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"The meth factor": group membership, information management, and the navigation of stigma.

Midway through our third interview, Val stopped telling me about reconciling with her daughter to share a recent conversation she had with her son. A "functional" methamphetamine user in her 40s, Val struggles with the drug's stigma. She had recently tried Adderall and observed that, although she obtained the drug illegally and used it for the same reasons she does meth, she didn't feel the need to hide her use of Adderall. So, she asked her son about it: "Why do so many of the same people who look down on meth accept Adderall?" He simply replied, "It's the meth factor, Mom. Meth is just dirty. Everybody knows that" (Field Note, Fall 2011).

Val's experience exemplifies those of many methamphetamine (or "meth") users in the contemporary United States, reflecting the ubiquitous nature of the stigmatization of meth use and user. As Val's son tells it, no explanation is required to accept or apply this stigma, for meth's "dirty" qualities are common knowledge. In recent decades, popular entertainment, news, and prevention media in the United States and other countries (e.g., the United Kingdom, Canada, and Australia) have contributed to the construction of meth as a social problem. This has resulted in an authoritative discourse that is undergirded by hyperbole, routinization of caricature, (1) and a moralistic focus that contribute to the moral panic that many scholars have identified as a "drug scare" (Armstrong, 2007; Ayres & Jewkes, 2012; Boyd & Carter, 2010; Linnemann, 2010; Linnemann, Hanson, & Williams, 2013; Linnemann & Wall, 2013; McKenna, 2011a). Past drug scares, such as the "crack epidemic," have been associated with the production of stigma and the subsequent shaping of policy in ways that contribute to the social exclusion and oppression of drug users (Bailey, 2005; Buchanan & Wallack, 1998; Buchanan, 2004; Buchanan & Young, 2000; Green, 2009; Green & Moore, 2013; Murphy & Rosenbaum, 1999; Rodner, 2005; Reinarman & Levine, 1997a; Semple, Grant, & Patterson, 2005; Siegel, 1997). Despite the continued recognition that stigma has real-life consequences for individuals who use drugs (Murphy & Rosenbaum, 1999; Semple et al., 2005), there remain few studies that seek to elucidate the way(s) active users make sense of and navigate this stigma (Green, 2009; Green & Moore, 2013).

In this article I examine the intersection of discursive constructions of meth use and users, the production of stigma, and the construction of ego identities of eight women who are active meth users. Drawing on data from in-depth, qualitative interviews situated in the social and media context of a medium-sized city in Northern Colorado, I elucidate ways that women who use meth interpret, navigate, internalize, and challenge the stigma associated with their use and what this means for their own engagement with broader social expectations regarding their roles and practices.

According to Goffman, stigmatized individuals often oscillate between embracing and displaying stereotyped ways of being and denying identification with the stigmatized group and its associated negative characteristics (1963, p. 107). Currie, Kelly, and Pomerantz (2006) demonstrate how awareness of subordinating discourses prompts girls to challenge these discourses and question the position of women in society.

Howarth posits that, while effective resistance to stigma is most often collective, to ignore the (albeit limited) agency of stigmatized and oppressed populations risks colluding "with stigmatizing representations that position the stigmatized as 'object,' as passive, as victim, leave the social inequalities of stigma intact and so deny the real human capacities of dialogue, debate and agency" (2006, p. 449). In his exploration of various populations' responses to stigma, Green (2009) argues that, at the individual level, drug users and other stigmatized groups are likely to both internalize and challenge stigma.

While few researchers have focused on the navigation of identity among meth users specifically, those that have suggest that they actively navigate stigma in nuanced and complicated ways. Both male and female users in Green and Moore's qualitative study navigated social stigmatization of meth use in order to make sense of their own use and related practices. Some individuals seemed to have broadly internalized this stigma, describing "meth as 'dirty' and 'addictive'" (2013, p. 4) while others focused on specific practices, distancing themselves from other users according to drugs used and mode of use. Neoliberal themes of control, agency, and risk avoidance were also used to distinguish "acceptable" use from use deemed "typical" or "unacceptable." In particular, women who use meth must balance social expectation, personal desires, and their realities of daily existence. For example, despite the constructed exclusivity of meth use and normative femininity, many women first initiate use in an effort to meet gendered social expectations. Several studies suggest many women appreciated the increased energy, improved mood, and weight loss promised by meth use as making them more ideal women and mothers (Boeri, 2013; Grinspoon & Hedblom, 1975; Joe, 1995, 1996).

This article extends existing knowledge about stigma, drug use and identity in several important ways. First, I focus on meth, a drug that, despite its long history of socially approved uses and relatively low rates of illicit use (Chouvy & Meissonnier, 2004; Goode, 2008b; Rasmussen, 2008; SAMHSA, 2012), has been consistently and broadly constructed in the English-language media as a "scourge" (Ayres & Jewkes, 2012; Boyd & Carter, 2010; Goode, 2008a; Jefferson, 2005; Linnemann et al., 2013; Linnemann & Wall, 2013). Second, this research was conducted in the unique context of Northern Colorado, United States, a setting in which there is considerable stigmatization of meth use and users. Although rates of meth use have declined in recent years, Colorado officials continue to identify meth as a significant and persistent public health and law enforcement problem (Suthers, Esquibel, Clark, Woodard, & Erb, 2012); The Meth Project (TMP) has a high profile multimedia prevention and community outreach campaign throughout the state, including the field site. Third, female drug users (including and perhaps especially meth users) tend to be disproportionately targeted by both media (Humphries, 1999; Linnemann, 2010; Linnemann, et al., 2013; Linnemann & Wall, 2013; McKenna, 2011a) and policy efforts (Boeri, 2013; Boyd & Carter, 2010; Flavin & Paltrow, 2010; Siegel, 1997) that juxtapose the perceived consequences of meth use with idealized notions of femininity.

