Woman of Substances
Published by Black Inc.,
an imprint of Schwartz Publishing Pty Ltd
Level 1, 221 Drummond Street
Carlton VIC 3053, Australia
enquiries@blackincbooks.com
www.blackincbooks.com
Copyright © Jenny Valentish 2017
Jenny Valentish asserts her right
to be known as the author of this work.
ALL RIGHTS RESERVED.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any means electronic, mechanical, photocopying, recording or otherwise without the prior consent of the publishers.
National Library of Australia Cataloguing-in-Publication entry
Creator: Valentish, Jenny, 1975- author.
Woman of substances: a journey into addiction and treatment /
Jenny Valentish.
9781863959223 (paperback)
9781925435573 (ebook)
Women--Drug use--Australia. Women--Alcohol use--Australia.
Women drug addicts--Rehabilitation. Women alcoholics--Rehabilitation.
Self-destructive behavior. Rehabilitation centers--Australia.
Cover design by Peter Long
Text design and typesetting by Tristan Main
An earlier version of ‘52 Observations’ was published
in The Big Issue, 31 Aug–13 Sept 2010
Some sections of chapter two first appeared in Tamara Sheward & Jenny Valentish (eds), Your Mother Would Be Proud: True Tales of Mayhem and Misadventure (Allen & Unwin, 2009).
It takes
dedication
CONTENTS
INTRODUCTION
PART ONE: PREDICTORS OF A PROBLEM
1.THE PETRI DISH OF YOU
How childhood temperament can foreshadow substance use
2.BABY MISOGYNIST
Hitching identity to drink, drugs and men
3.CHAOS THEORY
Impulsivity, and how it escapes detection in teenage girls
PART TWO: GENDERED ADVENTURES IN ADDICTION
4. TOTAL CONTROL
Self-destruction as a method of autonomy
5.AMATEUR ALCHEMY
Self-medicating mental illness and tweaking the personality
6.A CRUDE FORM OF SEDUCTION
The sugar-daddy mentoring scheme of drugs
7.PRETTY INTENSE
Promiscuity, borderline personality disorder and other labels that only come in pink
8.COLLATERAL DAMAGE
Blacking out, passing out, spiking … and the opportunists who dig it
9.BODY OF EVIDENCE
The effects of substances on the female body and vice versa
10.YOUR BRAIN AS A POKIE MACHINE
Other risky behaviours that hit the dopamine jackpot
11.THE GEOGRAPHICAL
Running away to the edge of the world and falling off
PART THREE: WOMAN’S LIB
12.52 OBSERVATIONS
A week-by-week account of my first year after quitting
13.A WORD FROM MY SPONSOR
The female spaces in AA and NA
14.KEEPING MUM
When addiction infiltrates the family home
15.A CALL TO ARMS
How drug and alcohol research and treatment can fail women
16.CHOOSE YOUR OWN ADVENTURE
Eight ideas for emancipation your way
ACKNOWLEDGEMENTS
SELECTED READING
INTRODUCTION
Women drink and take drugs because it’s fun. They do it to be bulletproof. To be more intimate, or more intimidating. To become themselves-to-the-power-of-ten. To experiment. To enhance sexual performance, or work performance. To bolster relationships with peers and partners. To be social. To belong. To lose weight. To unwind. To self-soothe. To wake. To sleep. For most people, for the most part, substance use is a manageable aspect of life. This book focuses on more problematic use, whether that be through dependence or just the severity of the outcomes.
In late 2008, I pitched a book along the lines of Woman of Substances to an agent. She suggested we thrash out the finer details at a bookshop cafe in Bondi, so I flew to Sydney the day before our appointment, dropped my suitcase at an absent friend’s apartment, and went out with another mate to celebrate my impending deal.
The next day I came to, naked, the front door open, a bad feeling. The agent had given up waiting in the cafe after an hour. Later, on the phone, we agreed the time might not be right. More pressingly, I had to find my friend’s cats and book a new flight. Don’t worry – we all made it home.
