Drug Misuse and Motherhood

Marcia Jackson, Hilary Klee, Suzan Lewis

• Publisher: Routledge
• Year: 2003
• eBook ISBN: 9781134485901
• Topic: Medicine
• Subtopic: Gynecology, Obstetrics & Midwifery

The growing use of illicit drugs among women has become a major concern for health professionals and social services. The reluctance of drug-using women to seek help from drug agencies and to disclose their use of drugs to ante-natal, midwifery and social services is now officially recognised by government agencies. However, devising an appropriate strategy that will overcome these fears will not be easy without a better understanding of their causes and effects.

Drug Misuse and Motherhood gives drug-using mothers a voice. Based on longitudinal research and in-depth interviews it provides new insights and much-needed information in five key areas:

* family life
* pregnancy
* motherhood
* service delivery and development
* implications for policy.

The user-perspective of this book is balanced by the professional viewpoint on the same issues. It offers a unique source of data for researchers and fresh inspiration for practitioners working in the field.

Part I
The changing context

Women, drugs and family life

This first part attempts to construct a context for the information that is to come later and comprises three chapters that focus on complementary topics: current attitudes to women who use illicit drugs, gender differences in drug use, and the concepts of motherhood that prevail in contemporary society. They are components of the broader picture, and the themes that emerge in subsequent sections of this book may be understood more fully by having a greater awareness of their implications.

The first chapter presents background material on drug-using women, locates them in the history of changing patterns of drug use and associated public health issues, examines public attitudes towards them, what keeps them in a drug lifestyle and what the consequences may be for their children.

In the second chapter, Samantha Wright provides a more detailed picture of women’s use and experience of drugs by comparing them with men. These are particularly important benchmarks in evaluating their experiences when they present to drug treatment and antenatal services. The neglect of women’s needs becomes more apparent when they become pregnant. The third chapter by Suzan Lewis explores contemporary images of motherhood that drive so powerfully public attitudes towards mothers. These are perhaps epitomised by the ‘squeezy mum’ image that has appeared in TV advertising for half a century. The idealised and romantic nature of popular stereotypes leads to demands that many women cannot meet and that are particularly unrealistic for drug-using women.

Chapter 1
Women, family and drugs

Hilary Klee

This book is about women who use illicit drugs, get pregnant and become mothers. It reveals that a stressful and possibly hostile social environment awaits a drug-using woman when she becomes pregnant. It is a world in which her dependence on drugs on the one hand, and unattainable rosy concepts of motherhood on the other, will set constraints on her behaviour and require major changes in her life. Whether welcomed or not, the pregnancy is likely to cause strain on her personal and interpersonal resources that must be faced and overcome in order to ensure the delivery of a healthy baby and its normal social development.

MOTHERS WHO USE DRUGS

A range of factors is likely to contribute to the ease with which a drug-using woman negotiates the path through her pregnancy and hospital confinement. They include the wider context of trends in drug use and the social and political responses to them that mould public opinion. In the last two decades there have been developments in the ways that illicit drugs are used that have resulted in societal consequences of global proportions. Within this period the start of the AIDS pandemic occurred, which is not only decimating populations in Africa and Asia but continues relentlessly to invade new territories (UNDCP, 2000). Injecting illicit drugs was, and still is, a part of this new and apparently unstoppable ‘plague’ and has become a serious public health issue. The threat of viral transmission has raised the spectre of drug users as a source of terminal disease. Their actions in sharing their injecting equipment are seen as potentially lethal, not only for other drug users in their communities, but for anyone who has sexual contact with them. An already unacceptable form of behaviour which was not responding to threats by the state and stigmatisation by the public was demonised further when drug use became associated with AIDS.

For women to use street drugs seems to plumb an emotional reservoir of distaste and fear in the public, perhaps because of the role they are expected to play in society as caring wife and mother. The implications for family life are serious and justifiably cause much concern. However, it is interesting that a wide range of attitudes have been exposed towards women drug users that can be positioned on a dimension of tolerance, with liberals at one end and the savagely punitive at the other. Internationally the balance seems heavily in favour of the latter. Sadly, the issues associated with drug use evoke powerful emotions that encourage a degree of polarisation that seems intractable to resolution or compromise.

