Women and Cocaine

Original Publication – Vogue, November, 1984.

The “glamorous” drug is clearly a lot rougher on its users than once was thought. But what we’re learning now is that cocaine addiction may hit women even harder than men.

Megan, thirty, is a beautiful and brilliant research scientist for a major oil company, the first woman to hold her job. About a year ago, co-workers began to notice that she was “hyper” and nervous in meetings; during the next six months she missed one or two days of work a week. Megan’s employers excused her erratic behavior because they knew she was going through a divorce, and they also suspected that she was ill with bronchitis. One day, she had a seizure on the job and passed out. When she woke up in the company infirmary, she blurted out the truth: she was snorting more than a gram of cocaine a day, a habit that had depleted her savings and left her in debt. She wrecked her car and spent all the insurance money on cocaine.

         Megan’s company sent her immediately to a drug-treatment facility, where doctors told her cocaine had caused her seizure. She refused to believe she was addicted to cocaine. It wasn’t until the third day of treatment that the truth began to dawn on her.

         Like alcoholism, cocaine addiction is a disease of denial. (Drug-treatment experts say that between 70 and 80 percent of women with a cocaine problem also abuse alcohol.) And because society condemns women who lose control—men get away with deviant behavior, but “good girls” and mothers do not—it is much harder for women to admit that they have a problem. “There is something repulsive to us about seeing a woman drunk or affected by drugs,” says Steven Bucky, Ph.D., clinical director of Alcohol and Drug Programs at Mission Bay Hospital in San Diego, California. “It’s inconsistent with our sex-role stereotypes.”

         Cocaine also has the reputation of being a fast-lane, glamorous drug and “glamorous,” “together” women reason they ought to be able to handle it. But thousands of women cannot. When the 800-Cocaine hotline began at Fair Oaks Hospital in Summit, New Jersey, a year ago, only one out of four calls was from a woman. Today, of the hundreds of calls every day, almost half are from females, and treatment centers across the country report increasing numbers of women asking for help. Hard statistics about cocaine use among women are difficult to come by, but last spring the 800-Cocaine hotline prepared a survey of 165 women who called for help. The survey found that their typical abuser was a white, twenty-nine-year-old who earned over $25,000 a year and spent $450 a week on cocaine. Sixty-five percent of those women reported that due to “severe depression, irritability, and erratic behavior produced by chronic cocaine use” they often had violent arguments with their boyfriends and husbands. And, the survey found, many of those women chose sexual partners “on the basis of the man’s access to or ability to supply them with cocaine.”

         So a woman doesn’t necessarily have to earn $25,000 a year to indulge in heavy cocaine use. “To be able to afford cocaine, you either have to be rich or cunning,” says a doctor who treats women who abuse cocaine. “We called it love,” says a former cocaine addict, “but my friends and I all basically gave our bodies for cocaine. We were known as ‘cocaine whores.’” Dr. Bucky adds: “Because some women in effect prostitute themselves, their guilt is a barrier to getting help.”

         It is known that about half the women who come forward for treatment of cocaine have children, yet less than 2 percent of drug-treatment programs have provisions for child care. Research dollars to study exactly how cocaine affects pregnant women, say, or if cocaine specifically affects women differently than men are even scarcer. “In terms of research on cocaine,” says Dr. Bucky, “women are severely underserved.”

         Josette Mondanaro, M.D., a family physician with a specialty in substance abuse and former director of the California State Division of Substance Abuse, now directs Wingspread, in Santa Cruz, California. Wingspread is one of the few drug-treatment centers in the country set up solely for women, and Dr. Mondanaro believes that women have special problems with cocaine. Here, she explains why:

Maureen Orth: Do a lot of women still not realize that cocaine is addictive?

Dr. Mondanaro: Yes. One of the problems is that once you start using cocaine you develop something called denial: you’re not even aware of the fact that you’re addicted. You’re not aware that you’re no longer getting the positive effects you once thought you were getting from the drug. You might have taken it one time to feel confident at a job, and all of a sudden your job is falling apart; you might have taken it to feel good in social relationships, and all of a sudden you don’t have any friends, or you might do what we call network displacement—you replace all of your friends with only those who do cocaine. Or you might have taken cocaine thinking it would help a sexual relationship, and then all of a sudden you’re not interested in sex anymore. Cocaine is your lover. People are not able to monitor themselves.

