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Women in the Context of the Drugs: Social Representations of Users in Treatment1 1 Paper deriving from the doctoral dissertation by the first author, under the advice of the second author and co-advice of the third author, defended in the Graduate Program in Social Psychology at the Universidade Federal da Paraíba. Support: National Council of Scientific and Technological Development (CNPq, Grant # 140154/2015-9).

Abstract:

Women drug comsumption is a phenomenom influenced by speeches regarding gender relationships and standardizing social structures. This study aims to analyze the representational dimension of female drug users through the social representation theory; it is a qualitative, descriptive field study with 45 women admitted to therapeutic communities and rehabilitation clinics in the states of Paraíba and Pernambuco, Brazil. This study uses a sociodemographic questionnaire and a semi-structured interview, which were submitted to qualitative textual analysis using IRAMUTEQ software. The results indicate that the female drug user is represented as someone who presents a threat and lacks self-control; anchored in representational elements concerning the transgression of social norms, she is considered to have set herself apart from the social roles assigned to women. Such images projected in society and shared by the users affect the manner in which they address chemical dependency and have consequences for their inclusion in their families and society, their expression of identity and the manner in which they perform social roles.

Keywords:
drugs; gender; social representation; women

Resumo:

O consumo de drogas por mulheres é um fenômeno influenciado por discursos acerca das relações de gênero e das estruturas sociais normatizadoras. O objetivo deste estudo foi analisar a dimensão representacional acerca da mulher usuária de drogas a partir da Teoria das Representações Sociais. Trata-se de um estudo qualitativo, de caráter descritivo e de campo, com 45 usuárias em tratamento. Utilizou-se entrevista semiestruturada, submetida à análise textual com uso do software IRAMUTEQ. Os resultados indicaram que a mulher usuária de drogas está representada como alguém que oferece perigo e que não tem o controle de si, ancorada em elementos representacionais objetivados na ruptura de comportamentos pautados nas normas sociais, distanciando-se, assim, dos papéis sociais atribuídos ao feminino. Tais representações postas na sociedade e compartilhadas pelas usuárias têm impacto na forma como elas lidam com a dependência química, repercutindo na inclusão sociofamiliar destas mulheres, na expressão de sua identidade e no exercício de seus papéis sociais.

Palavras-chave:
drogas; gênero; representação social; mulheres

Resumen:

El consumo de drogas por mujeres es un fenómeno influenciado por discursos acerca de las relaciones de género y las estructuras sociales normatizadoras. Se objetivó analizar la dimensión representacional sobre la mujer usuaria de drogas utilizándose la Teoría de las Representaciones Sociales. Estudio cualitativo, de carácter descriptivo y de campo, con 45 usuarias en tratamiento. Se usó entrevista semiestructurada, sometida al análisis textual mediante el software IRAMUTEQ. Los resultados indicaron que la usuaria de drogas está representada como alguien que ofrece peligro y sin control de sí misma; sujeta a elementos representacionales objetivados en la ruptura de comportamientos pautados por normas sociales, alejándose, así, de los papeles sociales atribuidos al femenino. Tales representaciones puestas en la sociedad y compartidas por las usuarias tienen impacto en la forma como estas lidian con dependencia química, repercutiendo en su inclusión sociofamiliar, en la expresión de identidad y en el ejercicio de papeles sociales.

Palabras clave:
drogas; género; representación social; mujeres

Within the pluralist context of social relations, situating the discussion of femininity in the context of drug use means facing a complex phenomenon that is relational in origin and driven by symbolic and representational constructs against a backdrop of political, ideological, and macro-contextual aspects that are interrelated and integrated into the common consensus of how people think about and represent drugs in the feminine universe.

Over the past few decades, greater visibility has been drawn to women and the possible social and health impacts arising from their involvement with drugs, given that it was believed that chemical dependency did not affect this segment of the public because women did not have “visible” experiential problems with drugs and were thus ignored by the public sphere (Medeiros, Maciel, Sousa, & Vieira, 2015Medeiros, K. T., Maciel, S. C., Sousa, P. F., & Vieira, G. L. S. (2015). Vivências e representações sobre o crack: Um estudo com mulheres usuárias. Psico-USF, 20(3), 517-528. doi: 10.1590/1413-82712015200313
https://doi.org/10.1590/1413-82712015200...
). This scenario makes one think that the recent increase in the prevalence of drug abuse and addiction among women has not been accompanied by the development of studies concerning their needs, and it can thus be affirmed that attention to the specific aspects of women in this scenario was marginalized and that most explanations and interpretations were phrased in moral terms, the products of a sociocultural construct concerning the female gender and women’s social roles (Ferreira, 2013Ferreira, L. O. (2013). Saúde e relações de gênero: Uma reflexão sobre os desafios para a implantação de políticas públicas de atenção à saúde da mulher indígena. Ciência & Saúde Coletiva, 18(4), 1151-1159. doi: 10.1590/S1413-81232013000400028
https://doi.org/10.1590/S1413-8123201300...
).

