Female Substance Abuse: Women, Heroin, and Gender-Based Addiction

Heroin is a highly addictive substance characterized by a rush of biophysiological symptoms, including a feeling of euphoria, heaviness in the extremities, and dry mouth. When it comes to heroin and gender, either gender can become addicted in a brief period of time: "Addiction to heroin is characterized by the compulsion to use heroin despite an onset of negative consequences and despite the user's best attempts at stopping via willpower alone." For women, one of the more common and detrimental traits of heroin abuse is acquired tolerance, meaning that greater doses must be taken to replicate the original effects of the drug. When women are under the influence, they may engage in unsafe sexual activity, which can lead to sexually transmitted diseases, unintended pregnancies, and a range of emotional issues. Furthermore, women who inject heroin intravenously face an additional risk of hepatitis and HIV/AIDS from shared needles.

This paper examines the proactive and alarming trend of female heroin users and explores why heroin use among women is on the rise. Specifically, it seeks to determine the motivations for women using heroin as compared to men, drawing on a diverse body of academic literature spanning ethnographic research, clinical studies, historical analysis, and cultural criticism.

In the article "Women Heroin Users," Susan Beckerleg focuses on the choices and lifestyles of female heroin users in a coastal tourist town in Kenya, collecting data on their daily lives through ethnographic techniques. Of the sample participants, 18 women completed questionnaires about their reproductive health and wellness. The data were gathered and analyzed with a focus on the victimization of these women in terms of social stratification and lack of opportunity — absences that often make women susceptible to health issues, injuries, and early mortality. One conclusion Beckerleg was able to draw was that the challenges facing these Kenyan women heroin users were comparable to those faced by other female opiate users throughout the world (2004). "These Kenyan women live in a country where the majority of people are victims of 'structural violence,' but as drug users and sex workers they face particular disadvantage" (Beckerleg, 2004). What Beckerleg found, essentially, was that these societal disadvantages were part of what led these women to heroin use and were also what caused their further stigmatization. For women in these contexts, using heroin was a double-edged sword: they were drawn to it as a form of escapism, yet their usage pushed them further to the fringes of society.

Another paper examining the social cost of drug abuse is "Comparison of Female Opiate Addicts Admitted to Lexington Hospital in 1961 and 1967" by Cuskey and colleagues, which similarly argues that the social costs of drug addiction — particularly for women — are exceedingly high. A particularly revealing finding is that four out of every ten women were readmitted for treatment, with many staying in the clinic for 14 to 15 days, being released, ultimately relapsing, and starting the cycle over again — spending the bulk of their lives in and out of treatment facilities (Cuskey et al., 1971). What the findings of this article highlight most strongly is just how difficult it is to find effective treatment for female opiate users. The study also suggests that when more adequate forms of support are available for Black women and their children, they generally fare much better and show lower rates of substance abuse and its associated harms.

Social connections and social support are no small factor in heroin use and initiation. The study "Heroin Use Among Female Adolescents: The Role of Partner Influence in Path of Initiation and Route of Administration" by Eaves examines how female heroin users in Baltimore begin using the drug, finding that the gateway is most commonly a male companion. "Participants were more than twice as likely to be introduced to heroin by a male friend or boyfriend (IHM) than introduced to heroin by other means (IHO). The majority of IHM females were introduced by a male friend rather than a romantic partner" (Eaves, 2004). No connection was discovered between the way in which users were introduced to heroin and the route of administration they subsequently adopted (e.g., smoking versus injecting). Notably, almost all participants (94%) reported using heroin via inhalation, while 75% reported having injected heroin at some point (Eaves, 2004).

While some experts had assumed that introduction was more likely to occur through a boyfriend, the researchers found an essentially equal likelihood of initiation through either a boyfriend or a male friend (Eaves, 2004). The finding that the majority of users eventually transitioned from snorting to injecting is discussed in connection with the potency of the drug and its impact on the human body's reward system, which makes a stronger high increasingly desirable and increases willingness to take the risks associated with injection (Eaves, 2004). This carries strong implications for treatment and recovery — a theme echoed throughout the literature. Effectively treating heroin addiction, these studies confirm, is far more challenging than treating addiction to other substances.

The study "Women and Heroin" by Friedman and colleagues takes a different approach by examining how this addiction manifests within the upper-class strata of females — a truly intriguing premise, given that so much research on this addiction focuses on how it manifests in lower-income populations and those on the margins of society. With 30 heroin-using participants, the study explores how their heroin use reflects a "rejection of restrictive gender and class expectations" (Friedman et al., 1995). This group of participants demonstrates how heroin use and addiction for upper-class women can function almost as a repudiation of the values and lifestyle in which they were raised — a rejection of their social strata and, frequently, of their families as well. The researchers employ a "dynamic view of resistance" to understand how these women attempt to resist dominant discourses through their heroin use and to reinterpret their experiences with the drug (Friedman et al., 1995). This is one of the most provocative approaches to heroin use in the literature, as the participants have a markedly different motivation for using, which should undoubtedly inform treatment approaches.

