[acb-hsp] Learning to Live Without It: Substance Abuse

[J.Rayl]

Learning to Live without It: Women, Biography and Methadone
by Grazyna Zajdow
Learning To Live Without It: Women, Biography and Methadone
This paper addresses some issues relating to Methadone-maintenance as a treatment
for heroin addiction. From the position of a sociologist in Melbourne, I am aware
that New South Wales has had a vigorous debate about Methadone, mainly presented
as a battle between the religious, dogmatic right and pragmatic health professionals
and public health scientists.(1) There has been no such debate in Victoria. Methadone-maintenance
has been presented as the best treatment for heroin addicts, with little or no comment
being made as to its shortcomings and problems. This has been the case even though
the Victorian Coroner had a major inquest into deaths related to Methadone in the
1990s.(2) I do not wish to be aligned with the religious right but, as a feminist
and sociologist, I have misgivings about the widespread use of Methadone as a treatment
and about the ideology of harm reduction as the only policy response to the issue
of heroin addiction. Many of my misgivings become evident through the stories of
women who have had experience of Methadone maintenance treatment. I have written
of my general reservations about harm reduction policies in a previous article.(3)
Women's relationship to all forms of drug use is quite different to men's. With the
exception of prescription tranquillisers, women use less of all drugs (and alcohol).
This lesser use (and abuse) has been an excuse in the past to ignore the problems
that drug abuse may have for women. However, since the 1980s, feminists have drawn
attention to the gender implications in the way that drugs are used and abused. There
has, nevertheless, been little critical discussion of the gender implications of
recent drug policies such as harm reduction. The assumption seems to be that harm
reduction is less punitive than abstinence based models, which therefore cannot be
good for women. We need to unpack this assumption to develop policies which will
be effective for certain groups of women.
This article is about a group of women who have been active heroin addicts in the
past and who had experience of Methadone-maintenance treatment (MMT) before becoming
totally drug-free. My intention is to try to understand public health policy through
the individual lives of women who are experiencing the pointy end of modern drug
addiction policy and thereby question the meanings we give to the term `harm reduction.'
The goal of harm reduction is the minimisation of the social, psychological, and
personal damage of drugs and, while this is a laudable goal, it can take on the flavour
of a platitude with little understanding by the layperson of what its effects are
on those who live with it. In the world of public policy and treatment, harm reduction
and abstinence are placed in opposition to each other. The choice of abstinence is
considered a failure on the part of the woman since she clearly has not developed
the necessary qualities of a `rational liberal' citizen. This paper tells a story
of the clash between a state policy (backed by an army of health professionals, researchers
and bureaucrats) and some women who have experienced a central part of this policy.
For me the question is always: harm reduction for whom? If it is for the addict,
then we must ask the addicts for their shared meanings of the term. If it is for
the relatives and friends of the addicts, then they should be asked. If we are talking
about harm reduction for other parts of the community, then it is up to the policy
makers to clarify who they mean when they use the term. These are complex issues
and cannot adequately be covered in one short article, so I will limit myself to
the group of women that I interviewed and portions of those stories that I will tell.
I present their meanings as told to me.
Biography, autobiography and science
Biographies are strange things; they presume to tell the truth but never the whole
truth. Biographies are like many other narratives, they have a beginning, middle
and end but the structure is always moving so that the beginnings for my purposes
here are really the middle of the interview, and the middle of the life as it has
been lived by the narrator. Because autobiographies and biographies are so messy,
the scientific project finds them hard to deal with. No biography can allow us to
see the graph representing the cut in the crime rate, or the table with the percentage
of HIV and hepatitis in the population. The ideology of harm reduction policies is
based on public health science; this in turn is based on epidemiology, not on the
life and experiences of individual addicts. Nonetheless, individual experience is
ultimately important for public health and the policy formulations that we help to
make. Individual addicts are often trotted out for the benefit of the media when
a new rehabilitation centre is opened or a new drug comes out to solve the problem.
But these are not the stories to be presented here.
Needless to say, autobiography is important to the person who is narrating it. Through
telling our own stories we validate our own experiences; through telling stories
of experiences relating to addiction and treatment, women are able to make their
own experiences speak as a universal singular. When we speak, we speak not just about
our individualised experiences, but also of our part in the whole social world. But
we do not speak for the world, but for ourselves.
