Copyright Sociological Research Online, 2000

Emma Wincup (2000) 'Surviving through Substance Use: The Role of Substances in the Lives of Women who Appear before the Courts'
Sociological Research Online, vol. 4, no. 4, <http://www.socresonline.org.uk/4/4/wincup.html>

Abstract

Drawing upon qualitative data gathered through fieldwork in three bail hostels, this paper outlines the role of substance use (illegal drugs, alcohol, prescribed medication and food) in the lives of women awaiting trial. Their use of substance is explored within the context of the multiple and complex problems which shaped their lives. It is argued that womenís use of substances can be viewed as a active strategy to achieve personal and social satisfaction, to cope with stresses and problem experienced and to exert some degree of control over their lives. Whilst seemingly beneficial for the women in the short-term, ultimately substance use for this group of women can be seen as counter-productive and self-destructive; increasing the control of others (health care, social work and criminal justice professionals) over their lives, leading to social problems and damaging their emotional and physical well-being.

Keywords:

Agency; Gender; Structure; Substance Use; Women's Lives

Introduction

1.1

Increasingly, there has been recognition amongst academics, health and social care practitioners and criminal justice professionals that women are engaged in substance use, involving both legal and illegal substances. Against this backdrop, feminist researchers such as Doyal (1995) and Ettorre (1992) have been influential in highlighting the need to understand the complex relationship between substance use and the realities of women's lives. Utilising these theoretical insights, this paper explores the role of substances in the lives for women who appear before the criminal courts. Qualitative data are used to explore and illustrate the importance of a gendered analysis of substance use which appreciates the difficult realities of their lives but does not deny them a sense of agency.

Researching Women's Lives

2.1

This paper reports on some of the findings from a study of women's experiences of waiting for trial. The focus of the research was on bail hostel provision for this group of women. The term bail hostel refers to small residential facilities managed by the Probation Service. The officially defined role of bail hostels is to provide accommodation in a supportive and structured environment for women and men at risk of being sent to prison to await trial (see Home Office 1995). More specifically, the research aimed to answer three questions: firstly, what are the particular problems experienced by women awaiting trial; secondly, how do bail hostels aim to offer support; and finally, what are the factors which facilitate or impinge upon the provision of support?

2.2

An ethnographic approach was adopted to allow empathic understanding of the lives of women who live and work in bail hostels. The essential characteristics of ethnography include involvement in people's lives for an extended period of time, watching what happens, listening to what is said and asking questions. This takes place within their 'natural' setting. These characteristics resemble the ways in which people make sense of their everyday lives and this has been regarded as a fundamental strength of ethnography for some social scientists (Hammersley and Atkinson 1995). Ethnography is a methodological strategy rather than a research method. Consequently, there is potential to mix methods and contemporary ethnography tends to be multi-method research (Pearson, 1993; Reinharz, 1992). In keeping with this tradition, the research discussed in this paper employed a range of methods, combining participant observation, semi-structured interviews and documentary analysis.

2.3

Three bail hostels^[1] in England were included in the study: a women-only hostel (Victoria House), a women-only hostel with provision for children (Carlton House) and a mixed hostel (North Street Hostel). A mixed hostel in this context refers to a hostel with accommodation for women in an otherwise male group (Wincup 1996). Access negotiations formed an important initial stage of the research process. Like other studies which involved organisations or agencies, approval was sought from gatekeepers: 'those individuals . . . that have the power to grant or withhold access to people or situations for the purposes of research (Burgess 1984: 48). In this instance, the gatekeepers were the Association of Chief Probation Officers (ACOP). Since the project only involved three probation areas, formal approval from ACOP was not essential. Instead, the decision to grant access is usually left to the discretion of chief probation officers in individual service areas. However, having the approval of ACOP can help to facilitate access by adding credibility to the project and I was fortunate to secure their support. A short summary of my research plans was included in the fortnightly ACOP bulletin and individual Chief Probation Officers contacted by letter. Once they had all agreed in principle, access then needed to be negotiated with different layers of the organisational hierarchy. Several months later, following careful consideration of the research proposal by hostel managers and/or management committees, all three hostels agreed to co-operate and showed enthusiasm for the project.

2.4

Obtaining physical access was only the first step in an ongoing process. Negotiations with staff and residents were an important and challenging part of the research. As I have discussed elsewhere, problems of achieving informed consent are heightened when conducting research in a criminal justice institutions (Wincup 1999). In addition, women within them are often distrustful of others, sometimes a product of previous life experiences such as violence and abuse (Comack 1999). In practice, the women were generally positive towards me and most welcomed the interest of another in their lives. However, a relationship based on trust and rapport needed to be established and could not be taken for granted.

2.5

To encourage staff and residents to be interviewed, a number of approaches were used: posters were up in the hostel, letters were sent and staff and resident meetings were attended. This was successful in terms of securing staff support (15 interviews in total) but not as successful in terms of encouraging residents to take part. Instead, women were more likely to agree to take part when approached individually in an informal way, sometimes after an introduction from hostel staff. Some difficulties were encountered. For example, some residents spent little time in the hostel and others felt that there were too many other things going on in their lives to talk to a researcher. Nonetheless, fifteen women agreed to be interviewed who shared with me deeply personal and often painful life experiences. These interviews were recorded and transcribed soon after each interview.

