by Melissa Raven
This article was first published in “New perspectives on ‘addiction'” (special issue of Dulwich Centre Newsletter, 1997 nos. 2&3, pp. 4–6.
Virtually all known societies have used drugs of some sort. Most people in contemporary western countries use drugs for non-medical reasons, although not everyone recognises their favourite beverage, smoke or pill as a drug. Drugs are used for many purposes. The desire for pleasure is a common reason for drug use – drugs can be fun – but it is by no means the only reason. Many people use drugs as a form of self-medication, to anaesthetise themselves in response to emotional and/or physical pain. People also use drugs to feel different (even if the new feeling is no more pleasurable, or even less so), even to punish themselves. Drugs are generally used for a purpose; however, drug use can also have unintended consequences.
On a different level, there are other explanations related to social influences: parental influences and peer pressure both affect the likelihood of drug use, as do general social norms and availability. Drug use can be learned in a variety of ways: through direct experience (both pleasurable and aversive), through observation, through sociocultural influences such as advertisements, movies, song lyrics, social rituals, and religious beliefs.
Drug issues can be complex. Drugs cannot be neatly divided into good and bad, soft and hard, safe and dangerous, or any of the other appealing and convenient dichotomies. Virtually all drugs have both positive and negative effects. In order to understand drugs and drug use, and to find helpful ways of addressing drug-related problems, there are many different dimensions to consider, including medical, legal, economic, moral, cultural, religious, and public health perspectives.
Drugs and power
Drug issues are highly political. The drugs trade is the second most lucrative industry in the world, following the arms trade but preceding oil (Criminology Australia,1995, p. 14). Drugs and the drug trade have both historically and in recent times been used as a justification by world powers for military intervention, and multinational companies relentlessly market tobacco and obsolete prescription medications to ‘Third World’ countries. The more one looks at issues of drugs, the more intricate become the relations of power and knowledge.
Which substances are defined as drugs, how their supply and use is regulated, how society responds to people who use drugs – all of these are political issues. The fact that the two drugs that cause the most harm and damage in the world today – tobacco and alcohol – are both legal in most countries powerfully illustrates this point. The status of various drugs has been greatly influenced by political and economic interests. For example, cannabis was inaccurately classified as a narcotic and prohibited for primarily racist and economic reasons (Goode 1993).
The status of marijuana is perhaps the most contested at present. Marijuana is widely used in many countries despite its illicit status. It is often considered to be a ‘gateway’ drug and a ‘stepping-stone’ which inevitably increases the likelihood of other more dangerous illicit drugs being used. There is in fact little evidence to support these ideas (National Campaign Against Drug Abuse 1992; Goode 1993). Indeed, an important policy strategy in several countries such as the Netherlands is the separation of drug markets. This usually refers to separating cannabis from other illicit drugs because it is very widely used and is believed not to be particularly dangerous, and because this strategy decreases marginalisation and criminalisation of users and saves unnecessary costs of law enforcement. The legalisation of marijuana for medical purposes such as the treatment of glaucoma and as an anti-nausea agent in cancer and AIDS-related diseases is highly controversial.
While there continues to be a disproportionate focus on illicit drugs, problems associated with prescribed medications receive little attention. Benzodiazepines (so-called minor tranquillisers such as Valium) continue to be prescribed for millions of people, often for long periods of time, despite clear evidence of the potential for these drugs to cause dependence and other problems. Women are much more likely than men to be prescribed these drugs, and it has been argued that this practice is a strategy for adjusting women to unjust circumstances (Beckwith 1992). Elderly people and migrants are also more likely to be prescribed these drugs. The use of benzodiazepines has declined somewhat in recent years, but antidepressants such as Prozac have filled the gap. Psychiatric drugs are also sometimes used for inappropriate reasons, for example to sedate patients for long periods of time. Other worrying forms of drug use that are often overlooked include the use of laxatives and diet pills which is common among young women.
Disparities in the responses to drug use by different members of the population, based on issues of class, race and gender, are common. For example, young Black males are much more likely to be jailed for illicit drug use than other people who commit the same crimes. And the meanings associated with drug use can only be understood within culturally and socially specific contexts. Hammersley (ADDICT-L, 12 March 1996) describes how this also applies to drug-dealing:
Dealing offers one of the few available routes out of poverty to badly-educated poor young people. As such it is understandable, rational behaviour, often engaged in by the most competent and ambitious people in that situation, not signs of major psychological pathology.
Language is central to many of the important power issues. The term ‘narcotic’ has profound social and legal implications. ‘Drug abuse’ has different connotations than ‘drug-related problems’. When the terms ‘drug-dealers’ and ‘drug-pushers’ are used, pharmaceutical companies, doctors, and pharmacists rarely feature in our thoughts.