Meth, authoritative discourse, and the production of stigma

Playing into more general and persistent "moral panics" (Cohen, 2002; Goode & Ben-Yehuda, 1994) about deviance, the media routinely construct drug users as dangerous yet lacking in agency, immoral, criminal, and violators of desired social norms. Although meth has been used medically and recreationally, licitly and illicitly, since the 1930s (Rasmussen, 2008), in the late 1980s it emerged in the media as a serious problem (Goode, 2008a). Meth was constructed as threatening populations previously believed to be insulated from or immune to "hard drugs" and their extreme consequences. The English-language media have portrayed those most vulnerable to meth use, addiction, and its consequences as white, rural, and poor (Armstrong, 2007; Ayres & Jewkes, 2012; Boyd & Carter, 2010; Linnemann & Wall, 2013), a claim that is not altogether incorrect, but is certainly incomplete (Boeri, 2013; Brown, 2010; Hser, Evans, & Huang, 2005; Joe, 1996; Lorvick, Martinez, Gee, & Kral, 2006). In the United States, women who use meth are frequently and disproportionately targeted and images of the female "tweaker" (2) are presented as mutually exclusive with and contradictory to those of normative expectations for women's appearance, roles, and behavior (Linnemann, 2010; Linnemann, et al., 2013; Linnemann & Wall, 2013; McKenna, 2011a). Meth use is constructed as a direct precursor to criminal and immoral practices (Armstrong, 2007; Ayres & Jewkes, 2012; Boyd & Carter, 2010; Linnemann, 2010; Linnemann et al., 2013; McKenna, 2011a).

At the center of the public, media-driven stigmatization of meth use are highly visible, often graphic, prevention campaigns showcasing the presumed criminality and physical deterioration of the meth user. The Meth Project (TMP), which features prominently in the research site, is a multipronged meth prevention effort, including an advertising campaign that can be found on television, radio, and billboards in seven states (TheMethProject, 2013). In recent years, critical examinations of meth use rates and TMP's evaluation methodologies have challenged the campaign's efficacy (Anderson, 2010; Erceg-Hurn, 2008) and highlighted its problematic portrayals of meth use and users (Linnemann et al., 2013).

Although TMP claims responsibility for falling rates of meth use in Montana, its home state, Anderson (2010) found use there was in fact declining prior to the campaign's release and the trend did not change with the presence of the ads. It has been argued that TMP's claims of success are based on poor evaluation methods and the misrepresentation of data. While youth report that they believe meth is dangerous, they also believe that the campaigns exaggerate the drug's consequences, which may undermine TMP's prevention intentions (Erceg-Hurn, 2008).

Nonetheless, due to the campaign's visibility and perceived credibility, TMP continues to play an important role in shaping opinions about meth use and users. For example, 98 of 107 undergraduate students asked to respond to TMP's website and associated ads believed they were produced by an official entity, such as the government (Linnemann et al., 2013). The messages contained within these antidrug media as such constitute a form of authoritative knowledge (Irwin & Jordan, 1987), that, despite the above described limitations, legitimize the very gender dynamics, power relations, and structural oppression that disenfranchise and exclude many drug users from mainstream, "civil" society (Buchanan, 2004; Buchanan & Young, 2000; Linnemann & Wall, 2013; Reinarman & Levine, 1997b).

The campaigns routinize worst-case scenarios, exaggerating typical physical consequences, playing upon gender- and class-based norms and claiming that addiction is instant and certain. Users are portrayed as developing zombie-like features such as pale skin, rotting teeth, and open sores; while female users are portrayed as trading sex for money and drugs or abandoning their children, their male counterparts are constructed as violent (Linnemann et al., 2013). Furthermore, despite TMP's claims of being evidence-based, the core message, "Not Even Once," runs counter to empirical data suggesting that most who try meth do not become addicts (Armstrong, 2007; Linnemann et al., 2013) and not all users become or remain addicted for life (Boshears, Boeri, & Harbry, 2011; Sexton, Carlson, Leukefeld, & Booth, 2008).

Gender and drug use

This study focuses on women who use meth and how they navigate and make sense of this stigma for several reasons. First, female drug users' have historically born the brunt of stigmatization by the media, especially with the "crack epidemic" of the 1980s and 1990s (Humphries, 1999; Mountian, 2005). Second, antimeth discourses in particular disproportionately focus on women, targeting them more often than men (Linnemann et al., 2013) although, in most contexts, women use meth at similar or slightly lower rates than men (Boeri, 2013). Third, female drug users face double standards within and considerable marginalization from and oppression by both mainstream society and drug networks (Boeri, 2013; Bourgois, Prince, & Moss, 2004; Lopez, Jurik, & Gilliard-Matthews, 2009; Maher & Curtis, 1992; Maher, Dunlap, Johnson, & Hamid, 1996; Murphy & Rosenbaum, 1999; Sterk, 1999).

Like other female drug users, women who use meth have different experiences and often face greater struggles than their male counterparts. Men and women often report different reasons for initiating and maintaining meth use; in particular, while men frequently use in order to work longer hours and improve their sex lives, women are more likely to use for generalized increased energy and weight loss (Brecht, O'Brien, von Mayrhauser, & Anglin, 2004; Lende, Leonard, Sterk, & Elifson, 2007). Women who use meth also face considerable structural and stigma-related barriers to accessing treatment (Rawson et al., 2008; Semple et al., 2005), basic as well as reproductive health care (Boeri, Tyndall, & Woodall, 2011; Murphy & Rosenbaum, 1999), and economic resources such as jobs and secure housing (Boeri, 2013; Boeri, Harbry, & Gibson, 2009; Sexton et al., 2008). They struggle to maintain diverse social roles--those that are licit and expected and those that are illicit and at odds with societal preferences (Boeri, 2013; Joe, 1995, 1996; Morgan & Joe, 1996)--and grapple with the meanings and trials of motherhood (Joe, 1995). Because of their biological and social roles as mothers, women who use meth are disproportionately targeted by policies against maternal prenatal drug use and the production of meth around children (DHHS, 2012; Flavin & Paltrow, 2010; Hohman, Oliver, & Wright, 2004). Finally, girls and women who use meth are more likely than men and boys to misuse the drug and suffer more direct negative consequences of their use (Lopez et al., 2009).

