Slough, England is the setting for the BBC comedy series The Office, and the childhood home of journalist and author Jenny Valentish, who calls it “anhedonia-made-concrete.” It’s in this inauspicious place that Valentish’s recent US release, Woman of Substances: A Journey into Drugs, Alcohol and Treatment begins. Her memoir of an unrestrained coming of age in the London music scene, and subsequent move to Australia, anchors a gendered exploration into the biological, psychological, and environmental factors that drive addiction. It’s a disconcerting read, not only due to Valentish’s fiercely honest prose, but because it becomes clear from her rigorous research that everything about substance abuse, from clinical studies to diagnosis and treatment, is centered around men.
I had the pleasure of speaking with Valentish about her personal discoveries, the unique contributors to women’s substance abuse, and why its treatment is largely mishandled. Following is a diet slice of the kinds of startling stories and information Valentish has deftly woven into her essential book.
The Rumpus: You first pitched a book along the lines of Woman of Substances in 2008, flew from Melbourne to Sydney to meet with an agent, and missed the meeting because you blacked out after a night of drinking. What made you pitch it then, before you quit drinking?
Jenny Valentish: I’d been mulling over the topics within for many years. There were questions I wanted answered. Why am I so impulsive? Why do I keep making the same mistakes over and over again and seemingly never learn? Why is my drinking so intertwined with the narrative of my childhood? Why am I constantly re-traumatizing myself? I was, at that point, trying to stop drinking, seeing a hypnotist, a doctor, and a psychologist, and it was just getting worse. I guess it was moving towards this point of stopping, and, perhaps in my mind, learning more about what was driving my drinking.
Rumpus: Did you start the research before you’d stopped drinking as well?
Valentish: I started approaching experts before I stopped drinking. It would have been such a different book if I’d written before I stopped. I would’ve been very bitter towards certain people, and wouldn’t have had the benefit of distance. Even if I’d written it in the first year or two after, it would’ve been a different book, because I was fully entrenched in AA. The language would’ve been different. The idea of what addiction is would’ve been different.
Rumpus: Do you feel your research satisfied your questions about yourself?
Valentish: I do feel they’ve all been answered, and what a privilege to be a journalist and be able to use yourself as a case study and exploit your position. I did feel, “Does the world need another white, middle-class woman writing about her addiction? Should I be the case study?” At the same time, I felt ethically dubious about using someone else, knowing how intense it would be. So I tried to use myself as a springboard to explore deeper topics, and make sure I had the trans experience and the indigenous experience in there as well.
Rumpus: Some of the stories and scenarios are devastating, like where a woman’s mother administers her first shot of heroin at age twelve, and now the woman’s in jail, with her mother taking care of her child because she’s the only family around. That woman isn’t going to respond to one-size-fits-all treatment, or support that’s packaged in optimism and feel-good sayings, as you point out. When you look at populations other than white, middle-class women, how does treatment play out for them?
Valentish: In particular with the indigenous women, there’s historical fear of having their children taken away because of the Stolen Generations, where aboriginal women’s children were taken as a matter of course and adopted into white families. But also, aboriginal women are more likely to have their children taken away if they appear on the radar of social services, and drug and alcohol services. That’s going to be extremely off-putting to someone considering seeking help in the first place. It’s a huge barrier to treatment.
Rumpus: You wrote that drug issues aren’t about the drug. Do you think people finally understand that? The public, and practitioners, and people who are designing treatment programs?
Valentish: I think it’s vastly different in Australia than the way it is in the States. We’ve had a national drug strategy of harm minimization since 1985, and more of a person-centered approach. There’s definitely an understanding that it’s not about the drug. Treatment services are geared towards all sorts of contributing factors to how you got where you are now. It’s a biopsychosocial approach, where we consider that there are environmental factors, psychological factors. You might have a genetic predisposition to being vulnerable, as well. I think in the States, it’s still very much about abstinence, and if you’re clean of the drug, then you’re going to be okay.
Rumpus: Doesn’t some of the problem go back to insurance and the way the health system is administered?
