DRUG USE AND EATING DISORDERS: YOUNG WOMENS INSTRUMENTAL USE OF DRUGS FOR WEIGHT MANAGEMENT

By KATHERINE ANN SIRLES B.A., University of Alaska, 2002

A thesis submitted to the Faculty of the Graduate School of the University of Colorado in partial fulfillment of the requirement for the degree of Doctor of Philosophy Department of Sociology 2009

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This thesis entitled: Drug Use and Eating Disorders: Young Womens Instrumental Use of Drugs for Weight Management written by Katherine Ann Sirles has been approved for the Department of Sociology

_____________________________________ Patricia Adler, Ph.D. (Chair)

____________________________________ Hillary Potter, Ph.D.

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Sirles, Katherine Ann (Ph.D., Sociology) Drug Use and Eating Disorders: Young Womens Instrumental Use of Drugs for Weight Management Thesis directed by Professor Patricia Adler This dissertation reports a qualitative study of young college women who used controlled substances, both legal and illegal, in order to manage their body weight. To date, no such studies, which examine the use of drugs as an instrument for weight control, exist. The research is guided by deviance and feminist theories, and was specifically designed to address womens personal understandings, explanations, and experiences concerning substance use and management of the body. The qualitative methods used for data collection provided prolific narratives for the analysis of womens relationships with their culture, bodies, and conventional or non-normative means of self-representation. The use of various forms of controlled substances appeared salient and meaningful for many women in their pursuits to achieve (and even exceed) social expectations for appearance, beauty, and the body. The majority of women in this research preferred pharmaceutical stimulants, while a minority used illicit substances. Overall, the data suggests that drug use was a powerful tool for the management of body weight and in turn, representing the self. In addition, although women potentially faced deviant labels, stigma, or clinical diagnoses, the nature of their lines of action was insulating against potentially negative social consequences. Generally speaking, women hailed drugs for their instrumental utility, and shunned popular conceptions of their behaviors as pathological.

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For my Mom, whose consistent reminders that a dissertation is written one sentence at a time encouraged me through every last word.

ACKNOWLEDGMENTS

This work would not have been possible without the help and support of many people. First and foremost, I thank the young women who participated in this research. I am grateful for your time, your willingness to share your lives with me, and your overwhelming support of this project. I am also greatly indebted to my academic advisor, Patti Adler. You have inspired, challenged, supported, and encouraged me, I am thankful for your guidance. I would also like to thank my dissertation committee: Sara Steen, Hillary Potter, Katy Irwin, and Louise Silvern. Each of you took great time and care in your contributions to this project, and I am a better scholar for having worked with you. Throughout graduate school I have been surrounded by fellow students who are strong, intelligent, fun, dedicated, and dynamic. Above all, an enormous thank you to Allison. For you the term best friend simply will not do. As a result, I have assigned you a new title: trusted-chief-sidekick-friend-sisterextraordinaire. I cannot imagine my life without you. In addition, special thanks to Amanda, Bethany, Tara, Rachel, Jackie, Jade, Ali, Kris, Kristina, Patrick, and Marshall for your encouragement, support, commiseration, and enduring friendship. For those who moved on before me, thank you for showing the way and cajoling me towards the other side. For the friends that I leave behind, I offer the words of Dori from Finding Nemo: Just keep swimming, just keep swimming.

I would also like to thank my wonderful Colorado friends, my life in graduate school would not have been the same without you. Michael and Patty, you are extraordinary friends. Thank you for all the laughter, many adventures, and for literally being my second home over the last six years. In addition, a heartfelt thank you to Stacey, Nick, Mike, Krista, and Billy. I cannot imagine a better group of friends, and all of you will be dearly missed. Finally, my family has shown exceptional support over the course of this project. First, thank you to my extended family. I am fortunate to have each of you in my life. Travis, thank you for being such an encouraging, generous, supportive, and reliable brother. You have always been a strong and admirable role model, so much so that I literally chose to follow in your footsteps. Paola, I am proud to call you family, thank you for all of your advice and support throughout graduate school. Claudia, when you are old enough to read this, know that I think of you often, and cannot wait to see your infectious smile again. Chad, thank you for your loving patience and complete support through the writing process. You, more than anyone, are responsible for me finishing my dissertation. I could not have done it without you. Last, but certainly not least, I am forever grateful to my Mom. Mom, I am afraid I do not even know where to begin, so I will simply say thank you. Without you, how would I ever know whether or not I am making progress? It is to you that I dedicate this thesis.

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TABLE OF CONTENTS

INTRODUCTION Creating the Project CHAPTER 1: Women, Drug Use, and Disordered Eating BACKGROUND Extant Empirical Literature THE SOCIOLOGICAL PERSPECTIVE Sociological Understandings of Weight Management Social Identity Theory Gender and the Body Representing Gender Feminist Perspectives on Eating Disorders The Role of Gender Traits The Role of Sexuality Gender and Instrumental Drug Use Gender and Licit Drug Use Gender and Illicit Drug Use Deviance Theory and Eating Disorders The Medicalization of Deviance Deviance as a Lifestyle Discussion on Applying the Deviance Framework CHAPTER 2: Research Methodology QUALITATIVE RESEARCH METHODS Feminist Research Methods Ethnographic Epistemology Defining the Variables What is a Drug? What is an Eating Disorder? The Research Setting Researching a Hidden Population The Research Sample Interviewing on Non-Normative Behaviors RESEARCHER ROLE Researcher Standpoint Concerning Researcher Intervention METHODS OF DATA ANALYSIS CHAPTER 3: Typology of Instrumental Drug Users

1 2 4 5 7 11 12 16 17 18 20 24 25 27 30 33 34 38 40 41 42 43 44 45 46 47 49 50 51 54 56 59 61 62 63 65

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TYPOLOGY OF INSTRUMENTAL USERS STRUCTURE OF THE DEVIANT ACT Deviance Among Licit Substance Users Deviance Among Illicit Substance Users Restricted Eating Practices Among Instrumental Users Temporal Nature of Weight Control and Substance Use CHAPTER 4: Deviant Careers ENTRANCE INTO THE DEVIANT CAREER Entering Deviance Through Disordered Eating Pathways Through Disordered Eating Pathways Through Drug Use Initiation of Instrumental Licit Drug Use Conventional Over-Conformists Journeyers Initiation of Instrumental Illicit Drug Use Scroungers Opportunists PERSISTANCE OF THE DEVIANT CAREER Stability of the Instrumental Drug Using Career Maintaining Licit Substance Use Maintaining Illicit Substance Use CESSATION OF THE DEVIANT CAREER Exiting the Instrumental Licit Drug Using Career Exiting the Instrumental Illicit Drug Using Career CHAPTER 5: Associations Among Instrumental Drug Users SOLITARY DEVIANCE Instrumental Drug Users as Loners LONERS AND SECRECY Secrecy Among Licit Substance Users Secrecy Among Illicit Substance Users Reactive Costs of Deviant Behaviors SOCIAL ISOLATION AMONG DEVIANTS Deviant Associations of Instrumental Users Normative Associations of Instrumental Users PRACTICAL HURDLES Health Consequences of Instrumental Drug Use Financing Drug Use CHAPTER 6: Stigma and Identity INSTRUMENTAL DRUG USE AND STIGMA Instrumental Drug Use and Identity

67 72 73 85 89 91 93 96 99 103 104 106 107 108 110 111 112 113 115 116 119 120 120 122 125 126 127 130 132 134 136 139 140 142 143 144 146 150 151 156

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ACCOUNTING FOR DEVIANCE Accounting for Instrumental Drug Use Types of Accounts Accounting Among Conventional Over-Conformists Accounting Among Scroungers Accounting Among Journeyers Accounting Among Opportunists Differential Power of Accounts Justifying Deviance Excusing Deviance The Role of Social Evaluation Concerning Behaviors that Elicit Stigma CHAPTER 7: Gender and the Body GENDER AND EMBODIMENT The Gendered Body EMBODYING FEMININITY Feminine Body Ideals GENDER AND EATING DISORDERS The Male Gaze Instrumental Drug Use and the Male Gaze Theorizing the Male Gaze THE SUPERWOMAN IDEAL Instrumental Drug Use and the Superwoman Ideal ALTERNATIVE UNDERSTANDINGS CHAPTER 8: Conclusion SUMMARY OF DESIGN AND MAJOR FINDINGS Review of the Findings THEORETICAL IMPLICATIONS Strain Theory Labeling Theory Defining Deviance Neutralization Theory Summary of Theoretical Implications THE SOCIOLOGY OF DRUGS CONCLUSIONS REFERENCES

160 163 165 166 168 169 170 171 173 174 175 176 178 180 181 182 183 186 188 189 193 194 195 196 201 202 204 208 209 211 214 217 218 219 221 223

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LIST OF TABLES Table 1.1: Typology of Instrumental Drug Users 69

INTRODUCTION

This dissertation reports original research on college women who use licit pharmaceutical drugs or illicit street drugs in an ongoing effort to manage their body weight. The sociological perspective has not previously been used to analyze this relationship. Scholarly work that focused on substance use and disturbed eating patterns hailed mainly from the medical establishment. In addition, researchers who have conducted empirical research in this field largely employed quantitative methods. These studies documented the correlation between two lines of action, disordered eating and drug use, but generally constructed womens practices as distinct behavioral phenomenon. To date, there is no research on womens use of licit or illicit substances as a tool for disordered eating behaviors. The goal of this research is to analyze the role that drug use played in womens attempts to modify their bodies. This dissertation represents the first sociological empirical study on the purposeful use of substances for weight control. Thus, my work contributes to the bodies of literature on eating disorders, womens drug use, and body modification. This introduction and chapter one outline the concepts and major theoretical contributions that were central to the formation of this research. First, I describe the creation of the project. Second, I detail the background of my research through the review of extant empirical research which focused on womens disordered eating and drug use. Third, I present the sociological perspective and describe past scholarship concerning womens relationships with

their bodies and disturbed weight management practices. Fourth, I introduce deviance theories as a framework for understanding the behaviors that are analyzed in this research. Chapter two details the specific research methodology that I used in the execution of this project. Chapter three presents the participants of this research by way of a typology of drug users. Chapter four describes drug use and weight managing practices in terms of life careers. Chapter five analyzes the various normative and deviant social associations reported by participants. In chapter six, I work with the concept of stigma, and discuss the impact that non-normative behaviors had on womens identities. Chapter seven engages with feminist perspectives on eating disorders, drug use, and the ways in which social proscriptions for gender affected womens embodiment. Finally, chapter eight presents conclusions regarding the association between womens use of drugs and their relationships with body weight. Creating the Project The idea for this dissertation emerged in 2000, while I was still an undergraduate student studying sociology. Through coursework I was introduced to a memoir in which a young woman detailed her long-time struggle with disordered eating (Hornbacher 1999). The authors narrative had an impact on me, particularly because of her descriptions of street amphetamine use for appetite control. While I was certainly familiar with eating disorders generally, I was awestruck that this young women reported the use of powerful, potentially

dependence producing, substances in order to control her weight. During the time between college and graduate school, prior to conducting this research, I never again heard someone speak of this means for body modification. When I began graduate school in 2002, I was certain that I wanted to conduct my dissertation research in the fields of deviance and the sociology of drugs. However, it was not until a brainstorming session with my academic advisor that I recalled reading about how one young woman had used drugs to control her weight. This was particularly intriguing due to the unusual nature of this type of drug use. Sociological scholarship on substance use largely focused on either recreational or medicinal manifestations, of which this specific type was neither. Instead, the use of drugs for weight control struck me as utilitarian, purposeful, and extreme. In addition, I hypothesized that the use of substances in this manner would largely be the pursuit of women, a population that I am most suited to research. Given the assumption that I would be successful at finding these behaviors among individuals in my community, I moved forward with the project. The fact that women who participated in illicit drug use were considered a vulnerable population, due to the illegal nature of their behaviors, made obtaining IRB approval an intricate process. However, by the fall of 2004 I was ready for data collection. I spent the next two years gathering the data from which this dissertation draws.

CHAPTER ONE Women, Drug Use, and Disordered Eating

Non-normative, excessive weight control practices, loosely described as eating disorders or disordered eating in this research, are a serious problem. Although there is evidence that eating disorders have existed since ancient times, before the late 1960s they were virtually unknown to the general public (Bemporad 1997). Diagnosis of anorexia nervosa, bulimia nervosa, and other eating related medical syndromes skyrocketed during the 1970s (Polivy and Herman 2002). As rates of disordered eating increased among young women, the public took notice. In addition, mass media fueled interest in the subject as more and more women began starving themselves, or bingeing and purging. This increased public attention led to not only popular reporting of the phenomenon, but academic scholarship in the field as well. As a result, since the 1980s researchers across disciplines have analyzed problematic eating behaviors from numerous perspectives. To use the words of Naomi Wolf, there is a disease spreading (1991:179). In our culture, sexy bodies are now depicted as thin ones, and eating disorders should be expected in a culture so obsessed with thinness (Anderson 2000:14). Anorexia nervosa, one specific type of eating disorder, is associated with high rates of morbidity and mortality, as well as numerous mental and physical ailments (Sullivan 1995). Since the discovery of eating disorders in the late nineteenth century, clinicians debated between biological, genetic,

social, and psychological understandings of disturbed eating behaviors (Brumberg 2000). Until recently, the medical model dominated scholarship the field (Condit 1990). Within current research, numerous perspectives and understandings have emerged. Although this expanded awareness has certainly illuminated and given voice to many diverse experiences, a systematic understanding of unconventional weight management has proved elusive. Among scholars who research disordered eating, debates over the causes and nature of these behaviors have grown and heated up for over a decade. Strain exists between the commonly used paradigms: medical, psychological, biological, sociological, feminist, and cultural perspectives. For my research, each of these frameworks offered unique analysis that warranted further investigation.

BACKGROUND

The majority of scholarship that focused on womens efforts to control and manage their weight has failed to recognize potentially extreme measures that young women may take in their efforts to conform to an American ideal of feminine beauty. Increasingly, women who are or wish to be a part of the cult of thinness (McLorg 1987) are turning to drugs, either illicit substances or illegally/unethically obtained pharmaceuticals, in their efforts to be ultra-slim. Despite the substantial amount of research in the area of non-normative weight

management, the use of drugs, both licit and illicit, among women aiming to control their weight is undocumented. Scholarship that explicitly addressed the relationship between substance use and weight control was not sociological in nature, and largely understood drug use as a coping mechanism for the trials and tribulations associated with lifestyles which included excessive weight controlling behaviors. While the exact extent of drug use and abuse is not known, the lack of scholarly inquiry into the relationship between utilitarian substance use and intentional weight management has left the impression that these are two completely distinct behavioral patterns. Although sociological literature on eating disturbances and the body is extensive, studies focusing specifically on the relationship between substance use and disordered eating are relatively limited. The correlation between the two warrants further investigation, as approximately nine percent of the general population regularly uses alcohol or illicit substances, while the rate for those with eating disorders is closer to fifty percent (Lamberg 2003). However, this is not news to scholars in the field, as the positive correlation between problematic eating behavior and substance use has been documented since the 1970s (Fox, Ward, and ORourke 2005). Of the empirical research on the subject, the majority hailed from psychological and medical fields, and largely relied upon clinical samples (Bulik et al. 1992; Kozyk, Touyz, and Beumont 1998; Mitchell, Pomeroy, and Huber 1988; Stock 2002). Few studies within these disciplines used non-clinical samples (Anderson,

Martens, and Cimini 2005; Dansky 1997; Dunn 2002; Garry, Morrissey, and Whetstone 2003). In addition, most psychological and medical scholarship focused on the comorbidity of these behaviors (Holderness, Brooks-Gunn, and Warren 1994; Jones 1985; O'Brien and Vincent 2003; Stice, Burton, and Shaw 2004; Westermeyer and Specker 1999; Wiederman and Pryor 1997). In order to illustrate current and historical scholarly research concerning drug use and disturbed eating, I begin with an overview of extant empirical literature. I then move on to discuss the models which have been commonly used among researchers to frame studies on problematic eating generally. I conclude this chapter by exploring the sociological perspective, including deviance and feminist theories, the paradigms that guided this research. Extant Empirical Literature Medical and psychological literature detailing the relationship between problematic eating and substance use has been informative in a number of ways, and was therefore useful background for this project. First, psycho-medical evidence suggested that women with eating problems were more likely to be substance users than women with normative eating patterns (Dunn 2002; Holderness, Brooks-Gunn, and Warren 1994). Several studies concluded that many of those formally diagnosed with eating disorders went on to develop drug and alcohol problems as well (Beary, Lacey, and Merry 1986; Hudson 1987; Jones 1985).

One factor commonly cited in this literature was the potential of genetic predispositions for both substance use (especially alcohol) and eating disorders. For example, Jonas and Gold (1987) suggested that those who developed one addiction may have also developed specific behavioral patterns which made them increasingly vulnerable to other addictions as well (Holderness, Brooks-Gunn, and Warren 1994). From this perspective, both disordered eating and substance abuse were conceptualized as problems of addiction. Interestingly, researchers demonstrated that substance users were more likely than non-users to develop eating problems as well (Beary, Lacey and Merry 1986; Holderness, BrooksGunn, and Warren 1994). Second, psycho-medical researchers suggested that women with eating disorders may have used substances as a coping mechanism for any associated anxiety, depression, or anger (Flood 1989; Killen et al. 1987). For example, Dansky et al. (1997) reported that women with bulimia and posttraumatic stress or depression coped with their anxiety and sadness by drinking. More generally, an association between depression and eating disorders has been well documented (Bulik 1987; Walsh 1991). Given that the association between depression and substance use (usually conceived as a coping mechanism) was also commonly reported, it follows that psycho-medical researchers consistently found a correlation between eating disturbances and self-medicating substance use. Furthermore, it appeared that deprivation through severe caloric restriction further increased the positive reinforcement of drug use. This meant that consuming

drugs while severely limiting food intake may have increased the potential for dependence on certain substances (Carroll 1984; Krahn et al. 2005). Third, psycho-medical researchers suggested that in terms of those individuals diagnosed in formalized medical categories regarding eating disorders, women with bulimia nervosa were more likely to use and abuse substances than were anorectic women (Bulik et al. 1992). In addition, women with bulimia nervosa were more likely to have reported personal experience with a variety of substances (Wiederman and Pryor 1997). Among psycho-medical scholars, it was commonly argued that this difference was rooted in specific dominant personality traits that have been associated with bulimic women versus anorectic women. For example, researchers have suggested that poor impulse control plays a role in both bulimia nervosa and substance use (Garfinkel 1980; Heilbrun and Bloomfield 1986). Aside from formal diagnoses of anorexia nervosa or bulimia nervosa, psycho-medical scholars demonstrated that the severity of problematic eating symptoms was highly predictive of substance use in general. In other words, as womens non-normative techniques of weight management multiplied and intensified, their rates of drug use increased in turn. However, isolated disordered eating behaviors had no simple correlation to specific substances. For example, there was no evidence to suggest that women who made a practice of skipping meals were likely to use stimulants for appetite control. This made it difficult for researchers to discern patterns between specific disordered eating behaviors and their relation to different types of substance use (Wiederman and Pryor 1997).

A small body of psycho-medical literature analyzed women with eating disorders who used substances instrumentally as a method of weight control, as did the participants of this research. Drugs can suppress appetite, combat the absorption of food, promote weight loss, or induce vomiting (Mitchell, Pomeroy, and Huber 1988). For example, cigarettes are useful as an appetite suppressant and are used as such by many women, not just those with disordered eating patterns. In fact, Tomeo and Field (1999) concluded that weight concern and daily dieting was significantly related to womens decisions to begin smoking. Among women with eating disorders, common drugs reportedly used for weight loss included laxatives, over-the-counter diet pills, and diuretics (Mitchell 1985). In one study, severe caloric restriction was associated with amphetamine use, a strong appetite suppressant (Wiederman and Pryor 1997). In addition, heavy cocaine use has been reported as a weight control tactic for both women diagnosed with eating disorders and women without (Cochrane 1998; Jonas 1987). The use of drugs for the primary purpose of weight management, as described in this latter small body of psycho-medical literature, is the focus of this study. While the empirical research has greatly added to our scholarly knowledge of disordered eating and drug use, a void exists in the literature regarding women with problematic eating patterns who used substances and never sought formal treatment. In general, only those with relatively severe disordered eating behaviors seek treatment (Keel 2002). This potentially skews scholarly understandings of non-normative eating behaviors. As such, this research aims to

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understand a population, and specific behaviors, from a non-clinical sociological perspective.

