By Trond Ola Tilseth
This article was shortlisted in the News Feature category of the INSP Awards 2015. Originally published in Norwegian street paper Sorgenfri, it was reprinted in street papers worldwide after being shared on the INSP News Service.
“I am a person who enjoys life, but I have problems setting boundaries,” says Rachel Husvik Aune (43) jokingly. But the tone is serious when she adds:
“You’re shaped by the fact that life gets in your face all the time. Is life really different for a female drug user compared to a male drug user? It depends on what type of drug environment you are in. In the most heavily loaded environments, the ladies end up prostituting themselves. I haven’t had to do that, which might be why I’ve managed so well.”
Liv Innstrand has used drugs for 40 years. She feels that she has a more stable life now. Since December, she has lived at the women’s shelter, Heidrun. The communal apartment she lived in before was not a suitable place to stay.
“Once, the women who lived next door to me lit a fire to grill sausages on the living room floor. I was too scared to sleep in the bedroom. I had my bag ready at all times in case I had to escape. It’s not acceptable that people with substance abuse issues are placed with psychiatric patients,” says Innstrand.
She is sitting in the Heidrun centre eating cereal with milk. The center is a municipal low-threshold service for homeless women over 18 years of age, who are dealing with substance abuse issues.
Innstrand is staying here in Heidrun until she is assigned new municipal housing.
The Heidrun center started 15 years ago. Male drug addicts had King Carl Johan’s Work Foundation back then. Women needed something similar.
There has been little research focusing specifically on how women differ from men in the drug environment.
“The gender dimension is rarely the main focus when we are researching substance abuse, but it is often one of several things we investigate. It is estimated that about a third of drug users are women,” says lead researcher Anne Line Bretteville-Jensen at Sirus, is the Norwegian national institute of drug abuse.
She has interviewed intravenous drug users since 1993.
“In the nineties, women actually reported a larger heroin consumption than men. This could be related to the fact that they often had a more stable income. The reason for this is that there was more prostitution among women than men.
“Today there is less prostitution among intravenous drug users. Is this because of the sex-purchase law? No.
“The decrease in the number of prostitutes started before the change in the law. Heroin has become cheaper and prostitution are the first thing women will cut out if they don’t have to do it. They state that they choose less unpleasant ways to make money.
“Many of the women I interviewed also state that they are selling street magazines. It may well be that if they did not have this income, they would have to resort to prostitution,” says Bretteville-Jensen.
It is well known that men drink more alcohol than women. But when it comes to heroin and amphetamine, women use as much as men.
“Men can tolerate more alcohol than women because of physiological differences. When it comes to amphetamines and heroin, these differences between the sexes do not exist,” says the researcher.
While women make up a third of drug addicts, they make up only one fifth of overdose deaths.
“We do not know why this is, but it may be that they often inject with others. If that is the case, this may lead to fewer deaths,” says Bretteville-Jensen.
Academic director at Heidrun, Vivian Hovset, thinks a different approach is needed for the treatment of the two sexes. An initiative for women in Trondheim has started a project which focuses on women-specific approaches. The goal is optimal assistance based on the individual needs of the drug user.
“Women think differently than men. They develop their self-esteem and self-image based on what they believe others think of them to a greater extent than men. There has been little focus on gender-specific approaches to substance abuse, but we think this is important.
“Another factor is society’s attitudes. An example of this is drug user’s relationships with their children. It is more socially acceptable for men to be away from their children. In dating, we see that women are often more self-effacing. They usually place the man’s needs ahead of their own,” says Hovset.
The idea behind the Heidrun center was that women in a drug environment required shielding during some periods.
Resident Liv Innstrand is unsure.
“The word ‘shielding’ suggests that we should be protected from men. But here at Heidrun just like anywhere else, there could be people that you want nothing to do with. We live in extremely close proximity to one another. You can hear it when your neighbor farts. But Heidrun is okay when you don’t have another place to stay,” says Innstrand.
Beside her sits Heidrun’s academic director, Vivian Hovset.
“You’ve made a few changes in your life, haven’t you, Liv,” she says.
“Yes, I’m beginning to rise in the ranks. Soon I’ll probably be in charge of Heidrun,” Innstrand responds with a smile.
One of the most important changes is that she has just switched to a different medicine. After getting suboxone as a substitute for opiates for years, she now receives morphine tablets from her doctor.
“Suboxone gave me headaches and nausea. I felt sick constantly. Additionally, I often misused drugs on the side. On morphine I’m stable, and I feel more calm. I am accustomed to morphine after using it for 40 years, says Innstrand.
Solveig Henden is sitting in one of the modern “smoke shops” at Heidrun. This is a kind of phone booth with air extractors where smokers can enjoy their nicotine without bothering others. Before the smoking bars were installed at Heidrun, the cigarette smoke in the house was so thick it could be cut with a knife.
Henden has spent the night at Heidrun’s emergency department. She was evicted from her municipal property the day before.
