The challenge for women with a drug-abusing family member: the Jamaican perspective
Author: K. BOYCE-REID
Pages: 23 to 30
Creation Date: 1995/01/01
Lecturer in Social Work and Coordinator of the Certificate in Addiction Studies Programme, University of the West Indies, Mona, Kingston, Jamaica
The abuse of alcohol and other drugs presents a multiplicity of problems for the abuser, family members and the wider community. The psychosocial, as well as the economic, problems can produce an environment of chaos and misery. Women in families in which there is an abuser are challenged in a variety of ways and, depending on the severity of the situation and their capacity to cope, they may confront the problem, seek help or withdraw from it.
The present article reviews the impact of drug abuse within the family on Jamaican women from the viewpoint of treatment and rehabilitation specialists and the women themselves and on the basis of case histories and the work experience of the author. Although there have been efforts through demand reduction strategies and culturally relevant treatment and rehabilitation programmes to control the epidemic of drug abuse, the specific needs of women have been left largely unattended. Both men and women are however critical in the fight against drug abuse and women have the skills and experience that en contribute to making such programmes achieve their desired objectives. Addressing their needs would not only help them, but also the family and the wider community. In order to address these needs effectively with the limited resources available, however, a credible basis for action has to be established, which can only be done by research and analysis so that the issues can be clearly defined and a plan of action developed.
The abuse of drugs that harm or threaten the physical, mental or social wellbeing of the user, his or her family and society is not new to Jamaica.
Up to two decades ago, the island did not perceive itself as having a problem with drug addiction. Since the early 1980s, however, the picture has changed considerably. While the extent of the problem is difficult to determine, there is enough evidence from police records, clinic records and family problems, which have been linked to cocaine abuse, to conclude that there is a problem, created not just by the trafficking of cocaine, but worse, by its consumption. Ten per cent of the violent crimes committed in Jamaica are said to be related to drugs. Between June and October 1995, 3,114 Jamaicans were arrested for drug offences  .
A national ethnographic study recently undertaken in Jamaica found that the most commonly used substances were alcohol, tobacco, ganjaand cocaine, which is either ingested or inhaled  . Intravenous drug use was attributed to tourists. While the extent and pattern of the use of alcohol and tobacco had showed little change compared with the findings of earlier studies, the data suggested an increase in the use of ganjaand that more women had been involved than was previously the case. Ganja,which the study showed was significantly more popular than cocaine, had gained in social acceptability because cocaine was seen to have devastating consequences.
In the complex quest to come to grips with the issue of drug abuse, the problems are often easier to recognize than they are to define. Its nature, complexity and impact can probably best be understood by focusing on the individual, such as the woman as part of a family unit, and on the challenges that confront her in dealing with a drug-abusing partner, child or other relative.
The family provides the most important context within which health is maintained and a health issue is resolved  . Unfortunately, the focus has tended to be more on the family as a social cause of illness than on its role in the maintenance of health. Living free from abusing substances or indulging in substance-abusing behaviour is inextricably linked to a healthy family system. Where there is abuse of alcohol and other drugs, there are complex problems for the abuser, family members and the wider community. The biological, psychological, social and economic issues, which may all present themselves, can produce an environment of misery and chaos.
Several research studies have recounted the detrimental impact of substance abuse, particularly alcoholism, on families  . Family members experience social isolation, poor communication within and outside the family, a lack of cohesiveness, shame and guilt, child neglect, physical and sexual abuse, domestic violence and role confusion. Children experience difficulties with trust and intimacy and in these circumstances learn not to build up an expectation of having their needs gratified. They often carry these difficulties over into their adult relationships. Many of the difficulties are related to the attitude of denial and the way in which the members of a family adapt to dysfunctional members.
Some researchers have focused on women in drug-abusing situations. Where there is an alcoholic father, for example, the mother may become so preoccupied with his problem that her energies become directed to parenting him and a psychological abandonment of her child results. In an ethnographical study by Dreher  , it is noted that, in respect of personal health, few respondents had a concept of addiction and most could not distinguish between the physio-psycho-socio-economic effect of substances. However, over 80 percent felt that cocaine, particularly in the form of crack, resulted in mental changes. Among the conclusions that Dreher drew is that cocaine does have a disruptive impact on the family and that this issue needs to be addressed.
Moos and Billings summarize some responses given by women who have encountered substance abuse in the family  . In order to cope with this problem, such women may engage in cognitive avoidance, active confrontation, behavioural withdrawal, professional consultations and activities outside the home to gain some independence. Depending on the severity of the problem, more than one strategy is employed, but the single most prevalent attempt at coping is behavioural withdrawal.