There are also the ‘innocent victims’ of drug-using mothers: their children. Revelations of foetal damage were seized upon in the US by news media that were keen participants in the ‘War on Drugs’ and obsessed with crack-cocaine users (see Reinarman and Levine, 1997). Already blamed for escalating crime figures, this was censure that could be attached most specifically to women. The sex industry, regarded as another aberrant aspect of womanhood, is a major source of funding a drug habit for female drug users that can involve risk of sexual transmission of HIV and hepatitis C through unprotected intercourse. However, it is the vertical transmission of disease from seropositive mother to child that seems to have been particularly influential in revealing public opinion on drug-using pregnant women, and this became one of the most emotive issues in HIV epidemiology.

Reactions to women using drugs are generally negative in all nations but risks of drug-induced damage to the child, combined with transmission to them of HIV, resulted in public actions in the US that resembled mediaeval witch hunts in Europe. The start of the 1990s saw a media-fuelled panic about ‘epidemics’ of cocaine use during pregnancy. Crack babies, it was predicted, ‘present an overwhelming challenge to schools, future employers and society’ (Murphy and Rosenbaum, 1999). Crack mothers were demonised; it was widely reported that they were indifferent to their children or directly abusive. Punitive legislation followed and criminal prosecution enacted in several states that resulted in their incarceration (Boyd and Faith, 1999; Centre for Reproductive Law and Policy, 1996), the publicity helping to perpetuate stereotypical representations of drug-using mothers in public consciousness. Irrespective of the risks of HIV, as female drug misuse continued to increase, women were criticised for bringing children into the world already damaged by their mother’s drug habit. It is suggested that the hostility was made worse by selective reporting of clinical data on the postnatal effects of cocaine use (Zuckerman et al., 1998) which favoured negative outcomes with little regard to more positive fine detail concerning their severity or longevity.

Typically the discourse surrounding drugs was and still is densely populated with condemnatory and stigmatising judgements on women’s behaviour. An otherwise useful study on social workers’ views of child neglect and abuse (Reid and Macchetto, 1999) frequently lapses into emotional, if not incendiary language: ‘A devastating tornado of substance abuse and addiction is tearing through the nation’s child welfare and family court system leaving in its path a wreckage of abused and neglected children, turning social welfare agencies and courts on their heads and uprooting the traditional disposition to keep children with their natural parents.’

Reactions to the rising number of pregnant drug users have been more muted elsewhere and the approach to containment of the negative consequences of illicit drug use in several European countries is guided by the philosophy of harm reduction. This is a perspective that is ‘more pragmatic and less idealistic, more reality based and less moralistic, and more focused on what could be done rather than what should be done’ (Rosenbaum and Irwin, 1998). Public attitudes towards pregnant drug users and drug-using mothers in Europe may be similar to those in the US, but there seems to have been no research on this topic.

STIGMATISATION: COUNTERPRODUCTIVE CONSEQUENCES

Perhaps the most wide-reaching and long-lasting effect of the apparently merciless judgement of drug-using mothers by the press, the law and the public has been their increasing reluctance to approach medical services (Guerra, 1998; LGDF/SCODA, 1997; Mounteney, 1999; Sheridan, 1995) (see also Chapter 2). This can only add to the health risks for their children and for themselves. The view that there may be reasons for women turning to drugs has rarely been considered. Many women presenting for drug treatment report histories of childhood abuse and domestic violence (Ludwig and Anderson, 1989; Miller et al., 1989; Nelson-Zlupko et al., 1995; Roth, 1991; Russell and Wilsnack, 1991) and drug-using women tend to be victims of violence throughout their lives (Amaro et al., 1990; Bollerud, 1990; Miller, 1998). Research that could produce insights into the consequences of such histories from the women’s perspective has been comparatively rare. In the US, NIDA ¹ has mounted diverse re-search programmes on women’s use of drugs, but the value of in-depth social studies, while having a long history, has only slowly become recognised (Boyd, 1999; Colten, 1980, 1982; Murphy & Rosenbaum, 1999; Rosenbaum, 1981) and researchers who seek the views of drug users are still relatively rare in the American literature.