A more recent study looks at the migration of heroin from the inner city out to the suburbs. In "The Changing Face of Heroin Use in the United States," Cicero and colleagues gathered a participant group of 9,000 opioid-using individuals across more than 100 treatment centers around the United States. Of these 9,000, approximately one-third were dependent on heroin. Cicero examined how this trend began, finding that people typically started with prescription drugs before moving to heroin, with cost and accessibility being the primary reasons for initial experimentation (2014). "The addictive properties of heroin are manifold greater than prescription drugs… It gets into the brain much more quickly than other opiates and causes 'a rush' that is far stronger than that of prescription pills" (Cicero, 2014). A significant portion of the study addressed the changing face of heroin addiction: the drug is no longer associated primarily with people of color, as 90% of users in the sample were white, many in their late twenties, with an increasing number being women. Ultimately, this study found that heroin had migrated from urban areas to suburban and rural ones.

The article "Drug Use and Gender" by Anderson looks more closely at the motivating factors that lead women to drug use in the first place. Anderson found that women enter drug-using careers largely because of their relationships with men (2000) and often exit such chapters of their lives because of their relationships with family (2000). Anderson also identified a pertinent and very real dimension of sexual abuse within the process, one that exerted a substantial impact on female users. Women who did exit this arena of their lives did so largely for personal and emotional reasons (2000). This study showed more dramatically than others that drug use manifests in profoundly different ways across genders as a result of the gender-centric social organization of contemporary society.

One intriguing study examining the influence of gender on drug use is "Opium Use and Romantic Women's Poetry" by Freeman, which focuses on how Romantic-era female poets discussed and described opium and its regular use (Freeman, 2012). A close examination of this poetry reveals a demystification of opium use and its effects on the human body. One of the most remarkable aspects of Freeman's analysis is the juxtaposition of male and female poetic treatments of the drug: male poets such as Coleridge and Wilde tended to exoticize heroin use and emphasize its foreign origins, while female poets — including Logan, O'Neill, Seward, and Sara Coleridge — treated the drug far more pragmatically, choosing to "incorporate opium use into the domestic hearth, its medicinal effects aiding in their wifely and motherly duties. The odes to opium demonstrate the presence of opium in the middle-class British home, the medicinal dependence on its use, and the longed-for mental escape it provided from the domestic realm" (Freeman, 2012). Beyond this practical emphasis, there was also a strongly communicated desire for release and relief from the tension between accountability to one's family and the need to exist in an altered state free from pain and pressure.

Articles like these are important not only because they illuminate a more feminine perspective on drug use, but also because they help shed light on feminine elements of the human experience in relation to substances — and because part of exposing the feminine experience of drug use is the task of dismantling harmful stereotypes. One of the most damaging is the image of the mother addicted to crack cocaine. Aline Gubrium, in "Writing Against the Image of the Monstrous Crack Mother," identifies the most common stereotypes applied to this figure: she lives in the inner city, is African American, is overly fertile, lives on welfare, and is addicted to crack (Gubrium, 2008). In this article, Gubrium draws on the concept of "writing against" culture, coined by Lughod, as a means of deconstructing some of the world's most damaging stereotypes. "Aiming to 'unsettle' the cultural stereotypes, this article presents the narrative of an African-American woman who has used crack, illustrating how elements of Twelve-Step recovery discourse and Afrocentric spirituality differentially frame her story" (Gubrium, 2008). Gubrium explores how recovery discourse and spirituality offer both narrative resources and imperatives, ultimately demonstrating how narrative can transcend stereotypical constraints (Gubrium, 2008). She argues that it is the responsibility of leaders, researchers, and other experts to actively challenge the unacceptable quality of so many stereotypes surrounding female drug use.

In a similar vein, Herzberg's article "The Pill You Love Can Turn on You" takes a close look at the cultural politics central to the Valium-addiction epidemic of the 1970s and comparable moments of American drug hysteria (2006). One of the more telling elements the article explores is how certain anti-drug campaigns in the United States consistently linked drug use with marginalized populations — the poor, immigrants, and non-whites (Herzberg, 2006). What is remarkable about the Valium epidemic is how it underscores the parallel with contemporary heroin use — now concentrated among whites in suburban areas and the middle class. The "Valium panic was a different matter, involving a quintessentially middle-class drug prescribed legally by reputable physicians for their respectable patients, and popularly recognized as an entrenched part of life in the comfortable classes, especially for women" (Herzberg, 2006). The Valium panic signaled massive changes in American drug politics, raising the prospect of new frameworks for combating drug use and addiction.