2.6

The data gathered in the form of interview transcripts, fieldnotes and hostel documents (for example, log books in which key events in the hostel are recorded) provided a strong basis for a sociological analysis of the gendered nature of experience and the importance of substance use in women's lives. The data collected through ethnographic fieldwork is voluminous and recalcitrant. After several months in the field, I had amassed fieldnotes, interview transcripts, analytic memos and a variety of documents. Concentrated data analysis began after leaving the field, but as Hammersley and Atkinson (1995) argue, the data analysis process is not a distinct stage in itself. Analysis begins with entry to the field and continues throughout the research. The analysis of the data began with the identification of key themes and patterns. Data was then coded and sorted with the aid of a word-processer rather than a dedicated software package (see Wincup 1997 for an explanation) in order to organise, manage and retrieve the most meaningful bits of data. Beginning to write was central to the data analysis process. As Coffey and Atkinson (1996) argue, writing is a vital way of thinking about one's data because it makes us think about data in new and different ways and develop analytic ideas. My findings were written up in the form of 'thick description' (Geertz 1973). Specific incidents from fieldnotes and interviews were presented, organised around analytic themes, and a discussion of empirically grounded theory was offered.

2.7

The research revealed both the diversity of life experiences of the women residents, but also common themes within their accounts. These included being charged with a criminal offence, low self-esteem and difficulties that stem from their socio-economic position in a patriarchal society. These multiple and complex problems include poverty, homelessness, unemployment, experiences of abuse (emotional, physical and sexual) and sole responsibility for the care of dependant children or adults. Many used substances including illegal drugs, alcohol, prescribed medication and food. Other studies of women who have appeared before the courts have highlighted the complex social problems experienced by women (see for example, Carlen 1988, Eaton 1993, Morris et al 1995, Walmsley et al 1992). High levels of substance use have also been noted by other researchers studying women who appear before the courts (see for example, Devlin 1998, Morris et al 1995, Smith 1996). The use of illegal drugs is higher amongst this group but as others have noted (Doyal 1995, Ettorre 1992) millions of women consume legal but potentially hazardous substances every day in an attempt to ensure their own well-being and that of their family.

2.8

The study discussed in this paper concluded that bail hostels can play an important role in offering women support during the period of waiting for trial; and help women to make changes to their lives, to overcome problems, or at least to find alternative ways of coping with them. However, ultimately the ability of bail hostels to offer support to women is subverted through criminal justice policies which fails to emphasise welfare-oriented approaches, to appreciate the particular needs of female defendants and the lack of social policies to support women in crisis (Wincup 1997).

2.9

Women's use of different substances - illegal drugs, alcohol and prescribed medication - will now be discussed. The different substances used by women warrant separate attention and analysis but it is important to remember the parallels and common themes are pulled out in the concluding section. First, a critique is offered of traditional ways of understanding women's use of substances, and alternative feminist perspectives are explored.

Discovering Women Substance Users

3.1

Traditionally, research on substance use has been dominated by theoretical perspectives which employ a medical model. Using this model, addictions have tended to be studied scientifically and have often been viewed as diseases. This has led to an analysis of some important issues; for example, the causes of addiction and the treatment of addictions. The problem with such analyses is that they remain only at the level of the individual, denying the importance of the wider society in which substance use occurs. The dominance of the medical model has had far-reaching effects. Addicted women tend to be portrayed as emotionally unstable, weak, dependent and passive (Friedman and Alicea 1995, Taylor 1993). This glosses over the centrality of structural factors in shaping an individual's life. Hence, important social divisions such as gender, social class and ethnicity are left unexplored. Most importantly, it does not treat addicted individuals as rational agents in control of their lives.

3.2

In response to increasing dissatisfaction with traditional perspectives, feminist critiques have been offered. This paper draws on the theoretical advances made, particularly in the work of Ettorre (1992, 1994). She argues 'for a critical approach which views substance use as a complex social issue with specific political implications' (1992: 5). Central to this approach is the need to consider the social position of women and the nature of the female role in a patriarchal society. She adopts a feminist analysis of women's use of both legal and illegal substances to develop links between women's dependency of 'the subordinate kind' and women's dependency of 'the addiction kind' (1992: 20). Ettorre argues that women's use of substances can be viewed as a maladaptive response to deal with life stresses and in this way individuals are viewed as active agents who are trying to cope with their lives. Her use of the term maladaptive can be regarded as effacing of how women may see the issues themselves and in some ways falls unintentionally into the same trap as the medical model which defines women's actions as irrational. However, crucially Ettore suggests that a theoretical perspective is needed which strikes a balance between individualistic, processual explanations and structural explanations. From this perspective, researchers studying women's use of substances need to consider the degree to which free will is exercised by the individual in their social action, although this has to be coupled with an appreciation that agency is expressed according to the degree of constraint experienced from structural factors.

3.3

The need to balance the impact of social structure and the choice of social action is an ongoing debate of general sociological theory. The debate revolves around the problem of how structures determine what individuals do, how structures are created, and what the limits are, if any, on an individuals' capacity to act independently of structural constraints. They have been a numbers of attempts to synthesise concerns with agency and structure. One of the best known theories of this kind is Berger and Luckmann (1967) who try to compromise both the idea of structure determining individuals and also that of individuals independently creating their world. They argue that there is a dialectical process in which the meanings given by individuals to their world become institutionalised or turned into social structures, and the structures then become part of the meaning systems employed by individuals and limit their actions.

