The Middletown Press (Middletown, CT)
White women: addicted, incarcerated, overlooked
Expectations, stereotypes, opioids play roles
As the country battles drug epidemics, mass incarceration and nationwide addiction, the people being increasingly affected by these issues are being left behind in the discussion. They are white women.
“Men and their behaviors have gotten the attention, especially when it comes to drinking and substance use treatment,” said Jonathan Lowe, executive director of clinical services at
Turnbridge addiction treatment center in New Haven. “We’ve concentrated on the noisy person, but women had to keep things quiet because they were holding things together, certainly not expected to have addiction problem.”
Across the country, middle-aged white women are dying at higher rates, particularly from drug overdoses, suicides and excessive drinking. Alcohol-related deaths for white women have increased 130 percent in the last two decades, far surpassing alcohol-related deaths for Hispanic women, which climbed 27 percent, or for black women, which decreased 12 percent, according to the Centers for Disease Control and Prevention.
Suicide rates for all women are among the sharpest increases compared with other demographics, according to the CDC, and drug poisoning was the most frequent method. From 1999 through 2014, the suicide rate for females rose by 45 percent, while rates for males increased 16 percent. The increases are more pronounced in age groups 25 to 50 years old.
Further, white women are increasingly binge drinking, suffering from addiction, being incarcerated and committing suicide. A number of combining factors make this population unique when addressing these issues, especially their status, stereotypes and cultural expectations.
When looking at who is being affected by the ongoing opioid epidemic, it’s disproportionately white women. One factor is their access to medications. They are more likely than women of other races to be prescribed opiate medications, according to the Washington Post’s analysis of middle-aged participants in a National Health and Nutrition Examination Survey.
“Look at the population that has the access to the health care that got the drugs into the houses and who was that population and that was probably the white population at large,” Lowe said. “Who are you more suspicious of as a provider? Is it a housewife or a black man? Racism leads to thinking that white women are safe. It’s seen as they don’t have problems.”
A slippery slope
Jaclyn Lucibello was the last person that anybody thought would fall into substance abuse and crime, including herself. She was a straight-A student and went to college at the University of New Haven. She never had any issues with drugs but fell into abusing opioids after getting prescribed Percocet after breast surgery.
The pills came at a time when Lucibello was depressed and anxious after losing her father and other family members in a short span of time. She was 23 and did her best to ignore the feelings and go on with life.
Lucibello said life changed dramatically when she took the pills, which made her feel her energetic and euphoric. The pills took away anxiety and depression that she didn’t know she was even suffering from, she said.
“I started eating them like candy and had a doctor, who for whatever reason, I was able manipulate to get more,” she said. “Never ever did it cross my mind that taking these pills would lead me down the path that it did. That’s really where the beginning of the end started, with 3-mg Percocets.”
A decade ago, the medication market was over-flooded with opioid prescriptions. Access to health care, status and race all made it easy for white women, such as Lucibello, to get pills. But as prescribers became more aware of abuse, the pills were in shorter supply for those addicted. Many white women who were getting drugs legally as prescriptions then began to seek out illegal means to continue the high.
As Lucibello’s tolerance for the pills increased, so did her using and the level of dosage in each pill. She started using more and more to get through the day, but after a couple months of getting refills, Lucibello’s doctor stopped prescribing the Percocet and she began buying them on the street, which was expensive. One 30 mg Percocet cost $25 for Lucibello and she was doing 10 a day for two years.
When she couldn’t sustain her addiction to pills, Lucibello checked herself into South Central Rehabilitation Center, where she initially met her then-boyfriend who introduced her to heroin. When someone comes out of detox, they feel sick without taking drugs again, she said.
“The worst of it is over, but you still can’t sleep, you can’t eat,” she said. “I just wanted a break for a night. I started to try heroin because it’s so much cheaper and easily accessible and it just went on from there. That one night ended up into a run. I did it that night and didn’t stop.”
Prison and parenthood
Physiologically, women will develop addictions much faster than men, said Katina Varzos, a psychiatric nurse practitioner at Turnbridge who is dually certified in women’s health adult psychiatric-mental health. Moreover, women are more apt to be introduced to a substance from an intimate partner than men and rapidly escalate the severity of their use.
“Because of how women are raised culturally, we’re caretakers and often relationally driven, so to leave an addiction means to leave a relationship, potentially,” Varzos said. “There’s a lot of loss there that’s beyond the use itself. Those are significant factors that are very different for women than they are for men.”
Soon, Lucibello was committing crimes to support her habit and her then-boyfriend’s habit.