THE SOCIOLOGICAL PERSPECTIVE

Scholarship concerning how individuals work to represent the self, construct the body, and control appearance, has enormous potential within the field of sociology both empirically and theoretically. As such, the use of the sociological perspective for research on problematic eating and body image in general may illuminate previously overlooked or misunderstood relations between women and their society. Although we are often told not to judge a book by its cover, physical appearance (especially for women) is an extremely important variable in contemporary American society (Wolf 1991). Researchers have consistently concluded that, most people, most of the time, are favorably biased in their reactions to good-looking people (Hatfield and Sprecher 1986:35). This bias was manifested in education (Felson 1980), and disparities in hiring, salaries, and promotions (Dipboye 1975). Feminine beauty has been associated with sanity, character, morality, and deservedness in a time of need (Hatfield and Sprecher 1986). Furthermore, research suggested that attractive women were more likely to be chosen as dating partners or spouses (Walster et al. 1966), and wielded increased influence over others (Lennon 1999). Bryne stated that it would seem safe to propose that in our society, physical attractiveness is a valued attribute (1971:54). Empirical

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research on this subject has demonstrated that what is beautiful is good (Dion 1972). In addition, women, more so than men, are generally expected to actively pursue cultural ideals of beauty (Brownmiller 1984; Paoletti and Kregloh 1989). Scholars have suggested that social ideals of physical attractiveness for women may be more culturally critical than standards of appearance are for men (Jackson 1992). Many women are cognizant of the social rewards for attractiveness. In turn, many make pointed attempts to alter their physical appearance in order to align themselves with cultural ideals of beauty (HesseBiber et al. 2006). Individuals may chose various methods for altering their appearance such as make-up, hair styling, dieting, piercing, tattoos, salon treatments, or cosmetic surgery, each of which represent personally preferred methods of body modification. Wesely suggested that these behaviors produced visible accomplishments writ upon the body, (2001:644) as women bow to powerful cultural forces that define females in terms of their physical attributes (Hesse-Biber 1996:10). Sociological Understandings of Weight Management One distinct physical attribute, weight, has been socially constructed as particularly crucial in terms of cultural ideals concerning feminine beauty (HesseBiber 1996). While the medical establishment continues to pathologize many methods of weight control, when the theorist considers that these behaviors may be deliberate and symbolic, actions towards the body encompass new meanings. As such, the phenomenon should be explored sociologically, where the questions

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are not what is wrong with this woman? but instead, how does society foster this behavior? and what does it say about us? Lovejoy stated that disturbances in body image and eating occur within individual bodies and psyches, but they also may be viewed as manifestations of troubles in the social body (2001:76). Over the past thirty years, idealized representations of the female body have evolved from curvaceous to ultra-slim (Banner 1983; Garner and Garfinkel 1980; Garner et al., 1980, 1983). As a result, many women increasingly evaluate their own beauty by the numbers on a scale. The prevalence of eating disorders and other unconventional weight control practices as means of controlling this seemingly important number continues to grow. Currently, the occurrence of eating disorders floats over previously defined boundaries, affecting individuals in different socioeconomic classes, ethnic groups, and across gender (Abrams and Stormer 2002; Altabe 1998; Atlas et al. 2002; Barry and Grilo 2002; Demarest and Allen 2000; Hesse-Biber 1996, 2006). Body image, or the cumulative set of images, fantasies, and meanings about the body, its parts and functions (Nieri et al. 2005), is an integral part of self-concept and often serves as a base for representing the self (Krueger 2002). For some women, eating disorders, which are controlled purposeful methods used to manage weight and shape the body, are but one component of intentional selfrepresentation. As such, disordered eating calls for scholarly examination from a perspective that considers womens agency, rationality, perceptions, symbolic systems, and deliberate decision making capabilities. For many women, a thin

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body is meaningful and symbolic. This is particularly true in our cultural context which celebrates thin female bodies, and the women inside, as somehow better than average women. For example, thin women have been perceived by others as smarter, stronger, purer, and more capable than normal women (Garner et al. 1980). In contrast, women of slightly above average weight have been characterized as lazy, slothful, unable or unwilling to fight temptation, less intelligent, and potentially needy (Bordo 1993). Many women specifically focus attention on their shape and size in order to combat negative feelings concerning the body, as well as these stereotypes surrounding weight. As Brumberg (1997:17) explained, young women of this generation, more so than the last, make the body into an all-consuming project. This project, which is guided by cultural scripts, is one means available to women in their pursuits of an imagined idyllic version of the self. In sociological scholarship concerning disturbed eating behaviors, mass media is often referenced as a dominant cultural influence. In terms of shifts concerning mass media, the quality and quantity of television as an everyday presence in our culture has greatly increased since the 1950s. As such, television as a medium for communicating standards or ideals of beauty has been recognized among scholars as increasingly important. Hoskins (2002) suggested that consistent exposure to media ideals has compelled women to view their bodies as an improvement project. Often, images of women in mass-media are unrealistic portrayals, setting unattainable physical standards of beauty for the

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average female. Many theorists contend that representations of women in these media representations have resulted in generations of women who are obsessed with their bodies. Preoccupation with weight and body appearance is commonly found among young women. This preoccupation may sometimes develop into disordered eating patterns. Essentially, disordered eating behaviors have become one method that women may use to reconcile the disparities they perceive between their bodies and those presented in media images. For many women, frequent exposure to popular messages and images that promote an ideal of thinness has been demonstrated to have significant behavioral effects. For example, Harrison and Cantor (1997) demonstrated that consistent inundation to media images led many women to feel high levels of dissatisfaction or even hatred towards their own bodies. Often, individuals levels of susceptibility to media images and ideals were highly concentrated during crucial times in socialization and identity development: adolescence. This was also commonly the time of onset for eating disorders generally (Thomsen, McCoy, and Williams 2001). It is not sufficient however, to construct eating disorders as simply resulting from distorted images of women as presented in the popular media. Generally speaking, almost all women in the United States are subjected (in varying degrees) to dominant media images and ideals, yet most women do not engage in disordered eating (Cusumano and Thompson 1997; Murray, Touyz, and Beumont 1996).

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Social Identity Theory Using social identity theory, Hogg (1992) suggested that individuals internalized ideals concerning their personhood based on characteristics of the group(s) to which they belonged or wished to belong. Hoggs use of social identity theory focused on explaining behaviors by examining individuals affiliations to specific social categories. Essentially, social groups have the potential to shape individuals actions, attitudes and conditions. In addition, social identities that are salient for individuals hold greater potential for controlling behavior through increased pressure for in-group conformity. For many women, membership in certain social groups, and the corresponding social identities, promoted values and ideals that supported disordered eating behavior. This meant that certain group memberships made individuals more susceptible to fixating on beauty ideals which promoted unrealistic thinness ideals. For example, eating disorders have been found at higher rates in social groups that emphasize the appearance of the body, such as ballet dancers or cheerleaders (Garner, Olmsted, and Garfinkel 1983; Garner et al. 1980). Thus, group memberships, which contained specific subcultural values and ideals, may have influenced individuals rates of developing eating disorders. Given that membership in the social category of women is critical to the understanding of eating disorders, many scholars have analyzed the role that gender plays in their development.

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Gender and the Body The concept of gender, or the established psychological, social and representational differences between men and women (Howson 2004:40), has been a complicated, if sticky, concept within the academy. Gender is a social construct, which places individuals into the culturally critical categories of male and female. Spence defined gender as a fundamental existential sense of ones maleness or femaleness (1993:79). Despite the socially imposed definitions and organization of these categories, men and women are generally understood to be naturally distinct from one another based largely on biology. For decades, many social theorists have worked to deconstruct these popular conceptions. Historically, De Beauvoir suggested that women are made not born (1949:8). Decades later, Stoller distinguished sex as biological and gender as psychological or cultural (1968:9). By disassociated the sexed body from gender, theorists demonstrated the ways in which individuals define, negotiate, and represent various forms of personhood. Individuals gender identities encompass self-images, self-concepts, and perceptions of others regarding social definitions of masculinity and femininity. How people identify in terms of gender has been commonly identified as an important variable for understanding behavioral patterns, as being a man or a woman in this society largely impacts the human condition. Individuals gender identities involve various levels of adherence to socially prescribed gender role expectations, as well as complex personal adaptations of cultural constructions concerning masculinity and femininity (Spence 1993). In addition, gender

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identity is closely linked to individuals conceptions of natural bodies (Wesely 2001). As such, individuals embody their genders in culturally influenced ways. Sociological application of the concept has described gender as a situated activity (West and Zimmerman 1987), an institution (Lorber 1994), and a structure (Risman 1998). For Lorber (1994), gender was firmly embedded in social institutions, and thus relational, never static or objective. Butler (1990) argued that in fact, gender trumped sex, and that the notion of biological sex was in itself, an invalid social construction. For Butler, perhaps it was always already gender, with the consequence that the distinction between sex and gender turns out to be no distinction at all (1990:7). It is never possible to isolate the affects of sex and gender, as they do not exist apart from one another. Instead, individuals occupy categories of gender which are defined, maintained, and perpetuated by society. As such, the processes of becoming and being a man or woman are largely social, instead of biological, in nature. Thus, many sociologists have argued that the attitudes, behaviors, or conditions of all things feminine or masculine are socialized, never innate (Reid and Burr 2001). Representing Gender De Lauretis suggested that gender, both as an abstract concept and embodied form, was a representation (1987:3) which was both the product and process of social and cultural phenomenon (1987:5). Symbols, images, and discourses concerning the ideal ways of being a man or woman are integrated, to one degree or another, into individuals actions and identities, and are important for the shaping of self-concept. For all, the processes of representation and

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subjectification of gender are ongoing and dynamic. Although women conceptually occupy a single category, the ways in which individuals represent femininity in their daily lives are vastly different. Althusser (1971) suggested that individuals create a subjective working of ideology, or personal scripts, which guide these daily representations of the self. As consumers of culture, women are spectators, who witness and analyze discourses concerning gender, and apply ideologies in individually specific ways. Scholarship concerning the ways in which gender ideals, including body expectations, are transmitted to women often focus on the mass media. Hoskins argued that representations of women in the media included harmful images, which are designed to express vulnerability, male dominance, dependence, and the trivialization of womens position in contemporary society (2002:234). In fact, many scholars have articulated the ways in which gender has consigned women a secondary status in society. For example, Malson suggested that the subjectivity of women: ... can be understood to be constituted within and by the discursive context of consumer culture which, rather than promoting any experience of sensate embodiment, represents our bodies to us as image. Much like cars and other status objects, the body-as-sign-commodity functions as surface image that (should) signify our (always fashionable) individuality (1999:140). Thus, women often view their bodies as an outward symbol of status, an entity to be molded in accordance with social ideologies concerning gender. Constructions of gender affect individuals bodies beyond the mere anatomical differences between men and women. Many scholars have suggested that eating disorders are rooted in our cultural constructions of gender. As such,

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the role of feminist theories for the analysis of unconventional body management has become increasingly important. Within the sociological literature on disordered eating, feminist scholarship is becoming increasingly dominant. Feminist Perspectives on Eating Disorders While there is no single, unified, feminist theory within scholarly research on eating disorders, many researchers have framed their studies from this perspective. Noted feminist scholars in the field include Bordo (1993), Chernin (1983), Fallon et al. (1994, 1986), Lawrence (1979), Malson and Usher (1996), Orbach (1978, 1986), and Shaw (1995). Recently, additions to this field of study have come from post-structural analysis through the work of Davies and Banks (1992), Hepworth (1999), Malson (1995, 1999), and Rich (2006). One of feminisms main critiques of classical explanations concerning disordered eating centers on the idea that women were often researched as though they existed alone in the world. In other words, psychology and psychiatry often employed the self in a disembodied manner, meaning that it was free of culture, gender, class, race, and other socially critical variables. Probyn (1993:2) warned: As an object, the self has been variously claimed and normally left in a neutered natural state, the sex of which is a barely concealed masculine one. And until very recently, when selves got spoken they were also taken as agendered although of course they were distinctly male. While the medical establishment treated the self as being free of said constructions, practitioners generally operated within definitions of mental health and illness that were bound by culture (Orbach 1978). Many theories on

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disordered eating neglected gender and class relations, and understood women as if they lived free of cultural influence. Through the inclusion of social variables in the analysis of eating disorders, researchers aimed to broaden scholarly understandings of the phenomenon. However, most researchers did not dismiss psychological factors as important to the study of eating disorders all together (Hesse-Biber et al. 2006). The use of feminist perspectives for research concerning unconventional body management has been extremely influential in demonstrating that sociocultural standards of beauty are a major variable in the development of eating disorders (Fallon, Katzman, and Wooley 1994; Hepworth 1999; Malson 1998). For many feminists, unnatural and unattainable beauty standards socially prescribed for women indirectly served as an oppressive distraction from relevant social and political issues. For example, theorists have argued that obsession with beauty diverted womens focus from controversial politics and the feminist movement of the 1970s, to a never ending cycle of dieting and self-hatred (Bartky 1990). Unfortunately, this cycle is one that many women feel trapped in today. In order to better understand women who resort to excessive weight control measures, many theorists have worked to deconstruct the symbolic meanings attached to food and the body. Orbach (1978) was central to the identification of gender in the analysis of eating disorders. Championed in her pursuit of fat as a feminist issue, Orbach argued that women lived within gendered political systems, which included values, ideals, and distinctly oppressive social processes. She placed the subordination of women as central to

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the theoretical debate on eating disorders, and argued that such behaviors were a manifestation of cultural ideals concerning femininity. In addition, Orbach (1978) argued that as a result of cultural pressures, women were driven to manipulate their predetermined biological selves, meaning their natural bodies, through the use of body altering techniques which were culturally bound. In turn, the processes that women used in order to shape their bodies, molded their social selves. Ultimately, Orbach (1978) viewed eating disorders as rooted in a society which controlled women through gender specific cultural ideals and expectations. For Orbach, cultural scripts, such as media images, or social ideals concerning femininity and proper womanhood, externally shaped womens gendered selves. Bordo (1990), another influential feminist theorist, suggested that eating disorders were a means by which women were able to act out the contradictions of contemporary social constructions of gender. For example, women are expected to be passive and docile, while at the same time smart and ambitious (Lovejoy 2001). Many theorists maintain that a thin body communicates the containment of womens power by symbolically limiting their social space. Bordo suggested that the emaciated body of the anorectic, of course, immediately presents itself as a caricature of the contemporary ideal of hyper slenderness for women (1993b:21). For Bordo (1990), a womans thin fragile frame represented many culturally valued feminine qualities. Specifically, Bordo (1990) rooted eating disorders in the contradictions of womens economic and social life-spheres. Women were conceptualized as

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having producer selves, alongside consumer selves. Womens producer selves were socially encouraged to delay gratification in accordance with cultural constructions of desirable work ethics. However, womens consumer selves were socially coaxed towards indulgence, which often resulted in the search for instant gratification. Consequentially, women were constantly tempted by, and punished for, overindulgence. Bordo (1990) argued that by repressing their desires (for comfort and nourishment), women with eating disorders were expressing discontent towards these cultural contradictions concerning proper womanhood. For Bordo, social ideals of female health and beauty resulted in, the construction of the body as an alien attacker, threatening to erupt in unsightly displays of bulging flesh (1993b:189). Thus, many women felt compelled to seize control over their bodies, and by extension, their destinies. The majority of feminist literature on eating disorders understood the phenomenon to be rooted in social control and problematic constructions of gender (Lovejoy 2001). Researchers that focused on social control viewed eating disorders as a product of increasingly oppressive beauty standards that idealized abnormal thinness (Bordo 1993; Kilbourne 1994; Lovejoy 2001; Rothblum 1994; Wolf 1991). These theorists contended that the cultural promotion of exceptional beauty ideals trapped women in a cycle of obsession with appearance that robbed them of both their social and political powers. In addition, this obsession created a thriving industry which was designed to profit from womens obsession with their appearance (Hesse-Biber et al. 2006). While navigating cultural waters, many women have engaged in internal

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struggles as they strive to gain ownership over the self. Orbach posited that throughout womens lives, interpersonal interactions which produced feelings of gender role conflict caused feelings of confusion, fear and powerlessness (1978:163). In addition, as girls, womens bodies went through periods of rapid growth and change, of course largely without their permission. As puberty inevitably changed womens bodies, social messages effectively conveyed that such bodily transformations should never be taken lightly. Orbach (1978) suggested that by controlling food and weight , women felt that they could effectively seize control over their lives. In addition, controlling the body through eating disorders was a means for women to meet social expectations in terms of appearance. Through disordered eating, many women perceived that they were able to regain control over their seemingly disobedient bodies. From this perspective, the social power and control that women gained through eating disorders significantly bolstered their sense of ownership over the self. For Orbach (1978), eating disorders were productive for women in two main ways. First, these practices allowed women to feel powerful in a patriarchal society by denying their traditional reproductive roles. Second, women gained social power and status by using body management as a means of achieving social ideals of feminine beauty. The Role of Gender Traits Murnen and Smolak (1997) suggested that women with disordered eating behaviors displayed higher levels of femininity, as well as lower levels of masculinity, than their peers with relatively normative eating patterns.

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Essentially, controlling the size of the body created a physique that was considered to be more feminine in nature. For many women, this achievement lowered levels of stress concerning the performance of gender. However, research on the roles of masculinity and femininity as represented in women with eating disorders have been largely inconclusive. For example, Barnett (1986) suggested that individuals who aim to achieve ideals of both masculinity and femininity are increasingly likely to develop disordered eating behaviors. Yet Cantrell and Ellis (1991) reported that there was no relationship between disordered eating and femininity. Since the identification of gender, masculinity, and femininity as important variables to the field, scholars inevitably began to examine the impact of individuals sexuality on the development of eating disorders. The Role of Sexuality Sexuality has been identified as important to the study of gender and embodiment (Namaste; Rubin 2003; Schrock, Reid, and Boyd 2005). In terms of eating disorders, research has demonstrated this to be particularly true of men (Lakkis, Ricciardelli, Williams 1999). For example, gay men have reported higher rates of disordered eating and concern over body-image than straight men (Beren et al. 1996; Epel et al. 1996; Schneider et al. 1995; Siever 1994). For women, the relationship between disordered eating and sexuality was not as clear. Research has suggested that gay women oriented their ideals concerning the body and gender towards an alternate set of social constructions than did straight women, and consequentially reported lower rates of disordered eating (Epel et al.

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1996; Schneider et al. 1995; Siever 1994). This suggested that sexuality played a role in the production of the self, including the intentional modification of the body. On the other hand, scholarship has demonstrated the ways in which dominant hetero-normative constructions of gender for women trumped the role of sexuality in the development of non-normative body management practices (Beren et al. 1996; Heffernan 1994, 1996; Striegel-Moore, Tucker, and Hsu 1990). Hetero-normativity refers to the values, ideals, expectations, constraints, and demands imposed upon individuals within society in terms of assumed heterosexuality (Chambers 2003). For many women, dominant ideals concerning what constituted female beauty were engrained in their understandings of gender and the social world. Many individuals internalized beauty and appearance ideals long before identifying their sexuality. Thus, for many gay women, cultural fascination with thinness persisted despite any supposedly different subcultural values. Social scripts concerning the body, which were based on heteronormativity, often remained overbearing regardless of womens other lifestyle choices. While the role of sexuality has been justifiably analyzed as important to the development of eating disorders, categorizing individuals in this way assumes that lesbians or gay men can be understood as a homogenous group (Bux, 1996; Lakkis, Ricciardelli, Williams 1999; Rosario, Hunter, and Gwadz 1997). Among individuals who are gay, there are various levels of identification with, and adherence to, complex subcultural values and ideals (Beren et al. 1996; Schneider

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et al. 1995; Stice 1994). However, individuals gender traits, or characteristics of masculinity and femininity, have been identified as mediating variables in the development of eating disorders in relation to sexuality (Basow 1992; Deaux and Major 1987; Lakkis, Ricciardelli, Williams 1999). This means that emphasizing femininity or masculinity in the representation of gender is important regardless of whether an individual is lesbian gay, straight, bisexual, or transgender. Gender and Instrumental Drug Use Scholarship concerning drugs and alcohol commonly uses the concept of gender in theoretical understandings of substance use. In fact, the intentional use of drugs for aiding or enhancing individuals representations of the self is seen across genders. For example, Keane (2002) suggested that instrumental steroid use among men was transformative for their representations of masculinity. Similar to the women described in my research, who used drugs to control their weight, male steroid users were largely defined in terms of pathology (Korkia 1997; Peters et al. 1999; Williamson 1994). As with the notion that eating disorders represent an over-adherence to cultural gender standards, discourses on steroid use often portrayed individuals as hyper-conforming to social ideals of gender and masculinity (Monaghan 2002). Gendered practices such as these have been described as one of the central ills (Bordo 1997a:139) of our culture, as social obsession with the body has resulted in rigid ideals of embodiment for both men and women (Keane 2005:192). According to socially constructed gender standards, individuals strive

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to achieve ideals of masculinity or femininity as they deem personally applicable. Both men and women may turn to instrumental drug use in this project. Male instrumental steroid users were similar to female instrumental stimulant users in a couple of ways. First, they were likely to orient their substance use towards body management, instead of consciousness alteration. Second, steroid users commonly created systems for their body management techniques, in which individuals controlled their cycles of use, dosages, and often included intentional periods of abstinence (Keane 2005). Midgley et al. (1999) suggested that continued, chronic use of steroids was more closely associated with positive social reinforcement regarding the transformation of the self, than the actual substances psychological or physiological effects. Essentially, men were dependent on the ways in which instrumental drugs use enhanced their gendered performances, not the drugs effects alone. The same principle applies to the women who participated in this research, who used stimulants to control their body weight and by extension, worked to represent ideals of gender. In this vein, Pope et al. suggested that the oppressive cycle of male body obsession was as deadly and insidious as eating disorders are for women (2000:17). Boys et al. (1999) suggested that individuals perceptions of a drugs instrumental utility was predictive of continued use patterns. The use of steroids among male athletes then, may be driven by the substances utility for achieving ideals of gender. Harkening back to Hoggs (1992) use of social identity theory, this same principle may apply to women using stimulants to shape their bodies. Specifically, stimulants psychopharmacological effects are well suited for

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womens pursuits of idealized femininity. Whereas men chose drugs that catered to the representation of ideal manhood, women preferred substances that tailored the body in a decidedly feminine way. In effect, bodies across gender have been socially commodified. This produces distress regarding how gender is conceptualized and experienced in everyday life, for both men and women (Miller 1998; Bordo 1999). Whitehead (2005) suggested that sports, where instrumental steroid use among men is most commonly found, represent social arenas which emphasize culturally constructed ideals of masculinity. For example, characteristics such as stamina, strength, endurance, and pain tolerance are all celebrated in sport. In addition, Burstyn suggested that sports are the most powerful social confirmation of masculinity that any male can attain in our culture (1999:254). Donovan et al. (2002) suggested that both instrumental and normative factors played key roles in individuals decisions regarding performance enhancing drugs. For Donovan, instrumental factors were individuals incentives for, and deterrents from, drug use. Normative factors, such as personal moral orientations, also affected individuals decisions regarding drug use. Donovan et al. (2002) conceptualized instrumental drug use as a largely rational process. However, Stewart and Smith (2008) suggested that external factors, such as social ideals concerning gender, exerted pressure on individuals to act irrationally. Practically speaking, the instrumental use of drugs includes elements of both rationality and irrationality. As such, the processes involved in these behaviors are complicated, contradictory, and in constant flux.