3.4

More recently, the work of Giddens (1984) has been particularly influential in finding a way to steer a course between the determinism inherent in a structuralist position and the voluntarism inherent in a position which emphasises freedom of choice. For Giddens, human beings make choices and do not simply respond passively to events around them, although there are material, punitive and structural constraints which in part determine individual actions. He suggests that the way forward in bridging the gap between 'structural' and 'action' approaches is to recognise that individuals actively make and remake social structure during the course of everyday activities. This is captured in his concept of 'the duality of structure'. His work encourages us to think about the ways in which structure is constituted, reconstituted and changed by human actors through their daily lives (Walklate 1998: 85). These processes which apply to the general construction of social action also apply to the way in which gender relations are negotiated (Walklate 1998). The question 'how is gender organised as a ongoing concern?' has been addressed by Connell (1987). His work has been developed by Messerschmidt (1993) in the context of criminal behaviour, combining it with insights from the work of Giddens. For Messerschmidt, three specific social structures underpin gender relations: the gender division of labour, the gender relations of power and sexuality. Their specific form varies through time and space but, taken together, they define the conditions under which gender identities are constructed,

3.5

In a chapter which sets out to explore the relationship between theory and research in criminology, (Bottoms 2000) argues for a 'culture of openness' which encourages empirical researchers to be open to the insights offered by many theories and to create a synthesis which welds together theory and data. He suggests that rather than adopting wholesale a general social theory such as structuration theory, selective adoption of concepts can be use as a way of seeking to enrich the theoretical explanation of the topic being studied.

3.6

In this instance, selective adoption of the theoretical insights of Giddens and Ettorre provided an agenda with which to enter the field. This influences what is seen as problematic, what data are to be collected in relation to that problem, how they are categorised and how they are subsequently analysed (Plummer 1983). When collecting and analysis the data, particular attention was paid to the reciprocal influences and interconnections between people's social activities (such as substance use) and the wider social environment in which they are played out. Being alert to individual agency and the structural divisions of gender, social class, ethnicity and sexual identity allows women's use of substances to be viewed as an active strategy to achieve personal and social satisfaction which they are denied access to in other areas of their lives. At the same time, it permits the realisation that women's attempts to cope with their lives in this way results in the underlying problems remaining and perhaps exacerbated by their substance use. Thus women's dependency of the addiction and subordinate kind continues. These theoretical themes are important aspects of the discussion which follows. Looking in detail at women's use of different substances, the link between women's use of substances and the realities of their lives will now be explored.

Women and Illegal Drug Use

4.1

Despite growing concerns about illegal drug use, findings from the 1998 British Crime Survey (Ramsay and Partridge 1999) demonstrate that illegal drug use is a relatively uncommon activity for much of the adult population. Usage is usually confined to short-lived experimentation, particularly amongst young people under 25. There are significant gender differences. Men are 1.4 times more likely than women to have ever experimented with drugs and twice as likely to have taken drugs in the last year or month.

4.2

The research reported here found high levels of illegal drug use amongst the women living in bail hostels. This meshes with a survey conducted at one of the women-only hostels, shortly before the research was conducted. This in-house survey conducted over one month in 1994 found that two thirds of those referred were from those charged with drug-related offences and/or drug users, a figure which excludes cannabis users.

4.3

Out of the fifteen women interviewed, seven women reported that they had used illegal drugs. Not all these women could be described a 'problem' or 'dependent' users. In some instances, there use of illegal drugs could be 'characterised as 'recreational' or 'experimental'.

I've only ever smoked spliffs. I wouldn't touch other drugs. (Rebecca)
I took drugs before but I ended up in hospital because of it. It was a one-off (Lindsey)

4.4

However, other women reported more problematic drug use. As their comments below illustrate, women varied in the illegal drugs used but what stands out is the length of time they had taken drugs for, particularly given how young many of them were at the onset of their drug-taking careers.

I took amphetamines for five years. (Margaret, 33)
I took heroin and crack. I've been taking it for ten years. (Siobhan, 25)
I've been taking drugs since I was 13. I took cannabis, speed, Es, rock. (Ruth, 21)
Heroin. I've been taking that for, well when I was 20 I meet up with a guy and he was taking heroin. I got involved with it when I was with him. (Sue, 28)
I can't remember how long I've taken drugs for. I took wizz, draw and E for years. (Judith, 21)

4.5

At the time the research was conducted, only three of the women identified themselves as drug users (Siobhan, Sue, Ruth), and two of these women (Siobhan, Sue) were linked in with methadone reduction programmes and counselling. For these women (and others who had only recently given up drugs), their use of illegal drugs was strongly linked with the criminal charges they were facing. Usually, this involved committing offences such as theft, handling, fraud or forgery in order to finance drug habits.

