Women and the Politics of Pleasure in Critical Drug Studies

A branch of cultural studies, critical drug studies is an interdisciplinary field that interrogates the relationship between power and knowledge production. By examining how institutions, organisations, ideologies, and policies reinforce and support regimes of power, scholars explore how those systems of power affect people and everything in the natural and human-made world. For critical drug studies, examining women and drug pleasures means engaging social knowledges, structures and norms to understand what we mean by ‘women’ and how their ‘drug pleasures’ are constituted as cultural experiences and practices. How is the gender of people who use drugs (PWUD) related to their drug use? How does gender as a social category intersect race, social class and other categories that shape and contextualise drug pleasures? And where does the issue of pleasure emerge in research about women and drug use? Critical drug studies situates these key elements – drugs and gender, gender and pleasure and drugs and pleasure – as composite factors in a dynamic relationship of selfand cultural production. From exploration of gender performance and embodiment to social roles and the structural determinants that construct and constrain them, critical drug studies seeks to make visible how these systems and their ways of knowing influence the lives of women who use drugs. There is a considerable body of interdisciplinary research that explores the distinct dynamics of gender in drug policy, medicine and addiction treatment, and other social issues. In 2017, Contemporary Drug Problems and Social History of Alcohol and Drugs co-published a collection that engaged this foundational work in a critical dialogue. Coeditors Nancy Campbell and David Herzberg

offer a robust schematic literature review of the research that influences and comprises gendered work in critical drug studies across sociology, history, anthropology, philosophy and feminist theory. Arguing that '[d]rugs demand attention in gendered ways ', Campbell and Herzberg (2017, p. 253) review and collect work that examines how 'gender structures lived experiences and relations between the kinds of knowledge, imaginative connections and practices that comprise drug experiences -and the commercial, medical and carceral acts that surround them'. Gender functions as a logic, they argue, through what it renders invisible: male-centric culture. By highlighting and obscuring difference, gendered accounts of drug use can elide the complex lived experiences of women. Disrupting the sense of a 'natural binary', feminist scholarship demonstrates that gender is non-binary, relational, and co-produced. Critical drug studies' scholars find that gender is implicated in every aspect of cultural ideology and practice, from doing drugs and drug markets to the policy, policing, science and treatment that affects PWUD. In that collection, Helen Keane (2017, p. 127) writes that gender's governing mentality collapses sex and gender even as it emphasises female vulnerability in drug research discourses. While the effects of a gender binary are continually projected, reinforced, and enacted by people and institutions, they are also resisted. By doing drugs, Fiona Measham (2002, p. 364) posits, women 'do gender' as a means of both claiming and challenging conceptions of femininity. Critical studies about women and drug use map and translate the dynamic production of gender positionalities through repression, transgression, activism and self-exploration.
Although gender can be expressed in ways that challenge cultural constraints, gendered drug issues in the United States manifest in a range of expressions of structural inequality for women who use drugs. The twin systems of drug criminalisation and medicalisation, which have had nearly exclusive authority to define what 'drugs' are and influence how users access and take them, impact women who use drugs differently than men. For example, the policing of women who use drugs, particularly through the biopolitics of surveillance concerning reproductive rights and motherhood, is significant (Campbell, 2002;Campbell & Ettorre, 2011). While women make up about 40 per cent of the people who use illicit drugs in the United States, arrests of women for drug-law violations over the last decade increased four times the arrests of men, primarily for drug possession and drug use convictions (Castillo, 2019;Federal Bureau of Investigation, 2017). Women experience more sexual violence in the criminal justice system, from cavity and strip searches to sexual assault (Ritchie, 2017). Drug testing and mandated treatment are not gender specific, but women experience unique surveilling and policing of their bodies during pregnancy: pregnant women who seek obstetric medical care can be drug screened and arrested for the crime of assault on an unborn child (Paltrow & Flavin, 2013). State-by-state legislation criminalises women's drug use from fetal assault and criminal child abuse to civil commitment laws (Amnesty International, 2017).
