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A new book exploring women’s experiences of addiction and substance abuse highlights the structural misogyny in the way women’s pain is researched, treated and silenced.

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A cry for attention is positioned as the ultimate crime, clutching or trivial – as if ‘attention’ were inherently a selfish thing to want. But isn’t wanting attention one of the most fundamental traits of being human – and isn’t granting it one of the most important gifts we can give?
___ – Leslie Jamison, ‘Grand Unified Theory of Female Pain

When, at 16 years old, I told my family GP that for three years my periods had been so painful I was regularly missing school, he put me on the pill. When they still hurt, he put me on a different one. For years, every time I spoke up I was told ‘some girls are just unlucky’, and given a different drug to keep me quiet. After 15 years of pain, at age 28 I was diagnosed with endometriosis, polycystic-ovarian syndrome and chronic pelvic pain.

Endometriosis affects the same number of people as diabetes, yet receives 5 per cent of the funding and is woefully misunderstood. It takes ten years on average for a diagnosis of endometriosis to be made, and 68 per cent of endometriosis sufferers are initially misdiagnosed. The condition affects a startling one in ten people who menstruate aged 15–49, and 82 per cent of sufferers are at times unable to carry out day-to-day activities due to their pain. Worldwide 176 million people suffer from endometriosis, yet there is little known about the condition and what causes it, the effects it may have on fertility and the additional risks it carries of breast and ovarian cancer. There is no cure.

With so little known about endometriosis, doctors rely heavily on medicating with hormonal contraceptives to mask and diminish the symptoms. Sufferers are often told it’s just bad period pain, but endometriosis means the body is developing additional uterine lining outside of the uterus – endometriosis means you don’t just have heavy periods, you have multiple heavy periods until the additional growth is removed through surgery (though it regularly comes back). But until a sufferer finds a sympathetic and knowledgeable doctor (which, again, can easily take up to ten years), they are medicated into submission.

Until a sufferer finds a sympathetic and knowledgeable doctor, they are medicated into submission.

I’ve been told that getting pregnant would cure me (untrue), that having a hysterectomy would cure me (untrue), that I will probably be on hormonal treatments for the rest of my life (likely). I am now 34, and I’ve been on three different forms of hormonal contraception, including a dozen or so variants of the pill. My body has invariably built up a resistance to all of them, leading my doctor to prescribe me something stronger each time. I don’t know what will happen when my specialists run out of pages in their prescription pads.

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Jenny Valentish’s book Woman of Substances (Black Inc.) explores women’s experiences of problematic substance use through a feminist lens. The book is divided into three sections beginning with ‘Predictors of a Problem’, in which Valentish outlines the traumas and societal structures that affect women’s relationships to alcohol and drugs. In ‘Gendered Adventures in Addiction’, Valentish shares her own stories of alcohol and drug use – often in harrowing detail – to show the insidious nature of addiction. Valentish then uses her experiences of coming through the rehabilitation system to investigate why women are treated secondary to men when dealing with addiction; utilising her interviews and research, Valentish unveils a medical system ingrained in misogyny. Finally ‘Woman’s Lib’ offers Valentish’s take on coming out the other side, sharing lessons learned and offering insight into navigating life after addiction.

In a book filled with extraordinary pain, Valentish’s down-to-earth nature is heartening. She shares her own story, but is self-aware enough to contextualise that with other women’s stories, to allow her Alcoholics Anonymous sponsor the right of reply, to highlight her privilege in being able to seek support as soon as she is ready. Many women are not able, and it’s these women that fuel Valentish’s motivation in sharing her experiences and research. But it’s her path to addiction that I identify with most: a need to self-medicate when the networks that are meant to support you turn a blind eye. The problem begins with keeping women quiet.

As a child, Valentish experienced sexual abuse which she felt unable to speak about, turning to alcohol from as young as 13 to numb her pain and depression. In her research, Valentish finds that trauma at a young age rapidly increases the likelihood of problematic relationships to drugs and alcohol, however men and women display different ways of coping with and processing their pain. Gender stereotypes, introduced to us from a young age, are constantly reinforced. For men, this means ‘boys will be boys’; for girls, it means putting on a brave face and keeping quiet. As a rule, boys and men are socialised to ‘externalise’ their pain through behaviours such as aggression, hyperactivity and attention problems. Girls, on the other hand, are more commonly associated with ‘internalising’ behaviours such as anxiety, depression and social withdrawal.