I know all my offences are drug-related. I went from 1990 to 1994 without using drugs. I was clean and I didn't get into trouble with the law. (Siobhan, charged with handling stolen property)
You look at the 609 [criminal record] and you see the definite links with them needing money to support that habit. (Staff member, Victoria House)

I think it helps to look at the circumstances of their lives and to look for patterns of offending. I see this with drug users where when they have been using drugs, there are lots of offences and when they've been off it, it's stopped. (Staff member, Victoria House)

4.6

However, the use of illegal drugs for some women resulted in them committing criminal acts which they felt they would not have otherwise committed.

That's when I began to get into trouble, It was sending my head funny, I wasn't thinking straight (Judith who assaulted a police officer when under the influence of drink and drugs)

4.7

Whilst the links between illegal drug use and crime are frequently explored in the academic literature (Bennett 1998, Hough 1996, NACRO 1999, South 1997, Tonry and Wilson 1990), less frequently are the victimisation experiences of drug users given any attention. The lifestyles led by women who use drugs can make them more vulnerable to violence, although this should not imply that they are in any way to blame for their victimisation.

These women lead dangerous lives . . . Throughout the time I've worked here we've had quite a number of women return from buying drugs who have been seriously assaulted. (Staff member, Victoria House)

4.8

Risk of violence is shared by women and men, but drawing on the experiences of hostel staff and female residents, women seemed to be particularly vulnerable. For example, some of the women referred to hostels (although none of those interviewed) were involved in prostitution and became involved with pimps, working for them in return for drugs or money to buy drugs.

Some of the women, none at the moment, usually have pimps hanging around. Hopefully getting methadone will break that link but it comes back to the fact that some of the women are so frightened of these men that control them that they still go out there and work for these people or they will be physically attacked. (Staff member, Victoria House)

4.9

The question 'what causes women to take drugs?' can be answered in different ways. One approach is to look at the presenting characteristics of women who use drugs and then provide a teleological explanation based on these attributes. This can lead to a circular argument because it is sometimes difficult to separate the causes of drug use from its effects. The characteristics of the women who used drugs in this study included domestic difficulties, experiences of abuse, homelessness, and poverty. These structural factors are crucial to explaining why some people are more likely to use illegal drugs than others. However, there are two main problems which relate to the danger of adopting a deterministic view. Firstly, it does not explore the interaction between the wider social environment (structural factors) and their daily activities (such as drug use). In other words, it does not explain the reasons for their drug use at a particular point in time. Secondly, this approach fails to acknowledge that many vulnerable women do not use drugs and may actively resist them.

4.10

In interviews with women living in bail hostels, the reasons behind their use of drugs were explored. A number of reasons were suggested. As Maher (1995) notes, women initiate drug use in a variety of settings and circumstances with diverse motivations and rationales that cannot be captured by a singular theory. Few women were able to offer a clear explanation for their use of drugs. Josie was an exception in that she was able to pinpoint an event which triggered off her use of drugs. For example, Josie strongly maintained that her experience of being raped was the initial cause of her drug use, and although she later gave up, the death of her son and experiencing a miscarriage 'forced' (her own words) her to use drugs again. Sue discussed how her use of heroin was strongly linked to a relationship with a heavy drug user who was violent towards her.

4.11

Some women were only able to offer vague explanations of their entry into drug use. For example, four of the women talked loosely about the influence of others.

I took amphetamines for five years . . . I was with someone at the time and she was on them and so I went along with her and I liked it so I said 'I'll have a bit of that'. (Margaret)
I've been taking it [heroin and crack] for ten years . . . I don't know how I got involved. I was just very young with nothing to do and very impressionable. I don't know. (Siobhan).
My brothers, they are all involved in drugs and crime. It's in the family. (Ruth)
I met up with a guy and he was taking heroin. He was bad into. I got involved with it . . . He used to beat me up. I had a really bad life with him . . . In the end I had to move away to get away from him, the beating and the drugs. Every time I left him, he found me and beat me up. I didn't realise it would be so hard to come off heroin. (Sue)

4.12

One of the most persistent observations found in the literature on illegal drug use is that men are responsible for the initiation of women (Maher 1995). Such accounts perpetuate stereotypical images of women as weak and submissive; as incapable of exercising agency and unable to make a choice in relation to drug use. Myths about women's 'natural' passivity and dependence condition the accounts of motivations for their drug use. The experiences of the Margaret, Siobhan and Ruth offer little support for this view. Margaret was introduced to amphetamines by her female partner. She was not pressured into taking drugs by her partner, rather her motivation was a product of her desire to understand or share what her partner was experiencing. Siobhan's use of illegal drugs was initiated in the context of a mixed-sex group and whilst she cited peer pressure as a partial explanation, she also referred to the availability of drugs and the lack of alternative activities. Ruth referred to the normalisation of drug use and criminal behaviour within her home environment and the inevitability that she would become involved, although it was not something she was pushed into. For all three women, they had made choices about whether to use drugs but these choices need to be contextualised. In contrast, Sue's account displays her vulnerability to continued drug use, if not the initial drug use, because she was caught up in a viscous circle of drugs and domestic violence.

4.13

Based on the interviews with women living in bail hostels, I would suggest it is just as fruitful to explore the reasons why people continue with their drug use as it is to seek to explain the initial drug use. When asked this question, the women were able to provide a number of reasons. The addictive nature of the drugs they were taking were cited as key factor for many of the women.