Changes in the social paradigm of women, such as a growing similarity between the social roles of men and women, have been identified in the literature as one of the factors contributing to the increase in the consumption of drugs by women, as noted by Marangoni and Oliveira (2013Marangoni, R. S., & Oliveira, M. L. F. (2013). Fatores desencadeantes do uso de drogas de abuso em mulheres. Texto & Contexto Enfermagem, 22(3), 662-670. doi: 10.1590/S0104-07072013000300012
https://doi.org/10.1590/S0104-0707201300...
). Women have been the target of advertising campaigns that promote their use of legal drugs such as alcohol and, subliminally, stimulants and appetite suppressants, associating them with the idea of beauty, well-being, and social advancement, reinforcing rules for social behavior and the ideal form of the female body (Ferreira, 2013Ferreira, L. O. (2013). Saúde e relações de gênero: Uma reflexão sobre os desafios para a implantação de políticas públicas de atenção à saúde da mulher indígena. Ciência & Saúde Coletiva, 18(4), 1151-1159. doi: 10.1590/S1413-81232013000400028
https://doi.org/10.1590/S1413-8123201300...
). The psychological appeal of the mass media ultimately exercises a negative influence by encouraging women to begin and continue using drugs.

According to present data of the World Drug Report (United Nations Office on Drugs and Crime [UNODC], 2016United Nations Office on Drugs and Crime. (2016). Word Drug Report. Vienna, Austria: UNODC. Recuperado de http://www.unodc.org/doc/wdr2016/WORLD_DRUG_REPORT_2016_web.pdf
http://www.unodc.org/doc/wdr2016/WORLD_D...
), it is estimated that there are 29 million “drug dependent” people in the world, being registered increase of the female population in the epidemiologic profiles. According to such publication, at the United States, for example, it was found that in the last decade more women than men started to use heroin, as noted that in the period of 2002-2004 the statistics were by 0.08% in the period of 2011-2013 this number increased to 0.16%. In an European country, like Portugal, for example, the women have presented higher rates of continuity of the consumption of marihuana, ectasy and hallucinatory mushrooms, when compared to men (Ministério da Saúde, 2015Ministério da Saúde. Serviço de Intervenção nos Comportamentos Aditivos e nas Dependências. (2015). Relatório anual: A situação do país em matéria de drogas de toxicodependência. Lisboa, Portugal: SICAD. Recuperado de http://www.sicad.pt/PT/Publicacoes/Documents/Relat%C3%B3rio%20Anual%20Drogas%20e%20Toxicodepend%C3%AAncias%202015.pdf
http://www.sicad.pt/PT/Publicacoes/Docum...
).

In Brazil, a research with national approach performed by the Fundação Oswaldo Cruz [FIOCRUZ] (2013)Fundação Oswaldo Cruz. (2013). Maior pesquisa sobre crack já feita no mundo mostra o perfil do consumo no Brasil. Recuperado de https://portal.fiocruz.br/pt-br/content/maior-pesquisa-sobre-crack-j%C3%A1-feita-no-mundo-mostra-o-perfil-do-consumo-no-brasil
https://portal.fiocruz.br/pt-br/content/...
on the consumption of cocaine/crack revealed that in the country there are about 370 thousand crack users, which 21.3% are women. The users who go to the so-called “cracklands”, the women sum up a quantitative of 20% and find a conjuncture of higher individual and social vulnerability, presenting low schooling; daily experience of living in street environment; history of sexual violence; uncommon use of preservative; trading of sex for money and/or drugs, among other marking situations of risk to the health.

Such contextualization has demonstrated the notoriety of the drug addiction phenomenon, compared to other periods of the history. However, the image of the “female drug user” is still viewed with reservations by society, whether it is because of abusive behavior with regard to the drug or because it represents a departure from the behavior that is expected of women, whom society still views as being deconstructed from her image as “good” and “virtuous.” This situation is largely due to a narrative discourse that throughout history has delegated certain characteristics and specific roles to men and women, constructed through hierarchized political processes and power between genders, which have been and continue to be imbued with value in social organization. A result of this construction is that women have been represented in the social imagination as more fragile, more emotional, passive, and limited to the domestic space, prioritizing care for the family and fitting into “ideal” models of femininity (Ferreira, 2013Ferreira, L. O. (2013). Saúde e relações de gênero: Uma reflexão sobre os desafios para a implantação de políticas públicas de atenção à saúde da mulher indígena. Ciência & Saúde Coletiva, 18(4), 1151-1159. doi: 10.1590/S1413-81232013000400028
https://doi.org/10.1590/S1413-8123201300...
). Because of this bias, revealed by structures of gender inequalities, drug use by women enters a minefield of disparaging representations of female drug users that legitimate the expression of biased attitudes and social exclusion (Medeiros et al., 2015Medeiros, K. T., Maciel, S. C., Sousa, P. F., & Vieira, G. L. S. (2015). Vivências e representações sobre o crack: Um estudo com mulheres usuárias. Psico-USF, 20(3), 517-528. doi: 10.1590/1413-82712015200313
https://doi.org/10.1590/1413-82712015200...
).

It is not difficult to identify in popular discourse and the media that when referring to female drug users, moral categories are invoked in an attempt to give meaning to the phenomenon, going beyond the realm of health and articulating with legal and, consequently, police practices regarding the issue of drugs in Brazil. Although Brazilian legislation on drugs and Federal Law 11.343 (Lei No. 11.343, 2006Lei No. 11.343, de 23 de agosto de 2006 (2006, 24 de agosto). Institui o Sistema Nacional de Políticas Públicas sobre Drogas. Diário Oficial da União, seção 1.) consider drug users to be “sick” because of the dependency caused by the disease or by psychological problems, the popular imagination still associates drugs with rebellious or deviant behavior, particularly in regard to illegal drugs.

