The Way Back Machine—Marsha Rosenbaum: Women on Heroin at 40

Editor’s Note: In conjunction with Women’s History Month, this is the first installment in “The Way Back Machine,” a series of interviews with key theorists and practitioners of alcohol and drugs research, treatment, and recovery among women and communities of color during the 1970s, ‘80s, and ‘90s. Through these interviews, Points co-founder and Managing Editor Emerita Trysh Travis works out some of the theoretical issues she articulated almost ten years ago in “Feminist Anti-Addiction Discourse: Towards A Research Agenda.”

Women on Heroin Cover
Cover of Women on Heroin by Marsha Rosenbaum.

When Richard Nixon declared drug abuse “public enemy #1” in 1971, the assumed abuser was male—probably a man of color, possibly a poor white man, but almost certainly a man. Women were known to use and abuse narcotics, but their numbers were small. As a result, theories of narcotics use, and the policy prescriptions that sprang from them, rarely paid attention to the woman user. Medical sociologist Marsha Rosenbaum set out to correct that problem with Women on Heroin (WOH), a field-defining study published forty years ago by Rutgers University Press.

Now retired, Rosenbaum went on to a long career as a researcher with the Institute for Scientific Analysis in San Francisco, where much of her work continued to focus on gender and narcotic use, especially the possibilities of methadone. She served as the Director for the San Francisco office of the Drug Policy Alliance from 1995-2008, where she took early and courageous stands in favor of harm reduction, marijuana legalization, and honest, science-based drug education for teens.

I caught up with Rosenbaum recently to celebrate the anniversary of WOH and discuss what lessons it might offer to feminist drug historians—including historians of the current opioid crisis.

Let’s hear about the feminist energy that led to Women on Heroin.

So, my relationship with feminism—I take it for granted; it wasn’t explicit, it was just what I was: a feminist. I graduated from UC Berkeley in 1970 and got married in 1972. I didn’t change my name, but I was not in a consciousness-raising group or anything. I didn’t see oppression at every turn—at least, not for me. Of course, I’m a privileged white woman, obviously. But that was my experience. So, at the outset I didn’t see this project as taking a feminist “position,” or contributing to feminist “theory.”

Okay, there goes that angle. So, if it wasn’t a sense of feminist mission, what got you into this work?

People would always ask me that question, and you could tell they were expecting to hear “I used to have a heroin problem.” But, really, I just stumbled into it. It wasn’t a passion or anything— that’s how life actually happens, often accidentally.

My first real job after my MA [Sociology, San Francisco State University] in 1972 was on a research project. My husband [the late John Irwin] was the PI and had gathered drug-use data on 1,500 men and 500 women incarcerated on drug charges. He hired me to crunch the numbers on the women, and even though I’m not a quantitative researcher, I found it fascinating.

I presented some of the findings at the American Sociological Association annual meeting in 1975. Afterwards, Louise Richards from NIDA [National Institute on Drug Abuse] introduced herself and said, “we have almost no qualitative data about women who use heroin. We could really use a good ethnography. You should submit a grant proposal.” So, in 1977, as I was finishing my PhD coursework at UC San Francisco, I submitted a proposal for “The Career of the Woman Addict.” My plan was to use a grounded theory approach, and interview 100 women to see how their experiences fit into Howard Becker’s “drug career” framework and that would be my dissertation.

Well, my proposal was turned down; I was so bummed. But I was also 29 and I thought, “well, now’s a good time to have a baby—I can do this later.” Then two months later, Louise Richards called me back and said, “we changed our minds.”

So, there I was, three months pregnant with grant money for an office and a staff. I hired Sheigla Murphy to be my assistant—she was SIX months pregnant—and we said to each other “okay, we need to go out into the heroin world and interview a hundred women. How should we do that?”

I remember walking around San Francisco, going to the neighborhoods we knew had a heroin-using population and putting up flyers advertising for interviews. We could offer $20 in compensation, which was a reasonable amount back then. Not only did it work, it also turned out that being visibly pregnant had an incredible effect. People were very helpful in the neighborhoods—protective even. My mother was freaked out—“you’re going to the Projects?!”—but it was fine. And we were meeting women in their homes, often in SRO hotels, seeing how they lived, and that added a whole dimension to our three-hour interviews.

And what did you learn about their “drug careers”? How did they differ from men’s?

What was remarkable was the women’s focus on their children. Most of them had children; some had already had them taken away from them; many lived in fear that they would be taken away. What separates women’s drug careers from men’s is their responsibility for their kids, and the struggle they had with their habits because of that.

The second thing was so blatant and obvious: so many of them had been physically, emotionally, and sexually abused—were still being abused—since they were children. The violence was unbelievable. It was painful to listen to their stories and to know that this was not something in their pasts but was ongoing. (We were not impressed with their partners.) This could’ve been the basis for a whole new grant proposal, but it was just too painful.

You were doing this work around the time that Edward Khantzian and others were first articulating the theory of substance-abuse as a form of “self-medication” for trauma. Did you get the sense that that’s what was driving these women’s drug use?

Their trauma clearly helped them appreciate heroin. But it was usually some guy they were hanging out with—that’s how they got hooked. And getting high was how they dealt with having to make money, often through prostitution.

In the book you are notably pessimistic about the possibility of treating heroin addiction.

The issues that women looking for treatment encountered were a cause for pessimism—it still is. You decide you want treatment. You call and get placed on a waiting list; someone will call you back when they can take you. There’s no childcare. A woman who wants to quit heroin needs something NOW.

But WOH is also pretty skeptical about whether treatment works once you can get it. You write that a woman’s “failure at abstinence, often brought about by treatment itself, convinces her that she lacks the control necessary to permanently kick heroin, [and] this belief ultimately locks her into the heroin world, thus furthering her career in addiction.”

Abstinence-based treatment can be pretty devastating.

Is seeing that what made you interested in harm reduction?

“Harm reduction” is a term that came about later. What we talked about then was methadone, which certainly “reduces harm.” It provides a respite. You don’t have to quit drugs, but methadone creates a lot of structure. You have to be at the clinic every morning at seven a.m. In our follow-up study, “The Methadone Experience for Women,” we called this phenomenon “surrendering to control.” Someone taking methadone is, first, recognizing that their life is out of control, and, second, asking for help to take back control. That’s not a particularly feminist thing—but it doesn’t need to be “feminist” to make a difference in women’s lives.

The pendulum has swung back over the last forty years, and we’ve got a whole new heroin problem. What lessons would you like public health and policy makers to take from WOH as they survey today’s opioid crisis?

I believe the fundamental issues for women remain the same: poverty; lack of options for earning a livable income; access to supportive, harm reduction-oriented treatment; and ability to care for their children.

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