However, the authoritative discourse about women who use meth does not take these complex, multilevel forms of suffering into account. Rather, meth is constructed as the primary cause of users' suffering and women who use as very simply and severely deviating from idealized gender roles and preferred feminine behavior (Linnemann, 2010; Linnemann et al., 2013; Linnemann & Wall, 2013; McKenna, 2011a).

Sociologist Erving Goffman's concept of tribal stigma (Goffman, 1963) can be extended to apply to groups "organized around achieved traits," including drug use and addiction (Nack, 2002). According to Nack's framework, American women are typically divided into two "tribes," shaped by the good girl/bad girl dichotomy that dominates the culture. Rather than acknowledging the multiplex factors that contribute to the practices and circumstances of all people, including drug users, the media have constructed women who use meth as "bad girls," routinely portrayed as: uncaring and incompetent mothers and caretakers (Linnemann, 2010; McKenna, 2011b); promiscuous women who readily trade sex for drugs or money (Linnemann et al., 2013; McKenna, 2011a); and failed women who lose their minds as well as their looks (Linnemann et al., 2013). The "bad girl" tribe of meth users is reinforced as mutually exclusive from all other socially acceptable roles (see TMP print ads, wave 4:

http://www.methproject.org/ads/print/junkie.html;

http://www.methproject.org/ads/print/prostitute.html;

http://www.methproject.org/ads/print/runaway.html;

http://www.methproject.org/ads/print/thief.html).

Such portrayals essentialize the impact of specific drugs, emphasizing their direct effects and the presumed moral weakness of the user. This stigmatization undermines individual agency and glosses over cultural and political-economic factors shaping practice, experience, and subjectivity (DeGrandpre, 2002; Hunt & Barker, 2001). The drug is blamed and the drug user's social identity is simplified into that of "folk devil," defined exclusively according to negative traits (Goode & Ben-Yehuda, 1994, p. 28) derived from his or her perceived failure to avoid drugs and achieve a socially acceptable role.

It is in this way that the authoritative, media-driven discourse about meth use can be viewed as a source of symbolic violence (Bourdieu, 1998) to be navigated by the very individuals who are represented so detrimentally in antidrug campaigns and other media outlets. Women who use meth, regardless of whether they have personally encountered the stigmatizing constructions of meth users, must cope with the images that have been imposed upon and likely adopted by the media's audience--the general, non-drug-using public (Linnemann et al., 2013; Linnemann & Wall, 2013).

Methods

Site

Despite receiving overwhelming attention in the media, meth use in the United States peaked in the early 2000s and past-month use decreased from 0.3% to 0.2% between 2006 and 2011 (SAMHSA, 2012). Nonetheless, issues associated with the drug's production, trafficking, and use continue to be significant priorities for a number of communities throughout the country, including Northern Colorado's front range, where local production is reemerging, access to Mexican-produced meth persists, and meth users make up about one quarter of treatment admissions (County, 2011; Suthers et al., 2012).

The present study took place in a medium-sized city along Northern Colorado's Interstate-25 highway corridor. This region is bordered by the Rocky Mountains to the west and the Great Plains to the east, and is home to small-to-large urban areas surrounded by rural mountain and agricultural communities. Due to the study site's proximity to rural agricultural land and a major interstate, locally produced and imported meth are available, and participants report that the quality and available forms of meth change on a regular basis.

In the years leading up to this research, TMP's ads could be seen from the highway, heard on the radio, and viewed during primetime television. In 2009, a short documentary featuring extreme consequences of meth use aired throughout the state (County, 2011). The processes of home purchase and rental are filled with questions about meth use and production. In casual conversations with the general public about my research topic, I quickly realized that the many extreme and decontextualized representations of meth use and users permeate popular consciousness. I was regularly asked questions such as, Aren't you scared--meth users are dangerous? and Do the people you talk to have their teeth?

Data collection and analysis

Between spring 2011 and winter 2012 (a period of approximately 9 months), I conducted formal and informal qualitative interviews with women who were "active" meth users. Using passive referrals through community-based organizations and snowball sampling (Schensul, Schensul, & LeCompte, 1999), I recruited eight women at least 18 years old who identified as current meth users and had been using for at least 6 months (see Table 1 for participant details). Participants received a $25 VISA or MasterCard gift card for each formal interview. This study was reviewed and approved by the University of Colorado Denver's Institutional Review Board.

The first interview took a semistructured life-story format (Reissman, 1993) and lasted an average of 2 hours, covering: the women's drug use and life histories; current drug use patterns; motivations for initiating and continuing use; interpersonal relationships including family, friends, and sexual/romantic partnerships; experiences of and responses to stigma; and experiences of day-to-day living. Follow-up interviews were more open-ended and took place at participants' convenience, rather than after a set follow-up interval. Although I asked women to fill in gaps and update me on their lives, I also encouraged them to guide the conversation toward the issues they deemed most important. In addition to these formal interviews, I conducted several informal interviews with women when I helped them run errands (e.g., I drove Anja to a job interview), met them for coffee, and chatted with them on the telephone or over text messages. While these informal encounters did not provide the depth of information I received from the formal interviews, they did provide important context, contributed to the building of trust and rapport over time, and helped maintain contact. After informal interviews/contacts and some formal interviews, I wrote detailed field notes. Formal interviews were tape recorded and transcribed verbatim.