In Bucher’s opinion (1992Bucher, R. (1992). Drogas e drogadição no Brasil. Porto Alegre, RS: Artes Médicas.), women who use drugs resist the control of society’s legal and moral rules and therefore cause “estrangement” in the existing social system. This perspective is similar to Becker’s (2008Becker, H. S. (2008). Outsiders: Estudos de sociologia do desvio (M. L. X. A. Borges, Trad.). Rio de Janeiro, RJ: Zahar.) studies with marijuana users and musicians on deviant behavior, which is based on the notion that social groups establish what is considered a breach of the rules and label rule-breakers as deviants. In this regard, Goffman (2006Goffman, E. (2006). Estigma: La identidad deteriorada (L. Guinsberg, Trad.). Buenos Aires, Argentina: Amorrortu.) performs a symbolic analysis of labels and defines them as “marks” or undesirable attributes that are imposed by society to establish a model for the category of “normality”. By not belonging to this category of normality, female drug users become targets for moralization and disparaging representation, which disqualify them and depersonalize them as “desirable subjects” and label them as dangerous and threats to social life.

Reflections of individual and group social manifestations, these images reveal social constructs that can render women vulnerable in various aspects of life (Medeiros et al., 2015Medeiros, K. T., Maciel, S. C., Sousa, P. F., & Vieira, G. L. S. (2015). Vivências e representações sobre o crack: Um estudo com mulheres usuárias. Psico-USF, 20(3), 517-528. doi: 10.1590/1413-82712015200313
https://doi.org/10.1590/1413-82712015200...
). Despite the subject’s relevance, there is scarce literature concerning women’s involvement with drugs that goes beyond the borders of the individual and the biological, seeking to understand the phenomenon at the level of society and focusing on the production of discourses and representations concerning the group to which they belong.

To pay close attention to this problem and anchored in a perspective of broader social analysis, this study has its theoretical basis in social psychology and the psycho-sociological contributions of social representation theory (SRT), which is understood as reflections of the individual and social manifestation of the social group with which the subject shares experiences and her personal life, that is, her individual responses, such that similar pronouncements reveal a certain level of generalization, a collective manner of thinking about a subject, as proposed by Jodelet (2001Jodelet, D. (2001). Representações sociais: Um domínio em expansão. Rio de Janeiro, RJ: Ed. UERJ.).

This investigation of the phenomenon of female drug users in light of SRT seeks to conceive the social object under consideration in a manner that is not aprioristic, meaning that the object of study will be understood in light of a multifaceted and dynamic approach, designed to construct knowledge that results from the praxis of different social actors and that is shared by the groups to which they belong (Jodelet, 2001Jodelet, D. (2001). Representações sociais: Um domínio em expansão. Rio de Janeiro, RJ: Ed. UERJ.). In the case of this study, these are the female drug users themselves, bringing their life experiences and producing a consensual, elaborated, transformed, and shared understanding of the social object being analyzed.

Accordingly, the question that this study intends to problematize involves the construction of popular knowledge about women in the context of drug use and, specifically, the representational content underlying these women’s discourses, which are exonerated from the broader social context in which they are inserted. It is believed that there is a common consensus of disparaging social representations concerning female drug users that implies exclusion from rights based on differences in the social roles that they have not accepted and sometimes have not tolerated, substantiating social discourses based on crossing the gender line.

From this perspective, this study aims to analyze the representational dimension of female drug users in a search for the meanings that are shared by society and also appropriated and transmitted by the female drug users themselves, affecting their representation and behavior and influencing the exercise of their social roles and their inclusion as active subjects with rights. Above all, this study seeks knowledge about elements that can assist in the treatment and prevention of dependence on psychoactive substances in the group of women, based on their wealth of life experiences, giving them a voice and making them active participants in the process.

Method

The social phenomenon was studied using a qualitative approach that considers the social to consist of a world of meanings that can be investigated through a detailed understanding of the representations of the actors under study.

Participants

The present investigation is a descriptive field study that used non-probability convenience sampling. The participants were 45 women drug users (with an average age of 29.11 years) who were in treatment in therapeutic communities and rehabilitation clinics, exclusive to the treatment of women dependent on chemicals, located in the states of Paraíba (PB) and Pernambuco (PE).

The participants who were interned in the places chosen for the collection, with age above 18 and that agreed on participating of the study were included. The ones who presented cognitive conditions that could undermine the comprehension of the instruments were excluded. The sample number was established by the criterion of the theoretical saturation which according to Fontanella, Ricas, and Turato (2008Fontanella, B. J. B., Ricas, J., & Turato, E. R. (2008). Amostragem por saturação em pesquisas qualitativas em saúde: Contribuições teóricas. Cadernos de Saúde Pública, 24(1), 17-27. doi: 10.1590/S0102-311X2008000100003
https://doi.org/10.1590/S0102-311X200800...
), consists of a continuous process of analysis of data where the interruption of the introduction of new subjects to the sample happens at the moment in which the data collected became repetitive and become redundant, not increasing more significant contribution to the content of the representation.

Instruments

Following the application of a sociodemographic questionnaire to develop a profile of the sample, semi-structured individual interviews were recorded in which the participants’ anonymity was guaranteed. The interview consisted of two questions to which the interviewee could freely respond: “How do you see yourself?” and “How do you think society sees the female drug user?”.

Procedure

Data collection. The data collection phase occurred at the treatment centers in private rooms that facilitated a personal conversation between the researcher and the participant. After a rapport had been established and the purpose of the research explained, the participant was asked to complete the questionnaire, and the recorded interview began, lasting, on average, 25 minutes.

