Highs & Lows: Preface

Nancy Poole and Lorraine Greaves

This book documents the past 10 years of practice in, and research on, women’s substance use in Canada. We have worked with over 100 contributors across the country to create this book, recording the significant achievements in Canada in this period. Highs & Lows is a testament to all the fine work of the past decade, building on the contribution of books such as The Hidden Majority, published by the Centre for Addiction and Mental Health (CAMH) in 1996. It is also a call for continued innovation in the next decade in research, policy and practice in girls’ and women’s substance use issues.

As far back as 2001, we - researchers at the British Columbia Centre of Excellence for Women’s Health (BCCEWH), in Vancouver - along with project developer Julia Greenbaum of CAMH, in Toronto, began discussing the idea for this book. We saw the need to describe the significant contributions made by Canadian researchers, program providers and advocates in the area of women and substance use. We were particularly interested in highlighting the contributions to reducing harms in the context of women-centred approaches to women’s substance use.

In Vancouver in September 2003, at the conference Women’s Substance Use Treatment: Celebrating and Moving Forward (the only national conference on women’s substance use issues held to date in Canada), the opportunity to publish conference proceedings emerged. The conference was held to celebrate 30 years of providing treatment services for women at the Aurora Centre at B.C. Women’s Hospital - but it also highlighted some undeniable gaps in service, research and programming for women in Canada. The plan for conference proceedings grew into the current book, which highlights both these achievements and gaps. The project reflects a partnership that included financial support and a strong vision from both CAMH and the BCCEWH, the collaboration among the executive editors and the project developer, and the commitment of the many contributors.

This book, Highs & Lows: Canadian Perspectives on Women’s Substance Use, is the result. It brings together a variety of viewpoints, not always congruent, on girls, women and substance use in Canada. It reflects a rich diversity of voices and perspectives, ranging from first-person accounts of women affected by substance use to descriptions of program, policy and research initiatives. This collection illustrates that substance use often has a profound impact on women’s lives, and that responses to women’s substance use are often complex, in both practice and policy.

Highs & Lows also shows that many women are open to sharing their experiences with substance use and with the systems’ responses to it. It reveals providers’ and planners’ caring, and their commitment to responding compassionately, realistically and productively. It shows that while there have been many “lows,” both for the women using substances and in our collective response, there have also been some “highs” - personal successes, program developments, systemic shifts and research innovations.

We are very pleased to bring together the views of researchers, practitioners, policy advocates and women with substance use problems, to reflect the complexity of women’s lives and illuminate the needed responses. It is impossible to cover everything in one volume, however. We do not address all substances with due emphasis, nor behavioural addictions, the biological and genetic bases for addiction, women’s use in the workplace, or use in many ethnocultural communities where still little is known about girls’ and women’s use. There is a lot more to be learned about substance use and addiction in girls and women, particularly regarding effective prevention. We hope that this book will inspire more dialogue, research, debate and praxis in the years to come.

The contributions in this book reflect the considerable progress in the last 10 years, and the authors’ immense dedication to the issues. We see emerging support in Canada for research and practice that focuses on harm reduction and is women centred, taking into account sex, gender and diversity issues. This interest is sharpening both our science and our practices, and will undoubtedly contribute to positive changes in policies and public opinion in the future.

The accomplishments of the past decade owe a debt to women’s advocacy, organizing and political pressure. Many of the shifts and trends described here have been in response to pressure from providers, academics or community advocates, often reflecting the strength and influence of the women’s movement in creating an awareness of women’s and girls’ needs with respect to substance use.

Feminist analyses have grown more sophisticated over the past decade, but continue to critique the nature of the system, and the inequities and inadequacies of androcentric or gender-neutral responses to women and girls. Practice, as you will read in this book, has responded with emerging girl-, women- and gender-specific services and approaches. Policy is increasingly being developed with gender and diversity in mind. Research is more focused, applied and critical. However, there remains a long way to go in creating effective prevention and treatment, as well as in reducing stigma, changing public attitudes, and creating sound knowledge and evidence on which to base future plans. Only then will there be more high points than low points in our response to substance use among girls and women.

Over the past decade we have both worked together to make the BCCEWH a visible and vibrant centre for research and knowledge translation on a range of women’s substance use issues. We hope that that this book will inspire more interest in this work and catalyze further advancements. We hope that more visibility, funding and uptake will be brought to research, policy and practice on girls’ and women’s substance use issues. Then, Canadian girls and women will truly benefit.

A note on language

When discussing substance use and responses to it, and when applying sex, gender and diversity lenses, there is always the challenge of language. The contributors to this book come from a wide variety of sectors, regions and disciplines, and have an equally wide range of perspectives. This fact is reflected in their language, which inevitably varies according to each author’s discipline or context.

Nonetheless, as editors, we encouraged the authors to use certain language guidelines. For instance, we felt it was more suitable in most contexts in this book to refer to substance use or problematic substance use, rather than to substance abuse or addiction. We wanted the language to reflect the full continuum of substance use and the related harms for women - since this reflects the scope of the book - and to reserve the term addiction to describe diagnosable substance dependence only.

We have avoided the use of medical terminology such as disorder unless the author, or the research being reported, is referring specifically to a DSM-IV diagnosis. Thus, various medicalized terms used to describe women with more than one concern - such as concurrent disorders or dual diagnosis—are also avoided. Even terms such as patient and client are used only when these words are necessary for clarity. Instead we prefer to call women women, and to describe their experiences or their relationship to a provider or counsellor in a less reductionistic way.

In addition, within a harm reduction perspective or framework there are different approaches to understanding and describing what has been traditionally known as relapse, and we have tried to use subtle language choices such as a return to former higher levels of substance use to reflect this perspective.

Finally, there are still overlapping uses of the terms sex and gender in general usage. In this book, however, sex refers primarily to either a demographic category or to biologically based issues, while gender usually refers to socially constructed factors that influence women’s lives, including economic, historical and cultural issues. (Nonetheless, some authors use the term gender to incorporate all of these concepts.)

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