Valentish reminds us that there is a whole industry built around what she refers to as ‘the tranquilisation of women’:

In decades past, big pharma marketers have actively encouraged women to self-medicate with over-the-counter goodies, such as with the addictive painkiller-and-caffeine combo Bex and its 1950s slogan: ‘Stressful day? What you need is a cup of tea, a Bex and a good lie down’.

Valentish reminds us that there is a whole industry built around what she refers to as ‘the tranquilisation of women’.

In her late teens, Valentish entered the workforce with no treatment for her trauma beside self-medication. Drinking heavily and secretively, often to the point of blackout, she hid her drug use by dissolving speed into pints of cider. Her behaviour was often brash and irrational, and though it was clearly noticeable to her housemates and colleagues, she did not receive the help she was clearly crying out for:

Being staggeringly drunk all the time when you’re young and irritating is a bit like affixing a bumper sticker to your fender that reads: ASK ME HOW I AM. Problem is, nobody wants to get close enough to read it.

My own experiences do not stem from trauma, but they have been amplified by systemic sexism and misogyny. When I have spoken up, I have been dismissed for being in pain. I have been questioned over my reliability (it’s probably just hormones), over the severity and frequency of my pain (it can’t be that bad), over the need for medication (just take some Panadol and see how you feel). My health problems, and the fact that they revolve around the reproductive system, intersect with broader questions over women’s control of their bodies. There is a taboo I need to navigate around speaking out at all, let alone asking doctors to legitimise my pain.

But this taboo is nothing compared to the experience of those affected by abuse, assault and intergenerational trauma. Alongside those in Valentish’s life who choose not to see something bigger going on than a teenager acting out, I also think about the ‘high-functioning’ drug and alcohol users she meets in her twenties. How many women must we all know who hide their vices because they have been taught to hide what drew them to drugs and alcohol in the first place?

For generations women have been told to keep quiet, to hide our pain, whether it be physical or emotional. When you hide your pain, you in turn hide your methods for coping with it. Crying in the car or in the toilet cubicle; hiding bottles in the back of cupboards; sneaking behind the backs of loved ones. To be in pain is to be vulnerable in a society that erases us even when we are well. So we keep our pain and ourselves hidden. We suffer in silence.

To be in pain is to be vulnerable in a society that erases us even when we are well. So we suffer in silence.

Woman of Substances is an emotional and engaging memoir. Valentish shares generously from her own experiences, but relays her issues and recovery within a broader context. It’s through this openness that I found myself relating to elements of Valentish’s journey, and recognising, for the first time, the scientific and social elements underpinning many of my own darker moments.

At the start of the chapter ‘Your Brain as a Pokie Machine: Other risky behaviours that all hit the dopamine jackpot’, Valentish notes: ‘This chapter could equally have been called “Actually, doctor, there is something else…”.’ I think of all the doctor’s appointments where no one thought to ask about my mental health. I think of all the hours I’ve spent lying very still yet feeling like I was falling down a well. I remember how my mental health improved after an endometriosis specialist finally acknowledged the toll chronic pain was taking on my psyche, and suggested I see a therapist.

Valentish writes: ‘Drinking feels like drowning oneself; taking drugs feels like obliteration. Self-mutilation takes the focus of pain from emotional to a precise point on the body. Throwing up is the literal purging of shame.’ As women we are constantly fighting for control over our bodies. Politicians argue about our reproductive rights on our behalf. Journalists write about what we were wearing or doing, putting the fault back on us. Meanwhile our own bodies run us through hormonal cycles that often leave us feeling separated from ourselves.

I numb my body to take control of it when I’m sick; I punish my body to show power over it when I’m well. After more than half a lifetime of doctors telling me my pain doesn’t exist, or telling me there’s nothing they can do, or prescribing drugs to mask the symptoms without addressing the underlying cause, I’m often faced with a feeling deep in my gut of pure hopelessness. If doctors can’t or won’t act on my pain, what chance do I have of gaining control over my body?

I numb my body to take control of it when I’m sick; I punish my body to show power over it when I’m well.

I don’t think about my relationship to drugs and alcohol as a recreational activity. Every time I go for one quiet pint and end up having five; every time I try to get through the day on over-the-counter painkillers, but use up my daily allowance by early afternoon and come home and smoke weed to numb the pain; these are crutches to get me through the day, until that pain subsides or I’m able to sleep. I’ve been in pain for twenty years – these are the things that keep me sane.