Even when less judgemental terms are used, language issues are important. To many people, the term ‘addiction’ implies some sort of extraordinary condition arising from abnormal psychobiological processes, and requiring specialist treatment. Furthermore, there is often the assumption that ‘addictions’ are lifelong problems which cannot be cured, only held in remission. Diagnostic terms also have significance. The words ‘alcoholic’ and ‘addict’ have the advantage of being succinct. But what impact does it have when a person is labelled as an ‘alcoholic’ (or the less confronting ‘problem drinker’) as opposed to a ‘person with an alcohol problem’? Does the former make it harder for them to see themselves as separate from the problem, and to focus on their strengths and resources rather than their deficits?
Issues of gender
Issues of gender are also relevant in that there has generally been a neglect of women’s drug use/problems in the drug field. There have been many examples of inappropriate generalisation of research on men to the situation of women. For example Jellinek (1952) based his disease model of alcoholism on questionnaires completed by 98 male members of Alcoholics Anonymous. The data from women were discarded precisely because they were so different from the men’s. Such research exclusively on men has time and again been used to argue that male-orientated services should suffice.
Women who use drugs are often considered doubly deviant within a patriarchal society (Broom & Stephens 1990). This can result in more oppressive responses to their drug use. The most powerful example of this is how some pregnant women have been placed under profound surveillance and have even been prosecuted and incarcerated because of their drug use and the perceived ‘immorality’ of their actions in relation to their unborn child. Another way in which issues of gender and drug use intersect is in relation to domestic violence. Many domestic violence shelters have a policy against accepting drug- affected women, and yet many survivors of domestic violence use drugs as a way of coping.
Another issue raised by some feminist writers is the validity of the concept of codependency, and its implications for women. The term codependency was first used in the 1970s to refer to the behaviour and experience of partners (primarily women) and children of people with drug problems, especially alcohol problems. According to this perspective, a codependent person was someone who lived with or had grown up with an alcohol-dependent person and been adversely affected by the experience. This concept gradually blurred into the theory that codependency is an ‘addiction’ and a ‘disease’ in itself. It can be argued that it pathologises women by pathologising behaviours into which girls and women are socialised from infancy: nurturing, care-taking, putting others’ needs ahead of their own, self-effacement (Walters 1993; Kaminer 1992). By ignoring socialisation, by ignoring inequalities of power and access to resources, by ignoring the fact that women’s choices are often directly and indirectly restricted, it individualises and depoliticises the problems that women experience as a result of others’ drug use. Yet, some women find it helpful to consider themselves to be ‘codependent’ and to make sense of their experience in this way. There are gender issues for men as well as women. The feminist movement’s achievement in creating a language for the gendered nature of drug use is now also creating the opportunity for the links to be made between dominant constructions of masculinity and certain forms of drug use such as heavy drinking (see Milton Lewis’s paper in this newsletter).
Remaining aware of the politics of drug use
Whether it be in relation to the ways in which different drugs are classified, the ways in which tobacco and alcohol companies exploit notions of ‘women’s liberation’ and western glamour in their advertisements, or the fact that drug use can be a form of self-medication to mitigate the effects of trauma and injustice, relations of power intersect with drug use in a myriad of ways. As we try to consider new ways of working with issues of ‘addiction’ and drug use, it seems relevant to ask of ourselves: how can we remain conscious of the political nature of drug use and the language that we use to describe and understand it, and what implications does this have for our work?
Beckwith, J.B. 1992: ‘Substance use, responsible use, and gender.’ Drugs in Society, 1, pp. 18-23.
Broom, Dorothy, & Stevens, Adele, 1990: ‘Doubly deviant: Women using alcohol and other drugs.’ The International Journal on Drug Policy, 2, 25-27. Criminology Australia, 1995, Summer: ‘News [Well, what’s number one?].’ Criminology Australia, 7(2): 14.
Goode, Erich, 1993: Drugs in American society (4th ed.). New York: McGraw-Hill.
Hammersley, Richard, 1996, 12 March: ‘Re: Coke and crime.’ In ADDICT-L [ADDICT- L@LISTSERV.KENT.EDU].
Jellinek, E.M. 1952: ‘The phases of alcoholic addiction.’ Quarterly Journal of Studies on Alcohol, 13, 673-684.
Kaminer, Wendy, 1992: I’m dysfunctional, you’re dysfunctional: The recovery movement and other self-help fashions. Reading, Massachusetts: Addison-Wesley.
National Campaign Against Drug Abuse, 1992: Comparative analysis of illicit drug strategy. National Campaign Against Drug Abuse Monograph Series No. 18. Canberra: Australian Government Publishing Service.
Walters, Marianne, 1993, March/April: ‘The codependent Cinderella and Iron John.’ Family Therapy Networker, pp.60-65.
Copyright © Dulwich Centre Publications 1997