The study's findings were shaped, in part, by methodological challenges, especially those related to recruiting and retaining

participants. Despite my affiliation with trusted community organizations, use of passive referrals, and snowball sampling, nearly every initial contact with a potential participant was characterized by wariness of my position and intentions. Several participants explained their own and others' hesitation to participate as the result of typical "tweaker" paranoia and I quickly learned to avoid terms such as "informant" during the consent and research process. Even among those women who participated in the study, all but two stood me up for at least one interview. Women's schedules--including jobs, job interviews, and personal obligations or priorities--anxiety about the interviews, and structural limitations, such as lack of transportation, were all barriers to our meeting. Several times, when a participant missed an interview without notification, I found her phone to be disconnected when I tried to follow up or reschedule. To minimize the consequences associated with these struggles to meet with participants, I strove to be available on short notice and called or texted participants to confirm upcoming interviews. Despite the challenges of coordinating and actually carrying out interviews, participants were remarkably candid, trusting me with their emotions as well as their stories and referring friends and fellow users to participate in the study.

I analyzed data iteratively and in a number of stages. Throughout the study, I listened to tape recorded interviews, sometimes multiple times, before transcription. This helped re-familiarize me with participant personalities and enabled me to note the emotional context of the interviews, highlighting themes that stood out in this format and contributing to the iterative process of data collection (I was able to identify gaps in prior interviews, for example) (Schensul et al., 1999). Once interviews were transcribed and proofread, I deleted the audio files to protect participants' confidentiality and worked from the transcript.

I began the process of analyzing transcripts using open coding to identify important topics and categories (Esterberg, 2002) according to criteria of frequency and intensity (Foss, 2009). This initial process of open coding enabled me to work with data organically to identify various ways similar topics fit together. Often, women discussed a number of topics throughout the interviews and in their life stories that were not linear or directly connected, but all related back to a particular theme.

I then used focused coding to engage in more in-depth analysis of specific passages related to the themes identified. First, I analyzed the data as "truth," treating women's stories of their lives as accounts of events and using these accounts to provide context and history to my understanding of the women's lived experiences. I copied passages into a spreadsheet/codebook I created, and organized them according to theme. This allowed me to examine specific passages that fell under each theme alongside related passages. Second, I analyzed longer passages--those that took the form of a story--as narrative, focusing on "the links between women's perspectives and the truths they reveal" (Group, 1989, p. 262) to elucidate not what they have done but how they make sense of themselves and their own practices.

Findings: Ego identity and the management of stigma

In the following pages, I discuss how female meth users' construction and presentation of their ego identities constitute both an internalization of and a challenge to stigma. I focus on ego identities because, while social identity refers to society's assumptions about the stigmatized individual, ego identity is the image an individual constructs of herself (Goffman, 1963). Green argues that "the personal challenge to stigma for substance misusers involves the construction of narratives refuting the stigmatized label of being a dangerous individual and putting forward a true self who is moral and responsible" (2009, p. 89).

The women in this study certainly construct such narratives, presenting their illegal and antisocial practices in context even as they impose more limiting social identities on other users. The degree of engagement with meth (and other drug) use varied between participants and over time, but each of the women did report struggling with her use at some point in her life and seven of the eight described themselves as "an addict," "addicted," or "out of control." These terms were often drawn from the women's treatment experiences and reflected cultural frames defining addiction in terms of a lack of agency (Bailey, 2005; Melley, 2002; Rodner, 2005). However, many of these women also recognized that, regardless of their own interpretations, actions, and contexts, they were contending with the general population's views of "the meth user."

In the remainder of this paper, I explore how female meth users construct their own identities, negotiating their actual and ideal practices, social roles, moral standards, and group membership. While most of the women in this study presented complex ego identities--emphasizing their non-drug roles as often as those related to their meth use--here I focus on two patterns that emerged as clear representations of the fact that women actively navigate stigma, often in ways that appear contradictory:

1) "I'm not like them": In telling their life stories, while the women in this study defined themselves as meth users, they went to great lengths to differentiate themselves from other meth users.

2) "I don't think they would hang out with me if they knew": The women in this study also navigated stigma by managing others' knowledge of their meth use, a practice that they themselves often viewed as simultaneously oppressive and empowering.

"I'm not like them"

One way that individuals establish and express membership in social groups, create a sense of community, symbolize shared values and ideals, and distinguish one group from another is through consumption of material goods, foods, and drugs (Gamburd, 2008). As such, meth can be conceptualized as a consumable product that is used as a symbol of group membership, both for those within the group and outside it. One of the most striking ways women in this study negotiated their ego identities and the meaning of their group membership was by internalizing the stigma and normalizing the positions of meth users in the larger social structure while at the same time challenging specific assumptions they found inaccurate, oppressive, incomplete, or otherwise limiting. For many of the women, distancing themselves from the stigma associated with meth use meant distinguishing themselves from the "scandalous tweaker." This meant extolling, enacting and presenting specific standards of morality and behavior that they saw as desirable and identifying and criticizing contradictory practices they saw in others as undesirable. The women also reflected on their backgrounds and expectations to set themselves apart, contextualizing their own practices differently than those of others they deemed scandalous. To distance themselves from other users, the women tended to draw on two categories of social morality: those related to theft and criminality, and those related to motherhood and sexuality.

Criminality

Gina was a meth user in her early thirties. She had been intermittently homeless and couchsurfing since her teens and continued to struggle with housing insecurity during this study. Her drug use, and perceived control over it, fluctuated during the several months she participated in the study; changes were triggered by life events (such as losing long-term custody of her children), living situations, and personal relationships. Because of her poverty and instability, she routinely engaged in a number of nonviolent criminal practices and hustles--shoplifting, dumpster diving, and sometimes cashing bad checks, for example--to obtain cash, resources, or a roof over her head.