Jamaican women, like other women in the region and many other parts of the world, have been making a contribution to the development of their societies, sometimes against many odds. The economic difficulties that pervade the Caribbean islands and the structural adjustment policies that Governments have enacted have had an impact on women's lives in varying degrees depending on their own economic situation and status. In effect, women consider that their ability to advance is directly linked to their awareness of education and work opportunities  . It has been observed that women have steadily moved from traditional areas of activity into new fields, gaining public recognition and improvement in their status as a result.
Like other Caribbean women, Jamaican women function in roles that span both the private and public domain and they have managed to make the dual roles of mother and worker compatible, working outside the home while carrying responsibility for maintenance of the household and the care and protection of children. In Jamaica, 45 percent of all households are headed by women. But, as Senior points out, this statistic must not be taken as a sign of "woman power" but rather as a sign of the feminization of poverty as women in those roles are usually at a great disadvantage  . If a man is present in the household, however, he may be regarded as head, although only symbolically, as his authority is usually more related to the financial contribution that he is able to make and that the family feels it can expect of him  . A recent study of gender socialization has revealed that men and women hold firm to their traditional assumptions about each other  . Manhood clearly implies authority especially over women and children. While women continue to make inroads into male-dominated fields, a trend that has generally been favourable for them despite the demands, it has not worked in the opposite direction for men.
Women have been nurtured into, and highly value, the caring role ascribed to them. They are in effect enmeshed in an extensive system of familial and community support so integral to their experience that it is often taken for granted  . Mothers continue to be on the front line in child-rearing activities, and while some fathers are willing to help, their contribution remains optional and they often remain on the sidelines while the mothers carry the responsibility.
The upbringing, discipline and education of children are, however, high priorities for parents and families. It had been difficult until recently to make any credible analysis of Caribbean men, their role as parents and attitude towards parenting, as there has been a dearth of objective data on which to make an assessment. However, this situation is beginning to change, and recent research projects are creating a new picture. For example, while it has been confirmed that women are the primary care-givers often without the presence of the father, there is evidence that men are making a more positive contribution to family life than the popular stereotype would suggest. There is also evidence that fatherhood has a strong meaning for men, and that they are actively involved with their children and perform domestic chores. They do not, however, feel that their lives are enhanced by these tasks.
All this evidence is set against the background of the rather interesting family forms and patterns that are described by some people as diverse and complex, but that have existed unchanged in the region for centuries.
A three-point classification developed by Roberts and Sinclair in 1978 describes the three states of union that are common in Jamaica  . They are:
Formal marriage, meaning a legally sanctioned union in which the partners share a common household;
Common-law union in which the partners live together without legal sanction but in a sexual relationship and share a common residence;
Visiting arrangements, where the partners live in a sexual relationship but do not share a common residence.
These patterns hold good for Jamaica, but they are similar in the rest of the Caribbean to a greater or lesser degree.
The image of Jamaican women is that of strong, independent, dominant and resourceful beings. They are indeed accustomed to facing challenges, a task that, for their own survival and that of their households, requires that they develop strategies for coping.
In order to understand the nature of some of these challenges when there are substance abusers in the family, a small sample of treatment and rehabilitation practitioners were asked to identify the ways in which this problem affects women. From their casework, they identified the following problems experienced by women:
Family disintegration, especially if the abuser is a co-parent and not only provides economic support but also assists with the care and supervision of children. The inability of the mother to maintain order exposes the children to the risk of abuse and to the risk that they could themselves indulge in drug-abusing behaviour;
Economic deprivation, which may result if the family unit is wholly or partially dependent on the abuser for financial support, or if the abuser misuses the family's financial resources to support the drug habit;
Alienation which, despite strong family ties, can affect a woman who is close to an abuser causing that woman to become alienated from the support of her family and community and from colleagues at her place of work. This situation may in part be due to others not being able to understand why the woman would choose to remain in an abusive and potentially explosive situation;
Domestic violence, including physical, sexual and emotional abuse of mothers and their children;
Stress, physical and psychological, which may be so overwhelming that the woman is unable to function normally. This situation could also expose her to the risk of relying on substances, albeit legal ones;
Embarrassment, when a woman becomes confused and distressed, especially in situations where she has little or no control over the abuser's behaviour and in fact feels ashamed of it and may even blame herself.
