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The aim of this book was to explore the ways in which the governance of illicit drug use shapes female dependent drug users’ lives. Their subjectivities, and hence their experiences, are shaped and regulated by drug policies. The relationship between the social regulation of female drug users and the construction of their subjectivities has been explored, which involved, first, an investigation into the ways in which women who are identified as having ‘problematic’ drug use are positioned in academic discourse and in official governmental policy. Second, it involved an analysis of the dominant governmental technologies of power from which the key constructions of women as ‘problematic’ drug users emanate in the UK, US and Canada – punishment and prohibition, medicalisation and welfarisation. The construction of female users’ subjectivities in policy discourse and the impact the characteristics ascribed to them have on their experiences have also been examined. Third, it investigated the meanings that women who identify as having dependent drug use attach to their drug use and to themselves. Insights were gathered from the in-depth accounts of 40 female drug users in the UK. Finally, the ways in which dependent female drug users position themselves vis-à-vis the ways in which they are positioned in governmental technologies was explored. This involved an examination of the operation of three technologies of the self operating in the lives of the 40 female drug users – the ascription of characteristics, normalisation and responsibilisation.
An analysis of the punishment and prohibition, public health and welfare strands of drug policy discourse, and how female users are constructed as a problem to be governed within them, was conducted. This was based on the assumption that objects of government are discursively constructed, and it is these constructions that make female users amenable to governmental intervention and regulation. It was found that the discourses of drug policy are not mutually exclusive, but interweave, overlap and combine in different ways to make particular subject positions available to female users. These emanate from the operation of governmental technologies operating in the UK, US and Canada, which intersect, intertwine and reinforce each other in the regulation of female illicit drug users.
The next three chapters draw on Foucault's concepts of governmentality and technologies of power to provide an analysis of the specific governmental techniques and procedures adopted in contemporary drug policy. They examine three key technologies of power through which women users are governed: prohibition, medicalisation and welfarisation. Foucault describes governmentality or the ‘art of government’ as ‘the encounter between technologies of the domination of others and those of the self ‘ (Foucault, 2000 , p 225). Prohibition, medicalisation and welfarisation may be seen as technologies of domination. These are practices of power that ‘determine the conduct of individuals and submit them to certain ends’ (p 225). Through these technologies relations of power become ‘firmly set and congealed’, and the freedom of the individual becomes ‘extremely constrained and limited’ (Foucault, 2000 , p 283). Prohibition, medicalisation and welfarisation can also be seen as:
… technologies imbued with aspirations for the shaping of conduct [behaviour] in the hope of producing certain desired effects and averting certain undesired ones. (Rose, 1999, p 52)
In the governance of illicit drug use prohibition, medicalisation and welfarisation form a curious meld as the criminal justice system, medical treatment establishment and welfare regimes intersect in the regulation of illicit drug use.
The technology of prohibition is the practice of prohibiting the manufacture, transportation, import, export, sale and consumption of certain drugs by law. The rationale underpinning prohibition is that unlawful drugs are dangerous to the health of the individual. Prohibition is enforced through the technology of punishment. Punishment as exercised by the state in law involves matching fair consequence to crimes to achieve justice. A fundamental element of punishment is the process of criminalisation, which, in modern neoliberal societies, is a tactic of government that endures after sentencing due to the criminal records system.
The medicalisation of drug use is based on the ‘disease’ model of addiction, and the distinction between ‘normal’ and ‘out-of-control’ behaviour. Historically, women, the poor, the working class and immigrants are assumed to be more at risk of the disease of addiction or the ‘disease of the will’. However, the medicalisation of women’s illicit drug use is arguably an inconsistent aspect of drug policy when the over-prescribing of legal drugs to women and their dependence on them is taken into account.
