Substance and Shadow traces the history of women’s drug addiction from the mid-nineteenth century to the present. Kandall begins with the observation that women comprised the majority of the nation’s addicts before the passage of the Harrison Anti-Narcotic Act (1914). More critically, he argues that in the twentieth century, when drug addiction was seen largely as a male problem, women addicts faced discrimination in treatment and extreme social marginalization. Many of his arguments will be familiar to those who have read the classic works on the history of American drug use, such as David Musto’s The American Disease (1973) and David T. Courtwright’s Dark Paradise (1982). What distinguishes Kandall’s volume, however, is its focus on women.
The book opens with several chapters on drug users from the Civil War era to World War I, a period when addiction was identified with middle-class rural Euro-American women who purchased patent medicines or who obtained opiates from physicians and pharmacists. Subsequently poor, urban males became publicly identified as addicts, spurring passage of the Harrison Act and pushing [End Page 152] women addicts into the shadows. Even as men became the majority of drug addicts, women continued to use and become addicted to drugs. During the classic era of drug enforcement—from the 1920s through the 1950s—women of means sought treatment in private sanitariums. Others underwent detoxification at the federal treatment facilities in Lexington, Kentucky, and Fort Worth, Texas. Most, of course, relapsed, and many faced prosecution for drug-related crimes.
In the second half of the book, Kandall describes the postwar period, in which the response to addiction ranged from the interest in treatment programs that developed in the Kennedy years to a reinvigorated war on drugs in the Reagan era. In each chapter he provides estimates of the numbers of users, addresses the sources of addiction and types of drugs used, and inventories the responses to women addicts by the medical and criminal justice systems. Testimonies of addicts (taken from confessional literature, biographies, and ethnographies) and descriptions of addiction (drawn from medical books, newspaper articles, and government reports) inform these discussions and help illuminate the particular plight of women. As Kandall notes, the sexual abuse of women addicts, the links between prostitution and addiction, and the glamorization of drug-associated sex have all been important themes in the history of addiction.
A physician, who has by his own count cared for more than a thousand drug-exposed babies, Kandall is deeply concerned about the plight of women who need medical assistance but are instead prosecuted for their addiction. In the book’s preface he discusses his appearance as an expert witness at the trial of Jennifer Johnson, a woman charged with delivering a controlled substance to her newborn, via the umbilical cord. In the concluding chapter, entitled “Today and Tomorrow,” he offers a rebuttal to those who would criminalize women like Ms. Johnson. He makes a strong case for understanding addiction as a chronic relapsing condition that can be treated with long-term methadone maintenance. Aware that “the current political climate precludes the possibility that legalization will receive serious consideration” (p. 298), Kandall ends by calling for what may also be, in the current political climate, utopian: the recognition that women’s addiction is a complex issue linked to social, political, economic, and sexual issues that cannot be addressed through the criminal justice system.