Valentish: Your average person doesn’t know that. They’ll talk about the disease model without understanding it’s necessary to call your addiction a disease so you can claim on health insurance. In Australia, if you went to any government-affiliated treatment service, you don’t talk about addiction being a disease at all. However, if you went to a private rehab where there’s a backbone of twelve steps, probably the main dialogue is going to be of disease. There’s this kind of duality going on. Same in the UK.
Rumpus: In the book, you included substance-related entries from your medical records. For example:”Tonsillectomy postponed after admission of heroin use the night before.” You never tried to hide what you were doing, but you noted that there was never a root-cause analysis. No one asked why you were doing these things that were leading to harm and medical issues. Why do you think the practitioners didn’t ask?
Valentish: In the UK, we’ve got this national health service where you have about three minutes, because it’s free. At one point, I did get referred to a drug and alcohol service, but the sensible thing would be to also note that this person has mentioned childhood trauma, and maybe that needs to be tackled as well. It’s down to time and resources. And perhaps then, in the 90s, there was less realization that addiction is a mental health issue, in my opinion, and there’s often an underlying mental disorder or trauma. We automatically know that now. Certainly in the UK and Australia, you’d be making that assumption. Also, trauma’s in the “too-hard basket.” I think a lot of GPs think it’s anxiety. Women often present with anxiety. I was sent away having been taught how to blow in and out of a paper bag without the idea of “what’s causing the panic attacks?” I was turning up on a weekly basis at one point, which surely says to any GP, “This person is seeking attention. Why is that?”
Rumpus: Another point you raised was that an addiction story doesn’t necessarily involve trauma, but it’s rare for a trauma story not to involve addiction. You’ve talked to drug and alcohol counselors who say between 70 and 99.9 percent of the women they work with have been sexually abused, yourself included. Why is trauma still so ignored?
Valentish: This is a massive generalization, but my understanding is that NIDA (US National Institute on Drug Abuse) is funding research that backs up the disease model, and is less interested in research that doesn’t. That has a trickle-down effect across the world, because NIDA funds more research than any other country.
Rumpus: From your interview with the Guardian, I read that the lack of research with participation by women comes down to money. In the same way trauma’s in the too-hard basket, organizing research around women, with consideration of how substances affect women, becomes too hard, and so it doesn’t get funded.
Valentish: Often research is building on previous research, using data from studies that have gone before. If that was mainly using men, or one-hundred percent men, then you’re going to continue down that route. The fact that women have menstrual cycles means that it skews the data, so people don’t want to use women. Not to even get into if you’re premenopausal, postmenopausal, perimenopausal, in puberty—that’s a massive skewing of the data as well. Studies rarely even use female rodents for that reason. Men are the low-hanging fruit is how it’s been described to me.
Rumpus: That’s a problem for the success of treatment for women.
Valentish: It basically means we’re just viewing women as mini-men.
Rumpus: But don’t we get that in so many different ways?
Valentish: Yeah. As if the experiences men have while in active addiction are going to be the same as what women experience. As if their treatment needs are going to be the same. They’re clearly not. I do think we need trauma-informed treatment across the board, and that would benefit men as well. A woman accessing treatment is more likely to have experienced family violence, perhaps financial abuse, emotional abuse, physical abuse, sexual abuse. Her needs are very different.
Rumpus: You wrote, too, that being born a girl was being born onto the losing team, and an accelerant poured onto the embers of your rage. The rage you had as a child, is it still there? And for women, is it going to be rage that turns the tides?
Valentish: Hm. First of all, yes, it’s always powering me along. I’ve taken to doing Muay Thai as a constructive way of using it, because when rage turns ruminative, it’s not constructive. As for the larger picture, there are some incredible books written lately that have been powered by rage. Why I’m No Longer Talking to White People About Race, for example. In Australia, there’s a feminist named Clementine Ford who has written books like Fight Like a Girl. My point being that rage can be focused into moving forward and picking up other people along the way. To me, that’s constructive. It’s pretty hard to get rid of rage altogether, so if it can be moved to further a cause, that’s useful.
Rumpus: Of course, there’s counter pressure to quell it.