The practitioners felt that many of these problems were related to the lack of knowledge that women had about the nature of substance abuse and the unavailability of services to assist them. They expressed concern especially for those who had a need to escape from their abusive environment, but who had either no place to which they could go or no place that would take them and their children.
In order to obtain a more subjective view of the situation, three cases were reviewed and the women involved were interviewed as they waited with their relatives in an out-patient screening clinic at the University Hospital in Kingston. One woman had brought in her alcoholic 57-year-old mother. She said that her mother had been drinking for over 20 years and that she had tried in every way to get her mother to break with the habit. The daughter had tried before to obtain help for her mother but she was uncooperative. The daughter was her mother's only child and, therefore, the burden of care rested on her. She talked about her anger and her embarrassment especially when she faced her own children (the grandchildren of the abuser) and friends who knew that her mother was an alcoholic.
The other two women had brought their sons who had both abused cocaine. Both were in their early twenties and both were the second of five children. The mothers felt that their sons had begun abusing drugs while they were at high school. The mothers had noticed behavioural changes but were not sure what those changes signified. Eventually the school careers of their sons were terminated.
In one case the father had migrated several years earlier and there had been no communication from him. In the other case, the father had refused to have anything to do with his son's problem, to the point where he had made the family relocate so that the abuser would not be able to cause them any trouble. The mother, however, had kept track of their son through her friends and, because she felt he wanted help and could be helped, she had sought him out and brought him to the clinic.
The women recounted the impact on their lives; one said:
"My whole life is inside out, I feel I have no control over the situation. I am so caught up with him that the other children feel neglected and it is a strain for me to try to please everyone. I worry about him. I spend every waking moment wondering what is happening to my child. It is especially difficult when it rains and I don't know if he is in any form of shelter. I am only able to cope because of my religious belief."
The other said:
"With father out of the picture, the sole responsibility for caring for the children is mine. The problem affects my work, I cannot concentrate,
I am forgetful, I cry a lot and I feel helpless. I have no control over him and he abuses me and the other children. I have migraine headaches and have to be under a doctor's care. I have no immediate family to help me but my employer has been very supportive."
Both women felt that the abuse of drugs by their sons was linked to the poor or non-existent relationship to their fathers. In the words of one:
"I think it's the poor relationship with his father. Men have difficulty expressing love to their sons."
Some women do seek help and will make the sacrifices necessary to obtain this help.
Statistics indicate that 50 per cent of those who participate in the community- based prevention and training activities in Jamaica are women. Data from the Addiction Alert Organization in Kingston, which operates a hot line, show that, in the first six months of 1995, of the 462 calls received, 55.4 per cent were from women and the majority (82 percent) were calling in connection with the drug abuse of a family member or a friend. Conversely, 62.7 percent of the calls received from male callers were about themselves.
Records for 1994 at the Detoxification Unit of the University Hospital in Kingston showed that of the 78 admissions, women represented 62 per cent of those who accompanied the patient. This statistic is significant and indicates the level of importance that women attach to their caring role and to supporting the efforts of the abuser to find help. The relationship of these women to the patients varied from spouse to mother, grandmother, niece or "baby mother", the name often given to a woman whose common-law union with a man has produced offspring.
Data from the screening clinic were consistent with these findings. Of the 270 persons who attended the clinic in 1994, 50 percent had been referred by a family member. Of that number, 57 percent had been referred by a female family member or friend.
Practitioners report, however, that while it is true that women do seek help, they often do so after years of enduring the problem and silent suffering. They are therefore a hidden group for whom appropriate services must be provided.
At the policy level, the planning and delivery of health services must become more gender-sensitive and depart from the traditional approach to dealing with the health issues of women. Provision must be made to address the physical needs of women as well as their psychosocial needs. Despite structural adjustment policies, the provision of adequate health facilities and the maintenance of a physically healthy population must remain a priority.
A national effort will also be required in educating women on such health issues as addiction, stress and mental health so that they can contribute their own ideas to policy formulation from an informed position.
Governments must also be prepared to support and encourage initiatives aimed at helping women. Such initiatives may spring from the efforts of non-governmental organizations, community groups, local associations, churches or service clubs. These agencies may serve women on an individual or group basis as some already do.
The Crisis Centre in Jamaica is one such agency. It was established in 1985 by Woman Inc., a charitable non-profit organization. There are two branches and a shelter for battered women. Clients who present a variety of problems are seen on a daily basis and there is a 24-hour telephone counselling service. Data from this source reflect an increase in domestic violence from a total of 24 cases in 1985 to 399 in 1995. Staff report that a high number of these cases are related to substance abuse. They are concerned about the apparent trend and particularly the fact that they are able to do very little about it because of inadequate staff and other resources.
