Women crack users: knowing their life stories

ABSTRACT

Objective:

To know the meaning and the implications of the use of crack by women, from their life stories.

Methods:

Qualitative study, like Life Story, developed in a Psychiatric Unit of a hospital in Porto Alegre, Rio Grande do Sul, from May to August of 2012, using the referential of Daniel Bertaux as methodological support. Six interviews were held with women users of crack.

Results:

Knowledge of the social context of crack consume by women shows a universe of meanings, in which there is a complexity about the phenomenon that goes beyond simplified understandings and preconceived ideas. In addition, the testimony of women unveils suffered realities, permeated by violence, family dysfunction and chemical addiction.

Conclusion:

This research may contribute to the implementation of actions in mental health, based on the needs of the users of crack, allowing a care focused on the social, a tool of transformation of realities.

Keywords:
Psychiatric Nursing; Mental Health; Women; Cocaine; Crack; Illicit Drugs

RESUMO

Objetivo:

Conhecer o significado e as repercussões do uso de crack por mulheres, a partir de suas histórias de vida.

Métodos:

Estudo qualitativo, tipo História de Vida, desenvolvido em uma Unidade de Internação Psiquiátrica de um hospital em Porto Alegre, Rio Grande do Sul, de maio a agosto de 2012, utilizando-se o referencial de Daniel Bertaux como suporte metodológico. Realizaram-se seis entrevistas, com mulheres usuárias de crack.

Resultados:

O conhecimento do contexto social do uso de crack por mulheres evidencia um universo de significados, em que há uma complexidade quanto ao fenômeno que vai além de entendimentos simplificados e ideias pré-concebidas. Além disso, os depoimentos das mulheres descortinaram realidades sofridas, permeadas por violência, desestrutura familiar, dependência química.

Conclusões:

Esta investigação pode contribuir para a execução de ações em saúde mental pautadas nas necessidades da usuária de crack, permitindo um cuidado voltado para o social, transformador de realidades.

Palavras-chave:
Enfermagem psiquiátrica; Saúde mental; Mulheres; Cocaína; Crack; Drogas ilícitas

RESUMEN

Objetivo:

Conocer el significado y los efectos del uso de crack por mujeres, a partir de sus historias de vida.

Métodos:

Estudio cualitativo, del tipo Historia de Vida, desarrollado entre Mayo y Agosto de 2012 en una Unidad de Internación Psiquiátrica de un hospital de Porto Alegre (RS), utilizando el referencial de Daniel Bertaux como soporte metodológico. Fueron realizadas entrevistas con seis mujeres.

Resultados:

El conocimiento del contexto social en el consumo de crack por mujeres revela un universo de sentidos donde hay una complejidad cuanto al fenómeno que va más allá de interpretaciones simplificadas e ideas preconcebidas. Además, los testimonios descortinaran realidades permeadas por la violencia, desorden familiar y dependencia química.

Conclusión:

Esta investigación puede contribuir para la implementación de acciones en salud mental, reglamentadas por las necesidades de las usuarias de crack, permitiendo una atención direccionada al social, herramienta de transformación de la realidad.

Palabras clave:
Enfermería Psiquiátrica; Salud mental; Mujeres; Cocaína; Crack; Drogas ilícitas

INTRODUCTION

Since ancient civilizations, humanity has always been permeated by the consumption of psychoactive substances, covering a multitude of uses, abuses and effects. The historical process of drug use shows that the social and cultural contexts prescribe the presentation of substances, dosages, forms of use and individual and collective meaning attributed to consumption, characterizing a way of life typical of early and contemporary societies of consumption^1,2.

In the current scenario, the crack phenomenon has been constituting as a center of discussions in Brazilian society, due to the prevalence of consumption, and for being considered a drug of relevant social impact³. Although epidemiological studies indicate a higher prevalence of psychoactive substance use among men, it has been found an increase in the consumption of drugs, including crack, by women^4,5.

However, it is still identified that crack consumption by women lacks studies that reflect this problem nationwide. Thus, investigating the meaning and the effects of crack use by women, from life stories, meets the identified knowledge gap by configuring as a time to put into evidence the woman who experiences the use of crack and to raise their mental health needs⁶.

The fact that women are consuming more drugs involves the complexity of the social environment and human relations in the contemporary world. The growth in the number of women who consume crack can reflect in changes to intersubjective human relations and the role of women in society, mobilizing, subjectively, this woman to search in the crack the pleasure in response to new social demands, which produce frustration and distress⁷.