When she discussed these practices, Gina frequently upheld popular assumptions about meth users. For example, she explained on numerous occasions that tweakers steal from one another and cannot be trusted. While she acknowledged that her own practices could be taken to be along these same lines, she challenged the construction of herself as a tweaker. In her opinion, the distinction between a meth user like herself and the scandalous tweakers from whom she distanced herself lies in the framing of behavior in relation to compulsion and motivation. Sounding much like the TMP ads that claim meth use will without exception lead to antisocial practices, Gina blamed others' engagement in theft on drug use and addiction. However, she framed her own behavior in the context of her personal history and financial circumstances, drawing upon experiences she described in terms of social or interpersonal injustice to justify her own actions. She also drew a moral line between her own habit of stealing from companies--a means of bucking the system--and the tweaker habit of stealing from individuals--which she deemed scandalous.

Kendra used meth for the first time while away at college in her late teens. She then married and had children with a man who was a career criminal and meth dealer. Because of this, she was exposed to an often violent criminal lifestyle, of which she greatly disapproved and from which she removed

her children at the first opportunity. When we met, she was trying to quit using meth, seeking out outpatient treatment support and working to repair troubled relationships with her parents and children. She viewed herself as addicted, and even when she had not used meth in a month or longer, she struggled with cravings and her own perceived lack of control over her use. While other women in the study believed they could one day be "controlled" or strictly recreational users, Kendra believed she would forever struggle with her meth use.

Despite these concerns, she did view herself as different from other meth users, and drew on the stigmatizing constructions prevalent in media and other authoritative discourse to distance herself from them. She expressed distaste for the criminal practices she saw as scandalous and routine among other users and set strict moral standards for herself. Like Gina, some of these boundaries were about the relative (im)morality of those stolen from rather than the act of stealing itself:

But I also know that I was never able to be the scandalous--That was just never me; or to steal from people. I could not--I could steal from stores because I did that a million times. But as far as from people, I never could bring myself to do that. And that's why I'd always say I'm not even cut out for this life, you know what I mean? (Kendra)

Val is a long-time meth user who was struggling to improve her relationship with her estranged daughter. For Val, separating herself from scandalous meth users was was central to her identity; she believed she had more control over her use than many users and she distanced herself based on both drug and non-drug-related practices. In her late 40s when we met, Val had been using meth for over 20 years; she explained that there were times during her meth use career when she would have described herself as an addict, but that in recent years she had become what she referred to as a "controlled" or "functioning" user. Consistent with Lende and colleagues' (2007) comprehensive and deliberate examination of functional meth use, Val's ability to get by (she held a job, had a car, and her own house), her sporadic and intentional (rather than compulsive) use, and her generally healthy relationships with both meth using and non-meth-using networks, were sources of pride and viewed as evidence of her current lack of addiction.

For Val, distinguishing herself from tweakers was not only a moral issue but a practical one as well. Because she retained custody of her youngest child, she worried about the legal consequences that could result from interacting with or just being around those who were robbing or stealing or otherwise breaking the law. As such, she distanced herself from other users figuratively and literally:

It seems like there's a known crowd and I kind of really don't run with the crowd at all, because it's just gotten me in trouble in the past. So, I've gotten to--being very leery of that and not having it around my house and my home and just all that kind of stuff, I have to be really cautious and careful. It takes a lot of work and a clear head. You have to be able to think clearly about what you're doing. And so, I kind of don't run with the crowds, but I'll pick up from them, you know? Like I'll go and score something from them. But that was the extent of our association really, you know? ... They're in and out of jail ... I know they're doing other [criminal] stuff besides just using meth. (Val)

Gender roles

The other main group of practices that the women in this study used to demonstrate their higher standards relative to tweakers centered on pregnancy, motherhood, and sexuality. Wrestling with both personal and socially defined definitions of normative femininity, they faced decisions that forced them to confront their own morals, ideas about drug use, and their personal constructions of agency, control, and the meaning of addiction.

Bridget began using meth in childhood and when we met she described herself as a frequent (multiple times per week) and heavy injector of the drug. Her preferred mode of use was injection and she openly admitted that she had recently begun to inject heroin as well. Bridget's nuanced and nonjudgmental views of meth use were in part the result of her long history around the drug and her consequent exposure to a continuum of users and types of use: She grew up with parents who were meth users and described her mother as a "controlled" user who avoids the compulsion that is often the social marker of "addiction" (Bailey, 2005). While Bridget referred to herself as an "addict," she did not view her meth or other drug use as a dominant part of her identity. Rather, she regularly emphasized her interest in psychology, her struggles with motherhood, and her goals for the future to present a complex and evolving sense of self. When discussing her long-term goals, she did not express a desire or internalized expectation to quit, but rather was pleased with and hoped to maintain her current ability to dictate the terms of her own use ("to say 'no' when I want to").

Despite the fact that Bridget did challenge social constructions of the meth user and addict as singular and absolute, she made a point of setting herself apart from other women who use meth when it came to pregnancy. Upon learning she was pregnant with each of her children, she simply stopped using for the remainder of the pregnancy. From her perspective, this was the only acceptable decision and she expressed frustration with the many women who struggled more than she had:

I've been doing it [meth] a long time. I did not do it, I quit doing it when I got pregnant. I mean, I'm not trying to do the whole "this evil is worse than another evil"; it's just something that I don't understand women, how they can do that. The baby did not ask to do drugs, it has no voice. You can't fuse your kid's DNA with meth. Just because I do it doesn't mean I think it's a great thing. (Bridget)

Anja's story diverged considerably from most of the women who participated in this study, although, like Bridget, she believed that pregnancy and meth use should not co-occur. A highly educated career professional from a middle class background, she did not begin using meth until she was in her late thirties, in an effort to bond with and better understand her husband. Shortly after she began using, Anja became pregnant, and she and her husband chose to terminate the pregnancy. Although both adamantly against abortion, they reconfigured their moral code out of concern that meth use during pregnancy is detrimental to the fetus. This decision forced Anja to renegotiate her own identity, not only as a meth user, but as a person. By the time she learned she was pregnant, she had already been using through her first trimester, when the infant would be most vulnerable to negative side effects. Not prepared to quit at the time and expecting that the drug had likely already damaged the fetus, Anja weighed her moral standards regarding motherhood against her beliefs about pregnancy and abortion:

I got pregnant over Thanksgiving and found out like in February and I was living back here and you know, I didn't know anything about the drug, like I really knew nothing. And he did, and we talked about it and even though neither one of us believed in abortion, we decided that that's what we were gonna do, and we still don't know if that's the right decision. (Anja)

This decision, coupled with her subsequent substantial loss of social status and material capital, contributed to her view of herself as an addict.