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Scholarship, including this research, has demonstrated that humans possess a willingness to use substances in an effort to shape, control, and manage their bodies. Decisions regarding which drugs to use, where to obtain them, and how to manage the deviant career were generally made in accordance with the social ideals of gender that individuals deem personally applicable. For example, women in this research largely chose to use stimulants not for their mind altering effects, but for their power to aid in representing their gendered selves. Men and women may have chosen different substances because they oriented their drug use towards accomplishing gender specific goals. However, both manifestations highlight the impact that ideals of masculinity and femininity have on individuals real, physical bodies. Furthermore, the phenomenon of male and female instrumental drug use illuminates a general pattern in our culture, in which individuals engage in substance use as a means for solving, what might arguably be, lifes everyday problems. Gender and Licit Drug Use In general, scholarship on licit substance use has suggested that women are more likely than men to use pharmaceuticals, of any variety, than men (Simoni-Wastila, Ritter, and Strickler 2004). In fact, women were twice as likely to use licit drugs (Cooperstock and Parnell 1982). Often, scholars and laypeople alike chalked up this difference to womens supposed natural emotionality (Ettorre 1995; Cooperstock 1971). In addition, masculine cultural scripts encouraged men to grin and bear it, so to speak, when it came to issues of mental health (Balter, Levine, and Manheimer 1994; Ettorre and Riska 2001;

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Parry 1968). As such, women have been over-represented among medical patients being treated for mental illness with psychoactive medical substances. Scholars have suggested that these gender differences, as represented by individuals who are categorized in formal definitions of mental illness, are no coincidence. Instead, womens relative positions, statuses, roles, and expectations in society have acted as social determinants for gendered rates of so-called mental disorders (Brown and Harris 1978; Miles 1988). In regards to licit substance use, women were also more likely than men to have access to pharmaceuticals with the potential for abuse (Cafferata and Meyers 1990; Clayton et al. 1986; Cooperstock and Parnell 1982; Hohmann 1989; Johnston et al. 1985; Mellinger et al. 1984; Simoni-Wastila 1998, 2000; Verbrugge 1985). For example, research has demonstrated that women were more likely than men to be prescribed narcotics and tranquilizers (Hohmann, 1989; Simoni-Wastila, 1998, 2000). In addition, women were more likely to be prescribed sedatives and stimulants (Clayton et al. 1986; Johnston et al. 1985). Simoni-Wastila, Ritter, and Strickler suggested that if one assumes that continued medical exposure to a substance is likely to lead to misuse or abuse of that substance, then women may very well be at high risk for non-medical prescription drug use (2004:3). Pharmaceutical instrumental drug use has certainly not been limited to weight controlling amphetamine use, as described in this research. For example, valium, a tranquilizer, was popularly dubbed mothers little helper in the 1960s for its extensive use among women (Koerner 1999; Metzl 2002). Blum and

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Stracuzzi (2004) suggested that over the past few decades, the widespread use and popularity of Prozac, an anti-depressant and anti-anxiety medication, represented a second wave of this phenomenon. Kegan Gardiner (1995) and Metzl (2002) suggested that the popularity and discourses that surround psychoactive substances like Prozac, Paxil, and Zoloft, were rooted in social constructions and reproductions of gender. For example, Koerner (1999) suggested that the effects of these drugs, such as a heightened sense of euphoria, sleepiness, and lowered ambition, had a distinctly feminine character. Thus, pharmaceuticals arguably have the capacity for enhancing or detracting from individuals embodied performances of gender, and have long been used as such. Critics of the medical establishment have suggested that the widespread prescription of pharmaceuticals has become a means for treating individuals everyday problems, instead of legitimate medical conditions (Gabe and LipshitzPhillips 1984; Koumjian 1981; Waldron 1977). In addition, discourse on pharmaceutical substance use engaged with the notion that society is ever evolving towards a state in which individuals are expected to be better than well (Blum and Stracuzzi 2004:270; Miller and Wilsdon 2006; Parens 1998). In fact, many licit substances were essentially designed to be performance enhancing. For example, Viagra, a pharmaceutical developed to treat erectile dysfunction, has been described as a substance intended to enhance lifestyles rather than treat medical conditions (Williams et al. 2006: 846). Viagra is not alone in the performance enhancing drug department. Modanil, a pharmaceutical substance which is prescribed for sleepiness and

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fatigue related concerns, has been lauded for its cognitive performance enhancing abilities (Williams et al. 2006). A few varieties of pharmaceuticals that increase concentration, memory, and thinking skills, such as Modafinil, have been described as smart drugs (Turner 2003, Hart 2006). So-called smart drugs are not necessarily used to restore health, but rather to aid individuals in their pursuits of happiness, productive careers, greater sex, or generally enhanced lives. When framed in this manner, the instrumental use of prescription stimulants to control weight, and by extension pursue gendered body ideals, can be understood as another manifestations of performance enhancing pharmaceutical use. Gender and Illicit Drug Use Scholarship on illicit drug use has suggested that men generally use and abuse illicit substances at higher rates than women (Faupel, Horowitz, and Weaver 2003; Springer et al. 2002; Substance Abuse and Mental Health Services Administration 1997a, 1997b; Thom 2003). In addition, men report earlier onset and higher rates of use than women for a variety of illicit substances (Faupel, Horowitz, and Weaver 2003; Opland, Winters, and Stinchfield 1995; Svensson 2003). However, previous research demonstrated that drug use has been problematic among women as well (Johnston, OMalley, and Bachman 2003a, 2003b; Lex 2000; Wetherington and Roman 1998). The differences in the rates of use and abuse of illicit substances between men and women can be understood in terms of gender. Expectations and social ideals of femininity may steer women away from the use of illegal drugs. In addition, constructions of gender may guide women toward licit substances, as

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this type of drug use is more socially acceptable. As such, the lower rates of illicit instrumental drug use reported by participants of this research may be due to gender ideals. However, women who chose illicit substances as a means to control weight were also aiming to achieve feminine gender ideals. Aside, from gender, mediating variables such as history of substance use, subcultural values, personality characteristics, and normative orientations, influenced womens preferences for one type of drug over another. Both men and women have been drug users, although the social organization and definitions regarding their use differs. However, if you deduct the legal definitions and social constructions concerning what constitutes drugs (for example, licit versus illicit), and boil the equation down to whether or not individuals will use substances in their various forms as a means of creating and representing the self, the boundaries separating men and women disintegrate. It is increasingly apparent that men and women have (and will) both use drugs in their efforts to construct or represent the self. However, they tend to do so in accordance with their gender identities. Deviance Theories and Eating Disorders It is generally understood that no behavioral act is inherently deviant (Erikson 1966; Gibbs and Erickson 1975). Definitions concerning what constitutes deviance or deviants, varies among researchers. Without consensus on what defines deviant behavior, sociologists are often left with a you will know it when you see it approach to research. However, among sociologists, the use

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of deviance theories for framing research on disordered eating practices has proved useful (McLorg and Taub 1987; Sischo, Taylor, and Martin 2006; Sharp et al. 2001). Through situating individuals in their social and cultural contexts, the deviance perspective works to demonstrate how situations affect individuals decisions regarding whether or not to participate in deviant behaviors, such as drug use and disordered eating (Sischo, Taylor, and Martin 2006). Reactivist conceptions of deviance maintain that an act is deviant only when labeled as such by others. Normative conceptions define deviance as actions which deviate from conventional boundaries regarding socially acceptable behaviors (Heckert and Heckert 2002). My research works with the concept of deviance as described by Tittle and Paternoster (2000), who stated that deviance encompasses any type of behavior or condition that the majority of a given group regards as unacceptable, and that evokes a collective negative response or would evoke a collective, negative response if detected (2000:17). In terms of gender, it has been argued that deviance theories are better suited for explaining male behavior (Agnew and Brezina 1997). Cloward and Piven described the deviance of women as typically individualistic, selfdestructive, and less frequent than male deviance (1979:651). However, Kaplan and Johnson (2001) argued that there were more similarities than differences between men and women in terms of the processes leading to deviant behavior. Sischo, Taylor and Martin suggested that the conditions that prompt deviance in boys also prompt deviance in girls even though the kinds of deviance they prompt

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may differ (2005:3). For example, Sharp et al. (2001) used strain theory to predict bulimia in women. Although many deviance theorists have historically focused on the actions of men, it may be that the social conditions that prompted deviance were similar across gender. It was the reactions to these social conditions that were gendered. For example, Sharp et al. (2001) found that negative self-evaluation for women was more likely to result in deviance directed at the self, such as disordered eating practices. On the other hand, self-derogating men were more likely to engage in criminal activity and outwardly aggressive behavior (Kaplan and Johnson 2001). Kaplan and Johnson (2001) suggested that for all genders, social rejection often resulted in self-rejection. The distress that followed self-rejection may have led some individuals to adapt, through deviance, in order to alleviate negative feelings of self-worth. In terms of cultural expectations and social rejections regarding thinness, Sischo, Taylor, and Martin (2005) concluded that those who felt negatively about their bodies during their teenage years were more likely to develop disordered eating patterns. Kaplan and Johnson (2001) argued that such negative feelings resulted from experiences or statuses early in life that devalued the self. They argued that self-devaluing individuals were likely to behave in deviant ways if the resulting attributes or statuses would result in positive evaluation from others. Positive social feedback alleviated negative feelings about the self, and also reinforced the deviant behaviors that prompted the feedback in the first place. In other words, individuals felt compelled to continue deviance that resulted in

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others praise and increased self-esteem. In additional support for deviance, selfdevaluing individuals were more likely to associate with deviant peers who provided, a resource that attenuates the effectiveness of internalized social control mechanisms and rewards (or possible rewards) for engaging in deviant behaviors (Kaplan and Johnson 2001:197; Sischo, Taylor, and Martin 2005). According to Kaplan and Johnson (2001), early feelings of negative self worth, perhaps resulting from early negative experiences, not only increased the potential that individuals would develop deviant behaviors, but it also placed them in social groups that were more likely to accept or support their non-normative behaviors. Self-derogation and social deviance theories have been used to explain a number of different behaviors, among them addiction, violence, drug use, and eating disorders (Epstein et al. 2004; Johnson and Kaplan 1990; Kaplan et al. 1984; Sischo, Taylor, and Martin 2005). Levine and Piran (1999) suggested that for many young women with eating disorders, early negative self-evaluation took direct aim at the body and resulted in feelings of powerlessness, insecurity, and irrational fear of fat. This may have been a gendered reaction to deviance prompting conditions. This phenomenon is becoming increasingly common, as more women continue to experience problematic body image issues. As unconventional body management techniques become more common in society at large, it might follow that such practices would gain social acceptance. However, most of these behaviors remain outside of normative boundaries. Given that individuals across gender have engaged with non-normative means for constructing the body and self, it is

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important to analyze why certain behaviors are defined as pathological in the first place. Sociologists have researched this topic from many angles, and many maintain that the medical establishment largely creates and perpetuates dominant definitions of pathological and normal. The Medicalization of Deviance Certain modes of body management or gender representation, such as transgenderism, anorexia nervosa, and bulimia nervosa, have been characterized as unnatural, negative, or disordered (Finn and Dell 1999). The processes involved in defining certain behavioral practices or conditions in these terms have been described as medicalization (Riesman 1983). As Conrad explained, medicalization is a process by which non-medical problems become defined and treated as medical problems, usually in terms of illness or disorder (1992:209). In so doing, the medical establishment codifies behavioral patterns clinically, and draws certain body management techniques into their culturally dominant discourses. Brown suggested that this process located the parameters of normality and abnormality (1995:39). By constructing specific behaviors as dangerous or mysterious, the medical establishment secured its stronghold as the social institution with the power to define and treat behavioral phenomenon. In other words, medical doctors became the authority on discovering and disseminating the truth about individuals in society. Conrad suggested that the primary problem with the medical establishments social power, remains definitional, the power to have a set of

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medical definitions realized in both spirit and practice (1992:16). This process involved a complex set of negotiations among professionals, the general public, and afflicted individuals, which is always mediated by broader cultural ideas (Irvine 1991:204). Medical knowledge is the product of social constructions, and cultural assumptions or beliefs continue to permeate this establishment. Through socially sanctioned means, medical researchers and practitioners reify cultural boundaries concerning what constitutes acceptable versus pathological attitudes, behaviors, and conditions. As such, cultural ideology concerning what is normal or abnormal, is reinforced and legitimized by the medical establishment. Dominant explanations of body management practices such as disordered eating continue to define individuals as sick, mentally-ill, and ultimately, pathological. The term mental illness refers to clinically diagnosed categories of certain behaviors or conditions such as substance use, personality, anxiety, or brain disorders. According to the Center for Disease Control (2005 Health Report), women were overrepresented in mental illness categories, as well as in certain areas of psychiatry. Consequentially, mental illness has been constructed as largely a female problem. However, according to Chesler (1972), women were more likely to be labeled as having a mental disorder than men. As such, many mental illnesses or disorders appear to be feminine in nature. In addition, many characteristics associated with mental-illness, such as anxiety, neuroses, depression or eating disorders, have a distinctly feminine character. The behaviors of these so-called disorders then, are gendered and resulted in

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and from social constructions, values, and ideals. In essence, gender was embedded in official definitions of mental disorders. However, the behaviors and feelings contained within many of these disorders, such as sadness, fear, and anxiousness, were more culturally acceptable for women to express. In turn, the expression of these feelings was more likely to result in the label of mentally ill. Yet, very few biologically based theories investigated why mental disorders were presenting more often in women. While there have been numerous understandings of eating disorders across academic disciplines, dominant discourses continue to rely on medically based constructions of the phenomenon (Rich 2006). Deviance as a Lifestyle Instead of viewing drug use or non-normative weight control as disorders, many women view their behaviors as lifestyle choices that creates safety, desirability, and a sense of power in the social world. For many women, deviant eating practices are an effective tool for alleviating negative feelings of selfworth, and aid in the construction of positive social identities. These behaviors serve as one means by which women are able to act and reenact the self on a daily basis (Butler 1990). In addition, deviant weight control practices are unique in that many individuals desire the condition, and actively pursue unconventional means. Warins (2002) ethnographic work on women practicing disordered eating supported the notion that individuals intentionally seek out disordered eating

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practices. For example, women with eating disorders often described the condition as a productive and empowering state of distinction (Warin 2004:101). From this perspective, work on the body is not entirely the result of individual pathology. Instead, sociological theorists have suggested that eating disorders are social in nature. Discussion on Applying the Deviance Framework Sociological research often regarded deviance in society to be an alien element and descriptions of non-normative behaviors depicted a vagrant form of human activity, moving outside the more orderly courant of social life (Erikson 1966:97). Some deviance theories suggested that in order to maintain social order deviants must be controlled, while others maintained that deviance was a necessary phenomenon within society. Konty suggested that in studying the weaker members of society, in calling attention to their differentness and labeling them deviant, the sociologist inevitably reifies the existing set of power relations (2007:155). As such, it is important to consider the consequences and implications for researching human behavior from this perspective. As a researcher, the use of deviance theories proves to be immensely applicable to my data. This research makes use of the concept of deviance, as well as deviance theories, but my intention is not to apply labels in a morally judgmental or hierarchical manner. The terms deviance and deviant behavior will be used to denote phenomenon that are non-normative, rare, and have the potential for eliciting negative social evaluations.

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CHAPTER TWO Research Methodology

The multiplicity of approaches to scholarly research that are available to sociologists in their quest to understand our social world abound. Two distinct methodological paradigms have demonstrated dominance as the major frameworks in which most sociological research is conducted: qualitative and quantitative research methods. The use of qualitative versus quantitative methods has long been debated within sociological scholarship. In terms of their utility for understanding the complexities of human behavior, strengths and weaknesses are inherent in both. Quantitative and qualitative research employ different, yet valid and reliable, methods for producing important scholarship. Utilizing different means, these methods both seek truths regarding social reality. Some quantitative methods allow researchers to infer results to the population in general, as they have the potential for application on a larger scale. Qualitative methods however, have the capacity to give meaning to quantitative numbers and voice to research participants. Despite their differences, both quantitative and qualitative methods play legitimate roles in sociological inquiry (Becker 1967). This research relies on sociological qualitative and feminist methods and perspectives. These methods were central to the conception, operationalization, design, and data gathering of this research. This chapter addresses these topics by detailing the execution of this project.

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QUALITATIVE RESEARCH METHODS

Qualitative methods are uniquely suited for studying behaviors that are largely private and therefore hidden from public scrutiny, such as drug use (Hesse-Biber, Leavy, and Yaiser 2006). In addition, qualitative research methods were specifically useful for this research, which aimed at understanding a hidden population. Hidden populations are those that are indistinguishable from the general population using currently available information and sampling techniques (Wiebel 1990). Individuals that are disadvantaged or disenfranchised, such as the mentally ill, homeless, school drop-outs, criminals, prostitutes, gangsters, or runaways, are often omitted from national quantitative social research (Wiebel 1990). As such, very little is systematically understood about these populations. While the population that this research aimed to understand was hidden as a result of individuals personal choices instead of conditions, such as mental-illness or impoverished living conditions, they nonetheless remained invisible in the public eye. When very little is known about a particular phenomenon, qualitative methods have the potential for collecting rich data (Lofland and Lofland 1995). By design, these methods are exploratory. Research based on qualitative methods has great potential for gathering data that can later inform large, national-scale, quantitative studies. For example, in terms of scholarly work on drug use, qualitative methods were useful when a new drug emerged and grew in popularity (Wiebel 1990). Quantitative methods were rarely applicable for studying such

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emerging phenomenon, as constructing valid measures and gathering a representative sample would be difficult given topics that were completely new to researchers. Feminist Research Methods In addition to qualitative methods, I incorporated feminist perspectives into the execution of this research. So-called feminist research methods are useful for both quantitative and qualitative work, however they are generally associated with the latter (Becker 1967). Although feminism contains no universal method for conducting social research, the feminist perspective has informed many diverse forms of scholarship. For example, Haraway (1988) suggested that knowledge is situated, and scholarship is affected by researchers standpoints, approaches, and analysis of data. Constructing a unified feminist method was implausible, given the diversity within feminisms. Generally speaking however, feminist perspectives hold that research should seek to understand the human condition by locating individuals within the contexts of their social worlds, and consider how a multiplicity of social variables affected individuals experiences and identities (Harding 1986). Feminist scholarship is commonly concerned with researcher standpoint, reflexivity, and ethics (Maynard 1994; Reinharz 1992).