“I was addicted to (him) as much as I was addicted to the drugs,” Lucibello said. “In a sense, we’re caretakers and I was willing to support both our habits ... I think a lot of women are like that, especially when you’re so broken you don’t want to lose that connection with one person you think understands you and the one person you think you have a connection to.”
She was willing to do anything just to support her addiction because “Your body equates that drug to survival and you will do anything to not feel that sickness,” she said. “At that point, it’s not really about the high anymore, because you’re not really getting high. It still masks that pain and gives you that numbness. That’s what it does. It numbs everything.”
“It’s like needing air when you’re drowning. You will do anything to not feel that sickness and that’s exactly what happened.” They were both so addicted, they fueled each other’s habits, she said.
Arrest warrants for property crimes started coming in August 2009, one after another. Every time Lucibello was charged, she was released on a promise to appear in court, which she never did. Before being sentenced a year later to prison, Lucibello had 25 open cases of larceny and burglary.
“At no point, did anyone in the court say ‘This girl is out of her mind. She keeps getting arrested with this guy and they need to go somewhere.’ ”
Lucibello said her addiction sent her to York Correctional Facility in Niantic, recalling that nearly all the women she encountered were there because of addiction. She spent three years in prison, during
which time she gave birth to her son. She has since been clean and is a leader of the New Haven Women's Resettlement Working Group, which helps women resettle into the community after incarceration.
“I know so many people addicted to prescription drugs and mostly, they are white women,” she said.
Lucibello’s road to drug abuse and incarceration is similar to many white women, starting out on pills to numb pain and escalating rapidly to the point they are committing crimes to support a serious drug habit that sends them to prison thereafter.
Misdiagnosed or undiagnosed substance abuse has led to white women having the highest rates of binge drinking, being disproportionately affected by the opioid epidemic, becoming the fastest growing prison population and committing suicide.
Since 1980, the female prison population has increased 700 percent, according to the Sentencing Project. While black and Hispanic women are still imprisoned at a higher rates than white women, the trend is reversing.
The rate of imprisonment for black women has declined 47 percent between 2000 and 2014, while the rate of imprisonment for Hispanic women rose 7 percent and imprisonment for white women rose 56 percent and continues its climb.
The crimes for which women are sentenced most are property and drug crimes; combined, they make up 42 percent of sentences for women. In 1986, 12 percent of women in state prisons were incarcerated for a drug offense, but by 2014, it was at 24 percent. Often, property crimes are connected with drug use and committed to sustain an addiction, Lucibello said.
“Every single white woman was there behind an opioid addiction,” she said. “Especially those in their 20s, 30s, early 40s.”
Jessica Santangelo, 28, was incarcerated on a charge related to stealing money for a heroin addiction and said imprisonment for white women is rising because of drug addictions.
“All the women I was there with were there because of addiction, she said. “Everyone had mental illness and substance abuse issues.” That’s what led Santangelo to prison, too.
When she was 13 and Santangelo’s parents divorced, she moved with her mother and stepfather to an affluent part of Ansonia. On the outside, her family looked perfect, but on the inside things weren’t, she said. “I didn’t come from broken parents, they weren’t abusive,” Santangelo said. “My parents weren’t addicts themselves, so for me to turn out as an addict was totally unexpected.”
By 14, though, she was buying pills from a friend’s mother, which is where her serious addiction started, she said. Being a white teenager in an affluent area, Santangelo had the money to support the addiction.
“The pills were the easiest to access,” she said. “There’s tons of older white people selling because they don’t care who they’re selling them to.” As her parents caught on to what was happening, though, the money stopped. That’s when Santangelo switched to using heroin.
“It was much cheaper,” she said. “By the time I got into heroin, it was all over the place in Ansonia and Derby. You could find heroin easier than a bag of weed.”
Diagnosis and treatment
Women tend to be underdiagnosed with substance abuse disorders because they don’t typically present symptoms as their primary issues during doctor visits, Varzos said. More often than not they’re presenting with psycho-social and mental health issues and the substance abuse is never discovered. Even when women do show signs of drug or alcohol abuse, parents and doctors often focus on other mental health issues instead.
When Santangelo was trying to get help as a teen for her substance use, “everybody wanted to treat me for depression or a mental illness instead of substance abuse, especially being younger,” she said. “Around 13 or 14 years old, when I really needed it the most, they were trying to put me in psych hospitals instead of substance abuse treatment.”
Her parents didn’t want to believe she had a drug problem, she said, especially because of the drugs she had gotten into.
“Parents of young men more readily are able to say ‘My son has a problem with drugs and alcohol’ whereas the parents of young women want to focus on it’s her depression, it’s her trauma,” Lowe said. “The substances abuse is secondary.”
