Women in Narcotics Anonymous: Overcoming Stigma and Shame

Overcoming Stigma and Shame

J. Sanders

• Publisher: Palgrave Pivot
• Year: 2014
• Print ISBN:
  9781349494569
  9781137440693
• eBook ISBN:
  9781137430496
• Topic: Social Sciences
• Subtopic: Social Policy
• Index: Social Sciences

This book looks at a sample of female drug addicts seeking recovery in Narcotics Anonymous (NA). Through working the Twelve Steps and by attending women-only groups, these women are able to confront the double standard that makes recovery from addiction especially difficult.

1

Introduction: Women, Addiction, and the Double Standard

Abstract: Women in Narcotics Anonymous (NA) bring to recovery the stigma they have perceived and the shame they have felt as female drug addicts. The gendered double standard that women experience based primarily on their reproductive capacity makes confronting their addiction even more problematic in recovery as compared to their male counterparts. Social policy and treatment options, too, unwittingly add to the stigma and shame that women experience as addicts. NA, however, offers an opportunity through its Twelve Steps for female addicts to work through both stigma and shame once in recovery.

Keywords: drug addiction; Narcotics Anonymous; women

Sanders, Jolene M. Women in Narcotics Anonymous: Overcoming Stigma and Shame. New York: Palgrave Macmillan, 2014. DOI: 10.1057/9781137430496.0004.

Women suffering from drug addiction often experience feelings of shame and guilt that arise from the stigma associated with over consumption of substances. Drug addiction is highly stigmatized for both women and men, but women are subject to a double standard. For women, drug addiction is viewed not simply as an act of over-indulgence, but as an act against womanhood. The perception is that the woman who abuses substances, especially illicit drugs, violates her body and thus her reproductive capacity. Society regards drug abuse as a threat to the woman’s alleged primary purpose—to bear and raise children. Although women’s social space has expanded greatly in the post-feminist era, a vestige of their earlier obligations for reproductive capacity lingers as part of a shared cultural norm. Therefore, stigma is used to align women’s behavior with this traditional gender script. There is little doubt that this imperative cultural norm that women take care of their bodies, especially, in their child-bearing years, serves society well. Nonetheless, this double standard leaves women with an extra burden to bear.

The double standard and the stigma that accompanies it help to maintain social control by deterring drug use in the first instance. However, for those women already engaged in substance abuse, stigma also can deter them from seeking the treatment they need in order to stop the drug use. Moreover, these same women often internalize the perceived stigma they feel, and this emotion becomes shame. Together, stigma and shame make it difficult for women caught up in a drug addiction to seek the help they need. Additionally, social policy and the treatment made available through such policy inadvertently contribute to social stigma and internalized shame. Lastly, women report awareness of the double standard applied to them even within the voluntary organizations that make up the twelve-step community, the most utilized mutual support option for substance abusers (Sanders 2003).

This work focuses on women who use the twelve-step model to recover from their addictions in order to gauge the extent to which they both experience and alternatively resist stigma and shame as part of their recovery program. In fact, mutual support groups have to some extent allowed women to acknowledge their perceptions and feelings associated with stigma, even if the double standard has permeated these groups. Prior research has found that women in Alcoholics Anonymous (AA) have helped to carve out their own gendered spaces within the twelve-step program, and this has facilitated open discussion of both stigma and shame (Sanders 2009). However, in spite of progressive elements found in the twelve-step culture, this work asserts that female drug addicts, as opposed to female alcoholics, are the most stigmatized of all substance abusers and thus have a particularly difficult time eradicating stigma and shame from their lives. Additionally, although stigma associated with drug addiction among women is prevalent across various and diverse groups of women it is thought to be more pronounced among those who are already socially marginalized due to racial identity or socioeconomic class status. A particularly rich locus for socially marginalized women working to recover from drug addiction is the twelve-step program, Narcotics Anonymous. Given the intersection between drug addiction, race, and class, it is expected that women in Narcotics Anonymous represent a group uniquely burdened by stigmatization and shame. Therefore, particular attention is given to a sample of women seeking recovery from their addiction in NA.