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Ethnographic Epistemology Research methods are intrinsically linked to epistemology. As Ambert et al. suggested, methods are procedures or techniques, epistemologies constitute ones view of the world (1995:881). Epistemologies are directly related to the questions that researchers ask, as well as their methods of data analysis. Scholarly emphasis on researchers detachment and objectivity, as commonly found within quantitative scholarship, has been questioned. Qualitative epistemologies on the other hand, have been hailed for their use of subjectivity as a research strength (Douglas 1970; Douglas 1976; Douglas and Johnson 1977; Feyerabend 1972; Johnson 1975; Mehan and Wood 1975; Phillips 1974). Instead of maintaining distance throughout the course of research, qualitative researchers aim to achieve relative closeness to the phenomenon being studied. While collecting data in this manner may have impacts on the research setting, it has been suggested that having zero impact on ones research is impossible (Jarvie 1969). From this perspective, I conducted semi-structured in-depth interviews with college students who reported the use of substances as a means of weight management. This research was ethnographic in nature, although strictly interviewing research participants is a limited form of ethnography (Wiebel 1990). However, it was not altogether plausible for me to explore alternative methods of data-gathering. Women using drugs for weight control had no subculture, nowhere that they hung out together, nowhere for me to visit. In addition, gatherings of women who use drugs to control their weight, such as

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twelve-step meetings or treatment groups, were non-existent. Given that most often, women used their drugs alone and did not disclose their weight control techniques to others, conducting individual interviews was a viable option for my research. However, given the immense time and energy that is required of this method, I had to make each interview count. Therefore, it was imperative that I clearly define the types of behaviors I was interested in looking at before gathering my research sample. Defining the Variables Determining the best way to execute this research required that I delineate specifically, which behaviors I wanted to examine. Generally speaking, scholars who inquired about either drugs or eating disorders employed these concepts in a variety of ways. For this research, constructing operational definitions for these concepts was tricky. First and foremost, discourses on both drug use and disordered eating were largely dominated by the medical establishment. Professionals who worked with individuals who engaged in these behaviors, such as medical doctors, psychiatrists and psychologists, operated from clearly articulated definitions of medical disorders as specified within their disciplines (American Psychiatric Association 1994). The clinical diagnoses that were related to the behaviors reported in this research were substance abuse, substance dependence, anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified. However, the expanded use of these concepts across disciplines has led to an increasingly diverse assortment

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of operational definitions. This was the case for both scholarly work on eating disorders as well as drug use. Johnson suggested that in terms of qualitative research, the repeatability ofcases is enhanced if methods, theoretical assumptions, and operational definitions are explicitly stated (1975:20). Here, I detail my operational definitions of drug use and eating disorders as they were used in this research. What is a Drug? A universal understanding of what constitutes a drug does not exist. Socially, the term is often used to refer to illicit substances that are sold on the street. Accordingly, use of the term drugs in casual conversation will generally elicit images of black market substances such as marijuana, cocaine, crack, meth, ecstasy, heroin, acid, or psychedelic mushrooms. While most people, most of the time, would consider these things drugs, this definition excludes substances that are relevant to scholarly discourse on psychoactive substance use. For example, it is on rare occasions during polite conversation that alcohol is defined as a drug. Yet, this substance induces intoxication and has the potential for both physical and psychological dependence. In addition, the term drug is rarely used in the same connotations found within discourses on prescription substances. Often, individuals in society at large rely on the legal definitions of drugs. These definitions were concerned with substances as they were constituted within the law, and were mutable over time (Goode 2005). In contrast, the medical establishment defined drugs in terms of various substances healing powers. Thus, for law enforcement and society in greneral,

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drugs were illegal substances, while for medical doctors drugs were a cornerstone of professional practice. To further muddy these definitional waters, some conceptions of drugs were overly-inclusive (Goode 2005), and contained substances such as caffeine, diet pills, or Chinese herbs. While these substances were arguably those with a rightful place in drugs scholarship, they represented relatively normative variations for the purposes of this research. In this dissertation, the term drugs refers to licit substances, such as pharmaceutical stimulants or painkillers, as well as illicit substances, such as street cocaine or amphetamines. While cigarettes were commonly included in research on drug use as well as eating disorders, they were excluded as a defining variable in this research. Many women in this research smoked, and some even reported cigarettes as a useful tool for weight management. However, cigarettes were not the central substance used for weight control, they were generally supplemental. In addition, given that smoking was not all together normative or accepted in society, the behavior certainly did not elicit the same negative social evaluations or deviant labels that were imposed on drug use as it is commonly understood. I did not interview those who used only cigarettes or laxatives as an appetite suppressant or weight control method, as this topic has been researched extensively (Harrison, Jones and Sullivan 2008; Kashubeck-West, Mintz, and Weigold 2005; Stock et al. 2002; Wesely 2003). In addition, the use of other over-the-counter products, such as Dexatrim or Trimspa to control weight was relatively normative, and was also excluded from this research.

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What is an Eating Disorder? In addition to the blurry interpretations of what defined drugs, there was no consensus among scholars as to what attitudes, behaviors, and conditions determined the presence of eating disorders. Across disciplines, many different understandings of what constitutes an eating disorder have emerged. In fact, use of the concept has expanded far beyond the medical establishment, causing increased disparity among researchers as to what defined disordered eating. These wider definitions were not limited to the academy, as people in society generally tended to use the concept of eating disorders in a less restrictive manner than did the those in the medical establishment. As noted, medical practitioners operated from clearly defined diagnostic criteria. These criteria were strict, and research that focused solely on clinical populations overlooked those with problematic eating behaviors that fell short of a formal diagnoses. For example, research has shown that up to eighty percent of college women displayed irregular eating patterns that were non-normative in nature, but did not meet the qualifications for anorexia nervosa or bulimia nervosa (Hesse-Biber, Marino, and Watts-Roy 1999). However, sociological research was not limited in this manner, on how eating disorders could be conceptualized. The feminist perspective called for scholars to redefine alternative, nonnormative eating patterns as problems rather than disorders (Hesse-Biber et al. 2006). Scholars have suggested that clinical disorders, such as anorexia nervosa or bulimia nervosa, do not represent all eating disorders generally. Rather, they epitomized the extreme end on a continuum of womens

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relationships to their body and weight control (Hart 1985; Hesse-Biber 1989; Hsu 1990; Striegel-Moore 1992; Zuckerman, Colby, and Ware 1984). Hesse-Biber reported that many women mimic anorexia and bulimia without the underlying psychological profiles (1997:199). Women with problematic weight control methods, who were not clinically anorexic or bulimic, have been described as having partial syndrome eating disorders (Shisslak and Crago 1994). Women in this gray zone (Hesse-Biber 1989) were certainly relevant to scholarship on eating disorders (Lachenmeyer and Muni-Brander 1988), and have been increasingly studied alongside of clinical populations. For the purpose of this research, the term eating disorders was not limited to anorectic and bulimic women. Instead, I conceptualized eating disorders as a set of excessive, non-normative weight controlling behaviors that crossed the generally accepted boundaries for healthy weight management. This operational definition certainly included women who met the diagnostic criteria for anorexia nervosa or bulimia nervosa, but it also encompassed women who clearly displayed disturbed or problematic eating patterns that may or may not have met the clinical standards set forth by the medical establishment. The Research Setting Data on which this research draws was gathered in a large public university community in the western United States. This setting consisted mainly of the town, the university, and its students. This was an appropriate place to study drug use and eating disorders for two reasons. First, body image distortions

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and disturbances in eating are common among college women (Hesse-Biber, Marino, and Watts-Roy 1999). Second, although alcohol was clearly the drug of choice for most college students, illicit drug use is also commonly found on university campuses (Mustaine and Tewksbury 2004). Both undergraduate students, as well as graduate students, have reported significant rates of illicit drug use (Globetti, Globetti, and Lo 1992). Hesse-Biber and Marino referred to college as an emotional pressure cooker (1991:199). As women transitioned into college from high-school, changes occurred socially, psychologically, and academically (Astin 1977; Komarovsky 1985; Perun 1982). Womens eating patterns, which were usually set by family in the past, were subject to change as well. Pressures that were associated with school, dating, and peer expectations have all been identified by researchers as important factors in the development of eating disorders (Brouwers 1988; Carter and Eason 1983; Holleran, Pascale, and Fraley 1988; Mintz and Betz 1988). Between the presence of relatively high rates of both eating disorders and drug use, this particular setting was well suited for my research. Researching a Hidden Population Due to the secretive and arguably deviant nature of both drug use and extreme weight management, the population this research targeted was hidden. As a result, standard sampling procedures were not applicable (Salganik and Heckathorn 2004). The use of convenience sampling, a broad approach, proved to be an effective method for gathering participants. Sampling through

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convenience has long been a popular means of researching sensitive topics (Berg 1997; Lee 1993). However, the limitations of convenience sampling affected the extent to which the findings of this research may be generalized to the broader population. However, given the nature of the research topic, few other sampling technique could have proved as effective. Gaining access to women who were using substances for weight management was difficult. There was no means by which I could identify individuals in the target population simply by looking at them. Accordingly, I gathered research participants by feverishly soliciting interviews on campus. First and foremost, I solicited interviews by making announcements in classrooms all over campus, including my own classroom. Aside from my direct call for respondents, I was also fortunate to have the help of a number of colleagues who were willing to spread the word on campus as well, either in their own classrooms or through campus e-mail listserves. My status as both a graduate instructor and graduate student allowed for relatively easy access to a number of different undergraduate classrooms. I took full advantage, and visited many classes (upper and lower division), where I announced my intentions for this project. In addition, I was able to locate a few participants by spreading the word among campus student groups. Since this research employed a limited social network, the range of narratives presented and analyzed is limited. In addition, since women who engaged in substance use for weight control did not tend to share their behaviors with others, relying on friends of initial contacts was not altogether feasible. I did

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however, have a few women come up to me privately and suggest that a friend or family member may have been involved in these behaviors. I suspect that for these few individuals, talking with me about their suspicions concerning another person, may have been a way for them to confront the individual about their behaviors by introducing my research. I offered my contact information in instances such as these, and received a few interviews as a result. Interviews varied in quality, however, over time, my skills as an interviewer strengthened. Faugier and Sargeant (1997) suggested that researching topics that are sensitive or threatening in nature increased the difficulty that researchers faced in gathering a sample. Throughout the course of my research this proved to be true. Generally, interviews came in waves following my call for participants. The beginning of the school semester was always when I was the most successful at collecting interviews. My rate of collecting interviews was therefore erratic. For example, in both the fall of 2004 and fall of 2005, I experienced a period of eight weeks or so in which I conducted between two and three interviews a week. The spring semester was generally not as fruitful. However, once summer came around, again I saw respondent levels increase. This may be explained by the changing seasons, as summer and fall were much warmer months of the year. These seasons called for less clothing, and thus potentially more attention focused on the body. On the other hand, students may have simply been more overwhelmed during the spring semester. On accessing deviant populations, Adler suggested that being forthright and friendly is not enough to gain entry; more calculated strategies may be

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necessary for these secretive and suspicious groups (1990:9) Knowing this, I constantly remained on the lookout, and was able to obtain a few interviews by drumming up participants in the course of my everyday social life. Most commonly however, potential participants contacted me via email or phone after my direct solicitation for research participants. In a few instances, participants passed along their personal contact information to me after hearing about my research from others on campus. First, I screened research candidates before scheduling an interview (Sudman and Kaltman 1986). This insured that interviews were reserved for women who were representative cases of the phenomenon as defined in this research. This meant that they currently or historically used drugs, either licit or illicit, for the primary purpose of weight management. The Research Sample Respondents were a self-selected convenience sample of sixty collegeaged students at a large public university in the western region of the United States. Fifty-seven research participants were women, three were men. This was largely expected, as women continue to be more dissatisfied with their bodies than men (McCreary and Sasse 2000). This dissertation exclusively reports on data that concerned womens drug use and weight managing practices. The interviews that I conducted with young men were never transcribed, and are excluded entirely from this research. Class rank among participants ranged from freshman to seniors, and also included three recent college graduates who

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remained engaged in the college environment. Women lived both on and off campus, and were from various geographic locals. The majority of respondents shared similar demographic characteristics. All participants were young women between the ages of eighteen and twenty-five. In addition, most identified as white. Research has demonstrated that race is an important variable in the development of eating disorders. For example, black women have reported much lower rates of eating disorders than white women (Petersons et al. 2000). Research has suggested that black men and women were more likely to accept larger women, and placed less emphasis on thinness as a beauty ideal (Powell and Kahn 1995). However, it is important to note that research on eating disorders in terms of race was inconclusive. As such, individuals orientations towards dominant versus subcultural values and ideals has been examined. For example, Browne (1993) found no differences in the rates of eating disorders among black women who prescribed to dominant (white) cultural ideals versus those who identified with black cultural ideals. However, Abrams et al. (1993) found that the degree to which black women identified with white culture versus black culture, had a positive correlation with increased rates of eating disorders. Research on eating disorders among Latina women has reported that white women and Latina women developed disordered eating at similar rates (Crago, Shisslak and Estes 1996). Smith and Krejci (1991) found that Native American women displayed higher rates of eating disorders than did white women.

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As college students, women in this sample represented a relatively privileged, well-educated group. Most participants reported growing up in either middle or upper-middle class homes. In addition, participants status as college students marked them as relatively well-educated. These characteristics have been commonly reported in scholarly research on women with disordered eating patterns. The majority of previous literature has suggested that eating disorders most commonly affected white women of privileged socio-economic status (Alexander 1998). However, the nature of this sample, as it draws from a primarily white, young, and middle-class college population, precludes my contribution to any analysis of the broader demographic. Participants fell squarely within the population that has already been identified by researchers as most prevalent among women with eating disorders. Interviewing on Non-Normative Behaviors Early in this research, I formulated the basic questions to address during interviews through coursework, literature reviews, and conversations with sociology faculty, students, friends, and family. My basic interview guide consisted of questions regarding demographics, onset of drug use and problematic eating, management of the drug using career, management of disordered eating, stigma, social isolation, practical issues (such as financing an expensive drug habit), drifting in and out of drug use, accounts of behavior, and exiting the drug using career. Interview questions were structured around topics I sought to understand, such as behavioral practices, episodes, encounters, roles,

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relationships, social groups, organizations, settlements, social worlds, and lifestyles (Lofland and Lofland 1995). Interviewing in a semi-structured style allowed me to cover the major topics and themes I wished to cover, yet still preserved a level of open-endedness, which invited more communication than closed interviews offered. Following each interview, I allowed time for questions and input from the participants. In a few instances participants asked for resources on where to find help regarding either their drug use or disordered eating, information I gladly offered to all. I later transcribed these interviews and analyzed them using concepts from existing sociological, feminist, deviance, psychological, medical, and sociological literature on drug use and weight control. This project relied exclusively on womens self-reports of their substance use. Without the ability to compare data with other sources, such as arrest records, drug tests, medical records, or the testimony of others, I counted solely on womens personal narratives of their drug use and weight managing behaviors. This meant that I was responsible for determining the validity of my research data. Scholarship on drug use has been consistently criticized for this method of data collection. Specifically, the reliability and validity of data on deviant behaviors that was gathered through interviews has been called into question. Becker (1963) suggested that people engaged in deviance often concealed their behaviors. This may have led individuals to under-report any behaviors that were perceived to be disagreeable. Further, face-to-face interviews exaggerated a social desirability bias (Tourangeau and Smith 1996). Wiersma (1988) warned

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that interview participants may answer questions by constructing what they perceived to be more culturally acceptable versions of the truth. Questions that were sensitive or threatening in nature may have caused respondents to retreat and intentionally minimize undesirable behaviors (Bryant 1990; Davis 1961; Nusbaumer 1990). However, under certain circumstances, such as an appropriate research setting, individuals have demonstrated their willingness to report nonnormative behaviors (Kinsey et al. 1948). Interviews generally lasted between one and two hours. I conducted interviews in a few different places, sometimes depending on the weather. Many of my interviews took place in the privacy of a campus faculty office or empty classroom in order to assure participants that our conversations would remain private. However, handfuls of interviews took place outside on a campus lawn, or coffee shop (usually outside, which oddly enough, often felt more private. To further reassure participants, I explained my own personal ethics concerning complete confidentiality, as well as the university research governing boards policies. Within this setting, most participants appeared more than willing disclose their current or past drug use and history of disturbed eating behaviors. While these interviews were semi-structured, they were usually very open and conversational. During interviews, I aimed to be an active-listener (Wolcott 1995). In addition, I tried to remain tactful and unobtrusive (Schatzman and Strauss 1973) in order to let participants illustrate lived experiences in their own voice.

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RESEARCHER ROLE

Ball suggested that the social situation and auspices under which interviews are obtained affected deviant subjects motivation to be either candid, equivocal, or deceitful (1967:654). I interviewed each participant only once, so it was important that each interview provide rich, raw data to analyze. It is generally understood that interactions between researchers and participants affects the quality of information that can be gathered through interviews. Since tolerance for deviance varies among individuals, research respondents may sizeup an interviewer and tailor their accounts according to their perceptions. As such, Denzin (1974) suggested that any sociological research method is best suited to the study of individuals that closely resemble the sociologist. I largely credit my unique subjectivity as a researcher for access to this specific population. I personally shared many demographic characteristics that were found among women in this research. First, during the data-gathering process I was between the ages of twenty-three and twenty-five, which made me scarcely older than the women I researched. Second, while I cannot speak for participants perceptions of me as an interviewer, during this time general status cues suggested that I presented as a white woman of slim build. This may have increased the likelihood that the women I interviewed identified with me. Third, I lived in the same community and university subculture as research participants, and our daily lives shared many similar qualities. Last, my personal history as a gymnast and ballet dancer greatly enhanced my comfort with discussing issues

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concerning the body and thinness ideals. Since a young age, I have encountered and felt close to, a few women with eating disorders. In addition, having grown up in a small Alaskan mountain town, my childhood socialization occurred in the presence of relatively higher rates of illicit substance use. While I can safely say that the majority of my family members have displayed an Irish-Catholic ideal of abstinence when it comes to psycho-active substances, my peers most certainly did not. As a result, I have historically felt at-ease in the presence of both illicit substances, as well as drug users generally. Consequentially, my standpoint as a researcher rendered me arguably open to candid discussion of drug use as it was related to eating disorders. As a side note, interviewing respondents who were under the influence of amphetamines created unique interviewing situations (Carey 1972). While the sometimes fidgety, jumpy nature of particular participants was apparent, for the most part the effects of womens chosen drugs likely enhanced my data collection. On a few occasions, interviewees presented as though they were experiencing acute drug effects, which generally increased the depth and breadth of the data obtained from that particular interview. Generally speaking however, most women appeared sober for the duration of our interviews.

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Researcher Standpoint Throughout the data-gathering process it became increasingly apparent that my personality, attitudes, and behaviors impacted the quality of each interview. My demeanor, appearance, and the information that I personally offered during interviews had noticeable impacts on the comfort and level of disclosure among research participants. Presser suggested that, participants may speak more or less openly depending on how the researcher conducts and presents herself (2004:83). Frankenberg (1993) also suggested that the level to which researchers were personally open affected interview participants willingness to do the same. For example, I found that offering a bit of sensitive information at the onset of the interview, such as the casual mention of a personal insecurity, eased the initial researcher-participant tension. This disclosure was aimed at reciprocity, and made me vulnerable (if only a little) to my participants. In addition, I also found that openly participating in a relatively non-normative act, such as smoking a cigarette with the participant, further eased the awkwardness that was inherent in discussing and digitally recording womens private narratives. The symbolic interactionist perspective directed me to try to the best of my ability, to take the perspective of the women I studied (Denzin 1974). This research aimed to analyze drug use and eating disorders from a perspective that was grounded in the behaviors, languages, definitions, attitudes, and feelings of those studied (Denzin 1974:273). As such, I incorporated aspects of feminist research methodology into this project. Much of the work that analyzed womens

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disturbed eating behaviors marginalized the narratives of women themselves (Rich 2006). Historically, the voices of women with eating disorders have been subjugated, thus feminist methods were of the utmost utility. By deferring authority to participants, I allowed women (instead of doctors) to be the experts on their behaviors (Hesse-Biber and Leavy 2004). As a researcher, I continually aimed to defer to womens personal accounts, meanings, and understandings that surrounded their drug use and weight management. Concerning Researcher Intervention Studying vulnerable subjects and risky behavior often puts researchers in sticky predicaments. Qualitative researchers are flesh and blood individuals, not data gathering robots. Given the nature of this research topic, I was faced with women who reported risky, even dangerous, behaviors. Over time, I found that when talking to others about this research during the course of my everyday life, they often inquired about what I was doing to help these women. The answer was always unequivocally, nothing. I strictly maintained my role in womens lives as a researcher and focused on the data as it emerged, while trying to maintain minimal impact on womens lives. I acted as an observer, and never pursued an urge to intervene.

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METHODS OF DATA ANALYSIS

I developed data analysis using coding and memoing on transcribed interviews (Lofland 1995). Before writing my codes and memos, I thoroughly familiarized myself with the data. In addition to personally conducting and transcribing research interviews, I read transcripts and notes very carefully, a few times over. Codes, as Charmaz (1983:111) explained, label, separate, compile, and organize data. I coded transcribed interviews with the questions, what is this? and what does it represent? (Strauss and Corbin 1994) in the forefront of my mind. My research included dozens of codes which organized a large volume of data in order to assign units of meaning to information compiled during the study (Miles and Huberman 1994:56). I manually coded my transcribed interviews using computerized qualitative analysis software. One advantage of using a computer program was that it allowed me to code a large amount of information relatively quickly. This aided the theory building process by highlighting patterns in my data efficiently. Software has its limitations as well, including that it was not engineered with theory building in mind and it may overwhelm the researcher with extraneous information during analysis (Richards and Richards 1994). After coding my data, I wrote memos for each code. These memos explained what each code meant, or what the code is about (Charmaz 1983:120). This process allowed to me to tie together patterns among specific codes in order to understand general concepts present within the data. As Miles

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and Huberman (1994:72) explained, codes are one of the most useful and powerful sense-making tools at hand. For example, I coded statements where participants were explaining their behaviors with excuses and did the same for justifications. I then grouped these codes together under one memo, accounts. This memo was an explanation of the associated codes and included my operational definition of the term as well as major scholars and theoretical perspectives within the literature. By generating memos on my computer using qualitative software, I was able to sort participants statements in a number of different ways. Throughout the research process, I continued to finely tune my codes and memos in accordance with new themes as they emerged from the data (Becker and Geer 1960). Most commonly, I sorted individual statements from different interviews based on the number of codes within a given memo. This helped illuminate patterns in my data. Throughout the theory building process I relied heavily on field notes, analysis of previous literature, and these codes and memos. In addition, while I was transcribing and analyzing interviews, I constantly compared data to literature in the spirit of grounded theory methodology (Strauss and Corbin 1994). Although I did not use grounded theory in a rigorous manner, I systematically gathered data with the intent to develop social theory. The following discussion and major conclusions reported in this dissertation concerning the relationship between womens drug use and disordered eating, draws on the patterns found within my data using these analytical tools.

