Mothers and Illicit Drugs: Transcending the Myths by Susan C. Boyd (Toronto: University of Toronto Pr., 1999) 212 pp, ISBN 0-8020-8151-7 $19.95 (Cdn) pbk.

This investigation is the first in Canada to provide an in-depth analysis of illicit drug use among women, and, in particular, the way in which illicit drug use impacts upon their roles as mothers. Susan C. Boyd, Assistant Professor in the School of Criminology at Simon Fraser University, draws upon her experience as a teacher, community support worker and counsellor in providing a sympathetic, powerful, examination of the complex issues surrounding mothers and illicit drug use.

Writing from a critical feminist perspective, Boyd redirects the inquiry of women and illicit drug use away from current social science research, which focuses upon the developing fetuses of women who use illict drugs, and examines instead the experiences of the women themselves. The voices of the 28 women who were interviewed are quoted at length throughout this study. Their opinions and experiences are central to understanding the myriad ways in which the medical, legal and social service systems exert control over what has come to be defined as a problem population: low-income, minority, drug-addicted women. However, women who enjoy the economic resources which allow them to hide their drug use from social authorities, particularly social workers, are invisible. While 53% of those interviewed for this study were on social assistance, the remaining 47% were in professional occupations, self-employed, or full-time students or volunteers. Contrary to the myth that illicit drug use is restricted to native and minority racial populations, 68% of the women surveyed are of European heritage, 25% are Native and 7% are of African ancestry. In terms of education, 35% lacked a high school diploma, 25% had finished high school, while 40% had attended college or university, with 22% completing either a BA or MA degree.

Boyd begins her study with a gender analysis which moves through a consideration of women and social control, illicit drugs, motherhood, maternal drug use and neonatal abstinence syndrome (NAS). She argues that women are subject to social control on the basis of gender-specific ideologies centred upon family roles and biological reproduction. Women who operate outside the norms of the established gender ideologies are subject to regulation and punishment. Women who use drugs are believed to be more out of control, deviant, sexually promiscuous, passive, pathological and morally inferior than male users, despite there being very little research undertaken in this area. Recent feminist qualitative research has, however, challenged these conceptions and has contributed to fleshing out our understanding of women and drug use, particularly around motherhood issues, which are of central consideration to women users. Neonatal abstinence syndrome is presented by Boyd as a social construction, a result of narrow research considerations which have failed to separate out the impacts of social health determinants such as poverty and environment, health problems associated with the illicit status of drugs, and licit drug use.

The guilt women experience, as users and as mothers, is palpable in these pages. However, so too is their conviction that society is misguided in their efforts at the demonization of users and at the continued criminalization of drugs and drug users. This is echoed by Boyd, as she advocates for decriminalization and the adoption of a harm reduction model of health care and service provision. Boyd devotes a chapter to NAS, focusing upon the program at Sunny Hill Hospital for Children in Vancouver, B.C., the only one in the province, for the period 1983 to 1992. In 1993, a task force was established by the province to investigate the program, at which time the founding director stepped down. His testimony to the task force is a goldmine of evidence demonstrating the demonization of mothers of NAS-diagnosed children based on moral judgements and mythological beliefs which portray mothers who use illicit drugs as a breed apart. It is scary to read. So too is the chapter on the role social services play in reinforcing these myths and the myriad ways in which social services agencies fail to provide service for these mothers, opting instead for control. The efficacy of drug treatment programs and the effects of drug criminalization on women comprise separate chapters. Boyd concludes her study with an evaluation of the implications for policy makers, and reiterates her contention "that the legal, medical and social service professions in Canada control and punish" mothers who use illicit drugs. She argues for decriminalization, and a move away from considering child protection as the sole concern in these cases, and toward an understanding of the relationship between mothers and children. Arguably, this model involves a complete rethinking of not only drug use, but also of the provision of social support for mothers. However, this study, and in particular, the women who share their experiences, have given us powerful evidence in support of decriminalization and increased attention to the social determinants which foster negative drug use.

This is a courageous work which will certainly challenge the beliefs that many hold regarding women who use illicit drugs. Boyd writes in a no-nonsense, matter-of-fact style, giving space freely to the women to tell of their own experiences. It is a compelling analysis of the current state of women, children and drug use in Canada and should be required reading for any who work in this area.

Margaret Shkimba