This manuscript presents an analysis of how women in NA break down the barriers of stigma and shame and how they work toward accepting themselves. This study of women in NA illustrates how women can and do use the twelve-step program to confront stigma and shame. The collective identity adopted as an addict in recovery helps to reduce the stigma that women bring with them into the twelve-step program. Additionally, NA’s Twelve Steps encourage women to let go of the shame they feel. Moreover, women’s meetings organized in the twelve-step program provide a gender-specific environment in which women can openly express feelings of both stigma and shame. Through active participation in NA, women are able to confront and begin to overcome the stigma and shame that characterized their identities as active drug addicts. Even those women who have historically been at the margins of society based on their race and class are able to push out stigma and shame from their lives, as they recover by working the Twelve Steps in NA.

Drug addiction: a woman’s problem?

Women make up a growing proportion of those who abuse substances. While many still associate men with drug addiction, especially illicit drug use, it is estimated that in any given year, 4.5 million American women 18 years or older suffer from this deadly disease (Substance Abuse and Mental Health Services Administration [SAMHSA] 2010a). The public attention that is given to women often comes in the form of highly sensationalized news events, restrictive social policy, and other exaggerated media depictions of women on drugs. Women are described as deeply disturbed, immature, promiscuous, licentious, or just plain evil. If not given the public image of the nasty girl or the fallen woman, then they are completely overlooked or invisible to the public eye. In either case, women are often blamed for their predicament, and a double standard persists that makes it more difficult for women, compared to men, to seek recovery.

Research efforts, too, concerned mostly with men as substance abusers have not helped to alleviate stigma and shame for the female addict. Until the early 1990s, much of the research conducted focused on men. Women as addicts were still viewed as an anomaly. Substance abuse was considered a male activity that was consistent with traditional gender-role ideology, whereas women who abused substances were breaking with traditional gender roles and, therefore, were more stigmatized than their male counterpart. Still today, as long as men outnumber women in the prevalence of drug use and abuse, research on women can easily be overlooked, minimized, or focused solely on reproductive concerns. While it is true that men are more likely to be substance abusers than are women, research specific to the female substance abuser is, nonetheless, warranted. In 2009, the US National Survey on Drug Use and Health found that 6.4 percent of females 12 and over met the criteria for substance abuse or dependence alongside the 11.5 percent of men who qualify as such (SAMHSA 2010a). Although a gender gap remains, it has been narrowing, and women need to become more a part of the focus in addressing addiction. While men dominate in numbers, women in many ways suffer more acutely from substance abuse and addiction. It has been well documented that women who abuse alcohol often become physically addicted more quickly than men (Wilsnack, Wilsnack, Miller-Strumhofel 1994; McCaul and Furst 1994), and there is evidence for the same in women who abuse other drugs. This phenomenon, called telescoping, also speeds up negative psychological and social consequences for women due to their substance abuse.

Among treatment-seeking populations, drug addiction is beginning to surpass alcohol addiction and gender differences remain. Almost 60 percent of all treatment admissions are for substance abuse and addiction to drugs other than alcohol (Agency for Healthcare Research and Quality [AHRQ] 2013). Of these admissions, more than one-fifth is for opiate (opioid)¹ abuse. A partial explanation for the percentage of drug addiction to opiates is abuse and subsequent addiction to legally prescribed opioids. Since women have been and remain more likely than men to receive prescriptions for opioids, this problem is of particular concern to them. Treatment for sleeping problems and for anxiety, as well as medication prescribed for chronic pain conditions, often lead to the use of prescribed opioids. Given that women become physically dependent faster than men, they often suffer more medical consequences due to opioid abuse. Moreover, concerns remain that clinical trials and medications to treat opioid dependence have not yet adequately addressed gender differences in treatment response.

In addition to prescribed opioid use, women have been a growing proportion, about one-third, of those addicted to the most abused illicit opiate, heroin. In fact, no longer is heroin abuse associated only with poor minority women. Heroin abuse has been growing among more affluent, white, young adults. Some feminist researchers have registered this growth as resistance to traditional gender and class roles (Friedman and Alicea 1995). Some have considered heroin use among women as a rebellious act (Ettore 1992) and a source of empowerment (Raymond 1986; Vance 1984). Ironically, once fully addicted, women suffer even more stigma due to the breaching of gender roles that attracted them to the drug use in the first instance. Moreover, the heroin subculture becomes even more oppressive than the male-dominated culture they sought to escape (Rosenbaum 1981).