In contrast, men more often disclose a substance use disorder or more readily admit to one because the impact on their lives tends to be much less, Varzos said. It could explain why one-third of people suffering from addiction are women but only make up one in five people in treatment, she said.
“Addiction treatment wasn’t designed for (women) in the first place,” Lowe said. “We haven’t been thinking about them as a special population needing special care or a unique style of treatment in terms of their substance abuse until the last decade, so (women) are going to be overlooked and not seen as having problems.”
The disparity may be because women often need to overcome social barriers and stigma just to get into treatment for addiction. The identity of a woman and her role in society is the first one.
“The societal cost of being a female addict is great,” Varzos said, adding, women who are suffering from addiction have a lot more to lose socially than men.
“Women have a harder time finding treatment because of everything they have going on at home or because they’re scared,” Santangelo said. “Women are supposed to hold it together, take care of their kids, take care of their family. To admit you have an issue, especially with addiction, is just a hard thing to do.”
While women’s roles in society have evolved from being solely housewives and mothers, “there’s still this stigma with women being domesticated and doing no wrong,” Lucibello said.
Another barrier to treatment is that women are expected to care for their kids, she said. “Women don’t want to admit they have a problem because we’re supposed to keep it all together. We’re supposed be the mature ones, the ones of sound judgment.”
“My son’s father can just leave and go, and he has,” Lucibello said. “It’s OK, it’s socially acceptable for him to do that.”
But if Lucibello were to leave her son to go into treatment, her family would shame her. There’s leniency for men to be detached from their families, she said.
“I lost custody of my kids because of my addiction,” Santangelo said. “Because I was the mother and a female, they looked at me instead of the father of my kids to get it together . ... My kids’ father didn’t have to get it together. He was able to do what he wanted to do, but I was looked at as the sole provider for my children. There’s a whole different expectation, especially for women who are mothers.”
Stereotypes and stigma
The identity of all women is compromised in society if she can’t be a caretaker or hold her life together as expected, she said. It’s powerful enough to stop women from seeking treatment.
Santangelo volunteers with the Connecticut Center for Addiction Recovery in Derby as a certified recovery coach and helps other people in recovery. She wants them to know what it’s like to experience it like she has.
Drugs are not the only substance abuse women deal with, though. A vast number of white women drink excessively, to a point that is considered alcoholism. But culture doesn’t call it that.
Excessive drinking, or “binge” drinking, for women is defined as having four or more drinks in two hours. One-third of white women reported binge drinking, according to the National Health Interview Survey. The rate has gone up 40 percent in the last 20 years while it has remained flat for other demographics.
Binge drinking is a form of addiction that’s not taken seriously as a harmful behavior, Santangelo said. Culture even promotes it.
Images of women drinking to excess have been normalized and the cultural climate is one in which it’s funny when women drink heavily. Google search results for “women drinking wine memes” produce images of women consuming massive amounts of wine in oversized glasses and memes of women drinking to excess.
Social media memes use women drinking as a punch line for humor, marketing wine a cure-all for women, stress relief and lifeline.
Binge drinking in college, especially, is not only normalized, but expected of young women, so the issue doesn’t get noticed until years later during middle age, Lowe said.
“When you’re younger you live in a system that supports your alcohol use and it’s accepted your behaviors are normal and expected,” Lowe said. “And it’s not until after you get out of college you find that some of your friends were able to put down the bottle and move on with their lives, and it’s really not cute anymore that (you’re) getting blackout drunk on the weekends.”
“These issues are happening in in their 20s but it’s not until later that anyone catches on,” Varzos said.
Having worked in a college setting, Varzos said substance abuse as an issue is under-addressed, minimized and “gets pushed under the rug in a time of experimentation. People who are demonstrating signs of severe substance use disorder aren’t getting help until things really become severe and they crash and burn. They can kind of fly under the radar to get through.”
Women are affected differently physiologically by alcohol as it takes fewer drinks for women to get intoxicated than it does for men. Their blood-alcohol levels climb faster and stay elevated longer. But some women try to “keep up” with men drinking because they want to be seen as cool or because it’s funny when a woman gets drunk, Santangelo said.
“In 2014, only one in three binge drinkers was asked about alcohol use and advised about risky or harmful drinking levels,” according to a report by the CDC. “Further, only one in six binge drinkers was asked about alcohol use and advised by a health professional to reduce their drinking.” The report states males were more often than women asked about harmful alcohol use and advised to reduce it.
Santangelo said many people suffering from addiction also have experienced trauma, especially sexual trauma from being raped while under the influence.