Data analysis. The software IRAMUTEQ (Interface of R pour les Analyses Multidimensionelles de Textes et de Questionnaires), is an computerized software that is anchored on the R software and allows several types of analysis of textual data, among them the Descendent Hierarchical Classification (DHC) (Justo & Camargo, 2014Justo, A. M., & Camargo, B. V. (2014). Estudos qualitativos e o uso de softwares para análises lexicais. In C. Novikoff, S. R. M. Santos, & O. B. Mithidieri (Orgs.), Caderno de artigos: X SIAT & II Serpro (pp. 37-54). Duque de Caxias, RJ: UNIGRANRIO. Recuperado de http://www.academia.edu/11753344/Estudos_qualitativos_e_o_uso_de_softwares_para_an%C3%A1lises_lexicais
http://www.academia.edu/11753344/Estudos...
). In this study, the textual data analysed were resulting from the 45 interviews performed. This lexographical analyses approaches the lemmatising and the calculation of the frequency of words, where the software provides bigger groups called axis, and in these, are organized graded classes that are characterized by their most characteristic words called a posteriori by the researcher, who must name the axis and the classes according to the most representative words in each class and according to the theory used for discussion of the results (Justo & Camargo, 2014Justo, A. M., & Camargo, B. V. (2014). Estudos qualitativos e o uso de softwares para análises lexicais. In C. Novikoff, S. R. M. Santos, & O. B. Mithidieri (Orgs.), Caderno de artigos: X SIAT & II Serpro (pp. 37-54). Duque de Caxias, RJ: UNIGRANRIO. Recuperado de http://www.academia.edu/11753344/Estudos_qualitativos_e_o_uso_de_softwares_para_an%C3%A1lises_lexicais
http://www.academia.edu/11753344/Estudos...
).

Ethical Considerations

The present study was approved by the Research Ethics Committee of the Center for Health Sciences of the Federal University of Paraíba (EPC/CCS-UFPB), under protocol number 0349/12, respecting all guidelines to ensure ethical research involving human beings. In addition, the participants were asked to sign an informed consent form.

Results and Discussion

As to the characterization of the sample, it was possible to identify that the age of the users varied between 18 and 42 years old (M = 29.11); 62% were single; 58% had fundamental schooling; worked in informal badly paid activities (40%); and 51% had between 1 to 2 children. According to these data, it is possible to say that it is a profile of young women with low social economic level and with pregnancy experiences in their life trajectories, supporting the literature that associates the abuse of drugs with situations of social vulnerability and exclusion (Acioli Neto & Santos, 2016Acioli Neto, M. L., & Santos, M. F. S. (2016). Os usos de crack em um contexto de vulnerabilidade: Representações e práticas sociais entre usuários. Psicologia: Teoria e Pesquisa, 32(3), e32326. doi: 10.1590/0102-3772e32326
https://doi.org/10.1590/0102-3772e32326...
).

The data processed from the CHD was composed of 45 Initial Context Units (ICU) (interviews) and presented a division of this corpus in 1540 Units of Elementary Context (UEC), with 7463 words or distinct words. The use of this corpus included 71% of the UECs and were considered for analysis the words with the χ² (chi-square) beginning with 3.84 with 1 grade of liberty, being these meaningful and revealing higher associative strength among each word and its corresponding class (Azevedo, Costa, & Miranda, 2013Azevedo, D. M., Costa, R. K. S., & Miranda, F. A. N. (2013). Use of the ALCESTE in the analysis of qualitative data: Contributions to researches in nursing [Special number]. Journal of Nursing UFPE on line, 7(7), 5015-5022. doi: 10.5205/reuol.4700-39563-1-ED.0707esp201326
https://doi.org/10.5205/reuol.4700-39563...
).

On the interface of the results, the software produced a dendogram (Figure 1) regarding the organization of four graded and organized classes by the program according to its lexical content, yet being aligned by these two big axis, which indicate groupings of context that reproduce the narratives resulting from the interview. In this dendogram, it is observed the description of each of the classes, composed by the title, by the words with higher frequency and association with the mentioned class (χ²), as well as by the number of UECs that compose it.

Figure 1:
Dendogram or descending hierarchical classification about the social representations of female drug users.

Figure 1 shows the articulation of the following axes: Axis 1 - Threat to Society and Axis 2 - Breaking with Accepted Standards, which are considered complementary with regard to the interpretation of the phenomenon under analysis. In the interrelation of these axes, one can observe the presence of elements related to the contextualization of female drug users and specific and figurative elements of the interpretations of the feminine in society.

Axis 1 (Threat to Society) refers to how society views female drug users, as “dangerous” (Class 2 - Danger) and “impulsive” (Class 1 - Impulsivity). The discourses that emerged in these classes showed that the female drug user is viewed as a trouble-maker and, therefore, as a threat to society. Axis 2 (Breaking of Accepted Standards) includes elements relating to the rupture that female drug users’ behavior represents with regard to the social norms expected of women in society, revealing in this discourse the devalorization of the female drug user, who is viewed as a “problem”, in addition to her detachment from the social roles assigned to her. This axis contains discussions that reveal gender asymmetries and power relations that persist in society with regard to women, formed by Class 4 (Separation from Feminine Social Roles) and Class 3 (Moral Devalorization of the Figure of the Woman).

The axes and classes are described below in the order in given by the program; several of the most frequently used words designated by the χ² and the most characteristic data of each class are discussed.