The way in which a sample is accessed ultimately affects the kind of respondents the researcher will interview. There were three cohorts from three different English cities: Bristol, Reading and London. The 21 women from Bristol were interviewed for part of the researcher’s PhD. Most of these women were contacted through a drugs project, some responded to a poster, four were contacted through the snowballing method, and a few through other means (such as on the street, or through a friend of a friend). The second cohort of nine women came from a Drug and Alcohol Team (DAAT)-funded study on stimulant services in Reading, and were accessed mainly through two of the DAAT-funded drug services in Reading. Forty-two men and women in total were interviewed during the fieldwork for the stimulant study, and nine of them were women. Only the women's interview data was used for this study. The third cohort of 10 women were all accessed in courtyards or doorways at the beginning of Narcotics Anonymous (NA) meetings in South or East London locations. This final sample were accessed with the intention of finding more women who were ‘in recovery’.
The 40 women who came forward to be interviewed were very much an ‘opportunity sample’. While the researcher attempted to gain a sample of women with a range of experiences, the women who did agree to be interviewed represented only a fraction of those involved in dependent drug using in Bristol, Reading and London. In addition, all of them were willing and able to discuss their experiences (although some did not find it easy). This raised the question of whether the accounts of the women who volunteered to be interviewed might be substantially different to those who did not. However, the aim of finding a ‘representative’ sample is a positivist concern displaced by the theoretical framework adopted in this study.
This study does not make any claims that the sample used was ‘representative’. No generalisations have been made about women who use crack and heroin based on the accounts of the women in this sample. For instance, at some stage most of the women funded their heroin or crack habit through crime or sex work.
This chapter examines the role of the technology of prohibition in the governance of female drug use. It investigates the operation of this technology by exploring the prohibition and punishment strand of drug policy discourse, how female dependent users, dealers and traffickers are situated within it, and the impact the criminal justice system has on their lives. The rationale embedded within the technology of prohibition is that drugs are dangerous. The ‘danger’ of certain drugs is constituted as residing in their individual properties, and the physical, psychological and social harm they are constructed as causing is what must be prevented. As outlined in the introduction, the technology of prohibition and punishment is one of the regulatory techniques of government that is used to shape female drug users’ and offenders’ behaviour through the construction of particular problematic ‘identities’, for example, an unfit mother. While male drug users and offenders are also subject to this technology of power, this chapter investigates the particular ways it operates as a gendered form of control, for example, through the criminalisation of pregnancy and the gendered iniquity of the criminal justice system.
The proclaimed aim of the drug strategies in the UK, US and Canada is to protect young people, families and communities from the harm caused by illicit drugs. The idea is to do this by preventing, stopping, disrupting and reducing both the supply and demand for drugs. The idea within government rhetoric is that strong enforcement and harsh sanctions at international borders as well as within nation states, including the threat of incarceration, will deter potential users, dealers and traffickers from becoming involved in the illegal drugs market. While the sentences for drug offences vary in the respective countries, a consequence of these criminal sanctions in all of them has been an increase in the number of women and men moving through the criminal justice system for drug offences.
A cross-national analysis in the UK, US and Canada shows that as law and order advocates proclaim the importance of saving the family and upholding family values, they seem intent on destroying them. A consequence of the need to protect young people and families from the harms of illicit drugs has been to incarcerate increasing numbers of women who are mothers, and to separate them from their children.
Parts One and Two of this book examined how women who use illicit drugs are governed by analysing how they are constituted within official and academic discourse. The operation of three technologies of power as they are expressed through academic and drug policy discourse was explored. Official discourse ascribes multiple and contradictory characteristics to women who use illicit drugs, and in so doing makes them amenable to governmental regulation. Particular norms of behaviour are established through official discourse, and various techniques and tactics are set up to control and regulate female illicit drug users who deviate from these norms. They are constituted as responsible for becoming dependent on drugs, and for the perceived harm they cause to themselves and to others.