Feminists have to start speaking about the nature of addiction. We also have to engage
with the hegemonic ideology that is harm reduction which explains itself as part
of the social enterprise, but dismisses the experiences of those who have not benefited
from their policies. When we listen to women's experiences, we allow this critique
to begin.
Harm reduction and the New Public Health
Harm reduction or harm minimisation is the official policy of both the Australian
and Victorian governments in relation to drug use and abuse. However, it means different
things to different people. In relation to heroin, harm reduction has meant drug
substitution programmes such as Methadone, as well as needle-exchange programmes
and other measures such as counselling.(4) Some Naltrexone-treatment clinics are
also in operation.(5) (Methadone and Naltrexone operate physiologically in very different
ways -- Naltrexone blocks the effects of heroin, while Methadone is a chemical substitute
for opiates. In effect Methadone is a legal addiction, but an addiction nevertheless.)
Harm reduction is essentially derived from the New Public Health models which emphasise
such concepts and strategies as health promotion, education, social marketing, community
participation and intersectoral collaboration.(6) In contrast to the biomedical model
of health which is based on individualist notions of health and illness and centres
its own enterprise on the individual body, public health is presented as a social
enterprise. It is a psycho-socio-epidemiological model. The main tool of public health
is epidemiology which relies on statistical analysis and probability theory. Public
health is a utilitarian enterprise. It is the greatest good for the greatest number
at the lowest possible cost.
Generally, this has been interpreted as meaning that the state spends the least amount
of money for the best return in relation to health or prevention of disease. This
form of policy may pit the individual against the so-called common good. This has
repercussions for all women, and women addicts in particular. Does the state spend
its limited resources on dealing with rehabilitation for individual addicts which
may be costly and take time, or act in the best utilitarian fashion and spend its
money to deal with the greatest number, even if the results are not positive for
individual addicts?
The `new public health' model has also been called `surveillance medicine'(7) and
the `epidemiological clinic.'(8) Changing the focus from the individual body with
an illness, here we have an emphasis on the social characteristics of whole groups
using profiles of populations. Identification of risks and risk behaviour in populations
has been a major part of preventive strategies in public health. Health promotion
has meant the diffuse targeting of risk groups by large-scale advertising and media
interest. Women as mothers and carers have become prime targets of this promotion.(9)
Cook notes:
There is a paradox in addressing women's practical and strategic needs: those concerned
with practical needs may develop concepts whose effects, and perhaps whose purpose
confine women to maternal, domestic and subordinate social roles. This denies women's
legitimate strategic needs and prevents them from flourishing to their full capacity
within the family, community and society.(10)
Ironically, the `new public health' also ignores the very real social nature of women's
health problems. In relation to tobacco smoking, for example, Graham illustrates
the problems which exist when we understand that the highest levels of smoking are
concentrated in the poorest groups of women, and that health promotion which relies
on persuading individual women to cease smoking for the health benefits to their
children completely ignores the benefits that better housing, secure incomes and
adequate schools have on reducing smoking rates.(11) In a world which is increasing
inequality, the best public health policy is one which relies on individual citizens
changing their individual habits.
Sociologists have argued that public health measures have entailed greater amounts
of surveillance by health professionals over individuals, greater monitoring of risk
behaviours by the individuals themselves, and the entrenching of women's normative
roles as mothers and carets by devolving care to the community while presenting women
as the most amenable group to public health messages.(12) However, women are also
among the most economically disadvantaged groups within our society and women addicts
have the double burden of addiction and gender to deal with.
Treatments for drug addiction
Different models of treatment for drug addiction are as much based on moral and legal
responses to drug usage in general, as they are on scientific and medical theories.
I would argue this is the same problem for abstinence-based models as for harm reduction
or harm minimisation models. Essentially, there are four models of treatment with
a high number of variations. These are:
1. Abstinence-based professional treatment models.
2. Abstinence-based self-help groups (mostly modelled on the Alcoholics Anonymous
12 Steps).
3. Harm reduction or harm minimisation models, which include Methadone and other
drug substitution programmes, controlled drinking programmes, safe use education
programmes, needle exchange programmes etc.