Axis 1 - Threat to Society: Danger (class 2) and Impulsivity (class 1)

The data gathered along this axis represent issues relating to the group of female drug users, in which this is linked to aspects of marginalization, violence, loss of self-control, and the idea that she is capable of doing anything to feed her drug habit.

In class 2 (Danger), it becomes evident that the image of the female drug user was associated with danger, whether in the family context or through the act of pilfering household objects or personal items from those around them, as highlighted by the expressions that were closely associated with the class in question, such as the words “home” and “take”, as well as public thefts and robberies, represented by the words “steal” and “take.” The excerpt below illustrates this discourse:

Sometimes, I’d leave the house to go out and steal in public, take things from the supermarket, from people’s houses. But it got to the point that if I asked for a drink of water, nobody would even let me in for fear I’d take something. Everybody was afraid I’d steal a cell phone (Woman 15, age 24).

Based on this excerpt from the user’s words, it is possible to identify representations that associate drug users with marginalization and threats to the social order. In this regard, several authors also indicate that users are commonly viewed as dangerous, violent, and solely responsible for their condition (Acioli Neto & Santos, 2016Acioli Neto, M. L., & Santos, M. F. S. (2016). Os usos de crack em um contexto de vulnerabilidade: Representações e práticas sociais entre usuários. Psicologia: Teoria e Pesquisa, 32(3), e32326. doi: 10.1590/0102-3772e32326
https://doi.org/10.1590/0102-3772e32326...
). In an international context, Fortney et al. (2005Fortney, J., Mukherjee, S., Curran, G., Fortney, S., Han, X., & Booth, B. M. (2005). Factors associated with perceived stigma for alcohol use and treatment among at-risk drinkers. The Journal of Behavioral Health Services & Research, 31(4), 418-429. doi: 10.1007/BF02287693
https://doi.org/10.1007/BF02287693...
) find in their study that primary care professionals are quick to implement preventive measures with regard to drug users, and the results show that these professionals feel unprepared to work with this public because they consider the patients to be dangerous, blame the patient for her condition, and thus subject patients to prejudice and segregation.

That said, it is obvious that the view of users as dangerous is associated with their potential to interfere with stability and, therefore, with the smooth functioning of society. This conception views drug addiction as a real threat to “social values” and, therefore, as a “deviation”, as proposed by Becker (2008Becker, H. S. (2008). Outsiders: Estudos de sociologia do desvio (M. L. X. A. Borges, Trad.). Rio de Janeiro, RJ: Zahar.), that is, as an agent who produces continuous social disintegration, with significant repercussions, particularly within the family.

As shown in this study, female users are considered to be as dangerous as male users. Through her addiction, the female user loses her female identify and dons the garb of a drug user, being associated with criminality and danger. With regard to drugs, the factor that determines relations and stereotypes is not gender but rather the drug abuse and its association with marginalization and crime.

Similarly, Class 1 (Impulsivity) draws together discourses that refer to impulsive behavior and a lack of self-control. In this class, the female drug user is conceived in terms of her drug consumption and the effects and sensations that it provides as well as in terms of her behavior toward the drug, exemplified in the words “smoking” and “feel”. The excerpt below illustrates a fragment of a typical conversation:

We didn’t feel happy about anything anymore. The only moment of pleasure was when I was smoking, I didn’t care about anything else, it didn’t matter what anybody said, I just wanted to feel that moment. I’d go out to smoke whenever that craving hit me. I saw myself like that, out of control (Woman 44, age 37).

In this regard, is should be noted that the interpretations based on common sense knowledge about drug use problems are permeated with behavioral changes that view the user as a person who is driven by impulses, unpredictable, and, therefore, devoid of reason. This modern logic of ensuring parameters for normality and organizing what is socially acceptable is also observed in the group of mental patients, as reported by Maciel, Pereira, Lima, and Souza (2015Maciel, S. C., Pereira, C. R., Lima, T. J. S., & Souza, L. E. C. (2015). Desenvolvimento e validação da Escala de Crenças sobre a Doença Mental. Psicologia: Reflexão e Crítica, 28(3), 463-473. doi: 10.1590/1678-7153.201528305
https://doi.org/10.1590/1678-7153.201528...
). Regarding drug users, in addition to the stigma of being “crazy”, “senseless”, and “unpredictable”, they are also labeled as “junkies”, particularly when associated with illicit drugs that are often related to misconduct, failure, and crime (Hartmann, 2013Hartmann, M. R. (2013). Representações sociais e ideologia: O usuário de drogas segundo Correio do Povo e Zero Hora (Tese de doutorado). Recuperado de http://www.lume.ufrgs.br/bitstream/handle/10183/80075/000901992.pdf?sequence=1
http://www.lume.ufrgs.br/bitstream/handl...
).

To the representation of mental patients as being devoid of reason is added the illegality of drug use, with the result that drug users are viewed as more unpredictable, more violent, and more responsible for their own problems than are individuals who suffer from other mental disorders (Ronzani, Noto, & Silveira, 2014Ronzani, T. M., Noto, A. R., & Silveira, P. S. (2014). Reduzindo o estigma entre usuários de drogas: Guia para profissionais e gestores. Juiz de Fora, MG: Ed. UFJF. Recuperado de http://www.editoraufjf.com.br/ftpeditora/site/reduzindo_o_estigma_entre_usuarios_de_drogas.pdf
http://www.editoraufjf.com.br/ftpeditora...
). In their study of social rejection of users of alcohol, marijuana, and cocaine, Soares et al. (2011Soares, R. G., Silveira, P. S., Martins, L. F., Gomide, H. P., Lopes, T. M., & Ronzani, T. M. (2011). Distância social dos profissionais de saúde em relação à dependência de substâncias psicoativas. Estudos de Psicologia (Natal), 16(1), 91-98. doi: 10.1590/S1413-294X2011000100012
https://doi.org/10.1590/S1413-294X201100...
) find greater levels of social rejection when the user was described as a cocaine addict, revealing a strong association between social rejection and a perception of the user as potentially violent.