From this perspective, the understanding of the life course of women crack users, has proved important for the establishment of mental health interventions targeted to these people. In addition, the observation of the life stories of these women can also contribute to the development of prevention strategies and education in health, through reflections and discussions about the reasons for the use of crack by women, as well as the consequences to their health and lives.

In this way, it is necessary to know the life stories of women users of crack, considering their trajectories of life as a way of visualizing the crack problem, in order to build a working model of organization on health, focused on this theme. In this sense, it is elementary to consider values, beliefs, desires, ideas and links of users. With this, there will be possibility to go beyond the definition of a diagnostic and/or prescription of a medicine, allowing to the crack user participate in actions proposed by health services and the construction of their care⁴.

Thus, the need for spaces that provide freedom, active listening, autonomy, as well as the insertion of women crack users on mental health therapy, by itself, justify the importance of knowing the life stories of these women. From this perspective, this study becomes relevant for giving voice to women crack users, through testimonials about the experiences in their daily lives, and thereby subsidize the development of actions on mental health based on the needs of those users.

Bearing in mind the exposed, the objective of this study is to know the meaning and implications of crack consumption by women, from their life stories.

METHODS

This is a qualitative study, derived from the doctoral thesis "Life stories of women crack users", by using the methodological referential of life story of Daniel Bertaux. The central focus of the process was to register the life story of women crack users, outlining a more concrete look at the trajectory of life of each one of these people⁸.

The Life Story Method is a narrative used by the subject to express the contents of a part of its experience. According to this referential, the report of life is the result of a peculiar form of interview, the narrative interview, in which the researcher asks a person to tell all or part of its personal experience⁸.

The study was conducted in a female psychiatric unit, in a hospital situated in the city of Porto Alegre, Rio Grande do Sul - Brazil, from May to August of 2012. The unit has 24 beds, of which five are destined for psychoactive substances users, being mostly crack users. The choice of field was intentional, due to binding of the researchers as teachers of the pedagogical practices of Mental Health Nursing discipline, in this unit.

The data were collected through interviews with six women users of crack, with inclusion criteria: 18 years of age or older; the reason for the hospitalization be due to the use of crack; and be hospitalized for at least a week. It should be noted that six interviews were conducted, with the total number of women users crack who were admitted during the period of data collection, ending the production of data.

The interviews with the participants were individuals and carried out in a single meeting, in a reserved place in the unit, with an average of 1 hour of duration, which were recorded and subsequently transcribed in full. At this stage, it was used the following guiding question: "Tell me about your life, which is related to the use of crack".

The information obtained was submitted to thematic analysis in line with the methodological referential of Daniel Bertaux. According to this referential, the thematic analysis of an interview aims to clarify the relevant information and meanings in it. Most of this information and meanings does not appear on the first reading, coming one after the other in the course of successive readings, since each reading reveals new semantic content⁸.

From this, in order to unveil the experiences highlighted in the speeches of women crack users about their life stories, the reports were analyzed according to the methodological referential of Bertaux, through the following steps: 1) first reading, aiming to know the content of the testimony; 2) second reading to select key points in the speech; 3) grouping of elements in common of the units of meaning, this is, the convergence that enables the emergence of categories; 4) presentation of the meaning obtained at the big panorama of the data.

From the convergence of the units of meaning, three categories emerged, related to life story of women crack users: 1. Women and the meaning to make use of crack; 2. Implications of the use of crack in the women's lives; 3. Expectations of women crack users and the future, treatment and family support. In this article, these categories were presented: "Women and the meaning to make use of crack" and "Implications of the use of crack in the women's lives".

To ensure the anonymity of the participants interviewed in the survey, women crack users were identified in writing by the letter "E" followed by the number corresponding to the order of interviews (E1 to E6).

For the implementation of the research were followed the ethical aspects necessary to develop research with human beings, as the Resolution nº 466/2012 of the National Council of Health of the Ministry of Health. So, the Term of Consent to the participants was distributed, in two copies, being one held by the participant and the other by the researcher.

The project was registered and approved by the Research Commission of the Nursing School of Universidade Federal do Rio Grande do Sul (UFRGS). Still, it was evaluated by the Research Ethics Committee of the Maternal Child Hospital Presidente Vargas, receiving assent to its execution under the Nº 03/2012.

RESULTS AND DISCUSSION

In this research, the woman user of crack is recognized from her life story, in a way that, in her experiences, are made explicit meanings and effects of drug use, which enabled to present the phenomenon in two categories: "Women and the meaning to make use of crack" and "Implications of the use of crack in the women's lives".

Women and the meaning to make use of crack

During the interviews, it was observed in testimony a psychic suffering scenario caused by crack consumption, in a way that the meaning of use permeated the speeches of women. Thus, the lived experiences were composed by episodes of violence, family disrupts, as well as for crack dependence.