4. Long-term therapeutic communities.
All these models are gender-blind. That is, there are no models specifically directed
to women and women's needs. Women addicts have either been completely ignored, or
it has been assumed that they have similar needs to men. The only exceptions are
those policies directed to women as mothers. The United States has also been the
focus of pro-natalist policies in relation to pregnant women and substance abuse
which posits women's autonomy against their responsibilities towards the babies they
are carrying.(13)
Feminist critics have long argued that gender-blindness works to disadvantage women
when it comes to addiction to drugs. Ettorre notes that the language used in relation
to addiction and substance use points to the problem.(14) Dependency, for example
is a two-edged sword. She argues that particular forms of dependency are deemed `good'
for women while others are universally condemned. A woman's economic dependence on
a man is considered part of normative femininity, and even dependence on prescription
tranquilizers is generally ignored if a woman manages to carry on her family responsibilities
more or less successfully. Dependence on heroin is not an acceptable dependency because
there is too much of a risk that women will be unable to carry out their prescribed
duties as wives and mothers.
The four models of treatment read diverse and contradictory effects for women. Abstinence
models clearly limit people's autonomy in relation to notions of choice. Residential
treatment facilities generally operate to limit people's movements in and out of
the programmes. Many women complain that they cannot take part in residential programmes
if they are separated from their children or they do not have the family resources
to place the children. In the American context, Iris Young is very suspicious of
most treatments for drug addicted women, arguing that `treatment often operates to
adjust women to dominant gender, race and class structures and depoliticizes and
individualizes their situations.'(15)
Abstinence may or may not be based on legal prohibition of drugs. As with alcohol,
an abstinence model may well operate within a legal environment which supports the
recreational use of a drug. Some proponents of harm reduction argue that this approach
essentially makes no comment on legal or moral issues in relation to drug use, it
is only concerned with public health issues.(16) But as I have noted above, public
health is as much concerned with political and ideological notions, as is any other
human institution. Many harm reduction proponents argue that the issue of drug abuse
should be taken out of the hands of the law and put into those of health professionals.
This is supposed to enhance the human rights of addicts, but it takes no account
of informal measures of social control and increased surveillance by many professionals
which may decrease the human rights of addicts. While a woman in jail clearly finds
the level of social control overwhelming, surveillance by doctors, psychologists,
social workers and even pharmacists outside of the prison system may be just as effective
in enforcing normative and prescriptive gender roles.
Abstinence-based 12 Step mutual self-help groups such as Alcoholics Anonymous or
Narcotics Anonymous are also victims of contradictory forces. On the one hand they
are free of professional control and surveillance and operate on democratic principles.(17)
They are also examples of the way that social capital can be built up in previously
disempowered groups.(18) However, there is continuing debate among writers about
aspects of their operations, and some feminists argue that they are based on models
of normative gender prescriptions which are disempowering in themselves.(19)
Since the mid 1980s in Australia, drug substitution programmes such as MMT as well
as other harm reduction measures such as syringe exchanges and education have been
implemented. Naltrexone treatment has also begun to be available. The introduction
of various programmes including MMT and needle-exchanges have been presented by policy
makers as resulting from systematic, scientific studies in what is now referred to
as evidence-based health policy. However, a reading of the literature indicates that,
while there have been many scientific studies involving statistical survey analyses,
there are many problems with comparisons between them because of differences in data
collection techniques, study participants, types of programmes and many other variables.(20)
The introduction of syringe-exchange programmes came not as a result of scientific
studies, but from intelligent hunches about the groups likely to spread HIV into
the non-addict and heterosexual population.
Differences in treatment goals also inhibit substantial comparisons. These problems
led Heather and Tebutt in 1989 to argue that up to that point there had been no clearly
effective treatment for heroin addiction.(21) No clear treatment has as yet emerged,
although Methadone maintenance is still considered the most effective medical one.(22)
However, successful medical treatment may not necessarily equate with successful
social or individual outcomes and there have in the past been many medical treatments
that have later been judged negatively -- much of what passed for gynecological surgery
in the nineteenth century and frontal-lobe lobotomies in the twentieth, are two instances
that come to mind.
