I still get this clenching feeling when I share my past as a woman drug usera mom who used drugs,

not just recreationally as so many women use drugs, but as an injection drug user. It was twenty some years ago, but the isolation never entirely fades. In some ways, my story is no different from that of women who drink too much wine after they put the kids to bed at night. Yet it is different and my experience made me different. It still separates me. I struggle with feeling inadequate and inferior to others. I fight too hard to prove myself, although Im never quite sure if its to myself or to society at large. After a decade of working in my field, Im still driven to organize better, learn more, work faster, and push harder, even as the demands to prove myself wane. I am sometimes hurt and amazed at comments from supposedly nonjudgmental friends and coworkers. I told one man that I lived in suburban Minneapolis and took my kids to mass on Sunday morning, set boundaries and curfews, and volunteered in their school. When I mentioned I also talked to the kids about using drugs and enlisted their assistance in stuffing condom bags, he quipped I was a wonderful mix of diversity. I hope I chipped a stereotype for him. Yes, women drug users can still be deeply involved with their kids. In my efforts to overcome my insecurity, Ive worked hard at learning about drug use policy and theory and the historical context of women and drug use. To successfully run an organization and apply for funding, I need a detached academic perspective rather than personal sharing that makes me more vulnerable. Raw emotion is more easily dismissed because it can make listeners feel uncomfortablepeople like nice neat clean

packages so they can sleep well at night. Raw emotion also creates boundary issues and causes me to over-identify with my clients in this target population. My priority is to get funding for the women I serve, so I always present the historical perspective of women and drug use that I have spent years researching and learning. It is my belief that proposals go a long way in educating others; the grant reviewers are often concerned people from the community who are social justice oriented. The historical context helps to set the tone for the importance of creative, cutting edge programming for women offered in a supportive setting that is based on the individual womans need. It is a balancing act to create a proposal that appeals to potential grantors, while they want to fund innovative, cutting edge programs, they also desire proposals that fall somewhere in the continuum of relatively mainstream. While funders may understand the need for sensitive programs for women they often dont understand a harm reduction approach working with pregnant drug using women, which recognizes any positive change rather than demanding abstinence. The Victorian values of the nineteenth century contributed to the notion of the ideal American family and despised the use of alcohol, particularly by women: however, opium was generally accepted by society and most likely prescribed by their physician. By the end of the nineteenth century, the majority of opium and morphine addicts were women. It is thought that the use of opium and morphine was largely by women of higher socioeconomic classes. While these women had easier access to these drugs, research shows that women living in rural areas of the country used these drugs as a way to relieve boredom and social isolation. Other women who were forced out of economic necessity to work in the industrial mills and sewing factories were also

frequent users of opium to relieve pain and physical exhaustion. Opium was also used frequently by prostitutes and sold in many brothels. The most important reason for the increase in opiate consumption during the nineteenth century was the prescribing and dispensing of legal opiates by physicians and pharmacists (Kendall, S. MD). The prescribing options were limited and this ensured that opiates would be used to treat an almost limitless list of ailments (Chase 1873; Faulkner and Carmichael 1892, Kendall, S MD). Nineteenth century women were also heavy users of cocaine. By the end of the 1800s, the American Pharmaceutical Association estimated that 1 in every 375 Americans was addicted to cocaine and 1 in every 300 was an opiate addict with the majority being women. It was during this same time period that the widespread use of patent medicines and the harmful effects of these drugs were beginning to be widely recognized. Special attention was being paid to the impact of these same drugs used by their mothers on their children. Known at the time as infant doping, this practice was initially prescribed by doctors to soothe infants and children and by the turn of the century the practice was abhorred. Mothers were to blame for their own addiction along with their childs. This will not be the only time in history that society judges mothers with drug problems so harshly. In 1914 the Harrison Act was passed which made it illegal for doctors to prescribe opium and the use of these drugs among women decreased dramatically. With the Harrison Act and subsequent court cases, the use of opiates effectively criminalized and greatly reduced the options for the people who used them. It was from that point forward that drug users were viewed as members of a deviant class and treated