At the beginning I could control it, but then it took over. I was taking it ever day then. (Margaret)
With heroin, it's not like you can stop. If you smoke hash you can wake up one day and say I'm not going to do this anymore. You can't with heroin. It goes on and on and on. (Siobhan)

4.14

However, the central position which drug use occupied within their different social networks, was vital too and the women interviewed referred to the availability of drugs and the normalisation of drug use within their immediate environment as influential.

My job [fashion designer] was high pressure and parties and very glitzy. It's great if you are shallow but it makes it hard to be clean and live a balanced life; and to look after myself and my daughter - mentally and physically. The two didn't go together very well. (Siobhan)
I'm trying to give up but I always hang around with the wrong people. I don't know anyone who doesn't use drugs. (Ruth)

4.15

This was a particular problem for women who were trying to give up drugs and who still felt vulnerable.

You can't give up in this place [Carlton House] because everyone brings it in and smokes it. (Ruth)
It's so easy to make one little mistake and especially in here [Carlton House] because there has been two girls who are still taking heroin and I'm frightened in case they offer me it because I'm still vulnerable. I haven't got to the stage yet where I can say no (Sue)
Where I live is awful. It's crack city and there are lot of drugs. Just as I walk out of my house and turn the corner, there's heroin. I have to walk past that every day. It makes it easy if you feel weak one day. (Siobhan)

4.16

The reasons behind women's use of illegal substances were also explored with hostel staff. Drawing on their experience of working with drug users on a regular basis, hostel staff were able to offer their own explanations of women's drug use and related it to the realities of women's lives. These tended to be gender-specific explanations and to focus on structural factors. In the main the staff saw drug use primarily as a response to pressures in the private sphere.

But drug and alcohol are not the problem. There is a problem why they are on drugs or have a drink problem: sexual violence, physical violence, emotional abuse. (Hostel worker, Victoria House)
The initial problem presented is the drug or alcohol use which has brought them into the situation, but underneath that we are often dealing with people's past lives, which I presume they are trying to mask through drug use. The main issues in that are abuse throughout childhood into their adult lives, parent's violence, sexual abuse, women who spend a lot of time in care. (Hostel worker, Victoria House).
Their own experiences as children are often what they bring to us. It doesn't go away until somebody is able to look at it. Drug and alcohol use is a way of obliterating those feelings and coping with the pain. (Hostel worker, Carlton House)

4.17

These accounts provide an illustration of an important aspect of the research findings. The comments of the hostel workers strongly suggest that women's use of substances can be interpreted in a political way, stressing women's experiences in a patriarchal social order. Women's use of substances are linked with patriarchal pain and 'the distressing ordeals which women experience both publicly and privately in the gendered system of domination' (Ettorre 1992: 153). As Marsh (1982) argues, the public issues of women's lives are manifested most painfully as the private troubles of individual drug users. Their use of substances can therefore be seen as ways of surviving the realities of their lives. This does not suggest that women are passive victims, rather what should be emphasised is that these women were making active choices to use substances, albeit in highly restrictive circumstances. This choice is intricately connected with a desire to manage pain.

4.18

What is not acknowledged in staff accounts is that part of the explanation for a woman's choice to use illegal drugs lies with understanding the quest for pleasure. Some of the women talked about their use of substances in these terms, although qualifying their accounts with a discussion of the negative effects of drug use.

Taking amphetamines was fun at the time. (Margaret)
It helps me get through the boredom of the day and makes life more bearable. (Ruth)

4.19

As Ettorre (1992: 146) notes if pleasure is defined as 'a deep sense of personal and social satisfaction, based on emotional and physical well-being', pleasure tends to be in short supply in the lives of women substance users, if not of many women. This is especially so for women who appear before the courts. Linking women's use of substances with a search for pleasure allows us to view women's use of substances as an active choice. This challenges stereotypes of female users. This form of analysis may involve taking insights from the highly individualised discipline of psychoanalysis but there is also a need for sociological analysis because a woman substance user's experience of pleasure is mediated by notions of acceptable and unacceptable behaviour for women. There are socially acceptable styles of dealing with the pain and searching for pleasure which are linked to gender and this theme will be explored later in this paper.

Women and Alcohol

5.1

Women's use of alcohol is explored in this section and again the theme of appropriate female and male behaviour is paramount. Female problem drinkers present a challenge to social stereotypes and culturally defined expectations of 'normal' acceptable women. A double standard operates whereby drunkenness defines a 'real man' but leads to women being defined as 'fallen angels' (Doyal 1995: 180). In recent years, there has been a growing concern about women's alcohol use. Whilst women are more likely to be abstainers, drink less than men and have fewer alcohol related problems than men, women's drinking is on the increase whereas men's drinking is fairly stable (OPCS 1996). Young women report the highest levels of alcohol consumption and dependence when women's drinking patterns are analysed.

5.2

Most of the women stated that they did drink alcohol in moderation. One women did not drink at all on religious grounds and another women (an illegal drug user) defined herself as teetotal. In British society, the consumption of alcohol is part of a cultural tradition with a significant recreational role. In moderation it is seen as a legitimate source of pleasure. Most women referred to their alcohol use as social drinking. Typical descriptions of patterns of alcohol use are offered below.