While some studies of drug treatments have used gender as a variable, few view gender
as worthy of exploration in its own right. When studies do look at the importance
of gender for those who go into treatment, it has been found that women and men are
really two quite different groups of clients. Women and men have been found to have
used drugs differently, women have been found to have more emotional and physical
symptoms than men do on entering treatment, and women are in general poorer and have
more children for whom they are responsible. Women also tend to be younger than men
on entry to drug treatment.(23) With these major differences between the situations
of women and men, I think we need to be careful when suggesting that MMT, or any
other treatment, operates in the same way for women as for men.(24)
The study
This research is a very small qualitative study of six women who are now totally
drug free and who have used Methadone or cared for users of it. The Methadone was
legally prescribed, not bought on the streets. All the women had very negative experiences,
and thus do not represent the experiences of those for whom Methadone has worked
to free them from heroin use.
This being said, these women's experiences are valuable in understanding how a variety
of methods are needed to help women with addiction problems. Their experiences also
help to demystify the whole issue of abstinence from drugs since all of the women
finally came to abstinence by their own choice and now lead (in their own terms)
productive lives.(25)
The women in this study were aged between 35 and 50. All had been drug free for over
18 months, the longest time being 12 years. Four of the women cared for children
during their lives in addiction. All the women had committed crimes to sustain their
addictions -- one had been a sex-worker, one had stolen from her place of work and
the others had been involved in the sale and distribution of drugs. Three of the
women had been arrested, but only one had been to jail. The women had also used other
drugs including alcohol, marijuana, amphetamines, and prescription drugs such as
barbiturates. All continued to use heroin while on Methadone. All of the women at
some point became members of Narcotics Anonymous.
The next section of the paper will present some of the women's experiences in their
own words.
Life with Methadone
As I have already noted, people's stories are rarely presented in clear, thematic
narratives. While the women's stories were, for the most part, presented as standard
biographical narratives with beginnings, middles and ends, I have broken them up
to suit my purposes in this paper. I will begin at the beginning of the Methadone
story -- not the beginning of the addiction story, that is for another time.
None of the women went on Methadone because they wanted to; each felt compelled to
begin because of the threat of jail or fear of being caught using heroin. All of
them had used heroin and other drugs for many years.
I went on the Methadone as a stretch to keep out of jail. I was going up before the
magistrates again.... I had just gotten off a suspended sentence and the lawyer suggested
that I really had to go to the magistrates and give them a good reason to keep me
out of jail. And so Methadone was part of that.(Betty)
I was put on Methadone by the psychiatrist...the day after I first got arrested....
For fraud. (Robyn)
I used to quite enjoy getting stoned but there was the guilt and I knew I was doing
things against my own will.... I went on Methadone...it was something I didn't want
to do and I knew it didn't work. I'd seen people use Methadone and use [heroin] every
day that they were on Methadone but I was desperate. (Sue)
For Penny, the initial dose was too high and she asked for it to be lowered.
First, I actually had to get my Methadone taken down because I just kept falling
asleep all the time and I couldn't do anything. I would have to wake up in the morning
and write myself notes, before I picked my dose up, so I could actually remember
what to do.
Betty asked to cut down the initial dose so that she could still get high on heroin:
When I went on Methadone I got up to 70mls and [it was] a bit pointless using it
because you had to use a lot of dope, so I actually got them to cut down my Methadone
to 40, so I could use [heroin].
All the women were given individualized treatment. By that I mean they were not directed
to any group-based treatment. All but one were given prescriptions which they then
went to the chemist to fill. This was really drug addiction treatment on the cheap.
There are, however, problems with Methadone clinics as well. Rosenbaum and Murphy
found that success on Methadone programmes for women often meant an inability to
separate themselves from the programme at all.(26) Ironically enough, being considered
a success among clinic staff and clients proves to be an obstacle to getting off
Methadone. Those who have status around the clinic enjoy a certain amount of respect
and admiration.
There are people who successfully detox from Methadone and remain opiate and Methadone
free. They do exist. But they are not visible to men and women currently on Methadone.
One of the reasons they have been able to `make it' and remain opiate-free is they
have separated themselves from the clinic environment.(27)
None of the women here spent any time at a clinic and all had negative experiences
of Methadone. Many women choose MMT and gain positively from the treatment. This
group of women clearly did not.
Penny describes the stigmatisation of individualised treatment. There is no group
reinforcement or validation of experience when you pick up your dose at the chemist.