accordingly. Women could no longer buy their drugs over the counter or obtain prescriptions from their doctors. Instead they were introduced to drugs as a result of contact with other addicts and drug dealers. This radically changed the environment for women who were used to obtaining drugs from the family doctor in nice genteel surroundings, as opposed to the criminal element of the street. It is after the passage of this act that the federal legislative agenda to control drug use began to develop. Much of this agenda was designed to control the social and economic fears posed by minorities, such as Asian immigrants and Blacks. To further these initiatives, women began to be depicted as the victims of minority men, who were crazed by drug addiction and were sexual predators out to lure white women away into a life of debauchery. The sensationalistic press did its part to contribute to this federal drug control policy by running frequent stories of good women being corrupted and forced into opium dens or the white slave trade. In addition to the inaccuracies printed in the press, the fledgling Hollywood movie industry would contribute to the same notion that minority men were leading good women astray, and made a number of films with titles like The Secret Sin (1915) and The Girl Who Didnt Care (1916). Making a connection between women, sexuality and drugs became an important way to breed public disgust of drug use by a population of users that was increasingly poor, minority and urban. (Kandall, S MD Women and Addiction in the U.S.-1850 to 1920) Overall, while the use of opiates decreased among women, the use of alcohol increased and other pharmaceutical drugs took their place in the medicine cabinets.

The prescribing practices of male doctors during the 1950s and 60s resulted in women becoming addicted to amphetamines prescribed for weight loss, barbiturates for sleep and tranquilizers and sedatives for anxiety. These substances were heavily marketed as a way for women to get through the day and achieve ideal slenderness. Use of illicit drugs by women in the 60s and 70s was common; during the 1980swomens use of cocaine increased, both for its stimulant and appetite suppressant effects. During the mid-1980s the use of crack cocaine begins to have a devastating affect on Black and Latino women and their families and brings a renewed focus on the impact of womens drug use on their children. Although the concern may have been valid, much of it was fueled by hysteria and continued to demonize women drug users, particularly poor women of color. Womens addictions are as varied as women themselvesthey include but are not limited to alcohol and other drugs, cigarettes, gambling, eating disorders and shopping. It is the use of alcohol and other drugs that has been and remains the most pervasive and stigmatizing of all addictions for women. According to the National Center on Addiction and Substance Abuse, 4.5 million women in the United States abuse alcohol or are defined as alcoholics, 3.5 million misuse prescription drugs, and 3.1 million regularly use illicit drugs. Women have made great strides in our society but are still treated as less than equal in our very male dominated culture, and many would argue that it is still secondclass, particularly for the poor and women of color. Women are often the objects of violence, statistics tell us that one in three women will be raped in her life time; domestic violence is rampant, as is sexual abuse of female children. Women often work, raise the

children, keep the house, cook, do the laundry and care for their partners and spouses. They may have traumatic histories, mental illness or physical illness yet frequently they do not seek help because they are too busy taking care of everyone else. Women are seen as sex objects and are often judged on their appearance rather than their achievements, education or intelligence. Women of color have additional stresses from racism, sometimes subtle, but they have an effect on their self-image and sense of self worth. Doors may be closed to them in areas of education, housing and employment, and that more often than not drug laws and child protection laws are unfairly applied due to racial profiling. Studies related to HIV prevention and care frequently exclude women; women are often seen as the vectors of transmission to men and babies despite the fact that they are actually at a higher risk for contracting HIV from a man. Lesbian women are frequently left out of prevention messages and it is implied that they have no risk, and are not given appropriate prevention information. Women drug users are seen as bad people, regardless of who they are. Chemical dependency programs are usually based on a male model. Few residential treatment beds are for women and many programs do not accommodate women with children, creating yet another barrier for women who are seeking help. Women drug users fear losing their children, which prevents them from accessing services and medical care. Many women use drugs to medicate themselves from depression and/or anxiety, to keep away memories of trauma or to endure current trauma in their lives. By focusing on the symptom and not the underlying issue, which is generally the approach taken by chemical dependency treatment programs is not very effective. Treatment programs that

demand total abstention from alcohol and other drugs do not recognize the stressors in womens lives that give rise to the use and abuse of drugs. Further, the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that the drug treatment gap- the number of individuals who need drug treatment for which no services are available are 3.9 million people. The gap appears to be even greater for women with children. A 2003 survey of substance abuse treatment services, reported that women made up less than a third of all treatment admissions nationwide and that 8% of all available programs offered childcare. Women of color face even greater barriers to treatment than their white counterparts. SAMHSA reports that an individuals race is one of the main factors in determining if a person will be admitted to treatment outside of the context of the criminal justice system. (Caught in the Net: The Impact of Drug Policies on Women and Families) When it comes to providing harm reduction based services that are inclusive of women drug users, they must be allowed to define what that inclusion looks like and feels like for them. Remember that harm reduction demands the active participation and representation of drug users in all aspects of the program or organization, and that often, depending on the organization and its geographic location, which can be a very lone voice, which could only serve to increase isolation from the community. This can be a very difficult experience for people who are marginalized and excluded because it is frightening to speak up against people who are perceived to be more powerful than you. Harm reduction based services are offered on the individual womans need, it is not a cookie cutter approach, so again services must happen in the context of that persons life.