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CHAPTER THREE A Typology of Instrumental Substance Users

This research focused specifically on college-aged women who used controlled substances in order to manage their body weight. This chapter introduces the research population thoroughly by detailing participants reports of their drug use, restricted eating, and other related weight control practices. Generally speaking, research participants behaviors can be described as extreme weight management, and thus fall within the populations that are commonly researched by scholars in the field of eating disorders. In addition, women in this research represented a specific type of drug user, and can be researched and analyzed from this perspective as well. These two variables, restricted eating practices and drug use, went hand in hand for these young women. By design, this research aimed to understand this pattern: how drug use and disordered eating were related, dependent, or supported one another. After a few dozen interviews it was apparent that while no experience was exactly like another, there were major patterns developing in the reports of these drug users collectively. In order to organize my data and effectively document these patterns, I propose a typology of the women who participated in this research. Typologies are a useful tool: they allow the researcher to categorize a large amount of data into an intelligible form. This aids the theory building process by reducing individual cases, which are inherently unique, to general types. Generalizing is necessary (to some degree), in order to work with abstract

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concepts. Given the number of interviews I conducted, creating a typology allowed me to reduce numerous pieces of complicated information into a simple model based on the patterns that emerged from my data. Typification, however, requires that phenomena be treated as though they were identical, recurrent, and general (McKinney 1969:3). Categorizing individual cases of a given phenomena into defined clusters may create the impression that in-group differences were less significant than out-group differences. Using this method, I analyzed data by considering what womens experiences had in common. This approach may have downplayed differences between the behaviors that were reported by individuals within any one group. In other words, by focusing on certain variables in order to highlight patterns in data, the researcher runs the risk of overlooking other variables that may have had an independent, dependent, correlative, or intervening role. By stressing the types of drugs women preferred to use, as well as how and when their disordered eating developed, I chose one specific perspective. However, I do not intend to portray these variables as the only defining characteristics of importance. For descriptive purposes, as it is used here, the typology is an efficient tool for conveying information about the general patterns within the phenomena at hand. In essence, by constructing different social types of weight managing drug users, I imposed general narratives onto individual experience. This takes a definite and formal step away from reality (McKinney 1969:3). While a typology will never perfectly fit an empirical data set, it possesses utility as a descriptive and analytical tool. After careful consideration of the variety of

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narratives presented and analyzed here, I am confident that the following fourfold typology of women using drugs for weight management is highly representative of my data in general. The patterns that emerged during data collection were largely undeniable. As such, I continue referencing the general types of drug users that are introduced below throughout the entirety of this work.

TYPOLOGY OF INSTRUMENTAL USERS

First, participants reported the use of two distinct types of substances: licit and illicit drugs. For the purposes of this research, the terms licit and illicit refer to pharmaceutical substances and street drugs respectively. Overwhelmingly, women who used drugs to manage their weight preferred stimulants. The packaging and distribution of these substances varied, but they all shared the side effect of appetite control, and were sought for that purpose. Womens drug use was oriented towards accomplishing a specific goal, which defined them as instrumental users. This concept denotes substance use that is motivated by a substances specific effects (Goode 2005). Their drug use was a tool, a mechanism that women used to accomplish a goal. Instrumental drug use does not share all of the qualities commonly associated with other types of drug use, such as recreational or experimental. Participants did not cite mind expansion, hedonism, or novel experience as motivating factors for their continued drug use. Not unlike body-builders who use steroids instrumentally, women in this research conceived of their drug use as

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essentially performance-enhancing. The use of stimulants helped women achieve their own personal goals of weight management. Differential motivations for drug use, such as having fun versus controlling weight, significantly effected womens behavioral patterns. From these two main varieties, users of licit or illicit drugs, four specific categories of instrumental substance users emerged. Women who used prescription drugs versus women who used street drugs were distinguished from one another into these four categories based on the temporal nature of their disturbed eating and drug use. Some women reported disordered eating behaviors before the onset of their instrumental substance use. For these women, the discovery of drugs instrumental utility followed months or years of experience with significant and deliberate weight management. Women with this history of extreme weight controlling behaviors reported methods of body modification that often crossed normative boundaries. In contrast, many participants reported the development of non-normative weight managing behaviors after drug use. Generally, these women transformed their personal use patterns from recreational or medicinal, into instrumental drug use. This usually followed positive social reinforcement and personal satisfaction concerning changes in the appearance of their bodies. Initially, weight loss was not necessarily intentional. Recreational (or medical) users of licit and illicit stimulants commonly lost weight as a result of the appetite controlling side effects of their substances of choice. If drug use was regular enough to produce noticeable changes in body weight, women often received feedback from others.

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While all of this feedback may not have included comments that were intended to be compliments, women often perceived reactions from others as positive. Women who then identified drug use as a desirable means to maintain or continue weight loss and perceived the results of their efforts as positive, were compelled to further develop their behaviors. Stages of this transformation varied among participants. However, during the time period of data collection, women largely described their drug using patterns instrumentally. To be clear, I termed the behaviors women engaged in first, whether it was drug use or problematic eating, as womens instrumental drug using foundation. Below is a table introducing the four types of instrumental drug users analyzed in this research: Table 1.1: Typology of Instrumental Drug Users Licit Drug Users Disordered Eating Foundation Drug Use Foundation Conventional OverConformist Journeyers

Illicit Drug Users Scroungers Opportunists

The first group of women in my typology are the conventional overconformists. These women reported a history of disordered eating prior to their instrumental prescription drug use for weight loss. This term is descriptive in a number of ways. First, women were conventional in their choice to use the more socially accepted prescription drugs instead of consistently denounced street drugs. Second, although these women were instrumentally using drugs, which is arguably deviant behavior, the overall goal of the behaviors centered on achieving a cultural ideal of thinness, and were thus conforming. However in most

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instances, womens weight management goals evolved from conforming to overconforming, with an acute fixation on weight that tended to exceed average social expectations for personal body modification. Participants focused attention on ideals of beauty, along with their nonnormative means used to accomplish their goals, distinguished women as deviants. Although women may be described as deviant, it is a label based on behaviors that were largely unknown to others in everyday life. Women instrumentally using drugs for weight control often called attention to their weight through how they dressed, but their outward appearance generally fulfilled societal standards. By this I mean that women presented as thin, but not too thin. Conventional over-conformists represented the largest category in my typology of users (n=24). The second largest category of instrumental drug users (n=13) in this typology were the scroungers. This group consisted of women who reported a history of disordered eating and later (after the onset of problematic weight control) instrumentally used street drugs for weight control. Women are termed scroungers because their choice of street drugs represented a much less socially accepted form of substance use. In addition, many of the women conceived of these drugs as dirty, unacceptable, or inappropriate. The term scrounger refers to their access to, and conception of, illicit drugs. Womens access to illicit substances was customarily not as consistent or reliable as it was for those using pharmaceuticals. At times women were forced to forage or scrounge for their supply. However, generally speaking, women reported no more difficulty in

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obtaining street drugs than is typically expected for illicit substances. My use of the term scrounger is not intended as a moral or judgmental label, it is merely descriptive. Third, women who recreationally or medicinally used prescription drugs prior to their instrumental use for weight control make up the category of journeyers (n=11). This term depicts the journey, or evolution, of womens drug use patterns. This process was a transformation from recreational or medicinal drug use into instrumental. While some women in this category reported using pharmaceuticals instrumentally for academic purposes, intentionally gearing drug use towards weight management shifted aspects of their deviant career in ways that were specific to goals of body modification. For example, journeyers tended to ration their supply of pharmaceuticals in a different manner once weight management became a priority. The last, and smallest, category within this typology of instrumental drug users are the opportunists (n=9). Opportunists are women who initially used street drugs recreationally, and later transformed their recreational drug use into instrumental use for the purpose of weight control. Women are termed opportunists for the ways in which they recognized the positive social feedback regarding their weight loss resulting from drug use, and saw it as an opportunity for the transformation of self. As was the case of journeyers, opportunists reported experiences using substances before their behaviors transformed into instrumental patterns. Opportunists, like journeyers, shifted a wide array of behavioral practices in order to accommodate their instrumental drug use.

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However, opportunists did not necessarily stop using drugs recreationally during periods of instrumental use. In fact many participants (not just journeyers or opportunists) reported recreational drug use, some on a fairly regular basis.

STRUCTURE OF THE DEVIANT ACT

As introduced, the specific substances that research participants used fell into one of two categories: licit or illicit drugs. Those who used street drugs chose cocaine (by far the most popular), crystal methamphetamine, other street amphetamines, and rarely opiates, all of which are known to strongly control appetite. Those who used prescription drugs chose Adderall (the most popular), Ritalin, Concerta, Dexedrine, certain types of opiates (also rarely), Wellbutrin, Xenical, or Meridia. Of these, the obesity drugs (which were not very popular) are specifically counter-indicated for those with a history of disordered eating. First, I discuss the structure of the deviant acts that were reported by women within the first two main categories presented in this research: licit and illicit substance users. Second, I describe the restricted eating practices of participants in general. Last, I discuss the temporal nature of restricted eating practices and instrumental drug use, the variable that separated participants into the four categories in my typology.

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Deviance Among Licit Substance Users Approximately sixty-one percent of the women that I interviewed during the course of this research used pharmaceutical substances in their efforts to manage weight. Most commonly, participants preferred prescription stimulants, which have been utilized in medicine since the early 1880s (Staufer and Greydanus 2005). Currently, physicians routinely prescribe stimulants for the treatment of Attention Deficit Hyperactivity Disorder (ADHD), Attention Deficit Disorder (ADD) (Greenhill et al. 2002), depression that has not responded to other treatments, narcolepsy, and in some cases, short-term treatment of obesity (NIDA 2005). These medications have also been prescribed in the past for the treatment of asthma and neurological disorders. Van Vranken (2005) estimated that over a million and a half adults took prescription stimulants for ADHD, and that over two and a half million children were diagnosed with the disorder. Historically, the prescription of pharmaceutical stimulants was less regulated by the government. Physicians cited the addictive nature and the potential for abuse of these medications for the stricter policies utilized today (NIDA 2005). Although the medicinal indication guidelines have narrowed, prescription rates for stimulants have recently increased (Robison et al. 1999, 2002; Olfson 2003). In other words, stimulants are prescribed for fewer ailments, but the number of prescriptions filled overall has grown. This increase has led to public concern over the potential for misuse of medical stimulants in general. The non-medical use of stimulants was most common among young people ages twelve to twenty-five (Hall 2005). In fact, the

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prevalence of non-medical use of pharmaceuticals among young people is greater than that for other illicit drugs, save for marijuana (Ford 2008). In addition, college students have had higher rates of stimulant use than their age peers not attending school (Johnston et al. 2003). College students who used pharmaceutical stimulants non-medically were found to have higher rates of marijuana use, binge drinking, and episodes of drunk driving than their non-using peers (McCabe et al. 2005). Non-medical pharmaceutical users were also found to have higher use rates of cocaine, ecstasy, and other types of amphetamines (Teter et al. 2005). Hall (2005) reported that many recreational users of prescription stimulants mixed pharmaceuticals with other substances in order to amplify the drugs effects. Accordingly, the non-medical use of stimulants is of particular concern among college students (Babcock and Byrne 2000; Johnston, OMalley and Bachman 2003a, 2003b; McCabe et al. 2005; Teter et al. 2003). The relationship between pharmaceutical use and students may be due to the nature of these particular substances utility within the college environment. College was unique in that the scholarly demands faced by students created a setting in which the non-medical use of pharmaceutical stimulants flourished (Teter et al. 2005). Commonly, college students who used stimulants for non-medical purposes reported increased concentration, aid in studying, increased alertness, and getting high as motives for use (Ford and Schroeder 2009). Many college students across the country instrumentally use pharmaceutical stimulants for academics. Prescription stimulants have a reputation for helping people focus,

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study, or pull all-nighters. In addition, college students often crushed and snorted these drugs recreationally, likening the feeling to that of cocaine or speed. Crushing pills was a practice that quickly released the active ingredients of substances into the bloodstream. However, researchers have found variance along gender lines in terms of motivations for use. For example, Teter et al. (2006) reported that women perceived weight loss as a motivation for stimulant use. However, among all college students taking prescription stimulants in general, use was commonly focused on academic achievement (Ford and Schroeder 2009). While women in this research often recognized the benefits of stimulants for academics, the majority of their drug using behaviors were reportedly oriented towards weight control. Currently, the market is dominated by four stimulant medications: Adderall, Ritalin, Dexedrine and Concerta. A small percentage of those whose disordered eating behaviors preceded prescription drug use choose medications other than those prescribed for ADHD or ADD. For example, a couple of women chose Meridia, a medication specifically indicated for weight loss, and for those whose weight category is considered obese (never for people with a history of disordered eating). A handful of respondents preferred Wellbutrin, a speedy antidepressant legitimately used to aid in smoking cessation (under the trade name Zyban) and the treatment of depression. These pharmaceutical substances were available as pills or tablets, either in fast-acting or extended-release doses. The long-acting formulations of prescription stimulants are thought to have less potential for non-medical use and abuse than the fast-acting varieties

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(Bright 2008). This was evident in the college drug market. Among college students who diverted their prescription stimulant medications, eighty-three percent did so with fast-acting pills (Wilens et al. 2006). In the short-term, prescription stimulants increase dopamine and norepinephrine in the brain. This increases respiration, heart rate, blood pressure, and constricted blood vessels (NIDA 2005). A person under the effects of these stimulants may feel more alert, with an increased attention span, energy, sense of euphoria, and loss of appetite. High doses of stimulants may cause depressive thoughts, hostility, paranoia, impulsive behavior, aggressiveness, loss of coordination, hallucinations, and disruptions in sleep patterns (Ray and Ksir 2004). Long-term effects of prescription stimulant use includes tolerance, weight loss, liver problems, and risk of physical and psychological dependence (McCabe 2005b). Women in this research predominantly reported the use of stimulants for the purpose of weight loss and management. Although some physicians occasionally prescribed stimulant medications for weight loss over a short period of time, use of the medication for this purpose is considered off-label. Stimulants are not approved by the Federal Drug and Food Administration for weight control (Greenhill et al. 2002). However, In the 1960s and 1970s Adderall (one of the preferred substances among licit drug using participants), which was then known as Obetrol, was marketed as a diet-pill. During this period, prescription amphetamines such as Obetrol were FDA approved for weight loss (Ray and Ksir 2004). This indication was withdrawn by the FDA after abuse of the medication became apparent (Diller 1998).

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Despite increased governmental regulation, access to prescription stimulants among college students has been rated third, behind alcohol and marijuana (Center for Substance Abuse Research 2005). Research participants reported three common modes for getting the medication. First, women obtained prescriptions in their name. Second, participants were able to locate a black market drug dealer with access to the medication. Last, some participants had friends, family members, or roommates who were willing to supply them with the medication. A few women also reported obtaining pharmaceuticals from work associates. This was not surprising, as research into college students with a legitimate prescription for ADHD and ADD medications has shown that up to forty-five percent had sold or given away their pills (McCabe 2005). Women who obtained prescription stimulants without consulting a doctor took risks, as often they were not properly informed about the drugs effects, potential interactions, or side effects. Many of the women in this research successfully obtained medical stimulants by persuading a physician or psychiatrist to write a script in their name. For a few women, this was easily accomplished by visiting their doctor at home, often a childhood doctor. These doctors, who were usually general practitioners, had a relationship with the individual that had developed over the course of time. This relationship may have instilled trust on the part of the doctor in the patient. Knowing an individual personally may have also made it more difficult for a medical practitioner to decline a womans request. Two of the women in this research, who asked their hometown doctors for

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ADHD medication, were first put on non-stimulant prescriptions, such as Strattera. Both of these women were later successful at convincing their doctors to give them stimulants, citing the negative side-effects of non-stimulant medication for the switch. Cadence1, a nineteen year-old sophomore and college athlete, explained: I knew Id probably have to be patient to get it. Umm, I mean, doctors have to be careful ya know? So, uh, I tried to play it cool, I didnt just ask for it I said something about how I was having trouble paying attention at school and this and that about how it was so much easier for everybody else She said we should try Strattera for a couple months She said she wasnt comfortable giving me Adderall I went back and said that Strattera was making my mouth really, really dry and that I was embarrassed to talk in class. But she made me stay on it and I think like, like a month later and I went back and she gave it [Adderall] to me. However, most participants did not march into their doctors office and ask for a prescription by name, even if they knew which medication they wanted. Doctors may become suspicious of an individual asking for a controlled drug by name. They also may suspect ulterior motives from those who suddenly manifest new symptoms of ADHD or ADD, without the supporting medical history. Women who obtained their prescription while at school generally did so at the universitys health center, where their medical history was less relevant. Many students on campus in general, felt that the health center was a relatively easy place to obtain pharmaceuticals. Cady, a freshman Adderall user, said: I think its easier to get it at [the student health center] than maybe anywhere else, I mean, oh, they hand it out. I mean, not really, but its not hard Youre supposed to take all these tests to see if you have it but you can say that you had it when you were a kid and uh you took Ritalin or whatever So they
1

Proper names of respondents are pseudonyms. As a rule, pseudonyms correspond with categories in the typology by the first letters in the womens name and user type. 78

might not make you go through all that. And even if you do, you can just fake not being able to pay attention. Dr. Robert A. Winfield, director of University Health Services at the University of Michigan, reported to the New York Times (Jacobs 2005) that he has seen a growing number of students falsely claiming to have ADHD in order to obtain prescription stimulants, and that things have really gotten out of hand in the last four to five years. The high number of ADHD and ADD prescriptions written on college campuses may be due in part, to the increased rates of the diagnoses of corresponding disorders in the late 1980s and 1990s (Mandell et al. 2005). Many students currently in college, and those about to enter, are a part of this generation. Students of today are more likely to be diagnosed with ADHD, or know someone who is. They are also likely to know about the specific medications that are used to treat these conditions. This trend may have led to a university medical culture that is more willing to, and more comfortable with, prescribing stimulant medications. Many women sought out the advice of others before making an attempt to get their own prescription for stimulants. Most participants had tried pharmaceuticals, either recreationally or medicinally, in the past and knew at least one person who they felt comfortable asking for advice. Women who asked others for tips usually claimed academic motivations in favor of disclosing the potential for weight management. In return, they often received the coaching they wanted. Cailyn, a twenty year-old college junior, took a different approach. She explained:

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I googled how to get Adderall, or something like that. It comes up with all sorts of stuff but mostly all of it says you just gotta pretend like you have no attention span. So I uh just figured out what sort of um, things go along with being all ADD I get distracted easy, I cant pay attention at school, things like that. During our interview Cailyn laughed when she recounted her initial visit to the doctor for a prescription. When asked about her relationship with the doctor, she rolled her eyes and explained, he totally believed me no way he thought I was faking. In fact, many women felt that they had successfully tricked their doctor, even those consulting psychiatrists, professionals who specialize in the diagnosis and treatment of mental disorders. Cindy, a college sophomore, conveyed surprise when she recalled obtaining her first prescription for stimulants: See the thing is, last year I came to [the campus health center] to talk to a person downstairs, um, I think he was a psychologist, about the nerves I was having over eating stuff, I mean, it was weird, I was obsessing about some weight I gained When I went in to talk about attention I was sure they would just look at my chart and be like no way am I gonna give this girl pills... But she totally did and didnt even ask anything about my weight It was pretty easy. Success at acquiring a personal script for pharmaceuticals was the first step. Maintaining it however, required continued engagement with the medical system. The fact that prescription stimulants are schedule II substances, in that they have accepted medical uses with the potential for abuse, means that regulations on their prescription are stricter than for other medical substances (Ford and Schroeder 2009). Physicians and Pharmacists are required to register with the Drug Enforcement Agency and receive a DEA control number upon doing so. This number is present on all prescriptions written for a controlled

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substance. Medical practitioners are also required to follow all governmental written rules and regulations, including codes of recordkeeping, valid prescription directions, and security requirements (US Dept. of Justice 2006). These regulations are intended to lessen the potential of abuse of these pharmaceuticals for both doctors and patients alike. One such government regulation states that schedule II prescriptions are not to be refilled, which limits the pill count that individuals can obtain at a time to one months supply (US Dept. of Justice 2006). This means that every time a woman wants to get more pills, she has to have a new prescription written. Thus, many women in this research were required to visit the doctor once a month in order to maintain a regular supply. However, a few women had doctors who were willing to post-date prescriptions, which lowered the number of times they had to meet face-to-face. For example, Camilla, a twenty year-old college junior, told me: I think I am supposed to go in once a month but there is no way my doctor is making me do that He just gives me three [prescriptions] for the next months and changes the date I just hold onto them and wait until they are supposed to be filled Its never been a problem. The practice of post-dating, or writing do-not-fill-until orders on prescriptions was prohibited prior to December 2007 (US Dept. of Justice 2006), during the time I conducted interviews. As a result, many research participants visited their doctors frequently. While this was an annoyance for many women, month after month most of the pharmaceutical users continued to visit their doctors for more medication. The actual act of consuming pharmaceutical stimulants was largely consistent among respondents. Generally, women would take a pill first thing in

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the morning, usually before their normal routine. Claire, a college sophomore, reported: Its pretty much the first thing I think of when I wake up, I mean, um, Im not like, crazy obsessive about it or anything, its like thinking about getting up and making coffee. I just take it right away At first it wakes me up and makes me really talkative Its a good feeling. Some women would take more pills during the day, spacing them out over the course of a few hours. However, many of the women in this research, when deciding what dose to take for the day, were careful to take into account their supply levels. Women would often compare the number of days until they were to run out of drugs against the amount of time until they were able to obtain another prescription. Accounting for their drugs allowed participants to ration out their supplies in order to avoid going without pills in between refills. Given that chronic use of prescription stimulants leads to physical dependence (Greenhill et al. 2002), keeping close track of supply levels allowed women to avoid symptoms of withdrawal. Some women visited multiple physicians in order to compensate for this limit on their legitimate supply of drugs. Generally speaking, visiting other doctors (sometimes called double-dipping or doctor-shopping) to obtain multiple prescriptions is a common practice among individuals who divert pharmaceuticals of all kinds. Other women supplemented by going to street dealers to secure more pills than they were prescribed. In addition, a few women claimed to their primary physician that they lost their prescription or it was stolen, classic attempts to get more pills. However, this latter method had limits, as doctors would surely grow suspicious of patients who continually misplaced their prescriptions.