I don't drink everyday . . . when I'm flush. I drink to socialise. (Margaret)
I drink socially. (Kelly)
A nice bottle of wine in the night with friends but nothing more. (Rebecca)
The only time I drink is when my boyfriend visits me, or me and my friend might go to the shop and get some drink. When I say a drink I only mean one can of lager, just one. (Sue)

5.3

For some of these women, whilst they did not regard their use of alcohol as problematic, they noted how alcohol can be used as way to manage difficult emotions and to deal with stress. As discussed in the previous section, staff argued that alcohol, like illegal drugs, was a way of coping with the pain which often characterised the lives of the women they worked with. For some of the women interviewed, the consumption of alcohol was associated with pleasure but also fulfilled another function.

I've got my ale and I'll turn to a drink of vodka if I'm upset. (Margaret)
I get strung out and depressed. Then I have a drink. (Rebecca)

5.4

Literature on women's use of alcohol has also proposed that alcohol is used 'to relieve feelings of helplessness, powerlessness, ineffectiveness and lack of self-esteem in the face of stressful life events' (Doyal 1995: 180). Carlen's (1983) research on women prisoners in Cornton Vale (Scotland) found that the women interviewed had learned that alcohol could temporarily deaden the pain caused by difficulties in their domestic lives, primarily slum housing and violent men. Both Margaret and Rebecca were experiencing multiple and complex problems, in addition to the criminal charges they were facing which led to difficulties in coping which they responded to through drinking (although their drinking was not seen as a problem for them). Margaret was homeless and struggling to bring up her teenage son alone. Rebecca was married to a man who was physically and mentally abusive towards her.

5.5

Of the fifteen women interviewed, only two women identified themselves as a problem drinkers.

I've got a drink problem as well [as a drug problem]. I used to go to Alcoholics Anonymous because I drink a lot. I used to drink more or less every night.' (Ruth)
Now I only drink alcohol free lager to be sociable. Drinking too much has got me into trouble in the past. It made me aggressive and I assaulted a police officer. (Judith)

5.6

Ruth and Judith were also illegal drug users. In common with other women interviewed who used substances, they found it difficult to articulate the reasons why they drank heavily. Judith's had given up alcohol without the support of others. Her way of managing her alcohol problem was to abstain. She discussed her poor physical and psychological health in the interview but found it difficult to ascertain whether this was the cause or effect of her use of alcohol and illegal drugs. Ruth described herself as 'screwed up' and argued that she would never be able to give up drinking, although she did want to control it.

I've stopped drinking since I've been here but I'm still screwed up. I'm supposed to be going for counselling but I'm never going to be able to give up . . . I'm only going to start drinking again. I don't want it give it up completely I just want to slow down. I can't sit in a pub with my mates and not have a drink. (Ruth)

5.7

A number of implicit themes can be pulled out from her account: firstly, she notes the pressure on people, especially young people like herself, to drink; and secondly, she points to the problem that many treatment agencies adopt an abstinence model which is not always suited to the needs of a particular individual. Rather than allowing Ruth to assert more control over her consumption of alcohol, she perceived counselling as an imposition of particular moral stance which she wanted to avoid.

5.8

Even though only Ruth and Judith identified themselves as problem drinkers, and Judith felt that some of her offences were alcohol related, the use of alcohol was linked to offending behaviour for two other women.

I can't drink at the moment because I'm not allowed in anywhere that sells alcohol. The offence [GBH with intent] I'm charged with happened after me and my mates had been out drinking. (Lindsey)
You see this murder [the murder of her partner, Brian] has happened due to drink. (Heather)

5.9

When asked about her drinking patterns, Lindsey offered the description below.

I drink mostly at weekends . . . I'll have four of five pints and a couple of shorts at weekends. (Lindsey)

5.10

Whilst Lindsey portrayed this as a 'normal' for a night out with friends, the pattern she described can be characterised as 'binge drinking', defined as consuming half the recommended weekly units in a single episode. Recommended safe limits for women are 14 units per week or 2 to 3 units a day. When the offence (an attack on a woman who had left children she was supposed to be looking after at home unsupervised) was committed, Lindsey had drunk between 10 and 12 units in one session. As many researchers have noted, the links between alcohol and crime are complex (D'Orban 1991, Mott 1990, Ramsay 1996, South 1997). Whilst alcohol may not be the direct cause of Lindsey's offence, it was certainly implicated in it. Her resort to violence may not have occurred had she been sober when confronted with the situation.

5.11

Heather's account also demonstrates the complex link between alcohol and crime.

Brian [her partner] was a very heavy drinker. He'd have sold his mother to get a drink and I tried to keep him that he didn't need to. I'm not saying I'm an angel because I used to like a drink and I used to go out with him a lot of the time. We had no commitments, either of us, and I packed my job in in 1985 due to an industrial accident at work.

5.12

Drinking assumed a central role within Heather's relationship with her partner. Other studies have similarly noted that women's drinking is reinforced by a male partner who is himself an alcohol abuser (see Doyal 1995). Drinking becomes an important and sometimes immutable part of their lives. Faced with few alternative ways to occupy their time, drinking structured the day for Heather and her partner. However as Heather described 'drink is the ruin of couples'. It was often after drinking with Brian that he was violent towards her.

If he beat me up after he had been drinking I'd stay in until my bruises went down. I never told my family what he was like.