It is clear from the experience of this agency that far more needs to be done to develop crisis intervention and to encourage some direct work with women, on an individual basis, in order to help them to overcome their sense of isolation and to gather the emotional strength needed to participate in therapeutic support groups.
While there are support groups and self-help groups on the island, very few serve the specific needs of women who are faced with substance abuse in the family. The literature speaks eloquently of the value of support groups for persons who have suffered abuse or periods of turbulence in their lives. There is little doubt of the lasting impact that such groups have on participants especially as the groups foster mutual aid and networking, which is so vital to developing and sustaining the skills of the individual in problem solving.
Two factors are important in such groups. First, the goal must be to empower women so that they can acquire a sense of mastery over the problem and the competence to deal with it. Secondly, women must be provided with the opportunity to educate themselves about addiction, its aetiology, effects, impact and treatment so that they can see the addiction of a relative not as a sign of their own weakness nor the weakness of their families but as a symptom of a problem that may originate from an earlier time or a cause beyond the family's control.
There is evidently a need to develop a standardized data collection system with particular reference to substance abuse in the family so that those areas that pertain to men, women and children can be identified, isolated and appropriately addressed. This undertaking would also help to give a full picture of the extent of the needs so that overall policies and programmes can be more properly designed and limited resources more creatively utilized. Plans would be expected to cover such areas as education at the formal and community level, prevention programming and the delivery, monitoring and evaluation of services.
Women have over many decades demonstrated their willingness to stay on the front line and to help their families through various crises. Their contribution to the national efforts to reduce demand is acknowledged and considered vital to the success and sustainability of such programmes. It is however recognized that any efforts to deal with the epidemic of drug abuse must have the full participation of men and women at all levels, from problem identification, and strategy formulation to programme implementation. Both sexes have skills that can contribute to enabling these efforts to achieve the desired objectives. While the needs of women in particular must be addressed and their special skills harnessed and utilized so that they can help themselves and others, it is vital to include men in the educational process. Unless men can reach an understanding of the problem of drug abuse and begin to take responsibility for it, it is possible that the best initiatives may not fully achieve the results desired.
The aim must be to make the best use of the human resources available so that the other resources can be deployed more efficiently.
Jamaica, Ministry of National Security and Justice, Narcotics Division, police records, 1995.02
M. Dreher, 'Drug consumption and distribution in Jamaica: a national ethnographic study", report prepared for International Narcotics Matters, Department of State (Kingston, Jamaica, Embassy of the United States of America, 1994).03
J. Bond and S. Bond, Sociology and Health Care: An Introduction for Nurses and Other Health Care Professionals (London, Churchill Livingstone, 1992), chap. 6, p. 140.04
S. Beletsis and G. Brown, "A developmental framework for understanding children of alcoholics", Journal of Health and Addictions, vol. 2, No. 2, pp. 1-32. See also J. Orford, "Impact of alcoholism on the family', in Alcoholism,G. Edwards and M. Grant, eds. (Baltimore, University Park Press, 1976), chap. 18, pp. 234-243. See also L. Shulamith, A. Straussner and D. Weinstein, "Effects of alcoholism on the family system", Health and Social Work, vol. 4, No. 4, pp. 112-125.05
R. Moos and A. Billings, Conceptualising and Measuring Coping Resources and Process: Handbook of Stress, L. Goldberger and S. Brenting, eds. (New York, Free Press, 1982).06
D. Powell, "Network analysis, a suggested model for the study of women and the family in the Caribbean", Women and the Family, Women in the Caribbean Project (Cave Hill, University of the West Indies, 1982), vol. 2, pp. 131-162.07
O. Senior, Working Miracles in Women's Lives in the English-speaking Caribbean (Cave Hill, Institute of Social and Economic Research, University of the West Indies, 1991), P. 100.08
E. Leo-Rhynie, "The Jamaican family: continuity and change', lecture given at the Grace Kennedy Foundation, Kingston, March 1993, p. 6.09
J. Brown and B. Chevannes, "Gender socialization in the Caribbean", University of the West Indies Gender Socialization Research Project. Presentation at a symposium held at Mona, University of the West Indies, 1995.10
R. Victor, The Family Relations and Support Systems: Women of the Caribbean, P. Ellis, ed. (Kingston, Kingston Publishers, 1986), p. 85.11
G. Roberts and S. Sinclair, Women in Jamaica: Patterns of Reproduction and Family (Millwood, N.Y., KTO Press, 1978).