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Context Matters: The Impact of Trauma, Culture and Policy on Women’s Health
We continue to live in a culture that stigmatizes women and mothers who experience substance use issues, and the standard approach to treatment often neglects a focus on the complex factors and circumstances that uniquely impact women. The paradigm needs to shift to integrate an understanding of the sociocultural and political implications, structural inequities, and the roles of trauma and shame in the development and maintenance of substance use issues among women.
The New School for Social Research recently hosted a panel discussion focused on the intersection of trauma, culture, and policy and how they affect women’s health and recovery from substance use issues. The panel featured Gabrielle Glaser, Emma Roberts, and Lynn Paltrow, J.D., with opening remarks by Andrew Tatarsky, Ph.D. and myself. I will outline the topics and issues raised in the panel discussion and argue for the need to offer a more integrative, compassionate, and empowering approach to working with women dealing with substance use issues. The universal message conveyed was the need to move from a position of penalizing and punishing women who are using substances to a public health model that addresses healing and positive change.
Scroll down to watch a full video of the panel discussion.
…many mothers and pregnant women are unfairly and harshly treated by the criminal justice system, which… may prevent women from seeking help due to concerns of being punished or losing custody of their children.-Jenifer Talley
Relational-cultural theory encourages us to acknowledge the relational disconnections occurring at multiple levels (i.e., personal and sociocultural) so we can begin to help women develop healthier connections to themselves and others, which leads to healing and growth (Covington, 2008). This is an inherently empowering approach that emphasizes a woman’s capacity for growth and healing while recognizing the significance of relationships and the multiple roles they experience throughout their lives. Integrating a relational-cultural perspective within a harm reduction framework that embraces “any positive change” in reducing risk may also help address barriers in help-seeking behaviors. Conceptualizing substance misuse as a public health concern rather than a criminal justice issue was also part of the discussion as many mothers and pregnant women are unfairly and harshly treated by the criminal justice system, which ultimately results in more harm and may prevent women from seeking help due to concerns of being punished or losing custody of their children.
Gabrielle Glaser on Alcohol Use Among Women
Glaser’s presentation set the stage by describing the epidemiology of alcohol use among women and noted increased prevalence rates and distinct risk factors for women. Specifically, she said that more women are endorsing alcohol-related concerns and that women are susceptible to negative health consequences at a faster rate than men. This phenomenon has been termed, telescoping, and acknowledges a quicker progression of medical, mental health, and social/relational consequences for women who use opioids, cannabis, and alcohol compared to men. Specifically, this means that women develop substance-related issues more rapidly even if they are using at a lower rate then men (Greenfield et al., 2010). Women tend to experience higher lifetime prevalence rates of mood and anxiety disorders than men and are also more likely to experience childhood sexual abuse, which increases the risk for developing a substance use issue later in life (Back, Conti, and Brady, 2006).
[Telescoping] acknowledges a quicker progression of medical, mental health, and social/relational consequences for women who use opioids, cannabis, and alcohol compared to men.-Jenifer Talley
In the panel discussion, Glaser raised concerns about the traditional “one-size fits all” abstinence-based approach to treatment that encourages people to admit powerlessness and submit to a higher power. She said that “a lot of women don’t find the message [of traditional treatment] empowering, they find it disempowering… women and men may be drinking for different reasons.”
Emma Roberts on Harm Reduction for Women
The subsequent presentation by Roberts, who works for the Harm Reduction Coalition, highlighted her experiences providing harm reduction services to women, particularly the importance of offering mobile services to those who are street-based. She discussed how a history of trauma and feelings of shame may have a negative impact on help-seeking behaviors and urged us to consider how to more effectively engage women by empowering them to make positive changes.
Roberts discussed her work with FROST’D, a non-profit harm reduction organization in New York City, and shared her observations of the women she met while providing mobile services on the street. She described the “layers of shame that women experience… [for instance] I’m a woman who uses drugs, of color, who is engaging in sex work for my survival, who has kids, who comes from a poor neighborhood with limited opportunities… layer upon layer of stigma and shame that these women are experiencing.” The solution to this, she argued, is to “try to identify what important needs their drug use is meeting” and develop a collaborative plan to address those needs while not assuming that just because an individual is using a substance means that there is harm or that the only solution is abstinence.
What really struck me about her presentation was her emphasis on fostering ‘health and dignity’ and that by helping women engage in services by reducing the barriers… the benefits extend to their children, families and the greater community.-Jenifer Talley
What really struck me about her presentation was her emphasis on fostering “health and dignity” and that by helping women engage in services by reducing the barriers and offering a compassionate and collaborative approach, the benefits extend to their children, families and the greater community. Roberts also discussed the importance of viewing women as caregivers with multiple responsibilities and needs (e.g., childcare) so that services can be tailored to allow them to engage in a way that feels comfortable and safe. Moreover, the approach to working with women with a trauma history ought to be sensitive to their experiences and affirm the courage it takes to seek help.
Lynn Paltrow on Public Policy Reform for Mothers
As director of National Advocates of Pregnant Women, Lynn Paltrow works to challenge policies that criminalize pregnancy and motherhood, and her organization offers legal support to mothers and pregnant women impacted by the war on drugs. In her presentation, Paltrow advocated for changing public policy so that it focuses on public health and not incarceration and punishment.
She described a sociopolitical culture that is invested in criminalizing substance users (especially mothers and pregnant women) and asked the question, “who profits by incarceration?” This is not about giving people permission to use substances, but rather, offering an alternative path focused on compassionate and personalized treatment that aims to keep families and communities healthy and together.
[Paltrow] described a sociopolitical culture that is invested in criminalizing substance users (especially mothers and pregnant women) and asked the question, ‘who profits by incarceration?’-Jenifer Talley
She stated that in “more than 20 states, civil child welfare cases, not an arrest, but the threat of losing your child can be based on nothing more than a [urine] drug test… there is nothing in that cup that can tell you whether I’m drug dependent, whether I’m an addict, or whether I love my children, care for them or anything else. And yet, child welfare policies in most states, even in NY where the law does not actually authorize this, if you are low income, particularly if you are a woman of color, your right to parent, your ability to stay connected to your children can be determined by a cup of pee.” She further argued that a harm reduction approach needs to include everyone, particularly mothers and pregnant women. They should be able to seek help and not be afraid of losing their children or being arrested.
Watch the full panel discussion video here: