“Mother needs something today to calm her down
And though she’s not really ill
There’s a little yellow pill
She goes running for the shelter of a mother’s little helper
And it helps her on her way, gets her through her busy day”
Songwriters: JAGGER, MICK / RICHARDS, KEITH
One of the things that I find fascinating about substance use is that the meanings attached to it can vary so widely, and with such far-reaching consequences. One example of this can be seen in the different policy, legal and social responses to alcohol and tobacco use, as compared to, for instance, LSD, heroin or cannabis. David Nutt, formerly a member of the Advisory Council on the Misuse of Drugs, for the UK Government, was famously sacked for challenging inconsistencies in legislation which did not, he argued, reflect the ‘objective’ harm caused by different substances. Social scientific work has a rich history of highlighting and challenging the variable ways in which substances are understood and given meaning both within and between different social and cultural contexts.
My own research draws on perspectives which address the diverse cultural meanings attached to substances, with a particular focus on opioids and opioid substitution – heroin, methadone, buprenorphine, subutex. An example I have used often in teaching is to encourage students to compare social responses to a morphine user who is in hospital, recovering from an operation, and one who is using heroin ‘recreationally’ at home. One is legitimate, the other illegitimate – but why? A more developed version of this is found in Helen Keane’s recent analysis of the stark differences in how medical literature approaches the same substance (methadone) when used in treating a) chronic pain and b) opioid dependence (Keane, 2013). Discourse addressing methadone use for chronic pain has to do a lot of work to try to avoid stigmatising patients, attesting to the highly negative meanings that methadone has come to imbue, associated as it is with: dependence, lack of control, lack of self-worth, epitomised in the cultural image of the underserving ‘junkie’.
Questions about the social construction of substance use often fade into the background in discussions about the impact of parental drug use on children. However, both parenting and substance use are clearly socially mediated, and given meaning in different ways according to a range of factors (social class, cultural background, religious belief etc.). Social scientific work on the dominance of middle-class models of ‘good’ parenting are one example of how this can play out in policy and practice (see e.g. Gillies, 2007).
In research completed in 2013 I was part of a team that explored accounts about parenting support among a group of opioid-dependent parents living in Scotland. A paper that has just been published in Drugs: education, prevention and policy, explores how parents accounted for their use of benzodiazepines compared to methadone. While policy often frames all drug-use as problematic among parents, in our research it became clear that some drugs were worse than others. In particular, while a range of problems can be associated with both methadone and benzodiazepine use; the latter was almost universally framed as unproblematic by parents who took part in the research. In particular, this applied to mothers – and several participants quoted the Rolling Stones song, Mother’s Little Helper (above), to support this view.
Benzodiazepine was described as helping parents to: sleep better, socialise, manage anxiety – so as not to impact negatively on children, and cope with traumatic histories. In contrast – methadone was associated with a range of difficulties, and almost all participants suggested they were committed to ‘coming off’ their methadone prescription. Though it was acknowledged that it was helpful in abstaining from illicit and/or injecting drug use – methadone was also framed as contributing to unpleasant physical symptoms, stigmatising identities (‘the junkie’), and the services connected with it (prescription pick-ups, monitored consumption) got in the way of ‘normal’ family life. Many of these constraining features were explored in more detail in an article published last year in the International Journal of Drug Policy (Chandler et al., 2013).
Different cultural images of drug-use and parenting (and especially mothering) highlight the importance of social context in shaping how we understand the impact of substance use on how we act, and who we are. For the parents we spoke to, these images had far-reaching impacts on their lives and on how they talked about parenting in the context of dependent drug-use. Those who continued to use methadone were tied in to services which monitored them and their children closely, as well as leaving them open to negative judgements from themselves and others. Benzodiazepine dependence was not seen as attracting the same level of scrutiny or stigma, and therefore stopping use seemed less pressing.
What I was left wondering when considering these findings, was whether methadone treatment could ever be viewed as benignly as benzodiazepine treatment seemed to be. I am far from an expert in the pharmacological make-up of these substances, but both can be ‘addictive’, both have psychoactive qualities, both have the potential (but not the promise) of impacting negatively on parenting. Yet one substance is imbued with (almost) positive qualities while the other has the opposite effect. Our research – and that of many others – has highlighted that these negative, stigmatising attitudes towards opioid treatment and dependence are ultimately damaging to both parents and their children: constraining help-seeking, leading to social isolation and lack of self-esteem. Can it ever be any different?
Chandler, A., Whittaker, A., Williams, N., McGorm, K. Cunningham-Burley, S. and Mathews, G. ‘Mother’s little helper? Contrasting accounts of benzodiazepine and methadone use among drug-dependent parents in the UK’ Drugs: Education Policy and Prevention
Chandler, A., Whittaker, A., Cunningham-Burley, S., Williams, N., McGorm, K. and Mathews, G. (2013), ‘Substance, structure and stigma: Parents in the UK accounting for opioid substitution therapy during the antenatal and postnatal periods’, International Journal of Drug Policy, 24, 6, e35-e42.
Gillies, V. (2007), Marginalised mothers: exploring working-class experiences of parenting, London, Routledge.
Keane, H. (2013), ‘Categorising methadone: Addiction and analgesia’, Int J Drug Policy, 24, 6, 12.