From this perspective, initially, the lines made clear that women are exposed and/or vulnerable to violence, both physical and psychological:

A man once pulled a knife at me. [...] He pulled a knife and I had to give up the payment. It happens a lot. (E2)

[...] I was seven months pregnant, and a guy tried to kill me suffocated. (E6)

I suffered violence once. A man grabbed me by force. I think he was very high, very crazy, grabbed me, and then we had sex. (E4)

From the set of reports, it was noted that women crack users suffer various types of violence in their social context, including the violence suffered because of prostitution, which provides negative events in the lives of these women.

According to this, recent study pointed out that prostitution is an alternative for a woman to support herself financially and, later, a way to acquire the desired drug. Moreover, prostitution offers independence, power and some advantages against the men, mainly for obtaining the drugs⁶

In the daily lives of crack users, the social violence appears as one of the elements that affect negatively the health of these people, because it can be perpetrated by spouses, relatives, clients of sexual practices, drug dealers and also by the police. In Brazil, the current scenario shows that these women are vulnerable to situations of rape, physical and mental assault and attempted murder even in their social environment, since society still reproduces the stigmatizing and reductionist look to women^9,10, and users of illicit drugs, in general.

Considering this situation, the use of crack can mean the escape from reality suffered, as well as the maintenance of a "parallel world", in which there is pleasure when using the drug, despite the context of social violence. Thus, the crack acquires importance in the life of the individual, in which there is constant urge to consume it and, subsequently, change of values that until then, guided their conduct, because the focus becomes the use of crack¹¹.

Parallel to this, the essential crack consumption borders the chemical dependency of users, where there is drug use at the expense of physical, psychological and social needs. In this context, the meaning of crack use for the user is lost in itself, since the individual devalues itself over the appreciation of the drug because it can commit thefts, violent acts and lie in exchange for crack¹², as visualized in the reports:

We think we can do anything! Whoring, to kill, to steal, to hurt. [...] I have already stole shops, prostituted myself. (E4)

The drug has always been above all for me. I got to prostitute myself; had sex to get the crack. (E1)

I was a slut, a month after he started using drugs. I tricked my boyfriend; I lied to him for a long time and mainly because of that, we broke up. (E5)

The testimonials show the appreciation of the drug by women, demonstrating some diagnostic criteria of chemical dependency, such as the narrowing of the repertoire of life due to the search and the consumption of crack, the abandonment of activities, which previously were delightful and almost uncontrollable desire for the drug (crack). Such attitudes are precursors of a risk behavior among users, putting them in a situation of vulnerability in their life context.

The obsessive contours in the search for crack, constantly, undermines the ability of choice and discernment of users, to the extent that their attitudes are focused on getting more crack, even with the remarkable physical, mental and moral degradation. However, there was disagreement in a recent study about the moral aspect, since the results showed that most women deny the practice of criminal conduct, emphasizing not needing to steal to get the crack⁶.

Is evidenced the advance in scientific knowledge, and in this research a statement expressed the possibility of execution of any action in order to obtain the drug. In this sense, it is emphasized that violence and marginalization related to unlawful acts are covered in other scientific studies, which highlight these situations as a social problem that is related to the use of crack, providing new health demands to users and other social actors^13,14.

On the other hand, it is elementary to understand the meaning of crack use by women, the investigation of family dynamics. With this, it can clarify the familiar context of these users, which is essential to understand the social factors and the negative and positive influences that motivate women to consume drugs¹⁵. Thus, it is considered important to unveil the crack phenomenon, the exposition of the experiences lived in the family, as expressed in the statements:

My mother was always on the street, in bars, when I was little. [...] My father abandoned my mother when I was 10 years old. I don't like to remember, [...] he abused me, and I could not tell my mother. (E6)

When my mother got pregnant, [...] She fought a lot with my father. And they broke up. [...] I am in need of everything, mother and father. (E5)

My mother was a chemical dependent, she died at the age of 25 years. [...] She was always on the drug, and my dad did not register me. I never knew my father. (E4)

Through my husband, I started using. I was raised by my grandmother, I don't have a relationship with my mother. [...] I have ten siblings, but I don't know all of them. My dad is an alcoholic. (E2)

It was remarkable the family disorganization identified in the speech of each crack user, leading to reflect on the social difficulties faced by these people and, especially, the meaning of drug consumption. The identification of the family context extends the understanding of crack problematic, since approaching the family, can unveil the economic, social and cultural conditions in which it inserts the woman using crack. This contributes to the understanding of potential causes of drug consumption that favor and "push" these women for the consumption of crack, as well as contributing to the pursuit of support mechanisms to insert this user in its family and social context.