While women are subjected to unique policing of their drug use, they remain relatively ignored or underrepresented in clinical drug research. Scientific essentialism about sex and gender differences sustains significant blind spots and inconsistencies in drug research (Du Rose, 2015). Feuerstein et al. (2018Feuerstein et al. ( , p. 1195 cite a series of issues raised in the 2017 Women's Health Congress that have yet to be addressed by medical researchers, from the inclusion of women in earlyphase clinical trials to the consideration of sex as a biological variable in preclinical research, as well as the analysis and reporting of sex and gender differences across the full biomedical research continuum. Researchers often fail to differentiate drug use practices by gender, although drug use has proven differential for women and men -from quantity and frequency to the types of drugs used in various contexts (Measham, 2002;Peralta, Stewart, Steele, & Wagner, 2016). Even as women's specific needs in terms of dosage or drug application are seldom studied in medical research, women have often been targeted by pharmaceutical markets, particularly with psychotherapeutics like Valium and Prozac (Herzberg, 2009, p. 8). Outside feminist studies, drug research tends to reinforce problematic notions of gender that inform and shape punitive drug policies and practices. Keane (2017, p. 133) identifies a significant outcome of research institutions, such as the National Institute of Drug Addiction, representation of drug use: the erasure of women's agency as pleasure seekers.
Within such cultural contexts, what can we know about how women engage drugs as part of embodied pleasures? When we use psychoactive substances, we potentially engage the mind, the body, and the phenomenology of emotion, action and social exchange -as well as cultural meaning. Drug use raises issues of subjectivity, embodiment and pleasure, as well as issues related to sexuality, gender, spirituality, etc. To ask why we use drugs is to invoke the complexity and spectra of experiences that PWUD have, meanings that reflect embodied experience and engagement with the world.

Pleasure in Critical Drug Research
Adrienne Maree Brown (2019, p. 3) writes that '[p]leasure is a measure of freedom', recognising that pleasure is contingent on as well as an expression of personal autonomy. Brown's focus on legitimising pleasure through the acts of our own pleasure-taking and -making is key to understanding embodied human experiences like drug use. Critique of the legal and medical systems to which PWUD have been subject, and an increase in ethnographic work that conveys the voices and lived experience of PWUD, has led to a greater recognition of the validity of drug pleasures in research. This turn is significant, especially for women, as it resists the marginalisation that has erased or ignored embodied drug narratives while broadening an understanding of the myriad of outcomes for which people use drugs.
An individual's encounter with a psychoactive substance is both profoundly social (encoded and enmeshed in dynamic fields of meaning) and simultaneously physiological and psychological. While drugs have effects on bodies that may be measured and are certainly experienced as 'real', people apprehend and make sense of their drug use by interpreting it through wider discursive frames. The coproduction of drug pleasures recognises that where people use drugs, with whom, and as part of what kinds of other experiences and circumstances, influences whether the associated sensations as perceived as pleasurable. Drugs are powerful signifiers of meaning, not just for individuals who use them but also across cultures, where drug use may signal inclusion, marginality, and even normalisation (Walker, 2020).
Critical drug studies' exploration of drug pleasures offers multiple trajectories. Scholars contend that drug use should be studied as a complex practice motivated by pleasure for the vast majority of PWUD (Race, 2009(Race, , 2017Taylor, 2016;Walker, 2017). Others challenge the ontology of the 'rational actor' when it comes to intoxicating pleasures (Dennis, 2017;Duff, 2002Duff, , 2008Duff, , 2013Keane, 2008;Moore, 2008;O'Malley & Valverde, 2004;Schnuer, 2013;Valentine & Fraser, 2008). Explorations of the antithetical relationship between addiction and pleasure find that people with substance use disorder articulate intricate pleasures regarding their drug use (Askew, 2016;Maclean, 2006). In the last decade, the two special issues of the International Journal of Drug Policy focussed explicitly on drug pleasures signify milestones in this body of work: first, opening wide a conversation about legitimising pleasure (2008) and, nearly a decade later, theorising social and material coproduction of drug experiences (2017) Duff, Sebar, and Lee (2017, p. 3) identify as 'the embodied, performative, situated, and affective dimension of drug use and the positive relations that pleasure produces'. Critical drug studies offers multivalent concepts for thinking about drugs, users, and drug pleasures in which drug consumption can be understood as a creative, symbolic act that, among other things, expresses the fluidity of identity.
