Substance use and addiction can affect anyone, anytime, for any number of reasons. Addiction is also a mental health issue, but given the lack of understanding around mental health itself, addiction remains a rather stigmatised issue.
While addiction can affect all genders, the vulnerability varies with the gender – the horrors are worse for India’s women addicts. Some time ago I was assigned to support a study to map the violence faced by female drug users in a city in Western India.
During the study, I met many women drug users who are attached to the national HIV program’s harm reduction units for needle-syringe exchange and a few ex-drug users who are currently on the oral substitution therapy (OST).
Meeting and interacting with them was a critical lesson in understanding how patriarchy permeates every aspect of our lives and even impact health issues.
I come from a society where ‘good women’ do not smoke or drink, but men can be alcoholics and smokers; something that I never really understood until I was confronted with the hypocrisy behind it. In reality, women are equally susceptible to substance use and addiction, but the burden of carrying family and societal honour rests on them which made it a taboo for them.
Therefore women resorted to indulging in their vices in the secrecy of their upper or middle-class homes and issues of substance use and addiction among them, remain neglected and invisible. Working class and lower caste women who often smoked and drank openly were viewed contemptuously through the prejudiced lens of class and caste hierarchy combined with patriarchy that anyway regarded women as lesser beings.
A change in attitude towards upper and middle-class women smoking and drinking was ushered in by the women’s movement, and a woman with a cigarette or a drink became a symbol of challenging and defying patriarchy and claiming her liberty.
This age-old and done with allegory was most recently used in the last scene of the movie, ‘Lipstick Under My Burkha’, and the use of the trope in the film remains highly debated. Even today women who smoked, drank, used other substances and may have addiction issues, remain trapped between the ideas of being modern, liberated, feminist and ‘bigdi hui’ – categories that often blurred and merged with each other.
They are regarded as doomed, losers, fallen and deserving no support or sympathy, a terrible perception that ignores the mental health aspect of addiction.
Our society allows men to flaunt some of the socially accepted addictions (the brand of drink or the smoke of choice, the paraphernalia involved, are all matters of bragging). In fact, men can even get away with the harder drugs on sympathy grounds.
However, women do not get away as easily; they are usually labelled and stigmatised as a ‘characterless, immoral and loose’. A woman drinking or taking any substance is apparently inviting the other sex to engage in casual and often non-consensual sex with her. While a man drinking is a jolly good fellow having a jolly good time or immersing his tensions and sorrows quite like our romantic, tragic icon Devdas.
This biased view of drinking and substance use is well documented in various cases where a sexual assault on women has been justified on the ground that she was drunk at that time, or had had a few drinks and therefore invited the situation upon herself.
The most recent example where the court blurred the distinctions between consent and violation and acquitted the accused because the woman was drinking with him, is particularly alarming and regressive – ‘A feeble no may mean yes.’
The social stigma around women using a substance is magnified by popular culture that unabashedly promotes the idea that women serve, both liquor and themselves and men enjoy being served, both liquor and women.
The Oktoberfest is an example this idea – Women are frequently sexually harassed at large festivals including the Oktoberfest in Munich and the Carnival in Cologne. In the popular television satire Simpsons, it’s never Marge – the wife and home-maker who gets to step out for a drink or two, but her husband Homer Simpson who goes to the neighbourhood bar for a few drinks.
Although it might have been pointing out the sexism rampant in the American society, including the show itself – Female Simpsons writer reveals she was ousted because showrunner wanted all-male writers room.
Therefore, popular culture corroborates the idea that men enjoy their vices and even serve as props to emphasise their masculinity. Remember the Marlboro man and closer home, jab mil beithe teen yaar (three friends and a drink), or Sherlock’s pipe and Feluda’s Charminar?
These portrayals are unlike the women whose vices make them either vamps or femme fatale or fallen like Priyanka Chopra’s character in Fashion or deranged like Kangana’s character in the same film or doomed like Meenakumari in Sahib, Bibi aur Gulam. Suggesting that men are incomplete without their vices while women are vile if they have vices!
During my interaction with women who used hard drugs, I learnt a lot about their difficult and complex experiences. The apathy they faced as a woman is extreme, they are less likely to be supported by their family. Their addiction is usually not tolerated, and all these factors increased the likelihood of isolation and destitution.
Also in many cases, the male partners introduced them to drugs, yet women are more likely to be blamed for the couple’s addiction issues and barred from accessing treatment, lest it brings shame to the family. In one of the cases, we came across a situation where the mother-in-law refused to allow the counsellor and outreach worker to meet the daughter-in-law or enable her to access treatment and counselling. However, she did not stop her son from getting help for his addiction.
Such was the stigma of being a female junkie that most women we met were mostly without social support, abandoned by family and had lost contact with their children, were dependant on abusive partners and often homeless. Even if there were shelter homes for women, they refused to take in those who used drugs or were on OST because of the stigma attached.
The way the country’s public health programs are designed are not surprisingly sexist and ignore the needs of female drug users. The harm reduction programs are progressive, efficient and crucial, they reduce the risk of injecting drugs, enable to quit or wean off.
Yet, they do not recognise the special needs of women drug users, resulting in a situation where men benefit from these programs while women continue to fall out of the safety net. Women deal with their addiction without any help or support, living with increased vulnerability to violence and sexual assaults, and ultimately untimely deaths that could have been easily prevented with a little sensitivity.
If only we could envision and implement harm reduction programs that responded to the specific needs of women, the increased level of the stigma they face and the vulnerabilities due to their sexual and reproductive health needs. If these programs also included specific services that benefited them, such as, services related to their sexual and reproductive health and rights.
Moreover, harm reductions units are spaces that are dominated by men, implying that there is an impending need to create and provide a safe space for women where they feel comfortable. Only a holistic approach can improve access to harm reduction services among women drug users.
It will certainly be more effective over the current piecemeal solutions designed to cater to men’s needs and therefore ignores the hundreds of issues that women face and their lived experiences.
To conclude, while it is important to highlight the gap in the public health programs, it is also crucial to call out our double standards when it comes to substance use, addiction and gender.
While we push for changes in the system, we have a lot of changes to make ourselves, especially, when it comes to how we perceive a woman who uses substance or have addiction issues.
We have to remind ourselves at all times that her vices do not reveal her character or personality, it certainly does not give the right to assault or abuse her and definitely to not use her addiction and vices as a justification for violating her human rights.
After all, substance use may be circumstantial, and addiction is a mental health issue, and people who do get into them deserve empathy and support irrespective of their gender.
The harm reduction programs will have to rethink its design if it wants to bring in women in its folds or until then women with addiction will remain invisible. However, until that time comes, it is upon each one of us to change our perspectives of a woman using substance or with addictions and treat it as a mental health issue that it is, neither glamorous nor shameful, without stigma, judgments and labels.