These data reflect that among the various health conditions commonly stigmatized by society, the use of alcohol and other drugs is one of the most likely to carry a moralistic connotation, particularly in regard to users of illegal drugs (Fortney et al., 2005Fortney, J., Mukherjee, S., Curran, G., Fortney, S., Han, X., & Booth, B. M. (2005). Factors associated with perceived stigma for alcohol use and treatment among at-risk drinkers. The Journal of Behavioral Health Services & Research, 31(4), 418-429. doi: 10.1007/BF02287693
https://doi.org/10.1007/BF02287693...
). By this logic, regarding the drug user as a “threat” imprints a social stigma as something “harmful” and “undesirable”, that is, something outside the parameters considered normal by society, which reinforces the symbolic character of the social imagination according to which the stigmatized people are considered incapable of and harmful to healthy interaction in the community.

Any discussion of drugs inevitably leads to the field of politics and ideology, which, according to Thompson (2009Thompson, J. B. (2009). Ideologia e cultura moderna: Teoria social crítica na era dos meios de comunicação de massa (Grupo de Estudos sobre Ideologia, Comunicação e Representações Sociais da Pós-Graduação do Instituto de Psicologia da PURCS, Trad.). Petrópolis, RJ: Vozes.), is conceived as the use of symbolic forms to establish or reproduce asymmetrical, unequal, and unjust social relations in social dynamics. According to Becker (2008Becker, H. S. (2008). Outsiders: Estudos de sociologia do desvio (M. L. X. A. Borges, Trad.). Rio de Janeiro, RJ: Zahar.), rules, deviations, and labels are always constructed through political processes in which some groups can impose their perspective as more legitimate than others. This author defines deviance as the “product of a transaction that occurs between some social group and one who is viewed by that group as a rule-breaker” (Becker, 2008Becker, H. S. (2008). Outsiders: Estudos de sociologia do desvio (M. L. X. A. Borges, Trad.). Rio de Janeiro, RJ: Zahar., p. 22). This conception understands that drug users threaten the social order and therefore become targets for devalorization and the consequent exclusion from social spaces.

The female drug user is thus represented by a “deteriorated” and visibly disqualified image, and the social representations expressed on this axis are permeated by and anchored in supposedly scientific knowledge shared by the media and society that justifies and standardizes the behavior of drug users, portraying them as bereft of their sanity, impulse-driven, and, therefore, unpredictable and dangerous. This discourse strengthens skepticism concerning whether drug addiction can be cured and casts it as a problem that is to be legally and socially addressed.

Axis 2 - Breaking with Accepted Standards: Separation from Feminine Social Roles (Class 4) Moral Devalorization of the Figure of Woman (Class 3)

This axis shows discourses that cover the understanding of the image of the female drug user as incompatible with what society regards as a woman’s role. There is an understanding that drugs cause the woman to break with norms, resulting in a distancing from her social roles and her moral devaluation.

Class 4 (Separation from Feminine Social Roles) indicates the distancing of the woman from her role in the family and society as a mother and caregiver for children and the home, as can be observed in the use of the terms “child” and “take away”. The conversations indicated a context of negligence and irresponsibility with regard to the roles of mother and homemaker. The following excerpt from a conversation illustrates this point:

I wouldn’t go home for long stretches at a time . . . it was my brother who raised my daughters . . . being a mother is a privilege, I think, but when we are not able to, because a person on drugs isn’t able to take care of themselves, being a mother isn’t a good choice (Woman 8, age 28).

It may be observed from this conversation that, culturally, a society transmits and provides a range of roles and symbols in reference to the figure of a woman, with the interviewee’s words highlighting the responsibility for preserving the species, linked to the shackles of motherhood and the naturalization of biological traits appropriate for parental care within the family framework. However, the fact that the woman is experiencing a problem with drug use is considered a major social threat to the model of wife, mother, and sexuality. This argument occurs through the replicability of the discourses in society regarding the incompatibility and inadequacy of the drug user in fulfilling the previously defined feminine functions and roles; it is also possible to perceive that this hegemonic discourse has been adopted by the drug users themselves, internalized and taken as truth, as observed in the excerpt cited above, thus determining behaviors and blame.