In late 2009 I pitched it to a different agent. Now I had quit drinking, but I didn’t know who I was anymore. The agent wanted an assurance that there would be redemption, and there I was fantasising about buying a length of rope. She wanted a memoir (and, no, a ‘novel’ wouldn’t cut it), while I wanted answers. Why am I governed by impulsivity? Why the constant restlessness? Why the urge to always press the big red button, even when it flies in the face of common sense?
I thought the answers ought to come from evidence-based research. So in 2015 I brought the idea of a research–memoir hybrid about women and substances (which includes drugs, alcohol and tobacco) to Black Inc. It was now approaching seven years since I’d quit drinking and redesigned my life, and I hoped to have the benefit of hindsight and distance. Even so, as the project progressed, it became way more personal and taxing than I had anticipated.
This was because the more experts I interviewed – doctors, researchers, clinicians, policy makers – the more I saw the commonality between my more distressing experiences and the path that plays out for many women whose substance use has become problematic. There were definite themes. It seemed negligent not to explore those parts of my history.
Yet the real revelations come from the drug and alcohol researchers and professionals. I travelled around Australia to piece together their individual expertise and form a bigger picture about the issues particularly pertinent to women, including: self-soothing shame; self-medicating anxiety and depression; the link with eating disorders and self-harm; the propensity to be drawn to abusive situations; the stigma around dependent mothers; the physical issues that women in particular can develop; and the fact that the treatment industry is still geared towards the male experience.
Why do certain people become addicted?
There’s no definitive answer. If there were, I would have turned it into a rhyme and trademarked it. One widely held assumption – if you poll the people either side of you – is that addiction is hereditary. Sure, it often is – in part – but only in that you’ll have inherited poor impulse control, or some features that make you more vulnerable to stress, such as anxiety, sensitivity to rejection, and low frustration tolerance. There’s no single gene for addiction.
To delve a little deeper, and with reference to epigenetics, within our DNA there are ‘switches’ that activate or deactivate certain genes. Sometimes this change of gene expression is triggered by physical development – say, puberty or menopause – sometimes by stress and exposure to a drug. Most relevantly to this book, repeated substance use can cause neuroadaptive changes in the brain that are the basis for craving, binging, tolerance and withdrawal.
Every year a new study seems to crack the code of addiction by isolating genetic anomalies in people with very severe dependence. The findings are then applied to larger populations of substance users, as though the explanation is that we must all have dopamine deficiency or a polymorphism of a certain gene.
The thing is, there’s a huge spectrum of problems around substance use, and most individuals who wind up feeling desperate and wondering if they should quit aren’t so dependent that
only their genetic code could have programmed them that way (in fact, it’s estimated that only twenty per cent of drug users meet the criteria for dependence). Consider the person who witnessed alcohol-fuelled domestic violence as a kid and then goes on to re-enact the same as an adult, but only on pay day. Or the person who takes a stranger home every Friday night, but could only be classified as a weekend binge-drinker. Or the person with anxiety who doses themselves with drugs to be a more natural conversationalist … until it’s impossible to imagine ever speaking sober. It’s certainly possible to be a problem drinker or drug user without being ‘addicted’.
There’s also a theory that addiction is a disease. The American Medical Association favours this ‘medical model’, with the view that addiction causes changes in the brain that remain for a long time, even after substance use has ceased. It’s also the view favoured by Alcoholics and Narcotics Anonymous, who believe the ‘addict’ is thus powerless over their use. In the US it’s necessary to have substance dependence classified as a ‘chronic relapsing brain disease’ in order to have treatment covered by private health insurance. For the same reason, obesity is classified as a disease. Additionally a disease is, in theory, treatable by drugs, which keeps the big pharmaceutical companies happy. Some professionals also feel the disease model is kinder on clients and their families, as it diminishes stigma and responsibility.
In Australia, the disease theory isn’t as popular. Here, policy and treatment largely align to the public health model, which posits that addiction is learned behaviour, and a complex interaction between the individual’s biological, psychological and environmental factors, and the drug.