By the time we met, Gina's drug use had already cost her custody of her children, yet she expressed frustration with other women's mothering decisions. Internalizing the notion that meth users do not make good mothers, she viewed herself as different from the bad tweaker moms because she had sacrificed custody of her children to avoid exposing them to her use. Once, she told me disapprovingly about a woman who tried to be both a meth user and mother:

I've seen her smoke in front of her [daughter] and I'm not that way. I don't even have it in the house when my kid's around, and I totally won't be high. Why do you think I'm away from my kids? 'Cause I'm getting high, you know? (Gina)

Thus, she both internalizes and challenges normative constructions of motherhood. Her criticism of the mother who uses meth reflects the broader discourse that constructs the roles of mother and drug user as mutually exclusive. However she praises her own decision to give up custody as a sacrifice in the best interest of the child despite the fact that it runs counter to social expectations that women have a primary responsibility to not abandon their children.

Other women in the study, however, did not believe their meth use precluded them from being good mothers. Val, in particular, went to great lengths to manage her relationships with her children and even to forge a new relationship with her grandchild. While Bridget recognized that her drug use often made her emotionally distant from her children, she believed that through therapy and increased awareness of her own strengths and weaknesses she could overcome this. She felt that, if she could control her meth use, she would be able to provide for her children materially as well as emotionally and mentally. These two women sought to integrate multiple aspects of their identities, an act that challenged the dominant construction of the meth user as an inadequate mother.

In addition to pregnancy and motherhood, several women specifically distinguished themselves from other users because of their refusal to engage in sex-for-drug or sex-for-money exchanges. While most of my participants readily admitted to such practices as shoplifting, selling drugs, and cashing bad checks, none admitted to trading sex for drugs or money. The nature of this study--consisting predominately of qualitative interviews rather than participant observation in private or limited access spaces--does limit my knowledge of whether or not women were actually engaging in this highly stigmatized practice. However, their discussion of these standards, the way it fits into their construction of an identity, is fundamental to understanding how they make sense of themselves and popular assumptions about them. Furthermore, all of the women were otherwise very candid about their sexuality, leading me to believe that they were being honest and straightforward about their interpretations of these practices, if not the practices themselves.

When we met, Michelle had been using meth for over 2 years, and she described herself as a heavy, often "out of control" user. Still young, although she did not have a job, she had few expenses because she lived at home (rent-free) and had access to her parents' car. This position enabled Michelle to access meth through friends, often for free or in exchange for a ride (users with cars are frequently able to pay for their meth by driving others around). She acknowledged that, for women, it is always an option to trade sex for the drug, but she adamantly denied engaging in this practice herself, reinforcing the boundary between herself and other, more scandalous, drug users.

Gina also expressed frustration that men often expect her to trade sex for meth. Her frustration, however, extended beyond the men who proposition her to the deviant women from whom she viewed herself as different:

I get a lot of dick talk too. It doesn't matter where I'm at, I get a lot of stupid comments like "suck my dick." Or you know, if I was running around getting high with someone and I didn't pay for that specific bowl, guaranteed the subject comes up, of what am I gonna do for them, and it's everywhere. A lot of bitches do, apparently. I'm learning, I mean like ... the other day, a bitch was in the bathroom giving the guy head. And I'm like, are you fucking kidding me? ... I'm like, you are so skanky. (Gina)

Although the women in this study did not see themselves as engaging in direct sex for drug or money exchanges, several did mention "hooking up" or being in relationships with "the dope man." These findings are consistent with the limited data examining transactional sex among women who use meth (Lopez et al., 2009; Rodriguez & Griffin, 2005). While individuals who use meth commonly use with sexual partners or engage in sex with other users, many do not view these encounters as transactional. Rather, they are often embedded in more complex relationships, systems of reciprocity, survival strategies, or are simply the result of sexual desire. Factors such as the increased libido commonly associated with meth use (Semple, Grant, & Patterson, 2004) and the relatively closed nature of meth markets (Rodriguez & Griffin, 2005) mean that findings about risky and transactional sex based on heroin and crack cocaine users may not apply.

TMP advances the assumption that the consequences of meth use are always visible and as such, information about the user's stigma is not under her control. Goffman (1963) notes that the individual who is discredited by a visible stigma must manage people's responses to that stigma, but the individual who is discreditable because her stigma is not visible instead must manage people's knowledge about the stigma, rather than their responses to it. This study suggests that, in reality, many meth users are likely discreditable rather than discredited. That is, they may not be readily identifiable as meth users, enabling them to do what Goffman (1963) refers to as "pass," or manage others' knowledge of their stigma, even hiding it if they so choose. This management of information is the second way women in this study struggle with stigma, striving both to resist it and to avoid it.

All of the women I interviewed contested the validity and credibility of the media's physical representations of the meth user, noting that users could have perfect teeth, clear skin, and even be fat. For the most part, the women themselves lacked these marks and as such were able to hide any visible signs of their use they did have. As such, all of the women in this study believed they could and regularly did pass for nonusers.