Marijuana, the third most reported drug of abuse (after alcohol and tobacco), and the most used illicit drug, has historically been more heavily associated with men, just as alcohol has been, but increasingly women use and consequently abuse of this drug, as well (SAMHSA 2013). Women make up about one-fourth of all treatment admissions for marijuana as their primary drug of dependence (AHRQ 2013). More research is needed, but evidence suggests that women, again, experience more and quicker medical effects of cannabis abuse compared to their male counterparts. The medical implications alone call for more gender-specific analysis of how drugs impact the body.

Moving from a medical to a social analysis, drug abuse varies among women based on race or ethnicity. African-American women make up just over 6 percent of the treatment population and the majority of them seek treatment due to cocaine addiction. White women make up just over 20 percent of all treatment admissions and represent almost a fifth (19%) of all those (male and female) seeking admission for alcohol, heroin, or cocaine. The greatest difference among women by race, however, is that white women make up 41 percent of all admissions for dependence on opiates other than heroin. Therefore, race and ethnicity must be factored into considerations of social policy and treatment relating to substance abuse and addiction among women in the United States.

A feminist explanation

The feminist theoretical tradition helps explain why stigma and shame are such predictable by-products of addiction for women. Understanding women’s historical place in society, the cultural attitudes toward women who abuse substances, and the psychological differences that women experience based on gender offer some conceptual frameworks from which to interpret findings. From the feminist orientation, the “emancipation” argument posits that as the gender gap closes in other areas, so should it in regard to substance use and abuse, and consequently women who use drugs are simply exercising a form of liberation. This view assumes that societal attitudes toward drug use by women and men are no different. In this scenario a double standard should not exist. Actually, one of the promises of the second-wave feminist movement, prominent in the 1970s, is for women to occupy public space and have the same privileges as their male counterpart. Gender neutrality is often perceived to be the goal of the liberal feminist agenda. However, the emancipation/liberation hypothesis does not adequately explain the ill effects of substance use such as abuse and addiction. This leads to a slightly different feminist view that asserts that while equality for women has moved forward impressively over the past 40 years, it is not enough to expect women to behave similarly to men nor should they have to in order to be liberated. These cultural feminists introduced the need for gender-specific recovery options to address the particular needs of women. Yet a third variant of the feminist perspective not only looks at gender and equal rights, culture and unique attributes of women, but also examines how gender intersects with other forms of stratification and difference. Specifically, race, ethnicity, and socioeconomic class influence women’s experiences. This perspective, initiated during the third wave of the feminist movement that emerged in the 1990s, best captures the concerns of drug-addicted women who do not come from the normative and privileged majority group, the white middle class, but from marginalized groups. It is this “difference” that is under study, as it is related to female drug addiction and the interlocking forms of stigma and shame associated with both difference and drug addiction.

In reference to recovery from addiction, a particular second wave, critical, feminist view of the twelve-step movement asserts that the twelve-step culture embodies elements of patriarchy that do not serve women’s recovery, as well as they do that of men (Berenson 1991; Kirkpatrick 1986; Faludi 1991; Bebko and Krestan 1991; Rapping 1996; Tallen 1995; Walters 1995). Feminists critical of twelve-step programs question the traditional religious references, the male-privileged language, and the focus on personal and spiritual development rather than social or political progress. This critique initially targeted at the original twelve-step program of Alcoholics Anonymous has been extended to include the full range of twelve-step programs. In fact, Elaine Rapping in The Culture of Recovery (1996) is most critical of the twelve-step model, because it has been adopted by the popular culture and generalized to many other social and psychological problems. She refers to the “feminization of recovery,” or growth in women’s membership, not as a positive development for women’s emotional or social well-being. Rather, she perceives it as a generation of women who have become dependent on not just one, but on multiple twelve-step programs and alleges that these women are “stuck in a myopia of self-absorption” (p. 13). Given this interpretation of women’s involvement in the twelve-step movement in general, it becomes even more important to look closely at some of the most stigmatized women who utilize twelve-step programs, women in NA.