What’s obvious to me is that addiction arises from a melting pot of factors spanning both nature and nurture. It can be influenced by availability; cultural messages; peer pressure; policy; social learning; adversity; mental illness; and temperament or personality traits. It’s a biopsychosocial soup, and that’s the script this book follows.
A note on language
The language of drug and alcohol use depends on what school of thought you align with. In the US, where treatment is predominantly based around abstinence, terms such as ‘alcoholic’, ‘addiction’, ‘substance abuse’, ‘sober’, ‘clean’, and ‘recovery’ are used, and have infiltrated the policy of many other countries.
In Australia, where drug strategy is based around harm-minimisation, the preferred language is: ‘person affected by drug use’, ‘problematic substance use’, ‘drug-related harm’, ‘giving up’, and ‘level of dependence’. These are terms that don’t create an us-versus-them divide.
I personally don’t call myself an ‘alcoholic’ or – to coin an increasingly popular phrase in the US – ‘identify as an addict’, because surely accepting a label disregards every other part of our multifaceted selves and keeps us forever in a box. I’m also far too English to use a dramatic term such as ‘in recovery’. However, in the subtitle of this book I use the term ‘addiction’ because it is less laboured than the alternatives.
Also it should be noted that when the word ‘woman’ is used, the context applies to all people identifying as women. When the word ‘female’ is used, the context applies only to those assigned female at birth, unless discussing pregnancy-related issues.
Some names have been changed throughout this book.
PART ONE
PREDICTORS OF A PROBLEM
1
THE PETRI DISH OF YOU
How childhood temperament can foreshadow substance use
It was 1982. The UK. The Falklands War erupted. The lowest temperature on record was captured by a lonely weather station in east Scotland, at -27.2°C. Unemployment exceeded three million, the highest since the 1930s. The IRA bombed Hyde Park and Regents Park, killing eight and wounding forty-seven. Thatcher’s Tories were top of the opinion polls. In every kid’s Christmas stocking there was a copy of When the Wind Blows, depicting a nuclear attack on the UK by the Soviet Union. I was seven.
I don’t want to lose your sense of intrigue straight off the bat, but I was a sickly child, matted with eczema and, later, permanently trailing a hankie. The umbilical cord had noosed around my neck upon my grand entrance, rendering me mute. I brought with me a special delivery of postnatal depression and was soon registered as ‘failure to thrive’.
Around our house they called me the Grizzler. My superpowers included a sixth sense for the acutely unfair, and internal combustions at perceived slights. My parents also bandied around ‘sulking’, or ‘sulking again’, but those words didn’t do it justice. When wronged, their youngest child was a kamikaze pilot in a nosedive, unwilling or unable to pull up. Empires should collapse.
‘It’s not the end of the world!’ Mum would exclaim, in an ascending tone. Dad’s favoured description of Mum was ‘wittering’. Mum’s nickname for Dad was ‘Eeyore’. We all did the Myer Briggs personality test one time and came out as introverts with tempers rising. Long car journeys were marked by the sucking of teeth, bursts of road rage and the odd hiss of ‘tedious’ or ‘bollocks’; a Mexican wave of low frustration tolerance between the two front seats. It kept me on high alert, every tut triggering a spike of cortisol.
Sometimes I’d study Dad’s eyes in the rear-view mirror as he steered us through European holidays of crumbling ruins. His handsome brows would draw upwards in an expression even a child could recognise as aggrieved. Some silent cinefilm of lost chances seemed to be looping eternally. Trying to smoke us out of the picture with repeated stabs at the cigarette lighter only served to jack a bit of dopamine out of those rusty neurons. He’d take the edge off by shoving Olivia Newton-John in the tape deck.
I liked to creep out my family in this way: sitting bolt upright in the back seat until they noticed me watching, nibbling on a plait. As a journalist I’ve made a career of it. Sometimes I’d lie down and cry undetected into the upholstery of the back seat, lost in some tragic fantasy involving one of their deaths. Outside of the car, we all kept to ourselves.
