Prevention Through Connection: A Collaborative Approach to Women’s Substance Abuse

This paper conceptualizes substance abuse as a disease of disconnection, which progressively separates and isolates people from relationships that can help them reduce their risk, promote their recovery, and ensure their health and well-being. Examining women’s substance abuse in particular, the author explores how women often use drugs or alcohol in two ways: 1) to facilitate and establish connections with others, such as intimate partners, peers, and social groups and/or 2) to cope with serious relational disruptions, violations, or trauma. In response, the author proposes a relational approach to prevention that emphasizes collaboration and the development of growthfostering interpersonal, professional, and community relationships—prevention through connection. Using an example from a college setting, this paper describes how everyone can participate in a relational approach to prevention, opening the way to new possibilities and opportunities to reduce high-risk substance use and abuse. This paper will appear as a chapter in an upcoming casebook on Relational-Cultural Theory, edited by Wendy Rosen and Maureen Walker and published by Guilford Press. Introduction After graduating as a high school Valedictorian and as a national merit scholar, Alicia was accepted at a prestigious college, a college she believed would ultimately prepare her for a fulfilling career in medicine. With an outstanding academic record and a promising future ahead of her, no one would have predicted that this successful, self-disciplined, conscientious young woman would find herself in a hospital emergency room during her first week of college. No one who knew her would have anticipated that she, like a growing number of college women, would find her life on the line after a single night of heavy drinking. Fortunately, Alicia was connected to a circle of caring friends who recognized the warning signs of serious intoxication. Acting quickly, these friends called 911 and Alicia was taken to the hospital where she was immediately treated for acute alcohol poisoning. Alicia’s story was one of many similar stories I heard while working in college counseling centers. A college education remains a key component of women’s efforts to overcome social, political, and economic obstacles, however, more and more women are finding their academic achievements seriously disrupted or derailed by the firsthand effects (e.g., lower academic performance, acquiring a sexually transmitted disease, physical injuries, car crashes, alcohol poisoning, etc.) or the secondhand effects (e.g., being a victim of verbal, physical, or sexual assault, etc.) of high-risk alcohol use and other substance abuse. Recent research suggests that approximately 41% of women at coed institutions are engaging in binge drinking, defined as four or more drinks in a row within the last two weeks (Wechsler et al., 2002). At women’s colleges, these researchers determined that the number of women engaging in binge drinking increased 36% since 1993 and the percent of women reporting frequent binge drinking (binge drinking three or more times in the past two weeks) doubled (C)2003 Hartling, L. 2 (Ibid., 2002). Another study, compiling existing data available from Federal sources, suggests that substance abuse in many instances is increasing more rapidly among women than among men (Drug Strategies, 1998). Historically, the majority of individuals engaging in substance abuse have been men; consequently, most approaches to prevention and treatment have not been designed to respond to the concerns of women. However, a growing number of studies suggest that women are rapidly closing the substance abuse gender gap. More and more girls are trying alcohol, tobacco, and drugs at younger and younger ages, and more women over 60 years old are relying on psychoactive prescription drugs, including tranquilizers, sedatives, and antidepressants (Drug Strategies, 1998). These trends indicate that there is an urgent need to develop approaches to preventing substance abuse that are attuned and responsive to women’s experience and psychological development. This paper will describe an approach to substance abuse prevention that incorporates an understanding of the issues that influence women’s substance use and abuse while integrating key concepts of RelationalCultural Theory (RCT) as it has been developed by the scholars of the Stone Center at Wellesley College (Jordan, Kaplan, Miller, Stiver, & Surrey, 1991; Jordan, 1997; Miller & Stiver, 1997). It will describe how RCT can be utilized as a theoretical foundation for establishing more effective methods to prevent substance abuse among women. However, rather than describing an individual case, I will describe the development of a collaborative community response to prevention, illustrating how multiple forms of connection can be mobilized to reduce substance abuse among women: prevention through connection. Substance Abuse: Moving Toward a Relational Understanding Most models of prevention are rooted in traditional theories of psychological development that define healthy development as a process of separating from relationships and becoming more independent and self-sufficient. Following these dominant theories, substance abuse is viewed individualistically, suggesting that the problem is located within the individual who is deficient in some way, e.g., illinformed, weak-willed, immature, or easily influenced by others; or one who has poor decision-making skills, low self-esteem, no self-control, or misperceives social norms (Buckman, 1995; Berkowitz, 1997; Daugherty & O’Bryan, 1993; Perkins & Berkowitz, 1987a). As a result, many approaches to preventing substance abuse emphasize teaching information or skills to increase an individual’s ability to stand alone, think independently, be self-sufficient, and resist peer pressure, i.e., prevention through self-sufficiency, disconnection, or separation. Individualistic understandings of substance abuse often spotlight and magnify the dangers of relationships through the use of “relational” terms that have grown to have negative connotations, such as “dependency,” “enabling,” “codependency,” “peer pressure,” etc. Yet recent research suggests that being in relationships—having a connection with others—can be a protective factor that reduces one’s risk of developing a substance abuse problem (Resnick et al., 1997; Blum et al., 1997; CASA, 2001a, 2001b). Perhaps the traditional, “separate-self” models of psychological development have constricted our understanding of the complex relational dynamics that influence an individual’s involvement with alcohol and other substances, thus preventing us from forming deeper understandings of these problems. Furthermore, traditional models have led us to overlook the important qualities of relationships that help reduce an individual’s risk of developing a problem with drugs or alcohol. RCT challenges us to bring a keen awareness of relationships into the center of our thinking about prevention. It offers us a way to understand the complex relational disruptions and violations—e.g., child abuse, sexual assault, trauma, depression, eating disorders, etc.—that can trigger or exacerbate addictions in women. RCT provides a template for examining alienating and isolating social/cultural conditions of sexism, racism, homophobia, and other forms of marginalization that can increase one’s risk of developing a substance abuse problem. Growthfostering relationships (Miller & Stiver, 1997), on the other hand—relationships characterized by mutual empathy, mutual empowerment, and mutuality—can enhance one’s resistance and resilience to the adversities that often precipitate the development of substance abuse-related problems or addictions (Hartling, 2003; Spencer, 2000). Putting relationships at the center of our thinking about substance abuse prevention gives us a new lens through which we can review existing strategies and formulate new, more effective approaches to prevention. Women and Substance Abuse: A Disease of Disconnection From an RCT perspective, women’s substance abuse can be described as a disease of disconnection, a