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Although citing a lost or stolen bottle of medication worked for a few women on occasion, it was certainly not a tactic that could be used repeatedly. Carly, a twenty year-old student, took a different approach for her supply: I am a college student so I guess they gave me the normal dose [20mg extended release once daily]... But Im super hooked on it. I take twice that cause I just went out and got another doctor... My doctor at home post dates prescriptions for me while Im at school then I go to [the student health center] and get another one. But its a pain in the ass here cause I have to go in every month. A few women supplemented their medical supply with extra pills here and there, buying medication from dealers, or receiving free pills from roommates, friends, or family. It was not uncommon among research participants to stockpile doses of stimulants, perhaps filling two prescriptions and taking only one each month, securing a future supply. Women were largely successful in obtaining their licit drugs consistently, as almost all pharmaceutical users reported daily use. For many women in this research, the school year contained spans of time away from school, which may have affected their supply. Stockpiling was a way to store up for these times. Most, however, stayed within the confines of their medically prescribed daily dose, as did Carol, a nineteen year-old student: Well, I took one 30mg one morning and I loved the feeling. It wasnt a high feeling it was just a feeling of goodness. Anyways, the Adderall made me want to socialize more, made me more talkative, I was always in better moods, I had way more energy and time just seemed to go by so fast The reason I liked it most was it made me not hungry. I loved that feeling instantly Im a person who is concerned about looks, weight, and appearance. I guess you can say Ive always been like that. Taking one Adderall a day gave me so much energy, made me so much happier and decreased my appetite like, one hundred and ten percent. The daily prescription stimulant dosage among women in this research varied greatly, from conservative levels to relatively high daily intake. For reference,

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Adderalls manufacturer, Shire Pharmaceuticals, suggests that an adult initiating use should be prescribed either five milligrams of the fast-acting pills up to three times a day, or twenty milligrams of the extended release formulation once a day. This dosage may be increased as needed to adjust for individual tolerance and symptom control (Shire 2008). The lowest level of use (save for some womens periodic abstinence) reported in this research was fifteen milligrams a day, well within the medically recommended limit. The highest daily dosage reported was one hundred and twenty milligrams daily, a high amount for any adult. However, this high dosage level was not usually maintained for long periods of time, meaning days versus weeks. Rather, some women would phase in and out of high and low dosages. One user explained to me that when she took higher amounts of Adderall and Ritalin, she felt insane. Jackie, a twenty-two year-old college senior, said: I get so shaky, see look, its not that bad right now but sometimes I cannot control my hands at all It really makes me want to chain smoke too, I smoke way more. If you take too much you get this really awful taste in your mouth and itll make my tongue tingle I have to remind myself to calm down when my friends are around, Ill just talk and interrupt, it definitely gets outta control and the problem is too that I end up not eating, like at all, and that makes you feel loopy and cracked out. Women reported that taking higher amounts of Adderall led to feeling jittery, sometimes nervous, and caused problems with sleep patterns. As a result, women who took very high doses of prescription stimulants daily, generally did so for a short phase, and then weaned themselves to lower doses. Many participants, not just licit drug users, reported periods of abstinence, ranging from a day or two, to in a couple of cases, months at a time.

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Deviance Among Illicit Substance Users Approximately thirty-nine percent of women who participated in this research used illicit drugs in their efforts to control weight. Not only is the use of street drugs deviant, it is illegal. Accordingly, participants using illicit substances differed from women using licit pharmaceuticals, in terms of the structure of their deviant acts. Most women using illicit drugs chose cocaine, while a few preferred illegal amphetamines (speed). Cocaine and speed can be snorted, injected, or smoked (Goode 2005). These illegal stimulants are similar in their effects to the pharmaceutical substances that were previously described. They increase energy, alertness, talkativeness, cause a loss of appetite, and give the user an overall sense of well-being (Kuhn, Swartzwelder, Wilson 2003). Street stimulants also increase respiration, heart rate, and raise blood pressure. High doses of street stimulants can lead to seizures, stroke, sudden cardiac death, or breathing failure. Repeated, chronic use can also lead to dependence, psychosis, and paranoia (Kuhn, Swartzwelder and Wilson 2003). While cocaine is sometimes used medically for legitimate procedures, it is rarely found in its pharmaceutical formulation (a solution in a glass vial) on the black market (Faupel, Horowitz, and Weaver 2003). Currently this substance, as sold on the street, is usually found in powdered or crack-cocaine forms (Streatfeild 2003). Women in this research almost exclusively used powdered cocaine (versus crack-cocaine), which may be an illustration of their relative privilege. Most women instrumentally using street drugs reported little to no problems accessing their supply, considering the illegal status of these substances.

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In contrast to licit users, there was no need to research elaborate symptoms of a medical disorder in an attempt to fraudulently gain access to a given substance. Instead, illicit users needed to find a person in possession of the type of substances they wanted and persuade that person to make a sale. Most women who used cocaine reported that the drug was easily found on campus. For example, Sadie, a young college student and habitual powder cocaine user, explained: I was always hanging out with people that were drinking and doing drugs. You know, drugs would just be around... I remember my boyfriend did coke but I said I never would. But then later I was with one of my best girlfriends and I was sort of like, why not? About once a month I started doing it when I would go out, and then like, it got to the point with my friends, that we were getting it all the time. While women tended to report easy access to this drug, many did not find their suppliers to be as altogether steady or reliable as women who obtained prescription stimulants. The conditions of the black market were not as stable as those of the medical industry and as a result, campus dealers were often less reliable. At times, campus dealers were apt to run low on, or out of, drugs. Some women also reported their street dealers to be unreliable professionally, in that they were sometimes difficult to get a hold of, unfair in pricing, or sold drugs that were excessively cut with unknown materials. These complaints aside, most research participants using illicit substances for weight control reported overall satisfaction in their access to drugs. The fact that many participants were daily users meant that most had figured out a system that worked for them. While many voiced strain in dealing with the black market, it was generally understood that some

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difficulties were inherent, given their choice to use illicit substances. The specific deviant behaviors that were reported by women using street drugs varied from the behaviors of women who preferred pharmaceuticals. First and foremost, being an illicit drug users required breaking the law. While pharmaceutical users may have lied or used manipulation in order to gain access to their substances, they did not have to engage with a black market. Also important was the different modes of administration for illicit versus licit substances. Cocaine users generally inhaled, or snorted, the substance through their nostrils, where it entered the bloodstream via nasal tissues. This method caused blood cocaine levels to rise quickly, reaching their peak around thirty minutes after snorting. This rise was followed by rapidly declining levels of cocaine in the blood, leaving the user ready for another dose in roughly forty minutes (Kuhn, Swartzwelder, and Wilson 2003). Pharmaceuticals on the other hand, even the fast-acting formulations, had effects that lasted for at least a few hours. Consequentially, women who snorted cocaine to curb their appetite, did so a few or more times throughout the day. Sally, a college junior studying biology, explained her frequent daily use: Cause I just always had it. And I would do it before, it was so easy to hide from people, so I would do it in the bathroom, or in my car on the way to school... Thats what this thing is for [she pulled out a small metal case that was attached to her keychain]. You can just stick a gram of coke in it, did you know that? I can take it to school no problem, its not like someone is going to notice. However, this act required a bit more discretion on the part of the participant, as snorting a powder versus popping a pill were two distinctly different actions. The frequency of use and dosage levels of women who instrumentally

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used illicit substances varied among respondents. As with pharmaceutical users, the majority of instrumental cocaine users consumed their substances daily. Often, women who were not daily users at the time of their interview, had gone through periods of using daily at one time or another. A few daily users did cocaine in small amounts once or twice a day, while others used more repeatedly. For example, Sarah, a twenty-two year-old college junior who was noticeably fidgeting during our interview, said: I do it, like, a lot. Consistently, like totally consistently When I was at school, I guess I never did a lot at school, but I would have my schedule so Id be done at like twelve every day. So then I would leave and usually meet up with someone I could do it with. Or go to my dealers house, but it got to the point where I was doing it so much, like people I used to do it with occasionally must have known I was doing it that much. So I was sort of on my own... Sometimes I would do it like every twenty minutes... Id have days where I wouldnt eat at all... Id try to make sure I got a lot of liquids. The highest dosage reported by women using illicit substances was one gram of powdered cocaine a day. That translates to roughly twenty doses of fifty milligram lines, a fairly standard amount. However, a few participants reported their daily use to be around fifty to one hundred milligrams, or a line or two of cocaine. Generally, instrumental illicit drug users were most comfortable consuming their substances at home. Often, cocaine users were wary of doing drugs in public, but many were still willing to do so. Many women felt at least slightly comfortable finding a private place to consume their drugs, either on campus or out in town. However, unless women were socializing with friends in celebration of the weekend or just partying in general, they usually kept their drug use private. Respondents each had personal methods for hiding their drug use.

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For example, sneaking off to the bathroom or excusing themselves to make a phone call. These methods of secrecy are discussed in further detail in chapter five, which details the secrecy and social isolation of instrumental drug users. Restricted Eating Practices Among Instrumental Drug Users Both the licit and illicit drug users described in this research focused a lot of attention and energy on controlling the shape of their bodies. Charlotte, an Adderall user, voiced a theme that was common among instrumental users when she said, you dont understand, if Im not skinny, then I feel like shit. I am always making sure that I dont get above one ten. While the substances utilized in this quest varied among young women, their overall goals remained consistent. The different drugs participants chose all had one major side effect in common: they curbed appetite. For example, Oksana, a twenty-two year-old college senior and regular cocaine user, explained: So I still do it [cocaine] and yeah, I think it really does help with not, like, uh, like I just literally wanted to stop eating. It got to the point where my stomach shrank so much that if I ate, my stomach would get so bloated and I would just flip out, it would freak me out. For women using street drugs such as cocaine, substances controlled their appetites in small bursts through out the day. Most of these instrumental users reported a chronic dulling of their appetite in general, but this effect was most acute immediately following the consumption of the drug. As such, instrumental street drug users often habitually used small amounts of cocaine when they felt their hunger growing. Consequentially, women reported fluctuations in both their

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moods and appetites during the time periods in which they were instrumentally using. Generally, the ups and downs that were commonly reported by illicit drug users were not as frequently cited among licit drug users. This difference may be attributed to the modes of administration for these substances, as well as the drugs specific psychopharmacology. Women taking pharmaceuticals felt the effects over a longer period of time than did street drug users. This was especially true of participants taking extended-release formulations, which were designed to last a long time. Licit instrumental users were also more likely to describe the effects of their medications as smooth, versus the unstable effects that were reported by street drug users. Sammy, a twenty year-old student, complained about one particular side effect of cocaine use: Id go days when I couldnt get any sleep at all which was awful. I had these horrible ugly bags under my eyes and I was really skinny. I know Im skinny now, but I was really skinny Id force myself to lie in bed and shut my eyes. My body felt tired but I just couldnt sleep at all... It gets you all tight and completely wound up. While both licit and illicit users reported disruption in their sleep habits, insomnia was most commonly pronounced among illicit users. Licit and illicit stimulants alike proved to be extremely effective tools for weight management. Both groups of women reported significant and relatively easy weight loss. Over time, most participants gradually transformed their weight control methods. For example, many women in this research reported that they had a few means of losing and controlling weight before they started instrumentally using drugs. After the discovery of appetite controlling

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substances, women generally relied largely on drugs for weight management. However, the temporal nature of their drug use and restricted eating practices varied, further distinguishing research participants from one another. Some participants reported practices commonly associated with eating disorders prior to adopting drug use as a tool for weight management. This was true of women who used both licit and illicit substances. Temporal Nature of Weight Control and Substance Use Women who instrumentally used drugs for weight management after a history of disordered eating made up the largest portion of participants (37). These were the conventional over-conformists and the scroungers. Regardless of whether women within this larger category chose to use street drugs or prescription drugs, they all shared many similar experiences concerning their relationships with their bodies. However, participants reported a few significant in-group differences. First, they diverged from one another in the length of their eating disordered behavior. This history ranged from one to twelve years. Second, women with a history of disordered eating also varied in the severity of their problematic eating behaviors. Some women reported disordered eating symptoms that were relatively mild and short lived. Others behaviors were more severe, sometimes resulting in a formal psychiatric diagnosis, and in one particular case, hospitalization. One unexpected finding of this research was discovering women who instrumentally used prescription or street drugs to control their weight not as a last

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extreme resort within the career of an eating disorder, but rather as the result of recreational (or medicinal) drug use. These women were the journeyers and the opportunists. The notion that women who lost weight as a result of a recreational or medicinal drug use would face the same level and strength of positive reinforcement from others as those with a history of disordered eating was unexpected. However, many women consistently reported this pattern. Often, positive personal and social reinforcements that women received concerning weight loss were influential enough to bring weight control to the forefront of their lives. These forces were enough to precipitate disordered eating. A few of the women with no history of disordered eating behaviors prior to their instrumental drug use insisted that before the positive reinforcement on weight loss, concerns over weight control or even dieting, were not a part large of their daily lives. This suggested that while weight loss may have been completely (or at least partially) accidental, reactions from family, friends, and the general public made many women feel increasingly positive about themselves, so much so that they chose to make weight management a priority. For some, the transformation from recreational or medicinal drug use into instrumental use resulted more heavily from their personal evaluations of changes in their bodies. This was true even if their methods came at a cost to their physical or psychological health. These transformations, along with other aspects of being a drug user, are discussed in the next chapter, which details instrumental drug users deviant careers.

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CHAPTER FOUR The Deviant Instrumental Drug Using Career

Women who instrumentally used drugs for weight management were engaged in deviant careers. The concept of a career may usually invoke notions of occupations or professions. However, sociological application of this concept has used it to structure analysis of individuals behavioral patterns. Within sociology, the careers concept can be used to describe and explain the trajectories of behavioral phenomena. However, regular activities or constant pursuits are not generally conceptualized as careers (Levy and Anderson 2005:246). Instead, a career is a set of behaviors that dominate individuals lifestyles, and are central to the organization of their daily routines (Van Maanen 1977). During any given time period, individuals are engaged in a number of different life careers (Levy and Anderson 2005). For example, women instrumentally using drugs for weight management may have had careers as employees, students, athletes, or girlfriends. Individuals engaged in concurrent life careers, lines of action that may have either complemented or conflicted with one another (Marshall and Levy 1990). Despite any strains between conflicting life careers, many women reported their deviant practices to be livable on a daily basis. This chapter analyzes womens weight managing behaviors in these terms, marking them as deviant careers.

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Theoretical application of the careers concept within scholarly work on deviance has worked to describe individuals movement through the deviant experience and is one of the central topics in the sociology of deviance (Luckenbill and Best 1981:197). Deviant careers are fluid, meaning that individuals move in and out of deviance across time; behaviors are not necessarily static (Sharp and Hope 2001). Instead, deviance involves initiation, maintenance, shifts and oscillations, and cessation of the career (Adler and Adler 1983). Past research concerning life-careers have contributed heavily to scholarship on deviance. In fact, researchers have identified factors that facilitate deviance, as well as created theoretical understandings of how individuals develop personal deviant ideologies (Becker 1963; Lofland 1969; Matza 1969; Sutherland and Cressey 1978). Historically, scholarly research has largely focused on the initiation of deviant behaviors (Luckenbill and Best 1981), thus entrance into many forms of deviance have been examined (Bryan 1965, Buckner 1971; Goffman 1961). Since the late 1960s researchers have also examined the processes related to exiting deviant careers (Harris 1975; Lofland 1969; Stebbins 1971). Changes occurred throughout these different stages and as such, scholars have analyzed many specific non-normative behaviors from the perspective this perspective. For example, Faupels (1991) work on hard-core heroin users conceptualized addiction as a deviant career, as did Adler and Adler (2005) for drug-dealers, Becker (1953) for marijuana users, Stephens (1991) for street addicts, and Taylor et al. (1986) for alcoholism.

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Rubington (1967) suggested that the processes involved in becoming and being a habitual drug user cumulatively represented deviant careers. Since the 1960s, scholarly research on drug use has employed the careers concept to explain the personal transformation that begins with the first episode of drug use to chronic drug use (Levy and Anderson 2005:246). Drug users must make adjustments to institutions, formal organizations, informal relations, and must follow a sequence of roles in confirming and sustaining his identity as drug addict. Although the personal and social adjustments that instrumental drug users made were deviant, the salience of weight managing behaviors in womens daily lives constituted them as life careers. Modes of initiation, persistence, and cessation (Chen and Kandel 1995:41) among instrumental drug users highlighted patterns that were common among participants. In this research, analysis utilizing these variables proved useful in terms of understanding individuals life courses. The concept of the deviant career also aided my analysis of the stability of instrumental weight controlling behaviors over time. This chapter presents aspects of womens deviant weight managing lifestyles through the stages of entrance, persistence, and exiting the instrumental drug-using career.

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ENTRANCE INTO THE DEVIANT CAREER

There were several themes to consider when analyzing individuals entrance into non-normative careers. Pathways by which individuals become deviant, their motivations and opportunities for deviance, and the perceived benefits and costs associated with deviance, varied among individuals (Osgood et al. 1996). Within society as a whole, it can never be assumed that all individuals were socialized in a dominantly conventional, normative manner (DeLamater 1968). Instead, it is safe to assume that conventional socialization is found to varying degrees throughout society. Without considering mediating variables such as social context, personal history, class, race, gender, subculture, opportunity, and identity, researchers run the risk of glossing over the nuances of individuals normative orientations. More realistically, individuals possess complex sets of ideals, values, and behaviors that make them unique agents in the social world. In fact, many persons who become deviant appear to have learned contra-conventional means and/or goals and supporting attitudes in their initial socialization (DeLamater 1968:447). People engaged in deviant behavior were often thought to have been socialized in nonconventional ways (DeLamater 1968). For example, Matza (1964) suggested that deviant behaviors resulted from drift, and a state of openness to deviant values but not a rejection of conventional values (Osgood et al. 1996:638). Regardless of womens normative orientations, adopting deviant behaviors required a certain level of motivation. Women instrumentally using substances

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reported various motivations for their behaviors. However, while it is important to include individuals motives in an analysis of the deviant career, motives in and of themselves are insufficient as causal explanations. Mills suggested that individuals motives for behavior are of no value apart from the delimited societal situations for which they are the appropriate vocabularies, they must be situated (1974:447). Further, the role and relevance of individuals initial motives, versus continued motives, for deviant behavior varied (Berard 1998). Briar and Piliavin (1965) suggested that motives are situational, meaning that conditions prompting deviance existed within a situation, not an individual. In addition, motivations for behavior may change or evolve over time. For example, individuals have described their motivations for initial drug use in a different manner than their motivations for chronic drug use (Schaps and Sanders 1970). Motivations can also be analyzed from perspectives that consider why individuals may lose motivation to conform (Kaplan 1976). Individuals may view conformity as a source of distress, and deviance as a viable alternative. Some forms of motivation were best suited to the explanation of why individuals adopted deviant behaviors generally, whereas others were suited for the explanation of specific behaviors. Aside from conventional orientations and behavioral motivations, it is important to consider individuals differential opportunity structures in terms of the deviance in question. Criminological research has highlighted the relative importance of opportunity for explaining individuals tendencies to adopt deviant practices (Brezina and Aragones 2004). In fact, opportunity alone has been found

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to significantly predict criminal and deviant behavior (Longshore 1998; Grasmick et al. 1993). Chambliss (1973) suggested that positive social labels increased individuals opportunities for deviance. Generally speaking, positive social labels, such as responsible or honest, increase individuals commitment to conventional society. However, these labels may also increase the opportunity for deviance by instilling trust and freedom from others in deviant individuals. The degree to which family and friends trust deviants may affect their willingness to give individuals the benefit of the doubt in the face of questionable status cues. In addition, the more conventional and norm-abiding that individuals seem, the more freedom they may be granted from others. This relative absence of scrutiny may have actually helped to facilitate non-normative behaviors. Brezina and Aragones (2004) suggested that the positive social labels given to deviants often resulted from ignorance on behalf of the observers, and were therefore erroneous. However, if others become aware of individuals deviant behaviors, they may retrospectively reinterpret their past narratives, behaviors, or conditions, potentially discrediting deviants altogether (Goffman 1963a). Social power variables, such as gender, age, class, education and race, may influence individuals access to (and ability to execute) different types of deviance. Participants in this research often had unique circumstances or traits that aided both their access to deviant means, as well as their ability to escape detection. As college students, many women reported relatively easy access to a variety of licit and illicit substances, as discussed in my typology of instrumental drug users. In addition, participants were largely white, middle-class, and female:

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variables that were generally excluded from social stereotypes concerning criminals or deviants (Brezina and Aragones 2004). As a result, women displayed relatively high levels of opportunity for deviance, coupled with a relatively low risk of being caught and labeled by others. This created personal contexts and social situations that may have fostered entrance into deviant careers. Entering Deviance through Disordered Eating A large portion of women in this research reported a history of disturbed weight management prior to their instrumental use of substances: the conventional over-conformists and the scroungers. Their entry into the deviant instrumental drug using careers that are described here, was through non-normative weight managing behaviors. These women often described their initial entry into disordered eating via conforming behavior. To begin with, womens attempts to control weight were confined to socially acceptable means, such as dieting and exercise. For example, Sara, a 21-year-old junior, explained that she didnt do anything weird at first. She simply wanted to lose a couple pounds and went on a popular fad diet with her roommate. McLorg and Taub (1987) described this phase, which characterized entry into eating disorder careers, as conforming behavior. They demonstrated that normal dieting, beginning in the teen years, was extremely prominent among women who subsequently developed eating disorders. This was evident in my research as well. For example, Shirley, a twenty year-old biology student and daily cocaine user, described the moment that prompted her first diet:

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I came home from a year away, a year abroad in Australia. When I got off the plane my whole family was there and mom looked at me with this horrible look on her face and said we are going to have to start watching your weight. I felt just horrible... I hadnt realized that I had really gained that much weight. At the time I weighed one hundred and twenty five pounds which isnt even big. Culturally, dieting is not considered deviant; in fact the opposite may be true. Popular fashion magazines, television shows, movies, and even fast food chains with low calorie products aimed at giving women license to eat, promote the idea that thin is in. Women were especially affected by such messages, as they were socialized to perceive themselves as visual beings (McLorg and Taub 1987). For many women, conformity to, and achievement of, thinness ideals promised a variety of social rewards. Often, success at mainstream diets yielded praise and signs of admiration from family, friends, or classmates. Many participants displayed a particular sensitivity to this feedback, with an acute fixation on culturally prescribed ideals of thinness. However, many women found that even with continued encouragement from others, maintaining weight loss proved difficult. For example, Claudia, a nineteen year-old freshman, explained to me that because of her consistent weight management, she looked fantastic, never better I even got noticed by these guys that didnt used to know my name. However, she felt that her weight loss and management had become increasingly difficult to maintain. Commonly, participants with a history of disordered eating cited the desire for continued acceptance and praise among their peers as reasons to pursue deviant means (McLorg and Taub 1987). This theme was also echoed by research participants who did not report a history of disordered eating.