5.13

Drinking was also Heather's strategy for managing the continual violence she experienced in the times when he was out of prison. Unable to ask for help, one evening under the influence of alcohol, she stabbed him to death.

5.14

Women's use of alcohol has many parallels with their use of illegal drug use, although these parallels are not always drawn. This may be because of their different statuses within criminal law and because alcohol use is more widespread. However, the use of both illegal drugs and alcohol can be linked with offending behaviour and both can be used as ways of dealing with pain and seeking pleasure.

Acceptable Dependency: Women's Use of Prescribed Medication

6.1

Whilst there has been a reported decrease in the consumption of minor tranquillisers since the 1980s, the number of people taking them remains high and women are over-represented among the recipients of minor tranquillisers (Doyal 1995). Researchers in the substance use field therefore need to ask questions about why women are less likely than men to become illegal drug users or problem drinkers but are more likely to use prescribed medication such as tranquillisers. Much of this can be explained through recognition of the gendered context of substance use. The themes are social control and acceptable and unacceptable behaviour are great relevance here. Whilst women who use illegal drugs or alcohol are judged with contempt and viewed as worse that their male counterparts, tranquillisers are seen as 'good' or socially necessary to maintain domestic bliss or the stability of the family (Ettore 1985). In her later work, Ettorre (1992) suggests that the female body is viewed as the embodiment of women's reproductive nature. Thus substance use is seen as an attack on women's nature. For Ettore (1992: 10) 'a substance-abusing woman is the quintessence of a wicked women defiling her body with harmful substance'. In sum, the norms governing social behaviour view women' dependence on tranquillisers as acceptable but double standards operate in relation to illegal drugs or alcohol. For many women, this social context takes them down the route of using more acceptable substances such as tranquillisers.

6.2

Researchers have argued that prescribed medication is used as a means of social control to keep women docile and passive. The widespread use of medication in penal establishments would seem to suggest that they have this potential (Sim 1990). However, qualitative research has challenged the notion that women taking tranquillisers are passive victims (Gabe and Thorogood 1986). Rather the research has illustrated how women use them as an active strategy to sustain themselves, weighing up the risks and benefits of this prescribed drug use.

6.3

Many of the women interviewed were using prescribed medication while in the hostel in order to cope with the anxiety of waiting for trial. Many showed concern about taking them and preferred not to, but felt this was the only way in which they could deal with difficult periods in their lives. The use of prescribed medication was thus a necessary but undesirable action as Kelly describes.

I'm not coping. I keep having anxiety attacks. I'm very low . . . I don't like taking tablets . . . I take them to level them out so I can cope. (Kelly)

6.4

Women who had used tranquillisers in the past were the most reluctant to resort to prescribed medication, even though they found it difficult to cope. They developed alternative survival strategies instead.

I used to be on sleeping tablets and this tablet and that tablet but I weaned myself of them. It was hard but I didn't like taking them. When I was in prison on remand instead of taking pills I used to work so hard in the kitchen that I would exhaust myself and would drop off to sleep quickly. This got me through the difficult nights. (Heather)
I have coped but at times I've been on the verge of a nervous breakdown. Sometimes I've felt like taking tablets. I've only coped because there are people here who support you . . . It's a wonder I haven't cracked up and ended up taking tablets like I have done for most of my life. If I hadn't have been here I think I would have. (Jackie)

6.5

When women did turn to prescribed medication, one of the main difficulties was that they often had high expectations about what they felt the medication could do, as a hostel support worker described

People have such emotional baggage that they are often expecting doctors to work miracles, and got to the doctors and hope they will prescribe something to make them feel better, and that isn't going to happen.

6.6

As Kelly found out minor tranquillisers cannot help women to deal with the traumatic experiences they had experienced and often continued to experience.

It's [taking tranquillisers] not working . . . I like to control everything about myself, to be in control of my life and at the moment I don't have that control and it is hard to cope. (Kelly)

6.7

Whilst prescribed medication, in common with illegal drugs and alcohol, may help to promote well-being, this is only a temporary solution. At best women's use of tranquillisers alleviates the pain in the short-term, but the underlying damaging situation remains. As a strategy to help women elude attempts by others to control, the use of prescribed medication can lead, paradoxically, to women feeling subjected to even greater regulation and control. Those who have taken tranquillisers noted feelings of being out of control due as they became dependent on them. Drawing on her research on anorexia, Lawrence (1987) terms this the 'control paradox'.

Discussion and Conclusion

7.1

The analysis offered in this paper of substance use by women who appear before the courts (illegal drugs, alcohol, prescribed medication) suggests the need for a more complex understanding of the role of substances in the lives of women who appear before the courts. In order to answer the question why do women use substances, we need to explore structural causes, precipiting causes and to acknowledge the resistance of some women to using substances^[2]. Substance use has been linked to particular contexts such as marginality from education or work, homelessness, problems within the family and the lack of opportunities to lead fulfilling lives. The lives of women who appear before the courts are often characterised by social problems such as these, although it is often difficult to establish whether these problems are the cause or effect of substance use. Whilst these are experienced by women and men, there are significant gender differences in the nature of these problems (see Wincup 1997 for a more detailed discussion). For example, women's greater vulnerability to victimisation was frequently highlighted by staff. Consequently, substance use for abused women was judged as a way of managing the pain.

