Mark (1986) noted that, maternal substance use can adversely impact the care-giving environment, which, in turn, can have long-term negative effects on childhood cognitive development. In addition, the conflict and stress in a dysfunctional substance abusing family, coupled with a lack of child supervision, further adversely impact childhood academic performance," (Pagliaro 93-4). Undoubtedly, this was the case with Patty as she grew up in Rosa Lee's home. Rosa was a prostitute and brought her business back home to where she shared a bed with her three-year-old daughter -- Patty. Patty learned about sex by watching her mother, and learned most of her other behaviors in the same manner as well: "I'm just like her. Anything my mother did, I did it. The way she walks, I can walk. The way she talks, I can talk. I just wanted to be like my mother all my life," (Dash 179).

Still early in her childhood, Patty was having significant trouble at school; she dropped out after fourth grade, and had still never learned how to read. Essentially, Patty grew-up in an environment in which drug abuse, illiteracy, and prostitution were the norm. Although witnessing these events is quite likely to have caused Patty significant psychological damage, her particular mechanism for coping with the troubles of her childhood was through identifying with her mother. So although she was, in all likelihood, damaged cognitively by being introduced to sex and drugs at such an early age, it is also likely that the most influential feature of her life was the desire to be like her mother. In other words, the particular coping mechanism she employed to survive also tended to amplify the impact of the negative influences surrounding her life. So, in Patty's case, it was not simply that she was forced to endure a difficult childhood and, as a result, had her cognitive development stalled; her desire to be like her mother caused her to not place any value upon schooling and, instead, she placed a higher value upon the type of "survival" that her mother's life epitomized.

One of the key effects of being raised in a household where prostitution and substance abuse are prevalent is that the young children often find that they are forced into more adult roles earlier than they otherwise may have been. Essentially, with the adult role models abusing drugs and often behaving in an irresponsible or immature manner, the child is sometimes forced to act as the pseudo-mature caregiver for the adult. In Patty's case, this first occurred when her mother asked her to have sex for money when she was just eleven years old. Patty's response to the request indicates the extent to which this phenomenon was taking place in Rosa Lee's household. When asked if she would go through with it, Patty said, "Yeah, I want to help you," (Dash 182). Importantly, it was not that Patty wanted the money herself, or that she necessarily wanted to become a prostitute; instead, Patty wanted to assume a more responsible role within the household and, with her mother as her role model, the way to accomplish this was by selling herself for sex.

Of all the criminally deviant behaviors few are as widespread, occur as routinely, or possess as long a history as prostitution. Yet it has often been noted that prostitution fails to fit the typical mold of what it is to be a crime: "A fundamental characteristic of behavior that is determined to be criminal is that its performance creates a victim, an entity that suffers harm or the deprivation of something to which the entity has a legal right," (Brown 625). Accordingly, it is not altogether clear precisely who the victim is in instances of prostitution. The obvious answer would be that the prostitute is the victim; however, this is not straightforwardly true in any situation where legal adults make decisions concerning sexual activity. Essentially, if the prostitute is a victim, it is easier to argue that the structure of society is the perpetrator than the john. This is because the social status of the prostitute may be something that he or she possesses little or no power over, while the nature of the transaction with the john may be mutually agreed upon. Yet because of the legal status of prostitution, the act itself becomes a feature of social deviance: those who engage in it are forced to decide whether or not to willingly break the law, and accordingly, whether or not they will break a common moral maxim.

Nevertheless, in cases like Patty's, where she was forced into a more adult role well before becoming a legal adult, prostitution becomes most detrimental because it becomes a feature of the child's life during their development. Accordingly, the child comes to identify prostitution as a fundamental aspect of life, and their individual interpretation of what sex, drug abuse, and adulthood are becomes increasingly skewed as physical maturity eventually arrives.

Prostitution itself was not the direct cause of Patty's later substance abuse, but it certainly was a proximate cause. The act became, for her and her mother, a symptom of their general economic depravity, and by sharing this burden, they became closer to one another. Accordingly, it should come as no surprise that Patty became her mother's favorite child; this bond extended to everything Patty perceived to be adult -- including heroin: "Patty learned about drugs the same way she learned about sex. By watching," (Dash 185). Rosa expresses the regret that if she had not sold and done drugs, then her children never would have either; she also feels that if she had never turned to prostitution, her children never would have either. Nevertheless, she points out that, for her, she felt that she really had no choice; as a result, she was incapable of preventing Patty from making the same choices and taking the same path with her life.