Despite the universally hostile attitudes to the use of drugs of dependence by women, and the correspondingly punitive consequences of transgressions, female drug use has been rising for some time (UNDCP, 1994), though perhaps undetected in many areas. The trend was described by a working group of the Council of Europe in 1996 in a way that hinted of surprise and concern ‘. . . in recent years drug use amongst women in Europe has been undergoing dramatic changes . . . with women rapidly progressing towards similar levels of drug misuse as seen amongst men’ (Council of Europe, 1995). The proposal for treatment services to address women’s needs has received much support, but the ongoing debate has yet to be translated into policy and evidence-based practice. It is to be hoped meanwhile that a restrained and realistic view of drug use among women will prevail and that the needs of drug-using mothers will be met without prejudice

SELF-MEDICATION BY WOMEN

Increasing use of illicit drugs by women is partly accounted for by a tendency for women to self-medicate (Khantzian, 1985) their anxiety, depression and fatigue with drugs. The universal role of women as carers and protectors assigns to them heavy responsibilities (Glenn, 1994). Women are critically involved in the health and well-being of others. Even as children it is usually the female child that is expected to respond to family needs when these exceed the capacity of the mother (UNDCP, 1994). Perhaps such responsibilities, combined with greater familiarity with home-based treatment of domestic ailments, have contributed to the tendency for them to diagnose and self-treat. This has a long history that goes back to the 1950s and 1960s when prescriptions, first for sedatives and then amphetamine-based stimulants, were easily acquired, the latter over the counter (OTC). Advertisements at the time were aimed largely at women (Kandall, 1998) who were more likely to receive prescriptions than men. Kandall concludes his observations on female drug dependence with the assertion that ‘a significant component of the problem of female addiction has come, and still comes from the inappropriate and excessive medicating of women by physicians and pharmacists, and through self-medication’. Should problems arise in maintaining legal supplies, strategies are widely used by both men and women that take the form of fraudulent statements. Most commonly reported are those made to doctors that allow them to obtain prescriptions from a number of clinics; and the nature of the symptoms being experienced which require heavy painkillers or sedatives. There is also a long history of collusion by physicians in private medicine who exploit this market. The drugs may change, but the practices continue. The limits imposed on benzodiazepine prescriptions once their dependence potential was revealed has now resulted in high profits for companies manufacturing fluoxetine (Prozac) which is prescribed significantly more often for women than men (Kramer, 1993). Self-medication through OTC drugs and the diversion of prescribed drugs to be shared by family members is a strategy that carries even less risk of detection for women than turning to illicit supplies or street drugs.

The attraction of pharmaceutical substances is understandable. They are safer than illicit drugs, have recognised therapeutic value, are pure, and the side effects are known. They do not carry the stigma of illicit drugs. Some have euphoric psychoactive effects, particularly if used in large quantities. Common examples are some anxiolytics, and OTC drugs that contain pseudo-ephedrine and codeine. Anorectics for weight control are amphetamine based and their use, mostly by women, is increasing worldwide (UNDCP, 1996) helped by liberal prescribing in ‘health clinics’ that results in diversion on to the illicit market. Most anorectics induce the usual positive effects of amphetamine on mood and energy, as well as suppressing appetite, which are an added bonus. Women diagnosed as overweight or obese and prescribed amphetamine have been known to respond to the termination of the supply by their doctors by going on to street supplies, resulting in some cases in significant dependence and absorption into the drug subculture (Klee, 1997). Amphetamine in another form (methylphenidate) is prescribed to improve the behaviour of ‘difficult’ children with ADHD (Attention Deficit Hyperactivity Disorder), and alleviate consequent family stress. Although particularly widespread in the US, this is increasing rapidly in Australia and there are signs of a similar trend in Europe (UNDCP, 1996). In all cases there is a risk of diversion on to the illicit market. The easy availability of drugs with psychoactive as well as therapeutic properties combined with the increasing use of the Internet for information and purchase, allows people to by-pass the normal controls imposed by GPs. This is a large ‘grey area’ of abuse about which very little is known.

PARENTING: CHANGING FAMILY PATTERNS

A trend that will affect parenting of future generations is the departure from the tradition of two-parent families. ‘There has been substantial growth in lone parent families over the last 25 years. Lone parents headed 22% of all families with dependent children in Great Britain in 1995’ (Social Focus on Families, 1997). The trend seems almost wholly due to a rise in the proportions of lone mothers, since the proportion of lone fathers has remained about the same.

There seem to be several features that are shared by lone mothers and drug-using women, most notably economic disadvantage and its consequences in family dysfunction and social isolation...

Table of contents

• COVER PAGE
• TITLE PAGE
• COPYRIGHT PAGE
• FIGURES
• AUTHORS AND CONTRIBUTORS
• PREFACE
• ACKNOWLEDGEMENTS
• THE RESEARCH BASE
• PART I: THE CHANGING CONTEXT
• PART II: APPROACHING MOTHERHOOD
• PART III: MOTHERHOOD
• PART IV: SERVICE DELIVERY AND DEVELOPMENT
• PART V: IMPLICATIONS FOR POLICY
• NOTES