Reprinted from "Women's" issue of Visions Journal, 2004, 2 (4), p. 15-16
Substance use was a central theme in the experiences of women who took part in a study focusing on the relationship between violence against women and the risk of HIV/AIDS. This study, completed in 2004, was undertaken in 2002 to develop a meaningful strategic plan for the prevention of HIV/AIDS in the Cariboo Chilcotin region. Concerned community members realized that HIV prevention strategies, such as condom use and negotiation of safe sex, are largely irrelevant to women who are being abused, sexually assaulted, or required to exchange sex for food, shelter, money or protection.
Ethnographic interviews were done with 30 local women who had experienced violence in an intimate partner relationship that may have placed them at risk for HIV/AIDS. The women were diverse in ethnicity, tended to be younger (16 to 58 years of age), and tended to have lower incomes (average income less than $20,000 per year) reflective of the area population.
As prior studies show, substance use can become a common feature in the lives of women battered by their partners.1–3 Of the 30 women in this study, 17 described using alcohol and drugs extensively and 13 described themselves as having had problems with alcohol (e.g., "alcoholic," "binge alcoholic," "heavily into alcohol"). Although only two said they had used injection drugs, 10 said they had problems with (i.e., "addicted" or "heavily into") other substances such as cocaine, crack and methadone, and also used alcohol to an extent they considered problematic.
As in other studies,4–6 multiple experiences of violence and multiple forms of abuse over their lifetimes detrimentally affected the women in this study. All experienced abuse as adults and 14 experienced sexual abuse as children or youth, primarily in the context of intimate or family relationships. Many of the Aboriginal women endured particularly horrific experiences in residential schools and/or abuse by family members who were residential school survivors.
Although some women saw substance use as one way of dealing with abuse, for many, substance use was integral to their lives in other ways. Exposure to substance use in childhood and as young women limited their social and economic options. In some cases, these limited options, together with fear, placed the women in further danger if an abusive partner was using drugs or dealing drugs as part of economic survival. For some women, substance use was part of the abuse: the person perpetrating the abuse used drugs and/or alcohol and required or encouraged the woman to do so as well, and/or the perpetrator abused the woman while she was under the influence of drugs or alcohol.
Physical, emotional, and sexual violations, the women's substance use, and the addictive patterns of their partners create and compound isolation and disconnection from social supports—particularly destructive dynamics in a rural context. Some women in this study relocated geographically a number of times and substance use was implicated in these moves. In addition to the ploy of isolation used by abusive partners, some women moved for affordable housing, employment, safety, or to escape environments or substance-using partners that placed them at risk for HIV/AIDS. For some—especially when they lost their homes or children—escaping the associated stigma and judgement proved extremely difficult in small communities.
Despite horrific experiences of abuse compounded by poverty and emotional and geographical isolation, each woman in the study dealt with the circumstances of her life in constructive ways. Not surprisingly, dealing with substance use figured prominently in their stories of growth, healing and pride.
Given the accounts of these women, there is need for integrated prevention and treatment that will be effective in a rural context. Policies and services that do not consider the relationship between violence, historical abuse, and substance use and addictions cannot be successful. Yet, we have such policies and services: for example, women's transition houses that are not equipped to accommodate women with addictions, and substance abuse prevention programs that do not attend to the long-term effects of violence.
If women are to change their lives substantially, health and social policies and services aiming to address violence and substance use must be coupled with those that foster women’s economic independence and safety.
About the Authors
Sheila is a counsellor/ facilitator working to improve living conditions of women in rural BC. She is a member of the Secwepemc Nation and is completing her MEd at the University of Northern British Columbia
Colleen is a nurse and a researcher at the University of Victoria’s School of Nursing, focusing on women’s health with an emphasis on violence against women
Martin, S.L., Kilgallen, B. & Dee, D.L. et al. (1998). Women in a prenatal care/substance abuse treatment program: Links between domestic violence and mental health. Maternal and Child Health Journal, 2, 84-94.
Fikree, F.F. & Bhatti, L.I. (1999). Domestic violence and health of Pakistani women. International Journal of Gynaecology and Obstetrics, 65(2), 195-201.
Stark, E. & Flitcraft, A.H. (1996). Women at risk: Domestic violence and women’s health.Thousand Oaks, CA: Sage.
Champion, J.D. & Shain, R.N. (1998). The context of sexually transmitted disease: Life histories of woman abuse. Issues in Mental Health Nursing, 19(5), 463-80.
Jones, A.S., Gielen, A.C., Campbell, J.C. et al. (1999). Annual and lifetime prevalence of partner abuse in a sample of female HMO enrollees. Women’s Health Issues, 9(6), 295-305.
Heffernan, K. et al. (2000). Childhood trauma as a correlate of lifetime opiate use in psychiatric patients. Addictive Behaviors, 25(5), 797-803.