How these technologies operate in the lives of the 40 women in this study who use illicit drugs is now explored in an analysis of the subjectivities the women adopt for themselves, in relation to how these are constructed in policy. Their accounts of the characteristics they ascribe to themselves, their view of normality, and what they felt responsible for was in some ways the same, but in other ways different from those constructed within academic and drug policy discourses. The female users in this study imputed new and different meanings to the technologies of power they are subject to by placing themselves into the process of their governance. They take the subjectivities constructed for them and the regulations imposed on them within drug policy discourse, and modify and reshape them at the level of discourse.
This chapter and the next explore the narratives the 40 women provided about their drug use. The women interviewed for this study were taken from three English cities: Bristol, Reading and London. The most dominant stories the women told were psychosocial stories of drug use, in which it featured as a solution to the emotional problems they were experiencing, but which eventually brought them more problems. The women related their experiences of drug use and the social conditions in which this drug use occurred to their psychological wellbeing, reflecting the broader sociopolitical context in which their narratives emerged, wherein illicit drug use is both psychologised and individualised.
Welfarisation is another technology of government through which female illicit drug users are governed. It is the process that constructs individuals or groups as needing social support, or that constitutes them as unworthy of it. Governments themselves create welfarisation through the maintenance of structural inequalities, social and economic marginalisation and its ‘management’. Certain ‘needy’ or ‘at-risk’ groups of individuals are targeted for welfarisation or ‘soft policing’ through formal and informal social control mechanisms (Worrall, 2001). Welfarisation is in principle, benevolent, and may involve the provision of support with social funds, housing, training, jobseeking or childcare. It may prove to be a lifeline for some individuals, but programmes of welfare have long been identified as having (darker) mechanisms of surveillance and social control embedded within them. This relates to Foucault's concept of the ‘carceral continuum’ and his view that regulatory techniques permeate ‘a whole series of institutions … well beyond the frontiers of criminal law’ involving doctors, social workers and educators (1991 , p 297). Drawing on Foucault’s work, Cohen (1985, p 3) argues that liberal capitalist countries such as the UK, Canada and the US all have ‘social control systems’ embedded in their programmes of ‘welfare’ and ideologies of treatment.
The idea that policies of welfare also operate as mechanisms of control and surveillance particularly over marginalised groups of individuals has been explored and developed by various writers across a range of disciplines and subjects (see Parton, 1991, on child protection; Carlen, 1988, on young women in care; Carrington, 1993, on juvenile girls; Phoenix, 1999, on sex workers). Interventions into the lives of women who use illicit drugs presented as policies and practices of welfare (concerned with their wellbeing) are often experienced as intrusive, coercive and punitive (see Chapter Seven, pp 238–245 and 253–256). Mechanisms of control and surveillance, including practices of welfare, also serve to enforce gendered expectations of behaviour and to reinforce inequalities of gender. The technology of welfarisation is closely related to that of normalisation discussed in the following chapter (see Part Three, pp 142–144).
This chapter investigates the surveillance and regulation of drugusing women through welfare and social work policies and practices.
Preliminary analysis of the women's narratives demonstrated that their accounts were largely psychosocial. Chapter Six focused on how the women related their experiences of drug use, and the social conditions in which this drug use occurred, to their psychological wellbeing. These most dominant stories the women told reflect the broader sociopolitical context in which their narratives emerged, wherein illicit drug use is both psychologised and individualised. The psychosocial accounts the women provided of their drug use rendered less dominant other more social stories, which, nevertheless, were present in their narratives. The social stories the women told about their drug use are tales of gender, poverty and regulation. The contradictory aspects of their narratives identified in Chapter Six, but with an emphasis on their more social meanings, are revisited here.
The subjectivities the women in this study adopted for themselves, and hence the way they saw themselves, were shaped and framed by governmental technologies. The women had somewhat assimilated governmental constructions, and unknowingly colluded in their own control and regulation. At the same time, they twisted the subjectivities and regulations imposed on them by ‘the authorities’ at the level of discourse. They inserted themselves into the process of governance that they are the subjects of, and ascribed new and different meanings to their subjectivities. Although they had absorbed and complied with dominant, psychosocial constructions of their subjectivities, through which they are responsibilised for their predicament, embedded within their narratives were more social stories that undermine and subvert dominant and official understandings of them.