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Consequentially, many women developed their behaviors into a stage of primary deviance, or non-normative behaviors that were undetectable to others (McLorg and Taub 1987). Women reported historically experimenting with a variety of disturbed weight control methods. These deviant methods included excessive calorie counting and cutting, skipping meals, binging, purging, laxative abuse, drinking excessive amounts of water, chewing and spitting food, constantly portioning food, keeping food diaries, use of thinspiration (images that motivate weight control), use of over-the-counter diet pills, and forced self-starvation. Individual techniques for weight management varied, and women reported different specific behaviors as personal favorites. For example, one young women explained how she kept a stack of magazines on her nightstand that weighed the amount she wished to lose. When she successfully shed pounds, she thinned the stack of magazines accordingly. Initially, many women found their weight controlling methods exhilarating. Christy, a twenty-two year-old Straight-A senior and longtime anorectic, told me: The pounds seriously melted away. I didnt understand why everyone wasnt doing it. I felt great and everyone said I looked great I remember wishing that I knew the things I do now, I mean like uh, how to stay skinny when I was younger I loved losing weight. This primary stage of deviance was usually a transitional phase. Non-normative behaviors, even if dangerous, often did not affect individuals self-concept or ability to perform socially (McLorg and Taub 1987). Participants at this stage of their disordered eating career usually did not identify as anorectic or bulimic.

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This may have been due in large part to the lack of negative social feedback that women received from others. Since most women were successful at hiding their methods for controlling weight, they most often eluded public identification as deviants. However, if people in their lives became suspicious of their behaviors (or their appearance) and publicly identified them, women transitioned into secondary deviance, a condition marked by others awareness of their non-normative behaviors (McLorg and Taub 1987). Women whose daily lives involved interactions in which others were aware of their disordered eating, reported that this dynamic caused strain. It took a while, said Colleen, an eighteen year-old freshman. She continued: But eventually I felt like everyone thought I was a head case. Like a freak or something. It was totally unfair, because I thought this was all cool, and that I was just making myself better looking... I think a lot of them were really just jealous. The notion that friends and family were just jealous of their new body was not uncommon for women with a history of disordered eating. Perhaps such thought patterns functioned to preserve a positive sense of self, allowing deviant individuals to continue their behaviors while leaving the self-concept intact. If women were labeled as deviant, many began to feel damaged and weak. However, this feeling did not always coax women to reevaluate their weight control methods. In fact some women, despite the disapproval from others, forged ahead with their weight management techniques. One potential explanation for this may be found in many participants insistence that the benefits associated with their disordered eating behaviors, whether

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perceived or real, were worth the negative consequences of being labeled as deviant by their peers. Pathways Into Drug Use Through Disordered Eating The conventional over-conformists and scroungers all eventually discovered drugs, whether licit or illicit, as an instrument for appetite control. For women with a history of disordered eating, this discovery came after trials and tribulations with various maladaptive weight control techniques. One common theme among women was that the discovery of drugs as an appetite suppressant was akin to seeing the light. After a potentially long and tiring pattern of deviant weight controlling behaviors, many women reported that taking a drug to control their weight seemed too easy. Cassie, a nineteen year-old part-time college student, laughed when she described her feelings concerning this initial discovery: I felt like I had been wasting the last four years being grumpy and hungry and (laughs) basically doubled over in pain all the time, when there was this solution out there... [Adderall] seemed like the best thing that ever happened to me. I could stay just as thin as I had ever been, but it didnt take any effort. I started to think that anorexia should be treated with this... If it keeps me thin and my mind off this damn thing [weight management] so I can do other things and be a normal person, then why wouldnt a doctor just prescribe it to me? Cassie was not alone in thinking that eating disorders could potentially be treated with prescription stimulants that control appetite. Interesting was Cassies notion that taking Adderall to control her appetite and manage her body weight made her life more normal. While illicit drug users with a history of disordered eating were not as likely as licit substance users

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to make this claim, both groups of women reported a relative absence of fears surrounding their current drug use. When participants compared the risks of using drugs to the pain and suffering that disordered eating had caused over the years, the health risks associated with instrumental drug use were deemed relatively inconsequential. However, this absence of fear was more pronounced in those using prescription drugs, as well as in those who had been instrumentally using drugs for appetite control for less than one year. Pathways into Disordered Eating through Drug Use Many participants did not report a history of weight controlling behaviors that would be generally categorized as disordered eating prior to their instrumental drug use. Instead, journeyers and opportunists initiated nonnormative weight control methods after their initial use of appetite controlling substances. These women later developed and fine-tuned both their drug use and weight managing behaviors. After journeyers and opportunists transformed their recreational or medicinal drug use into instrumental methods of weight control, many adopted other habits or techniques that are commonly associated with eating disorders. Whether or not there was something about these women that made them more perceptive or vulnerable to messages and images regarding weight is discussed in chapter five. However, some simply stated that personal weight loss and the accompanying positive social feedback that they received from others piqued their interest in various aspects of eating disorders generally. Some began reading heavily on the subject, seeking out information from a number of media

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outlets. Respondents became more aware of the issue of weight control as time progressed, and even with their successes in drug induced weight loss, their obsession with body size continued to grow. For many women, weight control became a much larger part of daily lives. This pattern of drug use leading to the development of eating disorders exists in the literature, but in a very different form than what these data suggest. For example, Fornari et al. (2000) reported that steroid use, specifically Corticosteroids, may lead to the development of an eating disorder. However, in the case of steroids it was not weight loss that created individuals concerns over weight control, but rather weight gain. The steroids in question had various medical uses for both acute and chronic illnesses. Many women who used these steroids gained weight and this often caused individuals serious concern. According to Garfinkel and Goldbloom (1988), obesity was a serious precipitating risk factor for the development of eating disorders. Women who were treated for medical conditions with this specific steroid often gained weight and subsequently faced negative reinforcement. In a seemingly parallel reaction to the women in this research who faced positive reinforcement, these women had the issue of weight control brought to the forefront of their minds. In both cases, social evaluations of weight loss or gain consequently compelled women to try new, extreme forms of weight control.

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Initiation of Instrumental Licit Drug Use Within the larger typology of instrumental drug users, as presented in chapter three, women who used licit substances were the conventional overconformists and journeyers. For conventional over-conformists, the onset of instrumental drug use did not represent the beginning of their deviant weight managing careers. Journeyers on the other hand, entered deviance through drug use. Accordingly, at the point in time that women determined drugs to be a useful tool for weight management, conventional over-conformists and journeyers were standing in very different places. Conventional over-conformists were already operating under personal ideologies that heavily favored and stressed the importance of weight control for overall life-satisfaction. Journeyers often developed similar ideologies concerning body weight, but this process followed substance use instead of preceding it. Journeyers did not enter the instrumental drug using career with similar normative expectations or experiences in terms of deviant weight controlling practices. While conventional over-conformists also enjoyed any positive reinforcement that they received from peers concerning their body shape, such feedback was not necessarily the original catalyst for womens deviant weight control methods. In contrast, the processes that lead to instrumental drug use among journeyers caused major transformations regarding personal ideologies of health and beauty, ideologies that commonly converged over time with those of the conventional over-conformists.

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Conventional Over-Conformists For conventional over-conformists, initial entry into instrumental drug use remained relatively consistent throughout interviews. The most common mode, as reported by roughly a third of respondents, was through the use of Adderall to study. This discovery sometimes happened during high school, but for most women, initial pharmaceutical drug experiences did not happen until college. For example, Carly, a twenty year-old student, explained how she discovered pharmaceutical stimulants: Lots of kids here take Adderall in finals week I had to finish this group project and two people werent even showing up at all. So the other two of us had to finish and this girl in my group shared her meds it was great, I mean we definitely finished but thats not my point I really liked taking Adderall. After using Adderall with friends during cramming sessions, perhaps a few times during the first semesters of college, many respondents decided that the drug was a miracle and sought their own prescription. For other women, the discovery of Adderall came in the form of recreational snorting, in some cases with onset of use as early as high school. For example, Connie, a college freshman from the Northeast, said: In my hall these other girls were crushing Adderall and snorting it one night. My roommate said something about it and I played it like I had never heard of people doing that... Id done it a couple times before in high school but not much. I can name at least twenty different people doing Adderall in that dorm. Everybody loves it. There were a few respondents however, who simply heard casually that pharmaceuticals such as Adderall or Ritalin were appetite suppressants and sought a prescription or dealer without ever having tried it before. One such instrumental user, Cara, a twenty-two year-old college senior studying sociology, said:

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I was out to dinner with friends and randomly this girls girlfriend said something about how she heard girls were using Adderall to stay skinny. I guess, and I mean right away, I started finding out anything I could When I was young, my doctor said I probably had ADD I just made an appointment to get tested, it was totally free... The only reason, and really, it was cause I wanted to see if it would help me lose weight I never would have done that otherwise. Caras report of friends talking socially about womens use of prescription drugs for weight control was one of a kind in this research. Generally speaking, others were largely unaware that women participated in these behaviors. Conventional over-conformists were overwhelmingly motivated to obtain and learn how to use pharmaceutical substances for the primary purpose of weight management. Regardless of individuals histories with disordered eating, the adoption of instrumental drug use for weight control transformed women into habitual drug users. While modes of entry into instrumental drug use varied among individuals, conventional over-conformists repeatedly championed pharmaceutical substances for their weight managing potential. Journeyers One mode of entry into instrumental drug use that was reported by (and specific to) journeyers, was through the legitimate prescription of pharmaceuticals for another condition. Most commonly this condition was a clinical diagnosis of ADD or ADHD. For example, Jade, a junior studying economics, explained: I recently got a prescription after trying some of my roommates for cramming and liking the effect it has on me. I really have ADD and [Adderall] has dramatically helped me in school. But I will admit that one of the main reasons for wanting to get the prescription was because I knew it would help me lose weight... After being on it my eating habits have changed and I have lost weight, and I am actually happy. Or at least happier than I was before.

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Jade represented an interesting variation of journeyers, in that she reported legitimate medical reasons for obtaining a prescription for stimulants, but her motivation to do so resulted partially from the substances reputation as an appetite suppressant. However, Jade was most accurately a journeyer, as her disordered eating practices followed her legitimate medical drug use. Although many journeyers who had a legitimate clinical diagnosis initially took their drugs as prescribed, they are included in this discussion of instrumental substance users for two reasons. First, journeyers motivations to use Adderall or Ritalin transformed over time. Originally, if used to enhance academic performance, these substances helped women focus and aided in their studies. However, the drive to maintain weight loss after initial use compelled many women to continue their pursuit of medications. For example, Joanna, a twenty year-old anthropology student, explained: I have an Adderall addiction that is out of control. I feel like I am smarter, more alert, and able to not eat while I am on it... The thing I love the most is the not eating part. Before I got my prescription I was at a healthy weight, I was a little chubby and it made me feel insecure [After Adderall] I was a star employee at my job because all I wanted to do was work, and my grades improved so much because I would sit down to study and nothing would keep me from finishing all of my work and it made me not even think about food. For many journeyers, motivations for drug use began to center around weight control, regardless of how well prescriptions worked in controlling their symptoms of ADHD or ADD. Second, many journeyers realized the weight loss benefits of drugs and started abusing their own prescription. For example, Jane explained:

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I kept thinking that my ADHD medicine is whats making me anorexic. It makes me like, not hungry at all. It bothered me that I always felt full from the medicine but it also makes me feel cool and together. Often, women lost weight and received positive feedback from others after taking the drug as prescribed. Aside from women who had a legitimate psychiatric diagnosis and medicinally used pharmaceutical stimulants prior to their instrumental transformation, some journeyers entered deviance through recreational use. Many journeyers reported historically experimented with Adderall, Ritalin, or other prescription drugs for fun. For example, Jamie reported that the recreational use of pharmaceuticals was: Really not as popular but lots of people still do it its totally disgusting though, it totally burns and tastes like shit. It makes your throat um, kinda drippy and runny Strong as hell too, it really makes you high... I didnt do it all that much but especially uh, around this one girl in my building I would. While recreational use of this sort was reported as less popular by participants than use for academics, college students in general commonly talked about this practice as though it was widely known on campus. Initiation of Instrumental Illicit Drug Use In this research, the women who instrumentally used illicit substances for weight control are the scroungers and the opportunists. Scroungers, like conventional over-conformists, began their deviant instrumental drug using careers through disordered eating. On the other hand, opportunists, like journeyers, initiated their deviant careers through drug use. Consequentially, comparisons of the onset of instrumental substance between scroungers and

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opportunists, closely resembled those of conventional over-conformists and journeyers. This means that instrumental drug use among scroungers was heavily motivated by the historical significance of their weight managing behaviors. In other words, scroungers were extreme dieters already. Opportunists did not share this quality. Instead, opportunists developed their instrumental drug use patterns, deviant weight control practices, and alternative ideologies, through their drug use. While this distinction concerning initial entry into instrumental drug use was arguably important, after the instrumental careers were in place, womens experiences with illicit substances became oddly similar. Scroungers Entry into instrumental drug use for scroungers was often wrought with more guilt and self-doubt than was experienced by conventional over-conformists. Many had used cocaine or speed recreationally prior to the discovery of their instrumental use for weight control. However, womens recreational use of street drugs was not generally as routine or consistent as their instrumental use. Sarah, a college junior, recalled her first experience with cocaine: Back home people were doing it everywhere. In the bathrooms you could always catch chicks doing coke. Yeah two girls in one stall all the time, we go to the bathroom in groups but I can shut the stall... I never did it back then but college was a whole other scene I sort of felt like I could do it and so I did. When I asked Sonya, a college sophomore, about her first experience with cocaine, she recalled: I felt like I should spare myself the agony. I was at this party on the hill and this girl I went to high school with was in one of the bedrooms with some guy,

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sort of, hunkered over the desk. I dont know, it was pretty obvious what they were doing and I thought they would be mad and I should run outta there. But she just offered me some I was in D.A.R.E. you know? So I was scared, which is so weird to think about now. While scroungers may have already been substance users, they were still likely to have internalized, to some degree, societys normative conceptions of street drug use as harmful or deviant. Some scroungers heard that certain street drugs controlled appetite, and experimented to see what would come of their use. This experimentation was largely motivated by womens deviant ideologies concerning weight. A few scroungers heard stories of celebrities such as Kate Moss, a super-model who was famously identified publicly for cocaine use and accused of being on a cokediet (Trebay 2005). In addition, one woman overheard friends speculating about another individual whom they suspected of using street drugs to control appetite. In both of these instances, participants decided to give drug use for weight loss a shot themselves. Opportunists Modes of entry into recreational street drug use among opportunists, as with scroungers, paralleled the experiences of many other illicit drug users in the general population. Some experimented with drugs in high school while others waited until college. However, prior to their instrumental use, women in this category did drugs recreationally. For example, Olicia, a twenty-one year-old college junior studying fine arts student told me:

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It wasnt about being skinny at first. And its not like coke was the only drug I was doing too. I went through it all a bit. Now Im strictly onto the coke. I still smoke weed but not that much... Im just on the coke diet now. Once women made the cognitive connection between substances and their weight loss, opportunists steadily changed the nature of their drug use from recreational into instrumental. Often this process included changing a wide array of behaviors, including the deliberate rationing of their drug supply. As with journeyers, opportunists transformed their drug using behaviors, whereas conventional over-conformists and scroungers were more likely to instrumentally use drugs for weight control in the first place. As did journeyers, over time opportunists continued to pursue their substances of choice for the purpose of weight management. Commonly, opportunists reported that how they perceived their drugs effects changed over time. For example, people who use cocaine recreationally generally enjoy the sociable, chatty buzz that the drug induces. However, many opportunists who once may have felt this way concerning cocaines effects, later came to dislike this effect of the drug.

PERSISTANCE OF THE DEVIANT CAREER

The categories within my typology of instrumental drug users consisted of many women who had reached similar places in their deviant careers. Within each type, the quantity, frequency and duration of drug use varied, but across all categories major trends in commitment to the deviant lifestyle emerged. Women

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who began their deviant career with an eating disorder and discovered prescription drugs as a useful tool in that quest, the conventional overconformists, were the most committed to their lifestyle choice. The ability to maintain this lifestyle arose out of the specific nature of their behaviors and consequentially, women were dedicated to their drug use and disordered eating. Second to the conventional over-conformists, journeyers displayed notable commitment to instrumental drug use. The cultural messages transmitted to women regarding their bodies had significant effects on individual behavior. This was true of women with a history of eating issues as well as those whose problematic eating developed after the discovery of drugs instrumental utility. This research suggests that instrumental drug use, which over-conforms to a specific cultural goal through non-conforming means, is often rewarded in society with positive evaluation. However, this positive evaluation is often based on false assumptions from others regarding how women maintain their bodies. Consequently the type of deviance portrayed here was treated very differently by others than negative deviance (Heckert and Heckert 2004a), which strayed from cultural expectations, and was negatively evaluated. Through reinforcement, others conveyed the message to women that being thin was a critically important cultural ideal, overriding health concerns. However, respondents who resorted to deviant means to reach this cultural goal were aware that their actions were not socially acceptable, and thus felt forced to maintain their deviant careers in private. Thus, maintaining deviant behaviors

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over time required individuals to negotiate various issues associated with their specific instrumental careers alone. Stability of the Instrumental Drug Using Career Dominant explanations of eating disorders and drug use that are found in society at large, generally hail from medical and psychological models of human behavior. As introduced in the beginning of this dissertation, these models often rely heavily on the notion of individual pathology. Accordingly, those who hold to the medical model consider mental illness an illness like any other, in that mental illnesses have a cause, course, lesion, symptom pattern, and treatment of choice (Scheff and Sundstrom 1970:37). This would suggest that behaviors associated with these so-called disorders would persist unless diagnosed individuals underwent medical and therapeutic treatments. However, deviance theorists have demonstrated empirically that the behaviors associated with these medical conditions, present, change, and cease in stages over time, often regardless of medical intervention. In fact, much scholarly work has generally shown deviance to be largely unstable over the life-course. As Ulmer suggested, continuity of both deviant and conventional behavior represents two sides of the same coin... that is, both involve generic social processes of structural, personal, or moral commitment to lines of action (2000:318). Structural commitments represent external constraints on individuals behaviors, whereas personal and moral commitments are located internally. Structural commitment variables includ the availability and

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attractiveness of meaningful alternatives, prior investments made in deviance, and difficulties inherent both socially and personally, in terminating deviant behaviors. Personal commitments include attitudes towards particular lines of actions, attitudes towards other deviant co-participants, and the salience of deviant behavioral patterns in terms of individuals identities. Last, moral commitments include feelings of moral obligation towards deviant participants, internalization of norms discouraging the termination of deviance, and internalization of general norms concerning consistency in lines of action (Ulmer 2000:317). In addition to these variables, individuals accounts, which also supported the maintenance of womens deviant careers, are discussed in further detail in chapter six. Maintaining the Deviant Career Among Licit Substance Users Regardless of which mode of entry licit substance users reported, positive reinforcement from society, as well as their own change in self-concept concerning weight loss, largely compelled women to maintain their drug using careers. In order to accomplish this, many licit substance users developed personal working ideologies that defined instrumental drug use as relatively unproblematic. For example, many conventional over-conformists and journeyers did not self-identify as having a problem. This was also true of a few women who were abusing their own prescriptions. Some felt that the problem of drug use was diminished if their use was instrumental instead of recreational. For example, a few women explained that the latter was more dangerous, as it often involved binging on substances, an arguably risky practice. Womens instrumental drug

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use on the other hand, was usually more systematic and involved fewer milligrams of a given drug at any one point in time. Participants often cited trust in the medical establishment for their relative comfort concerning their continued instrumental substance use. For example, Jennie, a quiet eighteen year-old freshman, said: The [weight loss] really wasnt intentional to begin with. I guess I just really started to like the way I looked because of [Ritalin] and started obsessing about it. I mean just for a while, but I thought the pills couldnt be that bad. Plus, in order to get them, I had to go into the doctor all the time... Im sure he would have noticed if something was wrong. Jennie, like a few participants who used pharmaceuticals, sometimes used up to four times her daily dose of Ritalin, yet generally characterized chronic use of the drug as safe. Conventional over-conformists were slightly more likely to abuse their prescriptions than were journeyers. Generally speaking however, maintaining deviant licit drug use was often reported with the precondition that we can trust medical doctors to take care of our health and wellbeing. Many women felt this way, regardless of whether they were totally honest during the course of their medical treatments. Trust in the medical establishment allowed many women to continue maladaptive weight control strategies on a daily basis without fearing for their health. Often, participants felt as though their behaviors were safe, effective, and of no cause for major concern. Tylka and Subich (2002) contested this idea in their research on womens perceptions of the safety and effectiveness of nonnormative weight control strategies. They maintained: There is certainly much medical evidence that many weight control techniques (chronic dieting, fasting, vomiting, and using laxatives and diuretics) are both

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largely ineffective and harmful in the long run, yet despite this literature many young women still use ineffective and unsafe techniques in hopes of regulating their weight (2002:102). However, many respondents did not perceive discontinuity between their weight control methods and the accepted medical uses these pharmaceutical substances. For example, while others may have been taking the same amount of Adderall or Ritalin for ADHD, those individuals were probably not severely restricting calories. The health consequences of instrumental use are further discussed further in chapter five. Generally, women trusted that their pills were safe, and thus the side effect of appetite control and subsequent calorie restriction must be safe as well. However, a few participants did in fact use much more than the average prescribed daily dose for ADD or ADHD. For example, Chelsea told me: I have the same habit and I take sixty milligrams a day. Each morning I wake up I try so hard not to take so much Adderall but I end up taking a little more periodically during the day... I take it to suppress my appetite I tried to slowly stop over summer break but have started to take them again. Generally, there was little to no acknowledgement that regardless of whether or not they felt hunger, their bodies needed nourishment. Consequentially for many women, maintenance of the deviant licit drug using career was not altogether difficult. Many conventional over-conformists did not self-identify as having an eating disorder, which was common among women with problematic eating patterns in general. Degher and Hughes (1991:215) explained that often women felt as though they were not anorexic enough, not skinny enough to warrant the label. When asked whether their drug use scared them or negatively affected

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their sense of self, the majority of conventional over-conformists said no. Cece, a twenty year-old college junior, explained that she never worried about having a drug problem, instead she was just too wrapped up in how well it worked and how great [she] looked. This was a typical statement of conventional overconformists. In fact, many licit drug users viewed their behaviors as maintainable over a long period of time. Maintaining the Deviant Career Among Illicit Substance Users Unlike pharmaceuticals, which have a legitimate (even celebrated) place within society, illicit substances remained largely denounced socially. Further, street drugs remain under prohibition legally. As a result, scroungers were more likely than conventional over-conformists to identify as having a problem. Many women who spoke in these terms described their problem as potentially two-fold, first with eating and second, with drug use. Sasha leveled with me when she said: Look, you know deep down you have a problem. In reality you have a huge problem. What you have is worse than most drug problems. You are addicted to drugs and your body is eating itself from the inside out. Illicit instrumental drug users were also more likely to see their behavior as temporary, a phase that suited their current lifestyle, but one they would outgrow eventually. In fact, many women reported hopes that one day they would not rely on drugs to control their weight. Many street drug users thought that they would outgrow these particular behaviors, whereas licit drug users more often viewed their behaviors as generally maintainable.