Some scholars have dedicated themselves to analyzing how female drug users experience issues related to motherhood. In their study, Marangoni and Oliveira (2013Marangoni, R. S., & Oliveira, M. L. F. (2013). Fatores desencadeantes do uso de drogas de abuso em mulheres. Texto & Contexto Enfermagem, 22(3), 662-670. doi: 10.1590/S0104-07072013000300012
https://doi.org/10.1590/S0104-0707201300...
) indicate that drug users report experiencing difficulty performing maternal tasks and leaving their children alone or with family members for long periods while they go out in search of drugs; this factor is also found in the present study. Numerous other studies have covered the use of drugs during pregnancy, most of them highlighting the consequences for the physical formation of the fetus, with teratogenesis assuming epidemic proportions in obstetrics (Martins-Costa, Vettorazzi, Cecin, Stump, & Ramos, 2013Martins-Costa, S. H., Vettorazzi, J., Cecin, G. K. G., Stumpf, C. C., & Ramos, J. G. L. (2013). Crack: A nova epidemia obstétrica. Revista HCPA, 33(1), 55-65. Recuperado de http://www.seer.ufrgs.br/hcpa/article/viewFile/33833/25672
http://www.seer.ufrgs.br/hcpa/article/vi...
). These studies generally tend to blame and criminalize female drug users, as though they were “murderers” or terrible mothers to their children.

According to Scavone (1985Scavone, L. (1985). As múltiplas faces da maternidade. Cadernos de Pesquisa, (54), 37-49. Recuperado de http://publicacoes.fcc.org.br/ojs/index.php/cp/article/view/1392
http://publicacoes.fcc.org.br/ojs/index....
), there is a normative appeal in the fact of giving birth and providing care to children, emphasized as a personal achievement for women because they are the protagonists in the process of the continuity of life. This reality points to a domestic imbalance in which a failure to perform the maternal role is a rejection of the idea of a “symbol of fecundity” and femininity. Despite changes in feminine social roles over recent years, such as new family configurations and the choice not to experience motherhood, women’ involvement with activities such as drug use, which is perceived as “transgressing” social roles, provokes a reflection of collective social estrangement and “social failure” with regard to what society expects of a woman. In this sense, it is possible to say that the social representations of female drug users are anchored in biologizing and submissive conceptions, crystallized around their social roles, particularly that of mother.

Similarly, class 3 (Moral Devalorization of the Figure of Woman) presents meanings associated with a loss of moral value related to the image of women in the context of drug use, visualized through the words “trash” and “worthless”. The excerpt below demonstrates this point: “People rejected and cursed me, said I was a slut, worthless, a prostitute, and a dyke. Some people think we drug users don’t care about that kind of thing, but we do. It hurts, it makes us feel like trash” (Woman 12, age 25).

This phrasing reveals a discourse cloaked in moralistic “garb”, the product of a construction at the symbolic level that entails social control over a woman’ body and sexuality. In this issue, Maciel and Medeiros (2017Maciel, S. C., & Medeiros, K. T. (2017). Mulheres usuárias de crack: Enfrentamentos e barreiras sociais. In A. Roso (Org.), Crítica e dialogicidade em psicologia social: Saúde, minorias sociais e comunicação (pp. 1-42). Santa Maria, RS: Ed. UFSM.) adds that female sexual identity has appeared throughout history as something veiled, the target of repression, and that those who express their sexuality in public are subject to moral and social “condemnation”.

The historical narrative that addresses the involvement of women with drugs, even in recent records, is built on their condition as rule-breakers and flouters of the norms stipulated by society for the exercise of femininity, being associated with the practice of prostitution, which is considered a threat to the family structure (Macedo, Roso, & Lara, 2015Macedo, F. S., Roso, A., & Lara, M. P. (2015). Mulheres, saúde e uso de crack: A reprodução do novo racismo na/pela mídia televisiva. Saúde e Sociedade, 24(4), 1285-1298. doi:10.1590/S0104-12902015138833
https://doi.org/10.1590/S0104-1290201513...
). Similar results are found by Maciel and Medeiro’s (2017Maciel, S. C., & Medeiros, K. T. (2017). Mulheres usuárias de crack: Enfrentamentos e barreiras sociais. In A. Roso (Org.), Crítica e dialogicidade em psicologia social: Saúde, minorias sociais e comunicação (pp. 1-42). Santa Maria, RS: Ed. UFSM.) study of crack users, in which women report being labelled by society as “worthless”, “whores”, and “irresponsible” and being the victims of prejudice and stigmatization.

This manner of representing the female user refers to a deteriorated feminine identity proposed by Goffman (2006Goffman, E. (2006). Estigma: La identidad deteriorada (L. Guinsberg, Trad.). Buenos Aires, Argentina: Amorrortu.), as social stigma and derives from a succession of historical facts in which the subjects, due to their behavior, are blamed for damage to society, with a consequent depreciation to the holder of the stigma. One of the consequences of the stigma for the stigmatized individual is the internalization of this. Authors like Ronzani et al. (2014Ronzani, T. M., Noto, A. R., & Silveira, P. S. (2014). Reduzindo o estigma entre usuários de drogas: Guia para profissionais e gestores. Juiz de Fora, MG: Ed. UFJF. Recuperado de http://www.editoraufjf.com.br/ftpeditora/site/reduzindo_o_estigma_entre_usuarios_de_drogas.pdf
http://www.editoraufjf.com.br/ftpeditora...
) and Sibitz, Unger, Woppmann, Zidek, and Amering (2011Sibitz, I., Unger, A., Woppmann, A., Zidek, T., & Amering, M. (2011). Stigma resistance in patients with schizophrenia. Schizophrenia Bulletin, 37(2), 316-323. doi: 10.1093/schbul/sbp048
https://doi.org/10.1093/schbul/sbp048...
), say that the internalized stigma is a subjective process characterized be the agreement and implementation of the social stereotypes to themselves. About this, it was observed in this study a self-responsibility of the own users towards their lives and negative experiences with the drugs, translating into an internalization of the stigma, presenting themselves, undervalued, marginalized and guilty for becoming sick.