The dominant trend in critical drug scholarship's theoretical explorations of drug pleasures seems to be moving away from understanding drug pleasures' messy subjective embodiment (Bunton & Coveney, 2011) through posthuman discourses that disassociate a person's phenomenology -the emotional, embodied experience -from theoretical explorations of drug pleasures. Critical drug scholars responding to the under-emphasis of the material experience of drug use in social-structural critiques use new materalism's conceptualisation as the co-creation and entanglements of an event (in this case intoxicated episodes) with an emphasis on the dynamic nature of matter and the contingent and multiple aspects of pleasure. Fay Dennis and Adrian Farrugia (2017) summarise the significance of drug pleasures through this lens as neither of the human nor nonhuman, drug consumer nor drug, or any subject or object (outside of drug use) for that matter, but always 'drugged', part of something more, that is, an assembled array of technological, social and corporeal forces. (p. 87) In this development, drug pleasure research echoes a tension with embodiment long articulated in feminist scholarship: gendered drug discourse has too often projected social power and structural inequities onto (female) bodies (Keane, 2017). Embodiment is central to understanding PWUD not only as cultural and social beings, but as corporeal entities in the co-constitutive process by which a drug experience comes into being (Elizabeth Ettorre & Riska, 2001;Ettorre, 2004). Questioning stable notions of categories like gender or sexuality, Merette Poulsen (2015) writes that 'bodies materialize gender in particularity' and, consequently intoxication emerges for specific women in specific contexts (p. 15). Scholars like Ella Dilkes-Frayne and Cameron Duff (2017) see new materialism as necessary to reconceive 'the ontological status of the human within these events' (p. 3).
Yet, in attempting to understand the dynamics of drug use, what Fay Dennis (2019) terms 'pleasure-in-tension', new materialist approaches de-emphasise the subjective experience of drug use which is, after all, a primary goal and outcome of drug use (p. 156). While emergent ontology or contingent subjectivity are not in themselves barriers, new materialist interpretations of these concepts can render drug use -and the scholarship about it -abstract and unknowable. Both the language and theoretical frameworks potentially distance researchers, as interlocutors, from engaging the human experience of drug pleasures. Although decentring is intentional in a posthuman theoretical approach, disregarding the phenomenology of drug use potentially marginalises the drug-using subject from her/their own experiences. Critical drug studies' scholarly purpose is to make clear the assemblage of sociopolitical dynamics of drug pleasures. But the politics of theoretically dislocating anyone, but especially women who use drugs, from their own pleasure is not insignificant. Recognising how that theoretical decentring impacts PWUD, particularly women, and their drug pleasures may be an essential next evolution for critical drug studies.
I do not mean to jettison the critical ground new materialism has claimed in thinking about the dynamics and contingent nature of drug pleasures, nor do I want to propose that critical drug studies should adopt an essentialism about PWUD. However, the ways in which PWUD are researched and theorised, particularly when it comes to the multivalent nature of drug pleasures, is underdeveloped and under-informed by their perspectives, including those of researchers with lived experience. Miranda Fricker's (2007) 'epistemic injustice' framework is useful in grasping the ethics of this knowledge deficit. It describes the circumstance of not understanding a person's experience based on an inability to conceptualise that experience due to her/their historic marginalisation from the very knowledge-making that defines that experience (p. 7). Critical drug studies engage intoxication and pleasure in ways that too often obscure the experience of the user as an authority of her/their experience, from the research questions posed to the models and methods used to answer them. Fay Dennis (2019) writes that '[u]nderstanding the epistemological as ontological that is, knowing-as-making, exposes the importance of our practices for intervening in the worlds we used to merely study ' (p. 130). The ways in which we, as drug scholars, use theoretical languages to try to better understand the dynamics of drug pleasures is subject to this same principle: we participate in the making of drug worlds -especially by informing those who create policy or provide healthcare and addiction therapies.
What can be 'known' about drug pleasures likely involves the influence of additional, different ways of knowing. Campbell and Herzberg (2017, p. 259) posit that to be more inclusive, research must take care to note how gender is deployed discursively by women who are seeking to maximise their own economic and political agendas. Drug research, I would add, must also take care to understand how gender is expressed by women seeking to maximise their own pleasure. Re-exploring the embodiment of pleasure by engaging the subjective experience of women who use drugs more directly re-situates the user in her/their experience, inviting different expressions of drug pleasures. How can we rethink approaches to addressing the materiality of the body and the ontological issues related to drug use? And how does gender lend itself to that project? Reconsidering women and drug pleasures suggests addressing the variable ways in which perceptions and judgments about pleasure seeking can and are often coded by gender and biology. Women are often judged more severely for drug use and especially for prioritising their pleasure. In a historical context in which women's intoxication has invoked shaming and criminalisation, control of their bodies, and silencing of dissent, a scholarly activism by and inclusion of women who use drugs should be foundational to critical drug studies.

