The cost of ignoring the trauma element in this addiction problem is that both our criminal justice system and our social-service systems are far less effective than they could and should be at both maintaining safety and justice and rehabilitating women—women who, too often, are dismissed as a sort of legal and societal underclass.
For Sophie, the drugs started at 14, the coke arrived at 18 and heroin at 25. She spent years floating in and out of jail. “I was arrested with drugs and prostitution at the same time,” she says. “It would happen maybe a month apart. I was no stranger to the courts.”
“Lady cops” laughed at her and called her “a crackhead.” Sometimes, she says, police were rougher than that. “A cop banged my head into the corner of the door,” she says, smoothing her hair to the side to reveal a thin white scar running down her forehead. She didn’t file a complaint. “Nobody’s going to hear me anyway, because who am I? I’m just a junkie. I just got arrested for prostitution, so they’re not going to listen to me.”
If anyone had listened, they would have heard about how the last thing she needed in her life was more violence, which had first defined her life at home while she was married, then again out on the streets.
Like Sophie—and all five other women interviewed for background information for this story—Anne Marie, 46, a graduate of the Interim House program, also grew up with addiction and abuse. She says her parents were both alcoholics and that she was sexually assaulted by an older relative when she was 13 years old. “That’s when I started to smoke weed and do pills and drink just to escape the pain of that,” she says. She had nobody to turn to about the trauma her family was inflicting upon her; her mother made her swear not to “take it out of the house.”
As many survivors of childhood sex abuse do, Anne Marie started having sex at a young age. She experimented with drugs. A teen marriage was her ticket out of the house. For a while, she managed. She had a baby. Then a relative sexually assaulted her daughter, who was the same age Anne Marie had been was when she was attacked. The pain was too much to bear.
“That’s when everything went to hell,” she says. “I just went to the streets and started smoking crack cocaine.”
She spent the next 10 years living on the streets and working out on Frankford Avenue. She estimates that she was arrested at least 25 times. She doesn’t recall a john ever being arrested with her. She refused to work for a pimp (“I couldn’t see me prostituting and giving my money to a man. I just couldn’t do it”) and was beat up by a john due to a lack of protection.
Women working out in the street are routinely assaulted, she says, with little to no recourse. Attacks are usually not reported; as Ann Marie says, you’d be breaking a code. “You live by a code in the street,” she says: “You don’t call the cops.”
The violence, she says, “just made the addiction worse, because I just wanted to numb all the pain. Being in an addiction and living on the streets and prostituting, you don’t want to have any kind of part of reality. You just want to be lost in that. I call it a black hole … And I just fell deeper into it.”
Most people have heard of post-traumatic stress disorder by way of stories about traumatized combat veterans: 1 in 5 veterans of Iraq and Afghanistan wars are diagnosed with PTSD, and veterans account for 20 percent of U.S. suicides, according to a report issued by George Washington University.
Dr. Frank Ochberg is a pioneer in the field of trauma studies; in the late 1970s, he served in policy positions at the National Institute of Mental Health and the American Psychiatric Association, developing the idea of PTSD. In the years since, a movement has emerged to replace the “D”-for-“disorder” part of that acronym with a different letter: “I,” for “injury.” Advocates of the change say not only would the word “injury” destigmatize the condition, it more accurately reflects trauma’s physiological impact. Severe trauma, Ochberg explains, “seems to have a signature of a disruption of the electrical field of the brain with an area in the right temporal lobe.” Essentially, it breaks down the normal human fight-or-flight impulse.
While many people are at least familiar with PTSD, he says, most are not aware of “complex PTSD,” a variation that more accurately reflects the condition commonly experienced by veterans of war, poverty and violence. Here’s the difference: A person with PTSD is stuck reliving a specific, traumatic moment from their past. But for veterans, or women like Sophie and Ann Marie, their problem isn’t reliving one defining, traumatic episode. It’s that they have successfully adapted to constant threat. They have evolved toward chaos.
“The issue is survival,” says Ochberg. “And it’s done in a way that assumes exploitation and degradation. You invariably have a low self-esteem you adapt to your tormentors. It’s very different to anticipate being raped tomorrow as opposed to anticipate having a flashback of the rape that happened three years ago.”
After three months in a coma, the Sophie roaming through Technicolor streetscapes inside Sophie’s brain suddenly stopped searching for a fix. When she opened her eyes, her father was sitting in the room. She hadn’t seen her family in seven years.
“My first words were, ‘I’m sorry,’” Sophie says. “My second [words] were, am I dying?’”
There was no easy answer. “They didn’t know what to say to me, because it wasn’t looking good, you know?”
The coping mechanisms she’d developed to adapt to and survive life on the streets hadn’t suddenly stopped. Once she woke, her nervous system lurched back into a jittery expectation of danger. She recalls being kept sedated. “My body just kept—I kept having bad anxiety attacks,” she says, “because from being out in the street and from going into that environment, my body was going into shock every time I woke up. I didn’t know what to do.”
As Ochberg says: “[If] it’s a life of degradation, of fear, you gradually get habituated to it. You develop coping mechanisms, and before you know it, you’re a person who is not well adapted to normal civilian life.”
This adaptive behavior is the reason why coming home can be harder for veterans than remaining on the battlefield, how it can be easier to face war than family. For women like Sophie, this counterintuitive aversion to homecoming is a major obstacle to recovery from the more obvious problem of addiction. “The combination of trauma and addiction is very, very difficult to overcome,” Ochberg says. “It creates a situation where 1 and 1 makes 5 or 6.”