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One of the strengths of Woman of Substances is Valentish’s ability to interweave research into her text in a way that contextualises and humanises otherwise dry statistics. She quotes a study in which 121 chronic pain patients demonstrated that women are more likely than men to ‘hoard unused medications, in order to take larger doses, and to combine them with other drugs. Over-the-counter drugs, such as those containing codeine, can be just as dangerous.’

Codeine is what I take to in order to leave the house on pain days. When I go to the chemist I’m given the standard lecture about its addictive qualities. I hand over my ID and my Medicare card for their records. I have to hold on to the counter in order to stay standing while I am reminded to only take a maximum of six tablets a day, never for more than three days in a row. But what happens when it gets dark and the codeine has worn off and I can’t take any more? What happens if I’ve been in pain for more than three days? What happens when I think about the damage I’m doing to my liver by going back again and again?

Having an invisible illness means others don’t see the severity of the pain I’m in, but I feel it weighing me down every single day, whether it’s a good pain day or a bad one. When I’m sick, I do my best to block out the pain and misery and boredom. When I’m well, I make up for lost time, desperate not to forever be ‘the sick girl’. I drink to be visible again, to be the person most know and see me as – the one with the loud laugh, who hits the dance floor early, who screams at the football.

The problem is, according to the gendered stereotypes our society continues to reinforce, neither myself or Valentish, nor indeed any woman, are meant to be either: we’re not meant to cry out for help, but we’re also not meant to be loud and visible. Valentish acknowledges that in using alcohol and drugs as silencers, we betray another unwritten rule, that drinking and doing drugs is an inherently masculine pursuit: ‘The very fact that I liked drink and drugs at all, typecast me as a ladette. Apparently it’s a man’s world; we just drink in it.’

Quoting Dr Nadine Ezard, the clinical director of the Alcohol and Drug Service at St Vincent’s Hospital in Sydney, Valentish points to the misogynistic belief that wishes to keep women under the control of men:

‘You can be mad, sad or bad…but for women it’s better to seem mad or sad,’ she says. ‘That morality still persists that young women aren’t supposed to have fun or have a sexuality. It’s problematic to me on every level. It’s about this whole moral overtone: first of all, that medication should only come from someone else, preferably a male doctor; then the idea that self-medicating is less stigmatising than wanting to just get off your face.’

As I finish writing this piece, my health has taken a rapid dive – the bursts of pain more frequent, more aggressive. I see another specialist and am scheduled for surgery. As I fill out the pre-admission hospital forms I hover over the questions about drinking, smoking and drugs. I answer honestly, but I know it doesn’t show the whole story. I want them to give me pills to help soothe my recovery, but I also don’t want to appear needy. I know the raised eyebrows of doctors all too well – the paradox of being constantly medicated into submission, but being questioned and threatened when taking that example into your own hands.

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A report cited in Woman of Substances concludes that, despite the perception that men’s drinking is higher or more dangerous than women’s, ‘by the end of the last century, men’s and women’s drinking rates were actually about equal. Further, there was some evidence that women born after 1981 may be drinking at higher rates or in more harmful ways than men.’

Yet despite this, medical research still heavily favours men, both when looking at substance abuse and broader medicine. For example, a study into schizophrenic research by Melbourne neuroscientist Rachel Hill found that of the 710 scientific studies she reviewed, 75–80 per cent had used exclusively male rodents in their trials. The irony here is clear: female rodents are rejected from studies because their reproductive cycles make them ‘unreliable sources’. As Valentish states, this ignores an inconvenient truth: ‘If the fluctuating hormonal levels of a female rat will complicate a pharmacology trial, then the drug being trialled cannot be relied upon to have the intended effect on human females.’

The medical community has a misogyny problem.

The medical community has a misogyny problem. Ethics committees attached to universities or hospitals – those who predominately oversee research – tend to be risk-averse and are ‘typically very nervous about giving drugs to women during her whole reproductive period because of the risk that the woman is pregnant and there could be harm to the foetus.’ I think of the paternalistic rituals I have been through – being told, when I questioned the usefulness of X-ray precautions that block out the exact area causing the issue, that it’s necessary ‘in case I’m pregnant’. My health is compromised for the sake of a foetus that, due to the IUD implanted in my uterus, I only have about a one per cent chance of carrying anyway.