For example, although Bridget claimed many might assume she is a drug user because of her colorful hair and facial piercings, she did not otherwise meet the stereotypical appearance of the meth user (e.g., she had clear skin and a laid back demeanor). When I asked Bridget what she thought of TMP, her many years of experience with the drug and her sharp wit led her to turn the question back on me:

I just wanna know, do they just take a picture of somebody who's using meth or is that enhanced? 'Cause that right there would tell me. Come on, that's not fair, that's not right, that's false advertising. (Bridget)

Even Jenny, who generally agreed with and even liked the ads, criticized the physical portrayals of the users, claiming they are exaggerated and pointing to herself as evidence of such. A mother and former health professional in her early 30s, Jenny's use had become problematic enough that she had lost her job, custody of her children, and her once-stable housing. Though her story was consistent with constructions of the meth user's "downward spiral" (Linnemann et al., 2013; McKenna, 2011a), her appearance was not. Jenny was attractive and, while she was petite, she was a healthy weight, and despite more than a decade of smoking meth, she had clear skin and near-perfect teeth:

Jenny: I think they're [the TMP campaign ads] perfect. They're perfect. Umm, except for that I think, I mean I've been using meth for 16 years and I think I look pretty good compared to the meth poster, you know what I mean? I should be the poster child but I don't know.

Interviewer: The poster child doesn't look like you.

Jenny: Yea, yea, I don't know why, I don't know what happened to them, I wanna know their story.

All of the women echoed Bridget and Jenny's criticism of the ads, opening up the notion of information management: These women were not readily identifiable by the general public as meth users and as such, they had control over whom they told, when, and why.

Dorothy noted that, despite her missing teeth (it is unclear whether her missing teeth are the result of meth use or over a decade of living on the streets), people rarely identified her as a meth user because, until 2 years ago, she was very overweight. In fact, when working as a dealer or runner, she was able to rely on her appearance to keep her use hidden. As she explained, she was also careful to vary her routine to avoid behaving like a stereotypical user or dealer:

They loved it when I drove them around because I didn't look like an addict. I wasn't skinny and bony and pock-faced. I did not look or act like an addict. (Dorothy)

Michelle also claimed that, despite 2 years of heavy, recently escalated use, even most of the people she socializes with do not know she uses meth:

Interviewer: Do you think that the advertisements have an impact on how other people treat you?

Michelle: Never thought of that. I don't think so because I don't look like any of the people in the--their ads and shit.

Thus, the caricature of the emaciated, zombie-like meth user with rotting teeth (Linnemann et al., 2013; Linnemann & Wall, 2013; Murakawa, 2011) actually provided users the opportunity to manage disclosure about their use, passing as nonusers if they so chose. The ability to physically pass for a nonuser enabled the women in this study to become active agents in the management and understanding of other information about their meth use and practices rather than only managing others' responses to it. However, the desire or perceived need to hide their meth use resulted from fears of negative treatment and judgment by nonusers.

The women recognized that if others knew about their use it could lead to problems in existing relationships or serve as a barrier to forming new ones. Therefore, while all of the women in this study did at some point feel negatively affected by the stigma associated with meth, it rarely related to their appearances or treatment by strangers; rather, they struggled to maintain long-term relationships with friends and family who were aware of their status as meth users. According to Goffman, the control of identity information has a special bearing on relationships. Relationships can necessitate time spent together, and the more time the individual spends with another the more chance the other will acquire discrediting information about him. Further, as already suggested, every relationship obliges the related persons to exchange an appropriate amount of intimate facts about the sell as evidence of trust and mutual commitment. (1963, pp. 96-97)

Consequently, when navigating relationships, whether new or old, the women in this study had to decide whether to disclose their stigma or to pass.

A number of factors played into women's decisions regarding whom to tell, when, and how much. Fear of judgment, especially by new or potential friends, was one of the most common concerns. One afternoon, after our interview, Michelle and her sister (who had accompanied her to our meeting) said they were going to a friend's house. When I asked Michelle whether she used with these particular friends, she said no, because they probably would not approve of meth use:

Michelle: I wouldn't--I don't think they would hang out with me if they knew. They smoke weed and drink beer.

Michelle's sister: But maybe they do know.

Michelle: You think? I hope not. I don't want to get judged, I hate getting judged.

Bridget also expressed concern about being judged for her use, so she rarely told new acquaintances, especially those she believed to be nonusers. She recognized this hesitation as problematic because she viewed honesty as fundamental to the development of friendships and to her view of herself. Nonetheless, sometimes her desire to be liked and not judged won out:

I really want people to love and respect me irregardless of what's floating around in my body. 'Cause they don't know it unless I say it. I mean some people can make guesses because I mean, I dress pretty noticeably and typically people with tattoos and funny colored hair are associated with drugs but like I actually have this, it's not a goal but maybe if I feel like it, maybe I'll go straight edge one day and just like, to be the total opposite, 'cause I have this weird need to prove shit to people that I don't know or even see or will only see once in my life. (Bridget)

For Kendra, the decision whether to disclose her meth use to new friends was largely rooted in her desire to be honest and open and she viewed her meth use and associated experiences as an important element in her past and her development as a person. As such, she did tend to disclose her meth use although she did so gradually and based on assessment of the individual and the relationship:

I'm the most transparent person I know. I don't hide nothing, never have, never had a reason to--not that I don't get high and then really call my parents like--look, guess what, I'm high right now. But I never hid the fact that I was a user from anybody.... that's not the first thing I say when I meet somebody. But, you know, actually you have a few conversations and you decide, you know, you're going to try a friendship or whatever, I'm very forthcoming with it, because it's been a big--huge part of my life.... And it's a big part of who I am now. And I'm not necessarily ashamed of who that I am now. I'm ashamed of some of the things that I did and decisions that I made. But ashamed of who I am? Not at all, no. Should I be? I don't think so. And whatever they say, that's them, you know, whoever they are. So yeah, I don't have a problem letting anybody know. (Kendra)

One of the most troubling issues for five of the women was whether and how to tell their children about their meth use. In some instances, they felt a need to explain their past practices and frequent absence from the child's life. In others, they wanted to reduce their children's assumptions and improve their actual knowledge about drug use. Jenny found that, although her grandmother was displeased that she had chosen to tell her son about her meth use, it improved their relationship:

Jenny: And my son knows 100%. The last, when we had to leave again, because we'd lived at my grandma's for like a year, you know, um, and like the last 2 or 3 months they were able to spend the night with me like twice a week but when I lost [custody] again in February I took my son and sat down and talked to him, and told him all the truth you know like exactly what the hell was wrong with me, like what was going on, and for the first time ever he looked in my eyes and showed me respect.