7.2

Precipiting causes refer to those immediate and situational ones which people recall when asked for an account of their use of substances. However, as this research demonstrates, women found it difficult to explain in clear terms the reasons for their initial use of substances. It was easier for them to articulate reasons for their continued use. Uncovering the reasons behind their use of substances needs to form a central part of any treatment package for women who seek support. A holistic, gender-sensitive approach to treatment is needed which addresses all aspects of a individual woman's life.

7.3

Adding in a concern with resistance allows us to explore why many women, including some of the most marginalised women in society, do not use substances. The concern with resistance requires us to ask different questions. Feminist criminologists have begun to ask why don't women offend to the same extent as men, as well as seeking to explain women's offending. They have focused their answers on the degree of social control women experience in both public and private settings and notions of acceptable and unacceptable behaviour. Similar insights can be adopted by those working in the field of substance use. In other words, researchers and practitioners need to ask more questions than are being asked at present: why do women use substances? why do they use the substances they do? why do they continue to use them? why don't some women use substances?

7.4

Traditionally women who use substances have been portrayed stereotypically as dependent, passive and at the mercy of their anatomy and emotions. The role of agency is central to any explanation to women's use of substances in order to avoid replacing the individual determinism which characterised the medical model with structural determinism.. In the lives of the women interviewed there were many factors which could propel them into substance use but we need to recognise that they made active choices to use substances, even if these choices were severely constrained. One way forward is to incorporate into our understanding of women's use of substances recognition of how they can contribute to a women's sense of well-being, as women decide that substance use is as way of managing pain and/or seeking pleasure. Perhaps, women's use of substances and self-harm techniques can be viewed as an active strategy to achieve personal and social satisfaction which they are denied access to in other areas of their lives.

7.5

This should not be interpreted as advocating substance use. The harmful effects of substance use need to be recognised. Whilst women's use of substances are important as strategies to deal with the difficulties women face in their daily lives, they do not deal with underlying problems Consequently, damaging situations may be perpetuated and additional problems introduced such as health problems or involvement in crime. For some women, their use of substances exposes them to the surveillance and control of individuals and agencies such as criminal justice professionals, therapists, counsellors, social workers and psychiatrists. There are also implications for women in general of using substances as a coping mechanism. If women's use of substances is in part a response to their position in a patriarchial society, responding to social problems in isolation through individualised rather than collective means seeks to de-politicise the issues affecting all women.

7.6

The development of a more complex understanding of the substance use in women's lives requires recognition of the similarities and differences amongst women. Whilst this paper has focused on women awaiting trial, the findings are illustrative, not simply of the lives of women charged with a criminal offence, but of women's lives generally. As Ettorre (1992: 16-7) notes

Objectively we live in stress-filled societies in which women's social position and the nature of the female role is more conducive to mental illness than psychological well-being; women are viewed as major health care consumers; dependence on substances, addictive or otherwise in a potentially important factors in any woman's life.

7.7

Close consideration of the social position of women in society suggests that women live with 'overburdened bodies' (Shilling 1993: 32). This refers to the many demands which women experience at home and at work, the lack of time they have to meet all these demands, and consequently, their experiences of emotional and physical stress (Rosen 1989). Many women routinely use substances such as food and prescribed medication to manage the realities of their stressful lives. Fewer will turn to illegal drugs and problem drinking used by some of the women who participated in this research.

7.8

By drawing parallels between the lives of women officially labelled 'criminal' and the lives of women in general, the tendency to portray female offenders as in some way pathological or 'other' is avoided. Detailed consideration of this issue is offered by Howe (1994: 3) as part of her feminist project of 'mapping the differential impact of disciplinary power on lived female bodies'. Rather than focusing on the aetiology of female offending or the conditions of women's imprisonment, she argues for the development of an understanding of the 'structural coercion of women' (1994: 163). This recognises the continuum from imprisonment to freedom, from social control in formal custodial institutions to informal sites of social control. The theme of regulation applies then to all women as Howe (1994: 207) argues

The challenge, then, is to continue the project of exposing and enlarging our vision of what constitutes discriminatory penal practices, while remaining cognisant of the theoretical and political significance of critical feminist analyses of the private prisons of docile yet rebellious bodies, drugged and tranquillised bodies, famished self-policing bodies in which many women lives their lives, 'free' from penal control.

7.9

Whilst it is important to draw parallels between women, there is a need to remain cognisant of the structural divisions amongst women such as social class, age, ethnicity and sexuality. Consequently, a theoretical perspective is needed which recognises these structural divisions, as well as gender. However, women should not be portrayed as passive victims and as a result, there is a need to strike a balance between individualistic, processual explanations and structural explanations. In this way, the required sensitivity can be shown towards individual agency and the structural divisions which permeate the lives of individual women.

Notes

¹They are identified in this paper by pseudonyms.

²A similar theoretical framework is used by Carlen (1996) to explain the causes of youth homelessness.

Acknowledgements

An earlier version of this paper was presented at the 1998 BSA conference 'Making Sense of the Body'. I am grateful to participants for their comments and ideas. Thanks also to Liz Stanley and the three anonymous referees for their helpful comments, and to Amanda Coffey and Ian Shaw for their advice and guidance on the initial research.

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