The very first day I picked my Methadone up the chemist said to me: `Now this is
the protocol, you don't come to the shop when there's lots of people here, you stay
in this corner.' It was like, `this guy is not here to help me.' `We want your thirty
five bucks a week.' He made that really clear. I always felt sick and I don't know
if that was the combination of the hepatitis but I always felt like my bones were
aching, I felt cold all the time, sweated a lot, my sleep patterns were hideous.
(Penny)
Penny also describes the physical symptoms experienced by many people on Methadone
but routinely dismissed by health professionals as non-existent. Sue also had many
distressing physical problems.
I think my teeth got a little bit worse.... I couldn't sleep, I sweated because of
the Methadone -- that makes you pour sweat, horrible stuff. (Sue)
MMT did provide some of the women with relief from some of the most severe aspects
of their addictions.
Methadone held me, I didn't hang out.(28) (Sue)
It cut down my use [of heroin] because I wasn't in such a desperate manic state to
go and get the dope. So it did, it made me a lot calmer in the morning, because I
knew I could get my dope and I'd be okay. I wasn't in so much emotional turmoil.
(Betty)
I was able to maintain a reasonable habit and no, it wasn't costing me too much.
(Penny)
Part of harm minimisation is to lower the cost of addiction to the individual addict,
and at this level MMT was helpful. However it did not stop the criminal activity
that Betty was involved with (she was trafficking heroin), nor did it stop the women
using heroin. MMT did ameliorate the worst aspects of heroin addiction such as some
withdrawals. The problem came when the women wanted to withdraw from the Methadone.
This part of the story comes later.
MMT in Victoria has been administered a number of ways, through specialist clinics
and on prescription from individual general practitioners. Penny has already described
the scene at the chemist shop. In Victoria it has only ever been administered as
syrup for oral consumption.
Yeah, you just took it in a little cup, there was a little juice mixed in it, little
bit of orange juice and just drink it. (Betty)
This was [a large private] Hospital; so he [the physician] had a clinic there and
we'd just go in and get whatever we could get. We might get up to two days' dose
as take-aways.... I don't know if it was exceptional that they gave us that many.
Bottles at that stage got bigger. They initially used to get tiny little packs of
bottles so then they started giving us big bottles of this cordial. (Sue)
As I have already mentioned, all the women used heroin while on Methadone.
I think the most I went without [heroin] was three days. It [her habit] was still
governed by the amount of money more than the fact that I wasn't hanging out any
more.... For the last twelve months I was using [heroin] because it [MMT] just wasn't
doing for me what I thought it would do. (Sue)
Interviewer: DM you use less heroin when you were on the Methadone?
Penny: I did yeah, I was able to maintain a reasonable habit and no, it wasn't costing
me too much.
Interviewer: I guess that's one of the arguments about Methadone maintenance; you
can't stop your heroin use altogether, at least you cut it down.
Penny: Yeah and it cuts the cost down to the community too, I guess.
Interviewer: Did you stop thieving and other illegal activities while you were on
the Methadone?
Penny: Not really.
Life without Methadone
All the women described extremely negative experiences of withdrawal from Methadone,
both for themselves and the people they cared for.
I had one friend that I helped withdraw from below 40mls, and he'd been on a 180ml
block-out programme for ten years.... He was a shell of his former self though, he'd
lost all his teeth, hair, his bones were disintegrating and he had to be watched
twenty four hours a day, because if he fell asleep he would quite often vomit and
start to suffocate. I had never seen anybody so sick. (Jenny)
I remember the first time I went off Methadone. No one told me I was going to be
very sick, so I thought I'd gone mad. I locked myself in the room for three months,
with Rohypnol [a prescription drug], and would only come out at night when everyone
went to bed, and then go back as soon as everyone got up. I lived in there for three
months. No one ever told me what happens. (Robyn)
Roger [her husband] had actually been on it [Methadone] the year before for three
months. His mother lived up in the country and we went up there [to help him withdraw
from Methadone]. He got so sick, it was really scary. His body was convulsing and
he was popping heaps of sleeping tablets. I ended up sticking him in the back of
the car. It was an eight-hour drive and we drove back to Melbourne and God, it was
pretty scary.... I got down to twelve mls, then I jumped off.... On the fifth day
I was really sick. The worst thing with my withdrawal from heroin was lack of sleep....
But I was just so sick of this Methadone, I'd fall back to sleep, wake up, throw
up green bile in the end.
Interviewer: So it was really severe?