An alternative, second-wave feminist view perceives the twelve-step movement as a therapeutic exercise, which has been very successful in helping women psychologically in terms of emotional and behavioral health. Feminists from this persuasion view women as active participants in developing a feminist culture within AA and the twelve-step movement (Davis 1997; Levi 1996; Sanders 2009; Schaef 1987; Van Den Bergh 1991). Therapists, psychologists, and educators integrate feminist principles into their work with women who attend twelve-step recovery programs and recommend that women simply modify, but not seek to change completely, the Twelve Steps to better match their own feminist interpretations. This includes adapting how women work the Twelve Steps, attendance at women’s meetings, and fostering relationships with other women in recovery. Women focus on how to create a recovery environment that is conducive to a gendered perspective rather than turning away from or resisting altogether the twelve-step option to recovery from addiction. This view is sympathetic to the idea that women have unique needs in recovery, and they urge women to create a culture of recovery that is more accommodating and comfortable to them.

It is this author’s interpretation that, rather than focusing on the perceived latent, patriarchal elements inherent in the twelve-step culture, focus needs to be placed on the stigma and shame that is so omnipresent in the larger society that it even invades the twelve-step culture and by default infects to some extent the subculture of recovery. The social-psychological processes of constructing stigma and internalizing shame act as barriers to women seeking treatment, encumber women once in treatment, and represent the often unspoken double standard that accompanies women both as active and as recovering drug addicts. Even a voluntary organization, such as NA, that exists to help individuals recover from drug addiction cannot fully eradicate the double standard that women feel as addicts. Though the program of NA is inclusive and women make up 43 percent of its membership (NA 2009), socially constructed stigma and the resulting internalized shame are hard to leave at the door, when a woman comes into the “rooms” of NA. What prevails outside of the rooms of NA is social policy that punishes women who are addicts, media that objectifies the female addict as a deserving victim, and societal expectations that label drug-addicted women as bad mothers and blame them for their affliction. It is perceived that the female drug addict should be more responsible to the needs of her family than her male counterpart is (Ridlon 1988; Schur 1983). If she is not, it is viewed as a moral wrong and not just as the inability to live up to expected social roles. Moreover, attitudes about sexual conduct continue to reinforce the double standard that women who are sexually active are promiscuous and the drug-addicted woman, in particular, is further denigrated and often referred to as a whore.

In addition to continued images that dehumanize and degrade women who do not adhere to traditional gender roles, the disease of addiction itself remains heavily stigmatized and is not viewed solely as a medical condition, like other chronic diseases such as cancer or diabetes. The ability to change one’s behavior is paramount and strongly connected to the disease of addiction. The idea endures that if one just doesn’t use the substance, then she can be fine. Therefore, the moral imperative stands, and addicts are judged. Acker (1993) discusses this emphasis on the behavioral aspects of addiction and concurs that, even though the medical model has helped to reduce stigma, individuals are still judged as blameless or blameful based on other factors, such as socioeconomic status or type of drug involved. Therefore, to study stigma requires a more sensitive lens, one that looks at particular groups such as female addicts.

Shame, like stigma, is part and parcel of the female addict’s experience. Whereas stigma is outside the self and a perception, shame is inside the self and a felt emotion. Shame is highly associated with addiction in general and women seem to harbor more than their fair share (Wells, Bruss, and Katrin 1998). Histories of sexual abuse and trauma often precede addiction for women and the origin of shame related to this early abuse is deeply seated and rooted (Murray and Waller 2002). The secondary shame that arises as a direct result of behaviors and problems related to addiction itself adds another layer of complexity to understanding gender, addiction, and shame. T...

Table of contents

• Cover
• Title
• 1  Introduction: Women, Addiction, and the Double Standard
• 2  Women and Their Drugs
• 3  Uncovering Stigma
• 4  Internalizing Shame
• 5  Womens Rap
• 6  Working the Twelve Steps
• 7  Conclusion: Recovery as Feminism of the Everyday
• Bibliography
• Index