Essentially, even those who take the hardest stance against prostitution upon the grounds of legal rights, are forced to fall back on the notion that it is more of a symptom indicating deeply seeded social woes than a legitimate crime: "Some regard it as the worst and most vicious product of a system of male domination which reinforces itself," (Brown 647). Patty's introduction to prostitution certainly reinforces this notion: it became a part of her life as a result of her social situation and a perceived necessity. Still, more fervent moral positions against prostitution, in the Untied States, often come from Christianity. Obviously, it violates the general principles of Christianity to pay for sexual intercourse; however, it is also a violation of Christian principles to engage in premarital sex, extramarital sex, homosexual sex, or even masturbation. Notably, none of these actions are illegal in the United States -- or at least the antiquated laws pertaining to them are not enforced -- and of them, only homosexuality is ever regularly regarded as a form of social deviance; though this too is a matter of debate. Ultimately, viewing prostitution as a moral crime from the standpoint of Christianity fails miserably, because doing so would require accepting that law should be solely determined by Christian ethics. Fundamentally, such a position is unacceptable because "Christian law" would inevitably impinge upon the rights of individuals both to act freely -- if they wanted to masturbate, for instance -- and to choose the nature of their religious lives.

Nevertheless, the moral problems with Patty's particular situation are somewhat more complex than the general moral status of prostitution as a practice between two consenting adults. This is both because she was exposed to it as such an early age, and because although she is HIV positive, she continues to work as a prostitute without making use of safer-sex practices -- specifically condoms. Patty contends that she does not insist upon her clients' use of condoms and she does not inform them of her disease because they should automatically assume that she is HIV positive because of her lifestyle; specifically, she is a middle-aged, heroin addicted prostitute: "I'm selling sex for money for drugs,' she continues. 'I don't care if they use a condom or not. Just pay me my money! It's up to them to use a condom," (Dash 189). This is another potentially criminal behavior that Patty willingly engages in and, potentially, could avoid. Her mother expresses her concern that Patty will bring retribution upon them by infecting a man without his knowing, but Patty seems largely unconcerned with the consequences of her actions -- so long as they result in the acquisition of heroin.

There can be little doubt that sex in many different forms is socially accepted by the mainstream of American culture. Despite the fact that the Christian Protestant dominant culture in the United States aggressively supports the notion that sexual activity before marriage is morally wrong, people's individual behaviors and the influence of the media strongly suggest that sex is very acceptable. Sex appears to be absolutely everywhere: it is on billboards, on television, all over the internet, and constantly on people's minds. The fact of the matter is that young, unmarried people have been engaging in sexual intercourse for ages. The only differences are that today we possess the technology to minimize the consequences of this sex, and today common strains of cultural morality object to it. Apparently, individuals are forced to make a choice between the increasing call for cultural tolerance and the moral perspective of a large portion of American society.

Some theorists have contended that prostitution, irrespective of its moral status, is actually a powerful gauge for measuring the widespread patters of moral behavior in society: "The history of prostitution... shows attitudes toward the institution varying from approval, through acceptance and tolerance, to violent opposition. Whenever the institution of marriage weakened, prostitution declined because gratification could be obtained without payment. Thus prostitution in a way is an index of 'morality' rather than 'immorality," (Taft 250). Taft el al. go on to argue that in the United States one of the major contributors to the continuance of prostitution is the ideal of the profit-making individual (Taft 251). In other words, the perceived possibility of improving one's social station is what impels certain individuals to commodify their sexuality -- it becomes their own skewed version of the "American dream." Once again, this way of looking at the problem of prostitution implicates the social system within which it operates; because a large number of prostitutes are destitute, they are forced to turn to the only mode of income that they can manage. Meanwhile, growing-up in Rosa Lee's household, prostitution for Patty began as a way to help her mother and her family, but with the addition of heroin into the equation, it emerged simply as a way to purchase the drug and use it.

One offered reason for why individuals might choose to engage in prostitution despite the moral objections to in and the laws against it comes from conflict theory: "The norm-sending process may be plagued by conflict situations... these conflict situations may determine the weakness or strength of a particular criminal law norm in regulating the relevant behavior of an individual and indicate thus the extent to which the individual is ready for the differential identification-association process," (Shoham 47). In other words, the continuing problem of prostitution may imply that the criminal law norms in the United States are perceived to be inconsistent by many members of society; people might see prostitution as a victimless crime, and accordingly, decide to deviate from the norms set by society by becoming a john. Because the inconsistency is believed to exist, they can still view themselves as behaving morally, despite their deviance.

This, however, is inconsistent with Patty as a case study. Patty does not seek any form of broad moral justification for her actions. Although her prostitution initially began with what might be perceived to be a moral goal -- helping her mother -- it has ended in the simple drive to further her drug habit. This fact further illustrates the fundamental importance of social setting in the case of Patty: all of the problems of her adolescence and childhood have conglomerated to feed each other in new, and in increasingly destructive manners. The mere elimination of one of the social factors leading to this situation would vastly improve her overall circumstances. Even if her addiction could not be overcome, but she somehow gained the economic means to purchase heroin without prostitution, she would no longer be putter herself, her mother, and her partners at risk. Yet, of course, the elimination of a setting in which heroin use is tolerated would likely result in the cessation or minimization of all these behaviors.