Valentish: These things tend to go in waves, don’t they? There’s a wave, there’s a backlash, it recedes, there’s another wave. I will say that if women don’t find a constructive outlet for their rage, we tend to turn it inwards. We experience self-harm, eating disorders, and things that we do to our bodies way more than men. It’s a mixture of self-loathing and frustration, and also trying to reclaim your body, because it’s been co-opted from such a young age, either through cultural expectations of what you’re supposed to do with it, or, more literally for some people, your body’s been taken over. We can express rage on ourselves. I certainly did for years, through self-harm, an eating disorder, and substance use.
Rumpus: You talk about being a sensitive child, temperament predictors linked to substance abuse, and how you had a lot of expectations around justice. Years ago, I was in the back row of a leadership class, and during introductions, I gave some random example about feeling let down by the world. “People don’t use their turn signals and I can’t handle it.” The instructor ran to me, dropped to her knees, grabbed my hands and said, “Don’t give up those expectations; we need people like you in the world.” I’m wondering if your expectations have eased? Or are you of the same mindset as that instructor, that we’ve got to hold on to those high expectations?
Valentish: I do agree with her, because I couldn’t have written a book heavy in research had I not had that mindset that’s focused on finding problems. The vast majority of my journalism these days is about social injustice and trauma. Not my own, other people’s. Yeah, in the first chapter I’m talking about temperament, how people who have low resilience, low flexibility, high reactivity, or low persistence could be more likely to experience drug and alcohol issues later because they’re so sensitive that they self-medicate. I have to say, going to AA for eighteen months taught me to let things go, that you can’t control things. So I’ve eased up on my expectations somewhat, but I still have that mind which looks for the problem in everything. I’ve accepted that’s a handy skill to have as a journalist.
Rumpus: Did you have that sense of not fitting in? Square peg, round hole?
Valentish: Definitely. I see a psychologist who specializes in two things, addiction and Asperger’s. He’s pretty convinced I’m on the spectrum, which makes sense, because I couldn’t understand social etiquette when I was growing up. I was always rubbing people the wrong way, and I would get so frustrated that people were, in my mind, misunderstanding my intentions. I’d get drunk, one, to give myself more social confidence, but two, as a form of bravado. It sort of became my shtick. Okay, if I’m unintentionally upsetting people all the time, I’d better make out that it’s intentional. It was because of that sense of not fitting in and not getting it, not having the manual.
Rumpus: This is all self-discovery. It’s this life-long process of connecting all these dots.
Rumpus: So even though you answered your own questions during your research, do we ever stop connecting the dots?
Valentish: I found out about that diagnosis after writing the book. I’m trying to stop connecting the dots so actively though. Having spent two years writing and promoting a book, possibly three, I’m sick to death of the topic of myself and I just want to move on to something completely unrelated to me. But you know, being the ruminative sort, it’ll return to me eventually.
Rumpus: You serve on the board of an organization in Australia. What led you to get involved to that degree? As I understand it, your advocacy revolves around harm reduction.
Valentish: SMART Recovery of Australia. Actually, SMART Recovery originated in the States. It does have a harm-minimization slant. You can go to meetings with no plan to be abstinent. So that aligns to a sub-theme of Woman of Substances, which is to promote the idea of addiction being a combination of factors, and not everyone’s automatically an alcoholic or addict. What I was trying to do with the book, and with SMART, is drive home the idea that your pathway into drug use was your individual pathway, your experiences were your individual experiences, and your way out should be tailored to your experiences. And to be clear, harm minimization can include abstinence.
Rumpus: Going back to gender, women tend to be pathologized in various ways. Borderline personality disorder is one. Can we talk about that?
Valentish: I went into this book thinking women self-medicate more than men. I’ve come out of it unclear. Certainly the more feminist, academic points of view were saying, yes, women do, because, for a start, we live in a patriarchy, with all the additional stresses that entails before you even get to things like sexual trauma and domestic violence.
On the flip side, women are definitely pathologized more than men. When it comes to drug use, men can be bads, but we prefer to see women as mads and sads. To put it technically, women are considered to be more likely to use substances for negative reinforcement, like to alleviate anxiety. Men’s reasons tend to be towards positive reinforcement, such as getting wasted or having the after-work drink, which is culturally acceptable. But women are conditioned to think of themselves as being unwell. You mentioned borderline personality disorder. The DSM (Diagnostic and Statistical Manual) has always had a task force behind it, making the decisions, that’s primarily male. The current task force is twenty-seven men versus four women.