This misogyny permeates treatment of substance use in women. When Valentish starts attending Alcoholics Anonymous meetings to tackle her problematic drinking, she chafes against a system that was originally designed for men. The Big Book – ‘that two-inch thick, hardback bible that every newcomer starts their education with’ – contains a chapter called ‘To Wives’. It speaks of a husband who is sick, needing care, and a wife whose role is to passively nurse him back to health. Valentish includes the following excerpt:

Try not to condemn your alcoholic husband, no matter what he says or does. He is just another very sick, unreasonable person. Treat him, when you can, as though he had pneumonia. When he angers you, remember that he is very ill… The slightest sign of fear or intolerance may lessen your husband’s chance of recovery.

It goes without saying that there is no chapter entitled ‘To Husbands’.

*

It’s only after reading Woman of Substances that I understand for the first time the extent of the role estrogen plays in my day-to-day life. I have known for years that my body has too much of it; the progesterone-only medications I have been prescribed for the last two decades to help relieve my intense period pain attest to this. I have known that it has played a role in causing heavy and painful periods, weight gain, headaches and often wild mood swings. But what I have never understood until now is how it affects my impulse control.

It’s only after reading Woman of Substances that I understand for the first time the extent of the role estrogen plays in my day-to-day life.

When – like now – the drugs I’m on to help essentially numb my entire hormonal function cease their effectiveness, I experience a cycle not unlike most who have periods. There are a few days of swollen and sensitive breasts. There are days of PMS which sink me mentally and physically. There are days of bleeding. There are days where my libido is high and I feel almost manic. It’s these days – these high estrogen days – where I find myself binge-drinking the most.

Valentish writes that estrogen tricks our brains into making substances more attractive. For example, when rats are given supplemental estrogen they accept an offer of cocaine more quickly than rats without estrogen. Some studies go further and suggest that the hormone – widely prescribed to women as birth control – slows down the elimination of drugs and alcohol. In combination with the other physical differences that see women process substances very differently from men, it means a woman could drink what is considered to be under the limit, but still come in over the limit when tested. This also has very real impacts on women’s safety, more prone to fragmentary loss of memory or blacking out entirely.

The balance of estrogen and progesterone is crucial in maintaining a woman’s physical and mental health. An imbalance on either side can lead to higher impulsivity as well as higher rates of depression and/or anxiety – both of which can lead to self-medication – but self-medication through alcohol only worsens this problem.

Valentish goes further, showing me for the first time the double-blow to my own relationship with estrogen: ‘Alcohol raises estrogen levels, and higher estrogen levels can worsen symptoms of polycystic-ovarian syndrome, fibroids and endometriosis, as well as increase the risk of breast cancer.’ Estrogen is the devil on my shoulder encouraging me to drink, yet it is also fuelling its own fire. As with many revelations in Woman of Substances, I feel it all click together in a way I’ve never understood regarding my body before. Yet with this understanding I’m simultaneously met with a deep sinking feeling of helplessness.

 I feel it all click together in a way I’ve never understood regarding my body before. Yet with this understanding I’m simultaneously met with a deep sinking feeling of helplessness.

The patterns of treatment across health care and substance treatment mirror that of the broader hegemony: women are secondary to men. Our pain is dismissed, yet we are chastised for self-medicating. Conditions that affect us are under-researched and under-resourced, and little is done to acknowledge the fact that our bodies process substances – both legal and illegal – differently to men.

Where does this leave us? We need stronger knowledge of how our bodies work, which comes from better research and a broader distribution of knowledge throughout the health sector. We need to acknowledge that self-medication comes from a place of pain and trauma, and that until we have better resources to deal with violence against women, sexual assault, and psychological trauma, too many women will remain reliant on drugs and alcohol to numb their pain. We need to break down barriers that tell women to be quiet; if we’re able to speak up when we’re in pain, whether it be physical or mental, we needn’t take matters into our own hands. We need books like this, and writers like Valentish, to give voice to our frustrations and concerns, to help legitimise and mobilise.

Valentish writes early on in Woman of Substances, ‘I was born to the losing team’, and throughout my life I have often felt the same. But I also know that women are strong, resilient, and supportive of one another. When we are given the chance to speak, we use it to make things better for others. As Valentish writes of her recovery: ‘At some point there comes the realisation that a choice can be made: whether to get help and build up your resilience to the best of your ability, or whether to allow the experience to define you forever and drive your substance use.’

So I choose to care. I choose to speak up and seek attention and not allow myself to stay in silence or in pain. I choose to offer my support to other women and give them a voice. Although the cards are stacked against me, I choose to not let the house win.

Read an extract from Woman of Substances here.

Woman of Substances is available now at Readings.