Nevertheless, it is often argued that prostitution is, indeed, a crime that directly victimizes women. This is because johns and pimps routinely brutalize, assault, and occasionally murder prostitutes. From this standpoint, many contend that prostitution in the United States is an institution that should not be tolerated, in the interest of protecting women from violence (Taft 257). It is often noted that the very nature of prostitution in America lends itself nicely to other criminal activities, including murder, rape, and drugs. Yet it is historically problematic to assert that the solution to these auxiliary social problems is repression of prostitution: additional repression will only force prostitution deeper into hiding. This, clearly, contradicts the idea that the women involved in the profession should be protected. It is far more reasonable to eliminate the clandestine nature of prostitution rather than the act itself -- the latter will never go away. By requiring prostitutes to be legally licensed, documented, and monitored for disease and drug use means that the more serious crimes associated with the institution and which thrive upon it will not be able to express themselves without legal ramifications. Overall, Patty's case is not completely unique in this respect: her lack of social support combined with the need to be self-reliant have forced her into prostitution and further added to her heroin addiction.

There are numerous factors that have led to the prevalence of heroin use among impoverished people in the inner-city United States. Essentially, the use of heroin can often develop into addiction based upon three major factors: social environment, genetic disposition, and mental health. As a result, three general types of addiction apply to the nature of heroin: psychological addiction, neurochemical addiction, and metabolic addiction. Yet, to a greater extent than many other drugs and heroin, psychological addiction, combined with social environment tend to exert the greatest amount of control upon heroin users. Since its physically addictive qualities are so powerful, the elimination of opportunity and a social situation in which it is tolerated become of the utmost importance; this is because relapse, following detoxification, is very common.

The fact that heroin tends to impart these multiple influences upon individuals means that it is often difficult to treat; commonly, heroin addiction must be treated by addressing each of these three effects of the substance individually. Medications and therapy stand as methods by which heroin addiction is sometimes battled; it is widely believed that these techniques, used in tandem, tend to result in the greatest amount of success. Nevertheless, some studies have shown that the ultimate success of heroin treatments is minimal, with much of the success rate being a result of factors unrelated to standard measures of treatment. Further studies have concluded that internal motivation and individual resolve play major roles in the recovery from heroin addiction, as well as external social environment. Since the effects of heroin abuse are so numerous and multi-faceted, it should not be utterly surprising that the most successful methods of treatment are highly variable, and seem to be connected to an individual's unique personality traits.

In the case of heroin, there is no specific definition to indicate when abuse, dependence, heavy use, or addiction is taking place; furthermore, there is no standardized way in which to differentiate between these terms. Broadly, heroin abuse is often believed to be associated with instances in which the consumption of it results in social or physical detriment to the user. Moral and religious groups also argue that moral degradation is one of the results of heroin use, but this claim is extremely subjective in nature. Yet, although there is no official way in which to diagnose heroin addiction, perhaps the most workable understanding of the condition is to infer its presence when an individual continues to partake in the use of the substance even after it has been demonstrated to be harmful to their lives in one way or another. Fundamentally, this is because there is no measurable physiological difference between an individual who uses heroin frequently, and someone who is dependent upon the substance in some way. Accordingly, questionnaires are routinely used to determine the level of influence that heroin addiction has on a subject's life, in order to make an accurate diagnosis.

The most immediate results of heroin addiction are simply those associated with being an individual who is compelled to take the drug in amounts or in a frequency that is harmful to himself or herself. In the long-term, on the other hand, there are numerous consequences of heroin addiction. Socially, the potential negative consequences of heroin addiction are even more varied. Some of the most common ones are linked to the complete loss of judgment and lack of reliability that associate being high on heroin: the loss of employment and friends is sometimes the result of heroin addiction as well. Yet, even in the presence of many of these indicators, the subject may fail to attribute their manifestation to the use of heroin; this can make bringing treatment to those who need it particularly difficult.

Still another complication associated with heroin addiction is heroin withdrawal. Heroin withdrawal occasionally results in the death of the patient; but this is caused indirectly -- the physical stress of withdrawal can magnify the negative effects of already present health problems, which can sometimes cause death. As a result, if heroin is quickly cut-off, then the patient may enter into a condition that could potentially further harm his or her health and could result in death. The significant effects of the sudden cease of heroin use further complicate the matter of treating heroin addiction effectively.

Since heroin tends to influence people in three major ways, it is also treated in three major ways. Therapy, of various forms, is often utilized as a method for addressing the social matters that can be harmed by or can contribute to heroin addiction. Group therapy is one of the more popular approaches towards therapy because it provides the subject with a social environment in which there is a significant level of support and where the use of heroin is not a part of interpersonal interaction. Some versions of therapy focus upon the complete elimination of heroin use from the patient's life, with no toleration for those who fail to adhere to this policy; meanwhile, other versions focus upon the support aspects of therapy, and tolerate relapse under the condition that progress is continually being made. Overall, every version of therapy is intended to aid the patient in the time following detoxification, or the time immediately deciding to eliminate heroin from one's system and life.