There was a paradox inherent in the women's accounts of their illicit and licit drug use. This was evident from some of their accounts of their experiences of prescription drugs as compared to their experiences of heroin and crack in the context of contemporary drug policy. Their accounts draw attention to the incongruent character of contemporary drug policy. All of the women in this study explained how their drug use functioned as a form of escape from experiences of trauma, abuse and isolation (see Chapter Six, p 163–171). While female users are not authorised to govern their emotional pain with illegal drugs, some described how they were encouraged to use legal drugs prescribed by doctors for depression.
Part One of the book begins from the premise that objects of government are discursively constructed. The meaning of female illicit drug use is not self-evident or an objective entity but is constructed in different discourses (e.g. prohibition, medical or welfare) and takes different forms. Drawing on Foucault's concepts of discourse and governmentality, the ‘problem’ of women's illicit drug use is understood as a realm brought into existence by government itself. As Foucault (1972)  argues, discourses are formed by ‘systems of dispersion’ or ‘forms of division’ (Foucault 1972,  p. 37) which ‘systematically form the objects of which they speak’ (Foucault 1972, p. 49). It is assumed that in order to gain an understanding of how women who use illicit drugs are governed, it is necessary to examine the discourses that define, categorise and differentiate them from others. It is these discourses that help to identify women's illicit drug use as a ‘social problem’ and make women who use illicit drugs amenable to governmental intervention and regulation.
This approach permits an analysis of illicit drug use and female (and male) illicit drug users that does not presume a chronological development of ideas advancing closer to the truth. Rather, it is one that allows for the exploration of the underlying points of differentiation, exclusion and contradiction in constructions of drug use and female users, as well as some of the material effects of these structuring principles. The accuracy and validity of particular constructions of drug taking and female drug users is not questioned. Rather, the underlying demarcations that condition the different constructions of drug use and women drug users are located. In this process, the space is revealed for alternative understandings of drug use and women’s constructions of resistant identities.
Part One is comprised of two chapters investigating ‘authoritative discourse’ on female illicit drug use. Academic and drug policy discourses are understood as ‘authoritative discourses’ which construct and situate female drug users identities in particular ways. These discourses produce a particular network of material relations which involve the production of various material effects on the lives of female illicit drug users (i.e. their subjection to various forms of state intervention).
This chapter discusses the research context in which this book is located, including the traditional inclination to view women's drug use as peripheral or pathological. It examines feminist work on female drug use and how this has challenged traditional understandings of female users. It concludes with a discussion of the contribution this book will make. This chapter investigates the various ways female illicit drug use has been made sense of and the different ways female users have been constructed within academic discourse. It explores how different explanations of women's illicit drug use have shaped the meaning of it in different ways and how the subject position of a female illicit drug user is continuously being modified and transformed as new and different explanations emerge in the chain of knowledge about it.
Traditionally, research on illicit drug use focused on male users, and women were ignored or seen as peripheral to predominantly male worlds of drug usage (File, 1976; Marsh, 1982; Jeffries, 1983; Gomberg, 1986). When the issue of female illicit drug use was focused on, the bulk of the research was concerned with women’s deviation from traditional gender roles, pregnancy and motherhood (Rosenbaum, 1997). Early studies that did include women were predominantly medical, psychiatric and psychological, and based on women in treatment (Rosenbaum, 1981). Women were considered as a subset of a larger male population or compared with male users (Taylor, 1993). Within this literature female users were constructed as more deviant, ‘sicker’, passive and emotionally and psychologically disordered than male users and ‘normal’ women (Rosenbaum, 1981 1997; Taylor, 1993). By the 1970s a growing body of research, mostly from the US, began to appear on the physiological effects of women’s illicit drug use on the foetus and newborn, and the ‘management’ of the pregnant user.