“I wanted to be nice, so I invited people who didn’t have anywhere to live to come home with me. This led to a number of complaints from neighbors. You lend a room, but they’ll take over the property with parties and everything that comes with it. But I hope I get a new place to live soon. It is dangerous to stay too long at Heidrun. With so many addicts in one place, it is easy to fall off the wagon again,” says the 42-year-old.
Vibeke Kleveland, of the health and overdose team in Trondheim, believes there are higher levels of conflict among women than among men in the drug environment. They experience more frequent episodes of violence among female addicts than among their male counterparts.
“Many of the women I interviewed also state that they are selling street magazines. It may well be that if they did not have this income, they would have to resort to prostitution.”
“Also, women do drugs more evenly over time because they commit fewer crimes and therefore get fewer natural pauses in their substance abuse in the form of imprisonment,” says Kleveland.
She estimates that about one in four drug addicts in the Trondheim area are female.
The healthcare team runs among other things the initiative Subrosa in Olav Trygvassons street. Subrosa is offered to both men and women involved in the drug scene in Trondheim. But every Thursday from 1pm to 6pm it is only open to women. It offers among other things haircuts, acupuncture and massage. Here, women can also make food and eat with the staff.
Rita (59) has just sat down in the barber chair.
“This is a nice break from everyday life. It means a lot to me that this service exists.”
She has been in the drug scene for decades, and points out that life just gets harder and harder.
“In the 70’s there was more positive contact and collaboration between those who are using drugs. More peace and love. Today, the drug environment has become much more selfish, and more and more drugs are being used. More and more cynicism. I miss rebellious attitude, the thought of standing together to achieve changes in society.”
Psychiatric nurse Hilde Mandt likes hairdressing as a hobby and is rubbing Rita’s hair with hair dye.
“We often meet the users other settings. But here we can have girl talk, about everything from recipes to sex, personal problems, hairstyles or knitting,” says Mandt, while she works with Rita’s hair.
A group of 40 women used the service regularly last year. There are usually between four and five women there each time. Nurse Vibeke Kleveland emphasizes that during Subrosa’s girl days, the staff and users are meeting on equal terms.
“For instance, I can learn how to make quilts or knit heels on socks here. In this way, users see that they actually have something to contribute, that they are a resource in themselves,” Kleveland explains.
She has the following to say about dating in the drug environment:
“There are examples of true love in this group. Some marry and stay together through thick and thin. But often the relationship is of a different nature as well. For some girls, their boyfriend is the one who provides them with drugs. In these cases, the supply of drugs is what makes them stay in the relationship, or what makes them find each other in the first place. There is no doubt that men who deal a lot of drugs also attracts a lot of ladies. I remember a man who used to drive here on his moped to get clean user equipment. He always had a new, young girl on the back of his moped.”
Kleve’s co-worker, psychiatric nurse Jan Erik Skjølås, notes that many girls in the drug world are terribly exploited.
“We know of instances where girls are sold or rented to other men. We have also seen episodes where women have been subjected to terrible violence, beaten black and blue,” Skjølås explains.
He believes women and men in substance abuse treatment should not be placed in the same location.
“When women enter such places, it often happens that they get the role of caregivers for the men. These women have enough to deal with on their own, and should not put other people’s problems on themselves as well,” Skjølås says.
We are back at the Heidrun center. Innstrand agrees that conflicts between women are more common than among men in the drug environment.
“I have not been in many conflicts myself. But here at Heidrun I’ve experienced quite a lot of theft. You are trying to preserve what little you have, and it is upsetting when it is stolen from you. Even underwear. Violence may take place in the house as well, but the guards intervene when they see such episodes. Securitas regularly drop by during the night, and respond to calls from staff as well. It happens quite often that men hang out outside, yelling and trying to get in to the center.
But they are not allowed in,” says Innstrand
“In that sense at least, we see that the place is shielded from men. That point we can agree on, says Brita Witzø, the director of Botiltak Rus, a housing measure in Trondheim.
“Well, once there was a guy who jumped into the window of the emergency department…one person can always ruin things for everyone else. And then there will be much focus on just that aspect of things,” says Witzø.
“It’s time to shine this place.”
Bjørn Dretvik takes a firm grip on the mop and energetically removes dirt and paper debris from the floor in the common area of the Heidrun center. He has worked with both men and women in the drug environment.
“I think women have more conflicts about chores than men have. But I understand them.
“They live so close here, and in that situation it doesn’t take much before bickering starts. But in general I think there’s a surprisingly low level of conflict,” says Dretvik.
Previously, only women could get jobs at Heidrun, so that residents would not have to deal with men. The fact that males are now employed there now is not something that bothers Liv Innstrand.
“It’s good that we get to see some men around here too. Besides, there are many things that are easier to talk about with men than with women.”
Tessa Asklund, who has been a resident at Heidrun several times, agrees.
“There is a lot more jealousy among the ladies. There are a lot of old grudges that haven’t been let go of. Sometimes violence breaks out as well. There’s always someone who can’t stay in line. Some think they are special and that they deserve more pity than others. But really we are all in the same situation.”
Translated from Norwegian into English by Maria Sødal Vole.