Rumpus: As soon as the DSM comes up, that’s when I start feeling rage-y.
Valentish: I want to look into the DSM more. I’d like to read more about what people who work in psychiatry and psychology think about it. For instance, borderline personality disorder. It’s kind of become a dustbin diagnosis where difficult women, and often gay men, are dumped. A big problem with that is it’s diagnosing and medicating people without addressing the fact that there’s underlying trauma, because the symptoms of BPD are basically coping mechanisms for trauma or neglect.
Rumpus: Didn’t one of the doctors you interviewed call it “complex trauma disorder?”
Valentish: She said that, but I think there’s a diagnosis called that already, or something similar. What she’s getting at is if we called it something like that, doctors and psychiatrists who are diagnosing it would be forced to acknowledge that there’s trauma. You can’t just medicate somebody. Borderline personality disorder usually involves multiple medications, so someone’s just rattling around with these prescribed medications. Probably illicit drugs as well. And still the trauma.
Not that there has to be trauma, as you acknowledged earlier. I remember going to AA meetings and lots of people would be quite puzzled, saying, “I had a great childhood.”
Rumpus: There was information in the book about different health impacts specific to women that I hadn’t read before. One is that a drink per day equates to an eleven percent increased risk of breast cancer.
Valentish: It elevates estrogen, which causes all sorts of problems. I’ve got estrogen dominance now, which is, uh, I can’t be bothered going into all the symptoms, but I often think, is that because I drank pretty much every day for twenty-two years? Probably.
Rumpus: I love the chapter on your first fifty-two weeks of sobriety. You discuss unexpected hurdles like the hormone changes you went through. Once a person stops taking substances, the body doesn’t automatically rebalance. It takes a long time. A woman in one of your groups realized her PMS week was also the week she wants to throw herself under a truck.
Valentish: Not only that, you’re more prone to relapsing. But you don’t read that anywhere. It should be on the AA scrolls when you walk into a room. It’s really important to know that at least one week a month you’ve got to be super vigilant, and be aware that your response is going to be heightened.
Rumpus: After going to mixed AA meetings, you sought out women’s meetings. Why is that?
Valentish: I felt much more comfortable doing that. Given my background, which you touched on, and which includes sexual abuse as a kid, I’m so aware when I walk into a room or train carriage where all the men are. There’s an automatic tension and wariness, which, I’m forty-three now and it hasn’t gone, so I’m not confident that it will go. But it meant that to be in an AA meeting where you’re supposed to make yourself vulnerable felt really unsafe. Even though it’s not literally unsafe, it doesn’t matter, your body doesn’t understand that.
Rumpus: Once you’d quit, you were facing, what did you call it? The taupe eternity. So you sought out ways to buzz your reward center, because much of addiction is about dopamine hits. Part of your recovery was to go do all these different things. Lots of crazy things. And by crazy, I mean skydiving. Can you talk a little more about that?
Valentish: There’s no reason you can’t still be a sensation seeker. My pathway of doing that was one of intense privilege. I had the resources and time. If you boil it down to its essence, it’s trying find out what you enjoy, because you’ve probably been frequenting bars or squats for the past twenty years, and your social groups and interests have dwindled. It’s about reconnecting to the things you enjoyed as a child and rewiring the brain.
Rumpus: You blogged about that period as well.
Valentish: I desperately needed to do that so as to not fall into a pit of depression. It was good to do as a lifeline.
Rumpus: What was it called? Wasn’t it a line from an Eels song?
Valentish: It’s the title of an Eels song, “Hey Man, Now You’re Really Living.” The guy in Eels, the singer-songwriter, is very depressive. He’s written a book, Things the Grandchildren Should Know, that reflects his history of depression. If that eternal pessimist could write this song about noticing the beautiful things around you, if he could, I could.
Rumpus: I need to start listening to Eels. I read it’s them that got Steve Perry back into music. What is it with this band?
Valentish: God, when you hear it, I don’t think that will be that obvious.
Photograph of Jenny Valentish © WILK.