MO: Why would cocaine be especially attractive to women?

JM: No matter how accomplished they feel, women in general have a low sense of self-esteem. Women basically feel that their problems are their own fault; women attribute their failures, their inability to cope in life to themselves. They don’t reach out; they don’t get angry at the world around them. And then you have a drug that makes you feel competent immediately—it’s the perfect drug for women, and the perfect trap for women.

MO: Do you feel women are usually trapped into it?

JM: Yes. Women are still considered second-best in the society, and I think one of the pressures in 1984 is that that’s not supposed to be the case. You know: “You’ve come a long way, baby.” So now that’s created more dissonance for women: they think they should be able to be equal, and then they wonder: “Why am I feeling so bad?” I think women are feeling they need to be better than who they are, and, for a moment, cocaine’s a wonderful escape from tremendous pressure.

MO: Is there anything in terms of research about the way cocaine specifically acts on women?

JM: I haven’t seen research that separates that out. But it’s generally believed that women who abuse drugs, including cocaine, get sicker more quickly than men users do. In other words, if they are inclined to abuse a drug they tend to become addicted more and get physically sicker than a man would.

         Now let’s just look at what cocaine does in animal research because I don’t think enough has been said about it. Cocaine is the only drug that animals will take until they die. They will press levers to take cocaine, and, setting aside food or sexual urges, they will continue to press a lever until they die from cocaine. The drug itself is a reinforcer. You want to take it again to get that ecstatic short-lived high that comes; then you have to take more and more to avoid the depression that comes after you stop taking it.

MO: Are many of the women you see addicted to more than just cocaine?

JM: Yes. Most of the women we see will say they have a much greater tolerance for alcohol when they’re using cocaine, and often they start adding Valium or Librium—or some other depressant—to bring themselves down from the high of cocaine and the irritability.

MO: Does that make it harder to quit?

JM: It may make it harder. Cocaine itself is a very short-acting drug, so physically we can get people off cocaine rather simply, although psychologically it’s a different issue. But some of the other longer-acting depressants that they take along with the cocaine entail a longer course of treatment. Patients may even need to be hospitalized. Many women who seek treatment with us also go to Alcoholics Anonymous.

MO: Why have you made your treatment group all-female?

JM: We feel it’s very important to protect women, to have a safe environment where they don’t feel they will be judged. Addicted women often have no defenses—they’re extremely vulnerable, supersensitive, and very judgmental about themselves. Their first feeling is often not, “I’m addicted to a drug,” it’s “I’m crazy.”

MO: Are women more passive in mixed groups?

JM: Women tend not to speak up in mixed groups. They tend to hide their feelings. The men usually speak first, and the women are put into the position of reacting to the men’s needs. We don’t want women to be in groups only with women for the rest of their lives, but they need some place to practice being assertive, to know that what they feel is valid and that they can express it.

MO: How specifically is our society harmed by having increasing numbers of women dependent on cocaine?

JM: According to a national study, something like 50 or 60 percent of all women who enter drug treatment centers have children. Women set the health tone of their families; if the woman in the family is addicted, it will have tremendous effects on generations to come. Many of these children end up addicts and alcoholics themselves. Also, a fetus can be harmed by cocaine.

MO: How?

JM: We know that during a cocaine high, blood circulation to the fetus is decreased and can cause anoxia, a lack of oxygen, putting the fetus in stress. We believe that among women with high levels of cocaine in their bloodstreams there are more miscarriages and spontaneous abortions.

         Many women who abuse cocaine also abuse alcohol. We know that drinking just three ounces of liquor a day during pregnancy increases the chances of alcohol fetal syndrome by 40 percent.

         What needs to be studied is exactly what effect cocaine use during pregnancy many have on the newborn. Many babies may look normal, but we’ll see only later if cocaine prevented the fetus from reaching its full mental potential because it had less oxygen than it should.

MO: Is the seriousness of the problem being addressed?

JM: Absolutely not. It’s just recently that we’re beginning to say that perhaps 50 percent of all those who use cocaine are women. We have to acknowledge that any drug which gains acceptance into mainstream society will be used equally by women.

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