Sue: Yeah. I couldn't believe it.
Even in the light of the positive aspects of MMT and the fear of withdrawals, the
women decided to finish with Methadone, anyway.
Betty stopped her MMT for rather mundane reasons, she lost the use of the car that
took her to the clinic in another town and she did not go through withdrawals because
she was using enough heroin to see her through. Penny went back to using heroin as
a means of withdrawing from Methadone and then she detoxed from the heroin itself.
It was too much of a tie, an addiction; it's using.... We could never do anything
except two days at a time. Two take-aways was the most we could ever get, so you
could have a three day sojourn away from Melbourne. (Sue)
That would be the same as been using all the time...it's like I have no control in
my life whatsoever. If I could use and keep my life, manageable, I would. I've no
doubt about that one, but because it [Methadone] overtakes every single aspect of
every waking moment, just to have that removed is so magnificent. (Robyn)
So finally all the women got to the end of their active addiction stories. They could
no longer carry on in the way they had, in one instance for over 25 years. They had
children to look after and/or they wanted to regain some control over their lives.
Eventually they each came into contact with someone in Narcotics Anonymous. As a
member of Narcotics Anonymous each woman could eloquently describe the effects of
a drug-free life.
The one thing that total abstinence does for me is that it meets the needs in me.
I felt socially inept but when I did take drugs, I felt good. And the thing that
was really important to me as a teenager is the same things now, to be part of a
group, having friends, being comfortable with who I am, having fun, everything that
makes a person happy, and harm minimisation doesn't give me that. I've been through
various treatments; the reason why NA works for me is because it gives me a group,
gives me a community where I belong. In our day and age we used to have churches
for that, we used to have clubs and societies. Church doesn't mean that much any
more, I think NA has become my church. I got into drugs because we had our own little
language, we were in a little tribe, in a little group, together, we didn't feel
alone, I had my part in the world and that's what NA has done for me. So harm minimisation
doesn't answer any of those primary needs that I took drugs for in the first place.
Methadone as harm minimisation didn't work for me, because when I took Methadone
it was the same thing. I was still socially inept; I was still uncomfortable in my
own skin. (Betty)
It [Methadone] overtakes every single aspect of every waking moment, just to have
that removed is so magnificent. Maybe NA is a little bit like that but I can fit
that into my life where I want. If I was on some form of medication, I wouldn't have
so much control over it. (Robyn)
I think they [addicts] need a support network. I used to have an argument with the
Methadone doctor over this because finally when the urine kept coming back dirty
[positive for heroin], he said: `I'll put you up.' I never went over 45 [mls] because
I really didn't want to, and he kept saying: `I'll put you up, you'll stop using.'
I said: `I won't stop using, I don't hang out now...I want to stick a fit in my arm.
I want to use smack even if I only get a bit of a feeling (which is what it was in
the end). It's here [pointing to her head] and all the Methadone in the world isn't
going to take it away.' And he wouldn't recognise that. (Sue)
There is a large literature about Narcotics Anonymous and other 12 Step groups some
of which is critical and some not.(29) The important point I would like to make here
is that much MMT is carried out in doctor's surgeries and does not involve women
with others in groups or communities. 12 step groups (with all their problems) give
many disempowered individuals the possibility of meaningful community contact.(30)
Robyn also points out that what she (and the others) wanted was control over her
life, this was something a drug free existence could provide for her, but with Methadone
she was always in the position of being controlled by a drug and those who dispensed
it. It is often assumed that autonomy and community are oppositional. I would argue
that autonomy cannot exist without community.
What do the stories tell us?
These women are the small percentage of women who have become totally drug free.
They no longer use heroin and they do not drink or smoke marijuana. Methadone was,
for them, as controlling as was heroin and they finally found a spot where they could
decide to become drug free. Indefinite MMT does not allow for a drug free existence.
It also means constant surveillance from pharmacists, doctors, nurses and welfare
agencies. The surveillance clinic that Castel discusses is the Methadone clinic.
MMT is also an individualising phenomenon when it is prescribed by a GP. There is
no supportive community, no place where addicts belong. Narcotics Anonymous provides
this community, but it is criticised by health professionals for its disease model
of addiction and anti-professional stance. Elsewhere, however, I have argued that
much of what passes as scientific criticism is really professional protection of
terrain.(31) There are other non-professional groups which could probably do the
same job for addicts, but these are not prominent in Australia.
