Women comprise a surprising proportion of people in youth alcohol and drug treatment services in Australia. In Victoria, for instance, one-third of clients are women.
Women in treatment have higher rates of vulnerability – such as homelessness and family disconnection – and more severe levels of substance use than males.
This disparity can be explained in part by the fact that women in youth alcohol and drug treatment also have higher rates of past sexual abuse, physical abuse, child protection involvement and self-injury.
I interviewed 26 young women in alcohol and drug treatment services in Victoria. More than half of them disclosed a history of sexual abuse and 20 spoke about cutting themselves.
Ebony had a biography typical of many of the women interviewed for my soon-to-be-published study. When asked if she had stayed at home much in her childhood, she said:
Nup, never … I’d rather live at my friends’ houses … [where] I’d never get bashed or hurt in other ways … I got, er, ah … by my so-called stepdad. I was staying in the living room, in the fold-down bed, and he raped me. I was only 15.
Lisa was also sexually abused, but this was outside her family home, which also was filled with violence and neglectful parenting:
… Mum put me in after-school care and I feel that’s what caused me to go off the rails a bit. Because … it was one of the ladies’ sons or something … I couldn’t tell my mum what he was doing because, well [starts crying], I felt like I was going to get in trouble or something. Yeah, he just kept … I had to go there every day. Mum sent me. Mum asked him to babysit me … he just kept making me do shit with him [sobbing].
Young people can survive significant adversity but research on resiliency shows support of at least one close, loving and secure adult is necessary.
The women I spoke to were not supported through traumatic events and did not have the care of even one adult. Homelessness was rife, with 96% of them having an experience of it that often began as abandonment.
Riley was 13 when it happened to her:
Mum sent me up to Melbourne, she just didn’t want me anymore … I cry, I cry every day.
Lisa’s mother forced her out:
… one night my mum kicked me out basically, and I went down to my best friend’s house and into the city … we both went into the city on a train and ended up staying in this squat with these old guys … So yeah, I don’t know, she got a bit sick of me being, just, um, just having a daughter, I guess.
Cutting to kill the pain
Self-injury refers to the purposeful, non-suicidal injury of oneself. It can take many forms but the most common is cutting.
The link between self-injury and childhood sexual abuse is also contested. On the available evidence it seems possible to conclude that only in some groups is there a correlation between sexual abuse and self-injury.
But almost all women in my study had cut themselves. When I asked what they liked about cutting, their answers were almost identical. Mary said:
It’s the only thing that makes you feel some other way than what you are feeling.
After I’d seen the blood, it was like a release of anger or some sort of release. I can’t really explain the feeling, but it was just a release.
It just made me feel better. I felt like I was punishing myself – I felt like it was my fault that he was doing it … I don’t know, it got out pain.
Although cutting may initially seem a bizarre way of dealing with emotions, it seemed cutting at their pain through their body was fundamentally tied to the embodied experience of rape.
From self-injury to self-medication
At the time of interviews, the young women were no longer engaged in self-injury. All of them had moved on from cutting to substance abuse.
Jazmine described the gradual shift from one to the other:
If I am on drugs, I wouldn’t cut – if that makes sense? ‘Cause that’s why I did them – so I wouldn’t get sad, but if I am on ecstasy or speed, obviously I am not really in reality at all; I am in another place, not really thinking about that stuff … it was an escape.
Jazmine’s need to escape reality to survive was similar to Roxanne, who used drugs to stop herself from taking her own life. When these women were without support, their coping methods were self-injury and substance use. As Roxanne said:
To be honest, I can’t imagine myself – the state I was in [psychologically] – dealing with what I was dealing with in any other way. I think that if I didn’t do drugs I would be dead, to be honest. I would have committed suicide by now.
Not only was self-injury logical when its function was understood, so too was the move from cutting to drug use. These young women were seeking to stop the pain associated with their childhoods. As Lisa pointed out: “The problem is that I can still remember it.”
Most who are sexually abused don’t go on to self-injure or abuse substances; and self-injury is not always representative of past abuse or a future drug problem.
But, in my study, most women presenting for substance-abuse treatment had a history of sexual abuse and self-injury. Understanding the relationship between these helps us to understand the long-term effects of trauma and to create programs more suited to the needs of the groups treated.