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Gender and Critical Drug Studies: Reproducing Female Vulnerability in Gendered Drug Discourse

Updated: Aug 29, 2023

Editor’s Note: Today’s post comes from Helen Keane, associate professor and head of the School of Sociology at Australian National University in Canberra. In it, she explores more about her article on perceptions of female vulnerability, especially in terms of drug use, which appeared in a special co-produced edition of SHAD and CDP, Special Issue: Gender and Critical Drug Studies. Enjoy!

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Helen Keane

Female vulnerability is a persistent theme of medical, public health, and popular discourses on drug use. Women have been understood as biologically, socially, and morally vulnerable to the harms of substance use, and the blurred boundaries of these categories have acted to exacerbate the naturalization of women as at risk from drugs. Men have higher rates of drug use than women, but they are rarely interpreted as suffering from an inherent vulnerability to harm. Instead their use is associated with risk-taking.

Discourses of vulnerability and norms of gendered responsibility for familial and social wellbeing combine to produce women’s drug use as more deviant and disordered than men’s use. In the figure of the pregnant or maternal drug user, the vulnerability of women is converted into a threatening capacity to produce harm. Female biology is contrasted with an unmarked male norm and viewed as more unstable and more prone to damage (in a set of tropes focused on reproduction and reminiscent of Victorian medicine). The vision of unruly drug-using women and the social disorder they produce is one of the “governing mentalities” of drug policy, to use Nancy Campbell’s term [1].

A NIDA online fact sheet on “sex and gender differences in substance use” [2] demonstrates the way women drug users are defined and indeed saturated by their gender and their sex. Although the heading refers to sex and gender differences, the overall topic category is “substance use in women.” Thus the difference in question is the difference of women from men, or as feminist philosophers would suggest, their deviation from a phallocentric norm [3].

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Would these women use drugs? And if they did, how would they be judged? Image from NIDA’s “Sex and Gender Differences in Substance Use,” link below.

The fact sheet begins with definitions that locate difference as the structuring logic of sex and gender: sex is “differences based on biology” and gender is “differences based on culturally defined roles for men and women.” Despite opening with this distinction between sex and gender, the fact sheet does not use these terms again (except when mentioning sex hormones), instead simply referring to “women” as the relevant subject category.

Therefore it is not surprising that the fact sheet focuses on the “unique” and “special” issues faced by women in relation to substance use, such as “hormones, menstruation, fertility, pregnancy, breastfeeding, and menopause.” These reproductive experiences are linked to women’s “struggles” with drug use. It is not mentioned that according to US data, drug use is “dramatically lower in pregnant than non-pregnant humans” and remains lower among mothers than women without children. This is not to deny that motherhood interacts with women’s drug use, but the fact sheet presents a state which is associated with low rates of substance use simply as a site of vulnerability to drugs.

The fact sheet also outlines “unique” reasons women turn to drugs, including weight control, coping with pain, coping with exhaustion, and self-medication of mental illness. It communicates the sense of an over-determined confluence of risk emerging from a general weakness and propensity to pathology, without any mention of sex and/or gender as a source of resilience or protection for women. Also absent is the possibility that women drug users are active seekers of pleasure and self-expression. Moreover, the reiteration of “uniqueness” as a characteristic of these issues constructs men’s drug use as unaffected by supposedly feminine experiences such as pain and illness, reinforcing the idea of a sexual dichotomy that is both biological and social.

In contrast to this gendered account of drug use, the dominant neuroscientific model of addiction presents a generic and universal model of brain dysfunction as the basis of addictive disorder. The brain of the brain disease model is unmarked by differences of sex, race and class. However, a sex-differentiated neuroscience of addiction has developed in recent years, characterized by strong assertions of male-female difference based on biology and shaped by evolutionary forces. This scientific literature can be read as a continuation of the gendered drug discourse found on the NIDA fact sheet. One recent account proposes two contrasting sex-differentiated pathways to addiction [4]. The first, based on “sensation-seeking,” is more common in men, while the second, based on “self-medication,” is more common in women. While the model highlights sex-differentiated neurobiological processes as the basis for this bifurcation, it also depends on pre-existing and taken-for-granted categories of men and women whose attributes and behavior are analyzed through gender norms. Female vulnerability continues to shape the governing mentalities of drug use despite neuroscientific recognition of the complexity of addiction and continued evidence of the harms experienced by men.


  1. Campbell, Nancy. Using Women: Gender, Drug Policy, and Social Justice (New York: Routledge, 2000).

  2. National Institute on Drug Abuse, Drug Facts: Substance Use in Women, 2015. (accessed 6 March 2017).

  3. Grosz, Elizabeth. Volatile Bodies (Bloomington: Indiana University Press, 1994).

  4. Becker, Jill, Adam Perry, and Christel Westenbroek. “Sex differences in the neural mechanisms mediating addiction: A new synthesis and hypothesis,” Biology of Sex Differences 3, no. 14 (14 2012): 2, 22.


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