The crack has been shown to be a devastating disruptive phenomenon in the family, generating situations of disorder and/or disorganization of the family, caused by conditions of uncertainty imposed by the drug¹⁶. Nevertheless, it should be noted that the purpose of this study does not focus on blaming family members on the drug use by women. However, it is important to highlight that the family plays an elementary role in the development of its members, being the main responsible in providing social and affective relations between their relatives, configuring it as an important factor that can promote and protect individuals from drug consumption.

Thus, in this category, it was observed a life scenario of life of crack users permeated by family disorganization, but also by violence and addiction to crack. Thus, the meaning of the use of crack by women proved to be large, since this problem permeates concepts, hypotheses and predictions about the crack users, including the social context and subjectivity that make up the existence of these women.

Based on these, it is considered relevant to reflect and entrench these issues related to the theme of crack and its impact on women's lives, described in the second category.

Implications of the use of crack in the women's lives

In this category, it was possible to reveal other facets of the phenomenon studied, referring to the effects of crack use in women's lives, through the testimonials of these users.

The drug consumption is not isolated from its social context because the daily life of each person appears as an essential factor for the onset of drug use, and also reflects the consequences of consumption¹⁷. Thus, the aspects related to the social context of crack consumption are closely related to the damage to the user's health. In the analysis of the interviews, it was observed that the crack use has produced negative changes in women's lives, in a way that these users started living on the streets and to getting involved with people linked to drug trafficking, as observed in the statements:

Crack leads to destruction. [...] I slept in the street because my uncles could not stand anymore; I was stealing too much at home. Exchanged for money, so I went and bought crack. (E4)

Everything has changed. When I used crack, I stayed on the streets, all the time. I didn't sleep at home. I stayed on the street and didn't sleep. (E1)

I liked more to sleep on the streets with the guys, a lot of people. When it was cold, we warmed each other up, everybody clinging. (E6)

I was a friend of traffickers. I dated one of them, so I was there. [...] I was living in this "place" practically. I was almost every day there. I used drugs all the time. (E5)

The statements allow visualizing that the users signal the social difficulty imposed by crack consumption from their experiences, with changes in the daily patterns like living on the street and linking to criminal organizations, for the use of drugs and/or makinh money. To enter the social context of these users, it is possible to understand the meaning of crack for every woman, which can be the fuel and the direction for construction of actions in mental health adapted to the world of social actors involved in the process.

The reality of daily life in the territory is increasingly living with drug use. The lack of social support - healthcare network, employment and family support - and the difficulty to access and link to health services, have contributed in worsening situation of crack use today. In this way, it becomes imminent the responsibility shared between the different sectors of society, proposing to the population actions in mental health to collectively face the crack phenomenon^15,18.

Given this, health practices that segment the crack user should be replaced for actions that aim for psychosocial care, committed attention in order to meet psychological demands, as well as social, evident in the vital process of these women, without neglecting the physical aspects. Thus, the mental healthcare to crack user permeates the attention focused on the use of the drug, directing the view to the individual and collective psychic suffering, as well as to the social demands such as unemployment, school expulsion, viewed in the statements:

My life became a hell, I did not study anymore (E1).

I didn't work. Who provided for me was my mother. (E3)

It was a suffering for me. [...] Because of that, I didn't last in any job. I stopped studying. Surely it would have been more peaceful without the crack. (E2)

I had just started work and I ended up dropping more for life. [...] I did not think of the consequence. It addicts on the first time, if you smoke you're addicted. (E5)

When reporting the fact of being unlinked from school or employment, the respondents demonstrated that the use of crack and the difficulty of establishing permanent activities in daily life are interconnected due to the need to obtain and consume the drug. Generally, this arises from chemical dependency syndrome, factor that limits the user's actions in their daily lives and, at the same time, motivates the search for drugs through licit or illicit and/or alternatives¹⁷.