The role of women as carets does not disappear for women addicts and the severity
of Methadone withdrawal is highlighted for women with Methadone-addicted partners.
Current Victorian government policies of deinstitutionalisation and community caring
transfer the responsibilities of care to individual women. Withdrawal from heroin
is severe enough; helping someone withdraw from Methadone can be overpowering. When
official policy privileges harm reduction measures over abstinence, there is little
support given to those people who desire to detoxify from Methadone. These women's
experiences demonstrate the difficulties of this issue for individuals, positive
outcomes of MMT for the community notwithstanding.(32)
MMT needs much more attention from feminists who are interested in the subject of
women and drug addiction. It cannot be assumed that the various components of harm
reduction are automatically gender friendly. Feminists should not be cowed (as have
been many sociologists) into not criticising components of harm reduction because
they might be seen as aligning themselves with the non-feminist right. As Room noted
in relation to sociologists, the fear of being seen as wowsers or being accused of
temperance sympathies led to more than fifty years of silence in relation to alcohol
policy and its implications.(33) The negative experiences of MMT detailed by the
women here are clearly not universal, but they are serious enough to question the
widespread belief that drug-substitution programmes are the only options for drug
rehabilitation policies. Bureaucrats who are carrying out economic rationalist agendas
are increasingly operating drug policies. Just as many of us are openly critical
of economic rationalist policies in education, health and many other areas, so we
should be as critical of these policies when they impact upon individuals with drug
problems, particularly in the ways they impact upon women.
Notes:
(1). In Queensland this year there was some (largely media) discussion of Methadone,
and criticism of it as the state-favoured treatment following the attempted closure
of a Naltrexone treatment facility in West End in Brisbane. This was allegedl due
to irregularities in drug-prescription proceedures on the part of the doctor (a very
public Christian). Following a demonstration at Parliament by addicts, their parents
and friends, the closure was averted. [Eds.]
(2). Victorian State Coroner, Coronial Inquiry into Methadone Related Deaths, Melbourne:
Victorian State Coroner, 1996.
(3). G. Zajdow, `Harm Reduction for Whom? Some Guilty Thoughts on Drug Policies,'
Arena Magazine 40 (1999): 30-33.
(4). D. Hawks and S. Lenton, `Harm Reduction in Australia: Has It Worked? A Review,'
Drug and Alcohol Review 14 (1995): 291-304. Harm reduction in relation to legal drugs
may mean limitations on the availability of the drugs to particular groups such as
young people and printing potential dangers on the products themselves such as the
label on cigarette packets. But here we strike the difference between use reduction
and harm reduction. We want to stop young people smoking altogether rather than teach
them how to smoke safely. Although the cessation of all drug use is lauded by many
of the proponents of harm reduction, a reading of the literature suggests that the
harm reduction and use reduction are mutually exclusive (see A. E. Roche and K. R.
Evans, `Harm Reduction: Roads Less Travelled to the Holy Grail,' Addiction 92.9 (1997):
1027-1213.
(5). Naltrexone treatment is still very controversial and not readily available in
many states. Currently in Victoria, Naltrexone is being hailed by a number of general
practitioners and state-run clinics. There is no consensus, as yet, on its value
in treating heroin addiction.
(6). A. Peterson and D. Lupton, The New Public Health: Health and the Self in the
Age of Risk, Sage Publications, Sydney, 1996.
(7). D. Armstrong, `The Rise of Surveillance Medicine,' Sociology of Health and Illness
17.3 (1995): 425-36.
(8). R. Castel, `From Dangerousness to Risk,' in G. Burchell, C. Gordon and P. Miller
(eds), The Foucault Effect: Studies in Governmentality, Harvester Wheatsheaf, Brighton,
1991.
(9). S. Nettleton, `Women and the New Paradigm of Health and Illness,' Critical Social
Policy 16 (1996): 33-53.
(10). R. J. Cook, `Gender, Health and Human Rights,' Health and Human Rights 1.4
(1995): 350-366, p. 352.
(11). H. Graham, `Women's Smoking and Family Health,' Journal of Social Policy, 24.4
(1995): 509-27.
(12). Nettleton, `Women and the New Paradigm'; Graham, `Women's Smoking.'