Baby vessels and bad mothers
The effect of women's illicit drug use on reproduction and childrearing largely dominated academic discourse on female illicit drug use in the 1960s and 1970s, and still continues to thrive, emerging from the clinical fields of obstetrics (see, for example, Naeye et al, 1973, 1976; Fraser, 1976; Kandall et al, 1976; Wilson et al, 1979; Lutiger et al, 1991; Mathias, 1992; Hepburn, 1993) and psychiatry and psychology (see, for example, Densen-Gerber et al, 1972; Carr et al, 1975; Pagliaro and Pagliaro, 1999).
Medicalisation is a key technology of power through which drug users are governed. It is the process by which non-medical problems come to be defined and treated as if they are medical issues. Another key strand of drug policy discourse in the UK, US and Canada operating alongside prohibition and punishment is that of public health. The technology of medicalisation underpins public health discourse, and compliments prohibition and punishment regimes. Medicalisation operates as a form of social control and regulation whereby social structural issues, such as poverty and social inequalities, are individualised and regarded as symptoms of a disease. It has provided legitimacy to punitive and intrusive policies and practices aimed at drug users. The interdependence of the criminal justice and treatment systems, and the way they reinforce each other in the governance of drug users, can be seen as a ‘deadly symbiosis’ (Wacquant, 2001).
The technology of medicalisation is grounded in the disease model of addiction. Historically, this was dependent on a distinction between the normal and pathological, and involved a ‘stratification of the will’, whereby individuals with weak, defective characters were constructed as unable to act freely and responsibly. Constructions of a lack of will on the part of female users are bound up with notions of their mental health, sexuality and maternal role. They are situated as pathological, prone to addiction and weaker-willed than their male counterparts. In its more contemporary configurations, combined with discourses of ‘risk’, the disease model situates all drug users as rational, free, choice makers. Thus, female and male dependent users are constructed as, on the one hand, irresponsible, irrational, bad choice makers, and on the other, as responsible for their predicament and for coming off drugs. How female users navigate their way through disease and choice discourses and construct their identities is explored in this chapter.
An overview of recent trends in drug treatment policies and practices, how female drug users are situated in relation to these, and the impact they have on their lives in the UK, US and Canada, is provided here. This includes a discussion of the ascendance of harm minimisation in relation to the HIV/AIDS pandemic, methadone maintenance, the current focus on ‘recovery’ and coerced treatment.
This book is about the ways in which the governance of illicit drug use shapes female users’ lives. It examines how women drug users’ subjectivities, and hence their experiences, are shaped and regulated by drug policies. The construction of female users’ subjectivities in policy discourse and the impact the characteristics ascribed to them has on these women's experiences are explored. The insights are based on in-depth accounts from the perspectives of women users themselves. It is argued that in the regulation of illicit drug-using women, particular subjectivities are constructed which, in themselves, become part of the narrative sustaining women in their problematic drug use. It is suggested that women users experience drug policy as something that exacerbates their social and economic marginalisation, and contributes to their lives being plunged into further poverty, social and economic marginalisation.
At the same time, the book analyses the contradictory choices, adaptations and resistances of female users. Although women users internalise many of the negative constructions of themselves found in policy discourse, they also find ways to resist them. Their resistances are explored through an examination of the pleasurable and painful aspects of the women's drug use; drug use as a means of escape from oppressive social circumstances; the social inclusion and ‘belonging’ found in marginalisation; the agency, rationality and control wielded in the face of ‘chaos’; and the women's responses to the negative impacts of the treatment, welfare and criminal justice systems. In this process, I subvert popular misconceptions of women users that condition oppressive interventions, and hope to contribute to the formulation of drug policies based on empowerment, gender equity and social justice.
The rest of this chapter discusses the main theoretical schools of thought informing the arguments in the book, including feminist sociological perspectives, the work of Foucault on government, power and the subject, criminological and sociological theories of drug use, drug policy and the social order. Finally, it provides an outline of the book's contents.