It’s fair to note that we are English, but there was more to the sense of foreboding than that. My mother worked in the community services sector and my father was descended from a long line of Essex cops – a paradoxical dynamic right there – though he pursued the dark art of marketing. Our house itself was a police state, which Mum would attribute to his childhood when he was out of earshot. It meant our mealtime manoeuvres were closely scrutinised for plebian plate scraping, too few chews, or using our forks like shovels. Some Sunday lunchtimes a tear might plop into my wholemeal apple crumble; but discreetly, since governance operated under the popular wartime maxim: ‘Children should be seen and not heard.’
My older brother and I got lots of advice like that. ‘Patience is a virtue.’ ‘Do as I say, not as I do.’ All variations of ‘shh’, really. Part of me has grown up similarly conservative. I think a lot more parents could be employing ‘If in doubt, don’t’ these days. Hapless Gen Y and Z #dreamchasers are taught to ‘Shoot for the stars, baby!’ They’re told they can achieve anything in life they set their minds to. It’s heartbreaking for them when they find out they can’t.
My default setting was: ‘Expect nothing and be pleasantly surprised.’ Addendum: ‘Any pleasant surprise will be a massive fluke and should be dismissed as such.’
This is why you should take my account of childhood and run it through your own sunshiny filter, adding a leafy suburb here, an idyllic seaside holiday there, The Morecambe and Wise Christmas Special on the telly, and being read the adventures of Winnie the Pooh every bath night – because those things were there, too.
In my memory, it’s like Nordic noir: everyone’s withdrawn and secretive, the sky is overcast, and people drift about wearing thick woollen jumpers (Dad never turned on the central heating). At any moment someone’s liable to walk out into a snowdrift and never return. But I am not the most reliable witness.
Nobody wants to start their own book looking like a sap, but the point of this chapter
is to illustrate that childhood temperament is a strong predictor of problematic substance use in adulthood. Temperament is observable from birth, and it’s the foundation upon which personality is built.
There’s an episode of the 2012 ABC documentary Life at Seven called ‘Tackling Temperament’. The Australian children it follows have been the subjects of a longitudinal study since birth, and now it’s time to test their response to frustration with ‘The Painting Experiment’.
In groups of three, the children in the documentary are given the task of painting a picture of flowers. Midway through they’re distracted by a researcher, who calls them over to inspect the real floral arrangement more closely. While their backs are turned, one girl – who’s in on the experiment – scribbles on their artwork, then slips back to her own easel.
Initially, each child is dismayed to discover their ruined painting – and they’re suspicious, of course.
Child 1 is subdued. She says she knows the other girl did it, but she keeps going with her painting regardless. By the time she skips out of the room, the insult is forgotten.
Child 2 finds another blank page beneath the first and, pleased with his own ingenuity, starts over from scratch.
Child 3 wants to get to the bottom of it, but eventually her desire to continue wins out. ‘I know,’ she decides, ‘I could colour the background in.’
Child 4 is angry. She stamps her foot. ‘That just can’t happen,’ she says. The researcher leans in: so what should Child 4 do? ‘I don’t know,’ she whimpers. Does she have an idea? ‘No.’ She rejects the suggestion of turning over the paper to the clean side, claiming that won’t work.
‘How did it happen?’ Child 4 repeats, aghast. Eventually she’s persuaded to start over, but the sense of injustice lingers.
Perhaps Child 4 adopted a permanent explanation for this ruined-painting scenario. This is a mindset described by psychologist Martin Seligman in his book The Optimistic Child. A positive thinker will regard a setback as being temporary: ‘This picture has been ruined but at least I had only just started.’ A child as pessimistic as I was will tell themselves a story with finality to it: ‘This is hopeless. Just my luck. This happens every time. People always have it in for me.’ This type will also have what’s called an external locus of control: the belief that they are a passive victim of their circumstances, rather than the architect of their own destiny. Every time a reasonable solution is offered, they’ll play the ‘yes, but’ game, preferring to nurse that sense of unfairness like Gollum and his ring. Something might go really well yet by the end of the day it’s catastrophised, remembered as an unmitigated disaster. They might similarly revise their entire childhood, levelling out all experiences to the baseline of the worst.