Critical Drug Studies as an Intervention
As a discipline, part of cultural studies key work has been to question the conventions and structures of academic discourse (Gregg, 2006). If the field is to embrace the embodiment of drug use in ways that re-centre the phenomenological lived experience of drug use, especially that of women, what offers promise? What concepts or methods will address a situated, embodied, experiential way of articulating drug pleasures in ways that do not marginalise the phenomenology of women who use drugs?
Kane Race (2017) posits that the indeterminacy of pleasure may function as a radical intervention in research knowledge-making if we consider drug use as experiments taken with an end in mind, with the deployment of particular sources of information, and with particular effects (pp. 145-148). In this view, an instance of drug use is exploratory (much like research) in that its end is unfixed. A user makes choices based on previous experiences and information, and often engages others in the sharing/experience of outcomes. Peta Malins' (2017) catalogue of the diverse dynamism of drug desires notes that we use drugs to generate sociality, transcend the bounds of self, to challenge political control of our bodies, thoughts, and ways of desiring, among innumerable other motivations (p. 130). This suggests that the kind of user 'experiments' Kane sees people engaging in are far more complex than the questions drug research tend to ask. The multidimensional phenomenology of drug use necessitates the development of a lexicon of drug experiences and pleasure to get at the habitus of drug pleasures in practice (from uncontrolled intoxications to lesser enhancements). Cameron Duff (2008) names one's drug-taking habitus 'practices of the self ', as a framework that contextualises the user differently (p. 386-387). As a person who uses drugs, I find this framework useful. We engage in many 'practices' of the self, of which drug use is but one. To conceive of drug pleasures as a legitimate and typical practice of the self is to expand how researchers conceive of drug use.
In that spirit, I am drawn to activism that invites knowledge-making that is oriented in the lived experience of women who use drugs. Judy Chang, Executive Director of the International Network of People Who Use Drugs, calls for a narcofeminism that rejects scholarly marginalisation of women who use drugs, particularly within critical studies and feminism: We're no longer willing to be marginalised by a movement that we hold claim to, where our bodies are deemed impure or our behaviour unnatural or immoral. What, after all, could be more patriarchal than telling a woman what to do with/put in her body? (Chang, 2019) One place to begin is with the autoethnography of PWUD as researchers and researchers as participants, situating the individual epistemologically in the political and cultural through the personal. Elizabeth Ettorre (2017a) writes that autoethnography invites 'speaking about oneself to transform into narrative representations of political responsibility -an important issue for feminists who often function as cultural mediators' (p. 359). She further argues that: 1) autoethnography creates transitional, intermediate spaces, inhabiting the crossroads or borderlands of embodied emotion; 2) autoethnography is an active demonstration of the 'personal is the political'; 3) autoethnography is feminist critical writing which is performative, that is, committed to the future of women; and 4) autoethnography helps raise oppositional consciousness by exposing precarity. (Elizabeth Ettorre, 2017a, p. 359) Autoethnography offers a modality by which personal narrative becomes a convention of academic writing. It also presents a way of performing the self critically and authentically within conceptual frameworks that explore the complex, intersectional politics of women's drug use, ways that are representationally missing in the scholarship.
Coming out as a person who uses drugs is not a small concern. Recently, I cohosted a conversation at a major conference in which researchers who use drugs were invited to discuss the implications of self-disclosure and the significance of their drug use to their work. The overwhelming number of researchers who attended indicated the importance of this issue. The concerns voiced by so many, especially women, detailed the risks to their professional livelihoods, reputations, collegial relations and institutional well-being. Kane Race and Rebecca Brown (2016) write that while cultural studies 'self-situating' inclination has helped navigate the critic's duality as practitioner and reflexive intellectual, the discipline does not offer a buffer against the legal and professional risks associated with disclosing drug use. They argue, however, that 'taking such risks has the potential to impact the affective climate in which policy thinking and practices take place