The main concepts and arguments in this book draw on the theoretical works of Foucault and the concept of governmentality, in particular, the ‘art of government’ (Foucault, 2002 , p 201).
This part of the book takes a case study approach, and analyses the impact of drug policy on the lives of 40 female drug users. Drug policy is articulated through technologies of power, the affects of which are explored through an examination of detailed life historical interviews focusing on how 40 female illicit drug users see themselves. The stories the women tell about their drug use, with a particular focus on the subject positions they adopt for themselves, are examined. The techniques of power, discussed in Part Two, are taken into account, but there is also a focus on how authoritative discourses shape women drug users’ identities by examining the key techniques of the self female users deploy managing their drug-using identities. These include the ascription of characteristics, normalisation and responsibilisation: female users are made visible, defined and categorised through the characteristics ascribed to them through ‘authoritative’ discourses; and they are also subject to normalisation and responsibilisation at the hands of the ‘authorities’. At the same time, the women negotiate alternative identities to those prescribed to them through policy discourse and in this sense their subjectivities serve as sites of resistance.
Technologies of the self
The official discourses of women's drug use not only govern their actual substance use through the governmental technologies of prohibition, medicalisation and welfarisation, but also shape and sustain their using identities. This is made possible through various technologies of the self that operate in the lives of the female users.
Foucault argues that technologies of the self exist in every civilization, and are ‘the means by which individuals determine their identity, maintain it or transform it’ (Foucault, 2000 , p 87). He describes technologies of the self as:
… the techniques and procedures which permit individuals to effect by their own means, or with the help of others, a certain number of operations on their own bodies and souls, thoughts, conduct, and way of being, so as to transform themselves in order to attain a certain state of happiness, purity, wisdom, perfection, or immortality. (2000 , p 225)
Part Two examined the technologies of power – prohibition, medicalisation and welfarisation – through which women users are governed. As discussed, these are technologies of domination or practices of power that ‘determine the conduct of individuals and submit them to certain ends’ (Foucault, 2000 , p 225).
This chapter discusses the political context in which the research was undertaken. It provides an insight into the ‘mentalities’, ‘governmental rationalities’ or ‘political rationalities’ embedded in governmental approaches to female illicit drug use. The history of prohibition, the ‘war on drugs’, and how this is wielded within the political climate of neoliberalism is explored. This is linked to the ascendancy of the ‘risk’ approach to governing illicit drug use, responsibilisation and the process of ‘othering’ these modes of governing sustain. The aim of this chapter is therefore to provide a general picture of the political domain in which specific drug policies in the UK, US and Canada have emerged. The discussion also aims to provide a framework for the ensuing chapters that focus more closely on the specific governmental techniques and procedures used in the control and regulation of women's illicit drug use.
History of prohibition
Prohibition is the practice of formally forbidding the manufacture, transportation, import, export, sale and consumption of certain drugs by law. Although less than 100 years old, it is widely regarded as necessary and/or inevitable (Shiner, 2009). However, the intentional use of mind-altering or psychoactive drugs has a very long history. Every past society has used and explored drugs as part of its cultural practice and social life, which indicates that drugs are an integral part of human nature – humans have been using psychoactive drugs since ancient times (Sullivan and Hagan, 2002; UNODC, 2008). In the 19th century in Europe and North America many elixirs, medicines and cough mixtures contained narcotics, cocaine or marijuana. Most women could not afford to see a doctor, and so self-medicated (Boyd, 2004). Opiates were used for many ailments considered specific to women, including menstruation pains, menopause and childbirth (Berridge and Edwards, 1981). Upper-class women visited opium dens, and opium eating and smoking were considered aristocratic vices (Brecher et al, 1972). Women were treated with cocaine for a range of nervous conditions, reproductive problems and illnesses (Kandall, 1999). Marijuana was prescribed to women for menstrual pain as well as migraines, asthma and depression.
While the late 19th century saw an increased public concern with drug use and dependency, it was not considered a major social problem.