Interviewer: Like he appreciated you telling him?

Jenny: Yea, he listened, he just looked at me and it was honestly the first and only time I felt like he respected me.

Val also struggled with whether to tell her son she used meth. On the one hand, she viewed herself as a generally open person who was not ashamed of her drug use and worked hard to control it, using only occasionally, for work-related purposes, and not engaging in practices or with people she deemed scandalous. However, her long history of drug use had severely damaged her relationship with one of her daughters. This experience translated into a fear that she could lose her son and for a long time prevented her from disclosing. Val, more than any of the other women in the study, was able to pass even with people close to her because of her high level of functioning--she holds a job, has her own house and car, and has a diverse network of friends, many of whom do not use meth. However, perhaps because of this, she struggled immensely with the stigma once people learned of her meth use.

Conclusion

Stigmatized individuals tend to define acceptable and unacceptable practice using the same social norms and ideologies as "normal people" and as such are likely to be ambivalent about their membership in a stigmatized group (Goffman, 1963). In the context of the study site (and in the United States as a whole), the mainstream social norms and ideologies of meth use and users was ever-present on the landscape through large-scale media campaigns, legislation, and the generalized discourse constructing methamphetamine as "America's Most Dangerous Drug" (Jefferson, 2005).

In response to this stigma, the women in this study both internalized and contested these negative constructions. To do so, they navigated their respective standards of morality and struggled with their interpersonal relationships in ways that acknowledged (and at times embraced) their drug use, yet sought to separate from the stigmatized group of tweakers and the negative connotations associated with such a group. By relying on the stereotyped image of the scandalous tweaker in opposition to their own identities, these women have internalized elements of the authoritative discourse about meth.

Thus, the "symbolic violence" of the stigmatization of meth use and users results for many in a misrecognition of socially deviant practices and roles as the direct result of meth use or an individual's personal moral failings (Bourdieu, 1998; Irwin & Jordan, 1987). While women's explicit separation of themselves from these categories challenges the essentialism of meth use as the sole or primary causal factor, it legitimizes the tribal stigma associated with the tweaker and the good girl/bad girl dichotomy. This process is consistent with Foucault's argument that even resistance, because it is built into the dominant social structure, may in fact legitimize and perpetuate it (Foucault, 1977, 1982).

Nonetheless, the women's recognition of the stigma and especially their intentional navigation of it serve to support the growing argument that researchers should avoid treating drug users as completely lacking in agency (Dickson-Gomez, 2010; Green, 2009). Rather, these findings suggest that factors from poverty to discrimination to personal context all shape the direction of agentive action. As such, it is worth the continued effort as researchers to explore not just the ways that structural forces limit agency, contributing to structural vulnerability, but also the ways that those who are structurally vulnerable make do, how they resist, and how structural change may in fact facilitate, rather than hinder.

This study of the navigation of stigma by women who use meth is relevant to future research and more applied public health. The findings demonstrate a subset of the varied ways even vulnerable populations exercise agency in an effort to avoid the consequences associated with stigma, leaving room for further systematic exploration of how this agency can be maximized, possibly through multilevel interventions (Weeks, Convey, & Dickson-Gomez, 2009). In addition, these data suggest that the lived experiences and subjectivities of women who use meth are in fact affected by the problematic portrayals of them. These effects extend beyond the overarching structural oppression associated with policing and regulation (Linnemann et al., 2013; Linnemann & Wall, 2013) and contribute to a form of social exclusion (Buchanan, 2004; Buchanan & Young, 2000) that is imposed both internally and externally.

AUTHOR'S NOTE: For additional information about this article e-mail: stacey.mckenna@ucdenver.edu

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Notes

(1.) The presentation of worst-case scenarios as typical (Reinarman & Levine, 1997a, p. 24).

(2.) An often derogatory term used by meth users and non-meth-users in reference to meth users deemed to be out of control and engaging in immoral and antisocial behaviors.
TABLE 1
Participant Profiles

Name *     Age   (Preferred)     Years        Children,
                 Mode of Use     Using         custody
                                 Meth          status

Jenny      30       Smoke        15-20     Yes, no custody
Gina       30      Inject        10-15     Yes, no custody
Dorothy    50       Smoke        10-15       Yes, grown
Bridget    29      Inject        15-20      Yes, custody
Anja       40      Inject      less than    5 Yes, grown
Michelle   19      Inject      less than        5 No
Val        46      Inject        10-15       Yes, grown/
                                               custody
Kendra     28       Smoke        10-15     Yes, no custody

Name *       Ever      # of Formal
            Been in    Interviews
           Treatment

Jenny         Yes           1
Gina          Yes           3
Dorothy       Yes           4
Bridget       Yes           1
Anja          No            2
Michelle      No            3
Val           Yes           3

Kendra        Yes           2

* All names are pseudonyms.
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Title Annotation:Colorado
Author:McKenna, Stacey
Publication:Contemporary Drug Problems
Date:Sep 22, 2013
Words:11174
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