Tag Archives: doulas

Substance Abuse and Social Capital

While the Donald Trump / Jeff Sessions administration is working to re-invigorate the war on drug users, a number of new studies look at relationships between social / cultural / economic capital on the one hand, and drug use, on the other. In my own research with criminalized women in the Boston area I witness the drug-encouraging perfect storm of poverty, marginalization, and the absence of meaningful opportunities for understanding how social inequalities cause suffering.

Despite popular articles (including this one in the New York Times) extolling drug treatment in prisons, newly emerging research suggests that locking up drug users is just about the worst thing we can do if we want to reduce drug-related deaths. By removing people from sources of social and cultural capital, we are exacerbating the very conditions that lead far too many Americans to abuse substances to begin with.

Opiate deaths in a former manufacturing community

A recently published qualitative study looks at factors contributing to drug overdose in the Monongahela Valley of Pennsylvania. This is a region that used to be a center of steel production but is now economically very depressed as manufacturing has shifted out of the area. The author interviewed people at a drug treatment program and found that they mostly spoke about lack of jobs and overall hopelessness in the local communities. The author concludes, “While state and county efforts to ameliorate overdose mortality have focused upon creating an open market in naloxone, this study suggests the need for interventions that address the poverty and social isolation of opiate users in the post-industrial periphery.”

To me, it’s interesting that the author makes the connection between poverty and social isolation for the “post-industrial periphery” but I think the same argument can be made for urban and suburban areas.  When people feel isolated and hopeless — and, of course, when mood altering substances are easily available — drug use can be quite attractive.

I suppose that the appeal of 12 step groups such as Alcoholics Anonymous and Narcotics Anonymous lies both in the sense of community (though, of course, it’s a constructed community that one loses as soon as one “relapses”) and the hope relayed by the success stories recited at meetings. Unfortunately, however, the hope and success (which is not as common as 12 step proponents like to claim) are limited to the specific context of the meetings. Commitment to sobriety does not change the economic reality of dead-end jobs, companies that do not have loyalty to employees, wages that don’t allow people to save money towards things like home ownership that truly bring hope, and so on.

Social capital and drug overdoses: a quantitative analysis

Another new study makes a similar point. In “Bowling alone, dying together: The role of social capital in mitigating the drug overdose epidemic in the United States” the authors used large-scale county-level data. The data show a pretty clear correlation between low social capital and high overdose death rates. The authors measured social capital in terms of the density of civic organizations, the percentage of adults who voted in elections, response rate to the census, and the number of non-profit organizations in the county.

While these measures are not perfect (in my opinion) they are suggestive. I’m particularly interested in the correlation between voting and drug overdose rates. In my own work I see a connection between substance abuse and the sense that one is stuck in world over which one has no power to make things better. Not just hopelessness but also powerlessness seem to drive at least some of the excessive drug use that we are witnessing around the country. In fact, according to the Sentencing Project, “one of every thirteen African Americans has lost their voting rights due to felony disenfranchisement.” Moreover, “A record 6.1 million Americans are forbidden to vote because of … laws restricting voting rights for those convicted of felony-level crimes. The number of disenfranchised individuals has increased dramatically along with the rise in criminal justice populations in recent decades, rising from an estimated 1.17 million in 1976 to 6.1 million today.”

What this study cannot get at is the variability of access to social capital within particular counties. I sometimes hear the women I have come to know speak with deep sadness about how other people seem to get the breaks while they just can’t catch a break. These women are likely to see their misfortunes as an individual failure or bad karma, but when I look at their life experiences I often see how identifiable policies forced them to be cut off from sources of social capital. Locked into jails, homeless shelters, rehab programs, low income housing and temporary jobs (at best), they are systematically excluded from the primary sources of social capital in our communities.

The women I know tell me that they want to help others, but even volunteer positions require criminal background checks. Many want to be part of church communities, but they find that churches drop them like hot potatoes when it becomes clear that they need more help than the congregations want to provide to any one individual.

Creating social and cultural capital: A revolutionary program in San Francisco

I’ll close here with a third article I read this week. This one highlights a program that addresses social and cultural capital in a very profound way. “Making the case for innovative reentry employment programs: previously incarcerated women as birth doulas – a case study,” documents a San Francisco program in which formerly incarcerated and low-income women were trained as birth doulas. 

According to the authors, “Realigning women within communities via birth support to other women also provides culturally relevant and appropriate members of the healthcare team for traditionally vulnerable populations. Doulas are important members of the healthcare workforce and can improve birth outcomes. Our work testing doula training, as a reentry vocational program has been successful in producing 16 culturally relevant and appropriate doulas of color that experienced no re-arrests and to date no program participant has experienced recidivism.”

Of course, not everyone is suited to be a doula! But the lesson from this project is far broader. Through participation in the program the women joined an on-going community, learned that they can be powerful agents in helping other women take control of their own births, and they not only acquire but also create meaningful social and cultural capital.