On the culpability of the individuals Macedo et al. (2015Macedo, F. S., Roso, A., & Lara, M. P. (2015). Mulheres, saúde e uso de crack: A reprodução do novo racismo na/pela mídia televisiva. Saúde e Sociedade, 24(4), 1285-1298. doi:10.1590/S0104-12902015138833
https://doi.org/10.1590/S0104-1290201513...
) highlights this issue, stating that historical facts refer to assumptions linked to hygienist reasoning, which blames individuals and attributes health problems to behavior or to involvement with unhealthy or immoral practices. For the authors an example of this point is the discourse that blames prostitution for the dissemination of sexually transmitted diseases; such common wisdom contributes to the feeling of worthlessness among members of this group and to the construction of cultural synonyms in the collective mind with respect to discourses imbued with negative and prejudiced images of the female drug user.

The results of this study indicate that the representation of the female drug user is still revealed by the social function that is assigned to her. It is apparent that the two feminine social roles are viewed as being inextricably linked in structuring a woman’s identity, and in this respect, the participants in this study view themselves as being unfit for the social and cultural responsibilities that are attributed to women; they exclude themselves from this social group, which has significant implications for the formation of their identity, self-esteem, and ability to perform their roles in society.

An understanding of the representational dimension of the female drug user allows access to the reasons used by this affinity group to guide judgments and actions with regard to the world and about their own experiences, making it possible to know how they address the facts of everyday life and reproduce knowledge that governs the process of communication and action in relation to the phenomenon of drugs and the women who use them.

The meanings attributed to “being a woman” and “drug user” are shown to be closely associated with a condition of vulnerability that seems to influence the retention of information about prevention and, consequently, the difficulty of access to public health services. This issue calls for a paradigm for understanding drug addiction among women that goes beyond a fragmented vision of women and their social roles to fully integrate women’s subjective and health needs. There is an obvious need for incorporating a heterogeneous perspective in campaigns aimed at preventing drug use and rehabilitating female drug users to recognize the psychosocial impacts of constructions of femininity, in search of more humane, less blame-based treatment.

Knowing the social representations of female drug users has enabled us to understand this phenomenon from the perspective of a common consensus, built on the backbone of society and shared among social actors. Through this knowledge, it was possible to access the manner in which this group (female drug users) is perceived, identifying the shared set of knowledge that underlies the beliefs, values, and attitudes related to this phenomenon.

The analysis of the data collected shows that the female drug user is represented as “doubly deviant”, both in her consumption of substances regarded as causing personal and social instability and in her failure to fulfill her assigned roles in society.

The repetition of terms, ideas, beliefs, stereotypes, and values is nothing more than the immense structure of images and knowledge on which people draw to understand the phenomenon in question, guide their practices, and give meaning to social life. It is worth noting that in their discourse, the interviewees hold themselves solely responsible for all of the damage caused to themselves, those around them, and their community; these images arise as though they were “self-fulfilling prophecies” because the users themselves adopt and share a discourse based on blame that excludes them from the very group to which they belong.

It is hoped that these results may contribute to illuminating new intervention proposals, with a view to demystifying these repressive, blame-based ideologies and reformulating treatment plans to consider the specific characteristics of women and their real needs. Along these lines, more recent studies that incorporate discussions of gender have sought in recent years to avoid fixed, naturalized binary oppositions, instead postulating a relational dimension between genders, bringing new interpretations and new approaches and perspectives to diverse historical contexts. It is necessary to break with the crystallization of images and representations of fragility, control, delicacy, paragons of virtue, and manners historically and socially tied to the identity attributed to women to seek to understand the multiple faces of femininity, which vary depending on the social and political context and particularly in relation to these women’s involvement with drug use.

This study is limited by the fact that it includes representations culled from interviews with female drug users in treatment exclusively and should be expanded to include other segments of society, particularly mental health workers and the population in general and particularly with regard to stereotypes and prejudices. From this perspective, it is important to emphasize that the present study highlights an important aspect: how the negative meanings attributed to female drug users influence how society views them and, particularly, how they themselves address the problem of drug use and their expectations for themselves, which affects their search for help or their persistence in specialized health treatment programs. Another unique aspect that can be taken up in future studies emerged from the discussions: the question of which factors explain the expression of biased attitudes toward female drug users. We live in a society in which gender constrains people’s action, and many still believe that there are activities and behaviors that are appropriate only to men or to women. Therefore, it is necessary to consider gender differences in proposals for developing public policies. Drug use is a sensitive topic that should be discussed with society in a more tolerant and less punitive manner; otherwise, it will be difficult to establish assertive and effective policies to reduce the consumption and harmful consequences of drug abuse, particularly among women.

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  • 1
    Paper deriving from the doctoral dissertation by the first author, under the advice of the second author and co-advice of the third author, defended in the Graduate Program in Social Psychology at the Universidade Federal da Paraíba. Support: National Council of Scientific and Technological Development (CNPq, Grant # 140154/2015-9).
  • 10
    How to cite this article: Medeiros, K. T., Maciel, S. C., Sousa, P. F (2017). Women in the context of the drugs: Social representations of users in treatment. Paidéia (Ribeirão Preto), 27(Suppl. 1), 439-447. doi:10.1590/1982-432727s1201709

Publication Dates

  • Publication in this collection
    Dec 2017

History

  • Received
    03 Feb 2017
  • Reviewed
    15 Aug 2017
  • Accepted
    18 Oct 2017
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