(13). W. Chavkin and V. Breitbart, `Substance Abuse and Maternity: The United States
as a Case Study,' Addiction 92.9 (1997): 1201-1205.
(14). E. Ettorre, Women and Substance Use, Macmillan, London, 1992.
(15). I. M. Young, `Punishment, Treatment, Empowerment: Three Approaches to Policy
for Pregnant Addicts,' Feminist Studies 1 (1994): 33-55, pp. 33-4).
(16). G. A. Marlatt, `Harm Reduction: Come As You Are,' Addictive Behaviors 21, 6
(1996): 779-88.
(17). N. Denzin, The Alcoholic Society: Addiction and the Recovery of the Self, New
Brunswick: Transaction Publishers, 1997.
(18). G. Zajdow, `Civil Society, Social Capital and the Twelve Step Group,' Community,
Work and Family 1.1 (1998): 79-89.
(19). E. Ettorre, `What Can She Depend On? Substance Use and Women's Health,' in
S. Wilkinson and C. Kitzinger, (eds), Women and Health: Feminist Perspectives London:
Taylor and Francis, 1994.
(20). Of course, feminists have also criticised scientific methodologies as reflecting
masculine notions of appropriate forms of evidence
(21). N. Heather and J. Tebbutt, The Effectiveness of Treatment of Drug and Alcohol
Problems: An Overview, National Campaign Against Drug Addiction Monograph 11, Canberra:
AGPS, 1989.
(22). National Consensus Development Panel on Effective Medical Treatment of Opiate
Addiction, `Effective Medical Treatment of Opiate Addiction,' Journal of the American
Medical Association 280.22 (1998): 1936.
(23). W. M. Wechsberg, S. G. Craddock, and R. L. Hubbard, `How Are Women Who Enter
Substance Abuse Treatment Different Than Men?: A Gender Comparison from the Drug
Abuse Treatment Outcome Study (DATOS),' Drugs and Society 12.1/2 (1998): 97-115.
(24). S. Harding, `Introduction' and `Conclusion,' in S. Harding, (ed), Feminism
and Methodology, Indian University Press: Bloomington, 1987; L. Alcoff and E. Potter
(eds.), Feminist Epistemologies, New York: Routledge, 1993; E. Fox Keller, Reflections
on Gender and Science, New Haven: Yale University Press, 1995.
(25). The small percentage of addicts who become abstinent (about 15% at any one
time) is often used as the major reason for not presenting abstinence as a viable
option for them. However treatments for many other life-threatening conditions have
often only saved a small percentage of people (I am thinking of many past cancer
treatments or even organ transplants) and this has not stopped the health system
from funding them.
(26). M. Rosenbaum and S. Murphy, `Always a Junkie: The Arduous Task of Getting Off
Methadone Maintenance,' Journal of Drug Issues 14.4 (1984): 527-52.
(27). Rosenbaum and Murphy, `Always a Junkie,' p. 531. Italics in original.
(28). `Hanging out' means going through withdrawals while waiting for the next dose
of heroin.
(29). See, in relation to AA: Denzin, The Alcoholic Society; K. Humphreys, B. E.
Mavis, and B. E. Stoffelmayr, `Are Twelve Step Programs Appropriate for Disenfranchised
Groups? Evidence from a Study of Post-treatment Mutual Help Involvement,' Prevention
in Human Services 11.1 (1994): 165-179.
(30). Zajdow, `Civil society.'
(31). Zajdow, `Civil society.'
(32). MMT has been shown to cut the crime rate associated with illegal drug use.
J. Bell, R. Mattick, A. Hay, J. Chan, and W. Hall, `Methadone Maintenance and Drug-related
Harm,' Journal of Substance Abuse 9 (1997): 25-25.
(33). R. Room, `Ambivalence as a Sociological Explanation: The Case of Cultural Explanations
of Alcohol Problems,' American Sociological Review 41 (1976): 1047-65.
-1-
Questia, a part of Gale, Cengage Learning. www.questia.com
Publication Information:
Article Title: Learning to Live without It: Women, Biography and Methadone. Contributors:
Grazyna Zajdow - author. Journal Title: Hecate. Volume: 25. Issue: 2. Publication
Year: 1999. Page Number: 63+. © 1999 Hecate Press, English Department. Provided by
ProQuest LLC. All Rights Reserved.
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