It is crucial to validate the strength it takes to survive and that many of the coping mechanisms that have been used have enabled survival. The goal of harm reduction is to create healthier, less harmful and adaptive strategies in a safe setting where women have an opportunity to develop new coping skills, and it is important that women not be pushed but allowed to create change in their lives on their schedule and not the providers. The objective of providing services based on this model is that they are relevant and responsive to women. The details matter, which include: times, location and atmosphere, safety, staff and volunteers with experience relevant to the lives of a diverse group of women, holistic services, recreation, and childcare. Service providers must address issues of power that keep women oppressed. This includes discussion on how to demand a condom, to say no, to use drugs safely, and the power not to share. It is essential to the recovery of women that chemical health treatment programs demonstrate unconditional regard and caring: no judgment; support in a positive environment where women recognize themselves. Interventions should be designed that are slow, incremental and validate women; their coping mechanisms and their past histories of trauma. When my previous colleague Toni and I began the needle exchange program in Minneapolis, We named it Women With A Point for a reason. The name captures so much when it comes to talking about women and drug use. It struck a deep personal cord for both of us at the time and it continues to have great significance for me now. As I have said before, we had a point to make and a point to give, and the point is women

drug users count! It is difficult to talk about women and drug use and remain objective. My goal in providing services for women drug users was first and foremost to create a safe space where women could talk about their lives in an atmosphere that was friendly and supportive. It is not limited to drug use but any issue that was important to them. This is a slow and deliberate process. At the storefront, we provided a variety of services. This included needle exchange, case management for people who were positive for HIV and/or Hepatitis C, individual client advocacy and a womens user group. Women may participate in any or all of these services based on their individual needs and desires. I think the best example I can write about is the womens user group. There were no requirements to attend this group. A person was not expected to be clean and sober to attend. It was not okay to be disruptive or disrespectful of other participants and we reinforced the guidelines set by the participants of the group. This group would meet for three hours, once a week in the evening. A meal was provided along with childcare. Different participants of the group facilitated with one staff person providing support and guidance if needed. Activities of the group varied and it was up to the women to decide what they wanted from the group. Examples of activities included: beading, yoga and acupuncture, presentations on various topics from people in the community, financial management and open group discussion. Women who expressed an interest in writing about their experiences in a journal were provided one. It was very rare that I was a part of this group but when I had an occasion to be working late, I would use it as an opportunity to drop in on the group if appropriate. I think the most fitting way to describe it would be powerful. There were times when I would walk in the storefront and there would be twenty women engaged in an animated

group discussion. It didnt matter what the topic washere they werecoming together and sharing experiences in a safe, supportive space. The women varied in all the ways you would expect but often their stories were filled with similar details. I am talking about the women who are often battered and sexually assaulted from they day they were born, with very little protection. They talk about multiple rapes like they talk about the weather. That they have been sodomized while prostituting for hours on end for a lousy twenty bucks only to have it stolen by the john that has agreed to a certain sex act and then decided he was going to rape them at knife point or stab them with screw drivers. I used to exchange syringes with a woman who had lost her two children because she was prostituting to raise the money for her small daughters home health care and child protection did not see this as an acceptable way to raise money. She talked about how much she loved her kids and did not use drugs while they were living with her but after she lost them she just didnt give a damn any more. Her boyfriend that pimped her kept her in line by dislocating both of her shoulders when she wanted to quit selling herself, or on another occasion he forced her to play Russian roulette with a group of his friends. Not with a gun but with shared syringes with one person being HIV positive in the group. So, how did I respond in this situation? I listened! I listened and let her cry and tell her story-with no judgment, opinion or advice. It is hard to keep my voice and emotions under control when I talk about women who use drugs. I freely admit it is hard to have objectivity. They have more guts and courage to survive then I could ever dream about. As I said in the beginning of this paper, people like nice and neat little stories so they can feel better about themselves

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while they are judging others, these are not nice and neat little stories! I always remember that these women are so much more than the drugs that they use, they were someones babies, sister and often someones mother but most of all they are a human being who deserves respect and dignity and they have value. This is a lesson that I did not learn in school but knew it from personal experience and continue to have it reinforced every day that I work on the streets with women that society deems less fortunate on good days.

All women are misfits. We do not fit into this world without amputations. Marge Piercy

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