One of the reports express the suffering of the user about her difficulty in remaining in employment and school, which could be consolidated in activities to contribute to the therapy, since the work and study could facilitate her (re)insertion in the social environment and in family. It is worth pointing out the diversity of social arrangements expressed by the use of crack, because some individuals have usage patterns that do not compromise their social functioning, dissociating the idea that every consumer of crack tends to marginality. In these cases, several people have managed to keep the job and the relationship with the family¹⁵. On the other hand, this study showed that crack users have faced difficulties in their social environment, experiencing emotional and material losses and family conflicts, as is shown below:

I lost many things because of the crack, my children, especially. I lost one of them because of it. My second child, I lost with six months of pregnancy. (E6)

I drugged myself a lot, then I tried to kill my mother. My life after using the crack was only bad things. (E3)

It changed everything. My life was peaceful and grew heavy. Everything has changed. Then I started to argue at home. I got into a fight with my mother, my nephews, my siblings. (E1)

I've already lost so much. I've made so many people suffer. My mother is the only one that's on my side. The others in my family, don't go along qith me, nobody talks to me anymore. (E5)

It is important to note that the effects of the use of crack under the individual's family should not be understood as a way of punishing, discriminate and judge the people who consume drugs, but rather a chance to reflect and discuss the problem of crack in collectivities. Thus, all social actors can analyze this phenomenon as an individual, family and social issue. Within this context, mental healthcare to the crack user's family can become the locus for effective actions in daily life, as a mean that may be favoring to the accession of the individual to the therapeutic process.

However, it notes that there is a large behavioral change in users from the frequent consumption of drugs. With this, the user can avoid relationship with family, break with friends and isolate themselves, in addition to frequent absences from school and work, and the lack of a life goal¹⁹.

According to the speeches of users, it is brought to light the social difficulties faced in the family core too, consisting of self and interpersonal conflicts due to the use of crack. Also, in women's daily lives, the lines show situations of risk to all family members, like the hetero-aggression and the disruption of affective bonds, which can accentuate the distress of these and also result in tragic events, such as homicide and suicide.

With the exposed in this category, it was found that the crack phenomenon is complex, reflecting widely in the lives of users, because there are consequences of the consumption of drugs in individual, family and social context. From the experiences of women, it was noted that the withdrawal from employment and school, the experiences on the streets, bond with drug dealers, as well as family conflicts, clearly show the life context of these women and, in addition, may constitute the analytical framework of actions on mental health, contributing to the construction of healthcare, from the life context of each woman.

FINAL CONSIDERATIONS

The relationship between women and the consumption of crack brings up many questions and raises reflections on how this drug use manifests among females. Historically, being a woman attracts a range of susceptibilities, favoring judgments and questions about socially acceptable and determined behavior patterns in accordance with the standards established by the culture.

This study addressed the problem of crack use by women, identifying the meaning and implications of this from their life stories, according to the methodological referential of Bertaux, creating opportunities for women to express their experiences in relation to the crack consumption. Thus, there was opportunity to expand knowledge on the subject, to the extent that it allowed a new look to the field of health and nursing.

On the other hand, the present study allowed identifying reasons for the start of crack use, pointing out risk factors present in the life trajectories of these women, which made possible to see the meaning of the use of crack. Still, the evidence brought to light suffered realities, permeated by violence, family disrupts, financial difficulties, combined with elements that are inherent in the lives of women participating in this research.

Knowing the trajectory of life of women crack users allowed to identify meanings to the use of crack expressed by them, that should be part of the planning of social and health devices that serve this population. These meanings point to needs that transcend the offers that, traditionally, are the responsibility of the health sector (treatment, prevention of diseases and health education), would also involve other sectors of society (education, labor, justice) and the family to be attended.

In clinical practice, such aspects should be based on actions that have in its horizon the search for minimization of social harm and health of these women, as well as the resolution of problems (when possible), promoting the social (re)integration of them. Thus, the psychosocial attention mode in mental health dialogues with this perspective in that it advocates care in an integral manner with the components of citizenship and social justice among its assumptions.

Furthermore, it should be noted that a generalization of the results of this survey would not be indicated, since the study brought the problematization of a reality in which there was no limitation on the number of participants, as well as the conduct of research in a unique scenario. Still, it is considered the consumption of crack by women an important and fruitful field for further research in the area of mental health, in order to show that, in the context of psychosocial care, emerge the need to discuss the forms of organization of the services and the conceptions of workers, users and their families in the process of care.

It is notorious the multifaceted characteristic of crack use problems by women, being necessary more researches that address this issue, in order to contribute to the construction of scientific knowledge and the strengthening of mental health network to meet this demand. From the recognition and appreciation of the life story of the person, it extends the possibilities of building a comprehensive care in clinical practice of the multidisciplinary team, considering the subjectivity of each and its social context.

As the phenomenon of drug use a resource that accompanies the human being though all History, to study it, there is a need to put ourselves in a position to consider the context as a central element to the understanding of each being or each group to be studied. After all, studying without the attitude to know and understand the other, indicates a lack in the approach to human being, which is essential for building health actions based on social needs.

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Publication Dates

• Publication in this collection
  Apr-Jun 2016

History

• Received
  17 Sept 2015
• Accepted
  18 Jan 2016