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CESSATION OF THE DEVIANT CAREER

A number of researchers have examined the processes of leaving deviant careers (Adler 1992; Adler and Adler 1983; Anspach 1979; Becker 1963; Brown 1991; Faupel 1991; Fuchs Ebauch 1988; Luckenbill and Best 1981; Meisenhelder 1977; Sharp and Hope 2001). For this research, understanding which variables are associated with participants reports of exiting deviance has the potential to highlight ways in which deviant behaviors are supported or dissuaded within society. While licit substance users had the legitimate framework of the medical establishment in which they could maintain their deviant careers, illicit substance users engaged in the illegitimate world of black market substances. Accordingly, the daily grind of weight management practices had significantly different effects on these two types of drug users. Here, I detail the few reports in my data concerning cessation of the deviant career. Exiting the Instrumental Licit Drug Using Career Among participants generally, it most often was not until worried friends or family members intervened that women acknowledged their behaviors as potentially dangerous. However, interventions with licit drug users were rare. This was true for a couple of reasons. First, a pill habit was usually easy for participants to hide. This aided women in the maintenance of their deviant behaviors by limiting the potential for discouraging feedback from others. In addition, the general public is less concerned with drugs prescribed by the

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medical establishment, making the risk of severe stigmatization less problematic. Even if women were caught in possession of prescription stimulants, an explanation for their use was close at hand. Given that pharmaceuticals have a legitimate medical purpose in society meant that women could justify their use, at least to a certain extent. Illicit substances on the other hand, are not only illegal, their possession will cause more alarm among others, and require more explanation from those engaged in their use. Of the four types of women instrumentally using drugs to control their weight, conventional over-conformists were the least likely to report the cessation of their instrumental drug using careers. Carla, a twenty year-old junior and ballet dancer, offered an explanation for her reluctance to stop using and seek medical treatment when she said: Why would I go for therapy? The second that I admitted to someone that I worry about my weight they would take away my prescription. It was so hard to get and I would rather have it than go for treatment and get fat with no Adderall around. Many conventional over-conformists like Carla, found themselves in a sort of catch twenty-two when it came to the notion of seeking medical treatment for either drug use or disordered eating. A few women described their reluctance to seek treatment for their disturbed relationship with weight specifically, for fear that documenting any disordered eating in their medical records would essentially blacklist them from accessing pharmaceutical stimulants in the future. Most importantly, licit drug users rarely exited their instrumental using careers because they were generally satisfied with both their methods and the

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results. For example, on the topic of dropping drug use from her weight controlling repertoire, Cece, a twenty year-old student, said: I have lost over fifteen pounds. I needed to lose the weight off that I gained when stopping the pills... It helps me to be successful in school and look wonderful... I never talk to anyone about this. None of my family members know that I take it. I do not like being dependant on Adderall but cannot stop taking them... Its a great way to keep off the pounds, have energy to work out, and study. In fact, many pharmaceutical stimulant users reported that they intended to continue using indefinitely. A few women cited pregnancy as a potentially limiting factor for stimulant use, but given that having children was generally a vision for the future, this possibility wielded little power in the present. Exiting the Instrumental Illicit Drug Using Career Of the women in this research who reported exiting deviance, most were illicit drug users. Generally speaking, continued, chronic use of street substances was difficult for women to maintain. Over time, the behaviors may become grueling, expensive, and tiresome. The effects that illicit substances have on the body over time are cumulative, which makes continued use an exhausting pursuit for any person. In addition, instrumental use that had endured over a long period of time was eventually likely to cause individuals to question their behaviors. As a result of being increasingly alarmed by their own actions, as well as an increased likelihood of interventions from those around them, illicit drug users were the most likely to have sought medical treatment as means of exiting the deviant career. The few women who chose professional intervention did so for either disordered eating or substance abuse.

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Savannah, a twenty-three year-old fifth year senior, took a year off from school following an intervention from her two college roommates. Savannah recalled that her mother was in tears, following a phone call from her roommates during her sophomore year of school: I am not sure it had occurred to me that my coke habit was so obvious to my roommates. I remember Jill, one of two roommates, mentioned I looked like I had been working out but when my mom called and told me that they said I was anorexic and had been using drugs, I was stunned. Savannah was mortified, and within a week of this phone call, her mom had traveled to Colorado, removed her from school, and placed her in a rehabilitation program for her cocaine dependence. Her habit was not minor; she reported the height of her use to be around one gram of powdered cocaine a day. Selena, twenty-two, and Sorin, twenty-four, took the route of most scroungers who sought help for their behaviors and went into treatment for their eating disorders and not the drug use. Selena explained her rationale by saying the coke was not the problem. If it didnt help so much with dieting its not like I would really be a coke-head. Sorin, who also went into eating disorder treatment, saw her drug use in much the same way, and said that once her concern over weight control had waned, her need for cocaine disappeared. The concept of addiction is complicated and this suggests that the motivations for using a particular drug may affect the difficulty individuals undergo in ceasing their instrumental drug using career. As with scroungers, opportunists were more likely to identify as having a problem than licit users generally. Some located this problem within eating, and some within drug use. Either way, the behaviors were identified as problematic

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and as a result, these women were more likely to be conflicted or scared by their own actions. Again like scroungers, opportunists were also more likely to seek treatment. Both scroungers and opportunists usually did so on their own accord, before family and friends intervened. However, there were more illicit drug using respondents whose family and friends intervened, urging them to get help. In response to this concern, a couple of women were not reluctant towards treatment. This may have resulted from their own weariness concerning their deviant weight management career. Of the instrumental drug users in this research, illicit users (who reported exiting deviance) had the shortest drug-using careers. In addition, illicit substance users were the most likely to have already exited their deviant career at the point of interview.

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CHAPTER FIVE Associations Among Instrumental Drug Users

Deviance exists throughout the social world in many shapes and forms. Some forms of deviance are carried out by individuals acting alone, while others require or enjoy the company or cooperation of others. People engaged in deviant behaviors exist somewhere on a large spectrum of possible deviant associations, ranging from individuals, loners, peers or colleagues, to large scale international organized crime (Best and Luckenbill 1982). These deviant associations may vary along many dimensions including quality, intensity, numbers, organization, duration, salience, hierarchy and sophistication (Best and Luckenbill 1980). The social organization of deviance is worth inspection and has been analyzed by many scholars in the field (Adler and Adler 2005; Best and Luckenbill 1980; Einstader 1969; McIntosh 1971; Mileski and Black 1972; Prus and Grills 2003; Shover 1977; Zimmerman and Wieder 1977). This chapter explores dimensions of deviant associations by analyzing the social organization of womens lifestyles, secrecy among users, participants social isolation, and how participants deviant or normative associations supported or detracted from continued practices.

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SOLITARY DEVIANCE

Deviance is often found at the individual level. Theorists have conceptualized forms of solitary deviance in a number of ways. First, Best and Luckenbill (1980) described individuals acting alone as loners. Loners were individuals who did not associate with others for the purpose of sociability, the performance of deviant activities, or the exchange of supplies and information (Best and Luckenbill 1980:15). Differentiated from loners were individual deviants, who resembled loners in many ways (Best and Luckenbill 1982). Individual deviants were those who were capable of enacting their non-normative behaviors without others: they acted by themselves and upon themselves. Loners on the other hand, may draw others into their acts exploitatively (Adler and Adler 2005:348), meaning that their deviance had the potential for victims. Prus and Grills (2003) further elaborated categories of individual deviance through their work on solitary operators and subcultural participants. Solitary operators like loners, acted alone, and did not associate with deviant others. Subcultural participants also acted alone, but their deviant behaviors were heavily influenced by particular group memberships. Theorists have largely conceptualized drug users as individual deviants (Beck and Rosenbaum 1994; Biernacki 1998; Goode 2005). Despite the fact that drug users acted on themselves, as did loners, they also regularly associated with others engaged in similar behaviors. Drug users had a deviant subculture at their disposal, and were able to collegially associate with like deviant others.

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However, Dabney and Hollinger (1999) described physicians and pharmacists who were dependent upon drugs as loners because they did not share the deviant associations of drug users generally. There was no subculture available to licit substance users. As such, physicians and pharmacists, like women in this research, complicated the conception of drug users as individuals. Instead, instrumental substance users manifested as all of the above: loners, individual deviants, solitary operators, and subcultural participants, depending on the specific form of drug use in question. Here, I engage with concepts of deviant associations and the social organization of deviance by examining womens patterns of drug use and weight managing behaviors. Instrumental Drug Users as Loners Of the various forms of deviant associations identified by researchers, the instrumental drug users described in this research are best understood as loners. Loners did not associate with others engaged in similar deviant acts, and lacked the support of a deviant subculture (Best and Luckenbill 1982). Research into loner deviance has included works on sexual asphyxia (OHalloran and Dietz 1993; Lowery and Wetli 1982), self-injury (Adler and Adler 2005), substance abusing pharmacists (Dabney and Hollinger 1999), embezzlers (Cressey 1971), and anorectics and bulimics (Gordon 1990; McLorg and Taub 1987; Way 1995). Like individual deviants, women who engaged in drug use for the purpose of weight control acted alone. They committed acts of deviance to themselves and by themselves. While some loners may have acted alone but victimized

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others, such as violent individuals or people who made obscene phone calls (Athens 1997, Sheffield 1989, as cited in Adler and Adler 2005:348), women in this research were completely solo actors. In addition, women did not have, or did not wish to have, access to others engaged in similar behaviors; they were devoid of a subculture. As a result, the behaviors described in this research were hermitical. Adler and Adler described loners as on their own, they must find the deviance, decide to engage in it, and figure out how to do it themselves (2005:352). Unlike other forms of deviant associations, where individuals may learn from and support each other, loners evolve from conforming behavior to non-conforming behavior without any aid. Such an evolution demands that individuals singularly create the means and rationalizations for any given behavior. This, in a large way, differentiated loners from other varieties of deviants. Loners may have been more insulated from stigma than deviants acting together, but they also relinquished any benefits that accompany associating with others. People engaged in deviant behaviors who associate with one another have much to offer. First, they are able to introduce specific behaviors to each other and aid in the learning process. Second, deviants associating together may offer support and guidance throughout the deviant career. Third, deviant peers provide alternative values and ideals, which affects the way individuals define and rationalize their behaviors. Last, fellow deviants may provide help with any practical hurdles or problems associated with the deviant lifestyle. The

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instrumental drug users in this research were unable or unwilling to seek out deviant others, and thus lived without the support that accompanies deviant associations. Generally, loners subscribed to normative social values, ideas, and behaviors. They were entrenched in the dominant culture and likely, then, to view their deviant acts through the value system of conventionality (Adler and Adler 2005: 347). This contradiction of normative values and deviant actions was ever present for women in this research, causing a strain that many felt forced them to keep non-normative behaviors private. In order to understand why instrumental substance use for weight control manifested as a loner deviant lifestyle, it was important to consider the deviant acts as situated within our culture. Specifically, what were the behaviors in question, how were they defined as deviant, and what did these behaviors require of an individual? Some forms of deviant behavior, such as drug smuggling or marital swinging, required the company or cooperation of others. Instrumental drug use did not require such association. While women using substances were forced to interact with others (whether physicians or drug dealers) in order to obtain their drugs, the actual act of using substances was largely accomplished completely by oneself. This was true of both women who used illicit and licit substances. Women may have associated with other drug users during episodes of recreational use, but this was not the case for instrumental use. For the most part, women in this research reported employing lies and secrecy during the course of their deviant behaviors.

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LONERS AND SECRECY

Understanding the loner deviant lifestyle requires specific understanding of the types of behaviors that are seen at this level of association. As with selfinjury (Adler and Adler 2005) and anorexia nervosa and bulimia nervosa generally (Gordon 1990; McLorg and Taub 1987; Way 1995), research on loners has included elements of delving into individuals private, personal worlds: peoples secrets. Women were fully capable of acting out their deviance with others, or at least sharing information with trusted others, yet they consistently chose to keep these behaviors hidden. In an effort to lessen any potential negative consequences that may have resulted from others knowing, such as deviant labeling, women often chose the loner lifestyle. As such, stigma, which is analyzed in chapter six, was not the only motivation for keeping behaviors private. Many women feared that if others knew about their instrumental drug use, they would be pressured or forced to stop using. Women who are motivated to adopt extreme weight control practices need look no further than an Internet search on pro-anorexia or pro-bulimia to find other like-minded individuals gathered in an online community. This suggests that women could have sought out the company of like others. Online, individuals were willing to trade tips and tricks for weight loss. In fact, many women in these forums explained and neutralized their behaviors as a lifestyle choice. Fox, Ward, and ORourke (2005) noted that being successful at this lifestyle choice often gave a sense of empowerment to anorectic women, as

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well as an elevated social status among their peers. However, outside of the anonymous support and camaraderie an Internet community may have offered, women practicing extreme weight control were often embarrassed of their methods. As a result, women went to great lengths in order to maintain secrecy. This consistent drive to conceal their chosen weight control methods highlights the deviant nature of these behaviors. The specific weight controlling behaviors that research participants engaged in at one time or another included drug use, severe caloric restriction, episodes of bingeing and purging, laxative abuse, cigarette smoking, dishonesty in the course of medical care, and obsessive thoughts about weight and body management. Most of these behaviors were arguably non-normative, and likely to be viewed as such by women themselves. Accordingly, many participants kept behaviors that they deemed socially undesirable to themselves. Although their means (drug use or other severe dieting behaviors) were deviant, these behaviors were specifically aimed at achieving an appearance that would be praised and admired by others. Thus, womens secrecy did not surround the results of their drug use, i.e. their thinner bodies, rather it centered on their pathways. Generally, research participants were achievers and showed signs of perfectionism, as illustrated in much of the literature on women with eating disorders (Cohen and Petrie 2005). For the majority of their lives, women in this research fulfilled or exceeded societal expectations in a variety of arenas. Participants included honors students, college athletes, social leaders, award winners, and future professionals. This research delved into the lives of many

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privileged and socially well-accepted individuals. In terms of pro-social bonds, ideals, and entrenchment, women often represented those with high levels of attachment to conventional society. It would seem then, that participants had a pretty high stake in normative society. Thus, many perceived the consequences of being caught and labeled as deviant to be severe, unacceptable even. Accordingly, most women were further compelled towards secrecy. Secrecy Among Licit Substance Users Women who engaged in pharmaceutical substance use displayed differences from those using illicit substances in their level and intensity of secrecy regarding their weight control methods. Many college campuses reportedly have high rates of prescription stimulant use, however, such behaviors were more socially acceptable when aimed at academic performance (McCabe 2005b). Most women feared that their specific type of instrumental drug use would be too readily associated with disordered eating. Generally, women who were labeled as having eating disorders were negatively stigmatized by others (Mond, Robert-Smith, and Vetere 2006). Women hoped to escape this process. However, labeling was not generally a major concern, as most women did not experience unwanted characterization. For example, Corina, a twenty-two year-old college senior studying sociology, reported that: Um, I dont think anyone knows. I never said anything and um I dont really want to. Ive definitely uh, thought about it, like who knows? But I think mostly Im being paranoid cause I dont know why they would Sometimes I talk about using Adderall to study um, but thats, you know, different, no one cares about that, theyll just ask you if they can have some (laughs).

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Given that it was relatively easy to hide both medications and their ingestion, many licit substance users suspected that no one knew about their use at all. Licit substance users employed a variety of means for hiding their behaviors. Secrecy surrounded the processes of both obtaining and taking pharmaceuticals. First, women often employed secrets and lies in obtaining their medications, as discussed in chapter three. In addition, obtaining medications called for covers concerning frequent visits to the doctor. Many participants, who visited doctors on campus, did so during the school week. Instead of going to lunch with friends, many women spent an hour at the campus health center. Women routinely created alibis for these visits. Cynthia, one of my last interviews, a twenty-one year-old young woman studying biology, spoke directly to this point: What would I tell people? Oh I dunno (laughs), I mean its not that much of a stretch Once a month, I say something like uh, um, say, I have to get my teeth cleaned, or I have a group project meeting in [the dorms] No one, you know, no one thinks too much of it. Often, women left little room for suspicion on the part of others. While levels of openness regarding the use of pharmaceuticals generally was different among participants, women rarely reported openness regarding the aspect of weight control. Some pharmaceutical users had friends or roommates with whom they could occasionally take drugs, usually to study or pull an all-nighter. This made participants more comfortable with their substance use in general. For many women, the associated lifestyle of being a college student yielded a sense of

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freedom from the rules that governed society as a whole. Many felt that college was an acceptable time in life to be a drug user. For example, participants were young, unmarried, without children, and lacked heavy conventional responsibilities. While the presence of drug users around them may have comforted women regarding drug use in general, most were still cautious about discussing their use as either habitual or instrumental. Many women were comfortable talking with certain friends about aspects of their drug experiences in general, but information regarding use for weight control specifically, was almost always guarded. Secrecy Among Illicit Substance Users When compared to licit substance users, women using illicit drugs instrumentally reported secrecy of a different nature. Generally speaking, all illicit drug users were unconventional. The use of street drugs was not only illegal, it was largely frowned upon socially. Regardless, subcultures surrounding black market drugs have existed throughout history (Goode 2005). These subcultures were composed of individuals who, despite dominant cultural proscriptions concerning psychoactive substances, engaged in deviant drug use. As a result, illicit drug users had access to others who valued, to one degree or another, psychoactive substances. Thus, street drug users were likely to know people who participated in the social world of illegitimate drug use. For example, Opal told me: A lot its by myself but uh, you know I always do when my dealer is around uh, not too much, you know, but always some I have friends who I sniffed

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up with but uh, also people who did not by any means, you know, blow coke, like ever. While these associations did not include openness about weight control in general, illicit substance users associated, nonetheless, with others involved in using drugs. As a result, womens secrecy largely centered on weight management when dealing with other members of deviant drug subcultures. While illicit users were generally discrete about their drug use in casual everyday conversations with their peers, they were able to let loose while in the company of others engaged in substance use. In addition, much of the secrecy reported by street drug users surrounded their motivations for (and consistency of) instrumental use, rather than the drug use itself. Often, women were very secretive about the regularity of their drug use. Despite the fact that illicit users could be relatively open when in the company of fellow drug users, the instrumental lifestyle still involved other forms of secrecy. For example, women were extremely reluctant to talk about this with friends and family who did not participate in any drug use. Sasha, a twenty-one year-old college senior reported that her family was relatively unfamiliar with drugs: Absolutely not, no way, uh uh They would shit. I mean, look, let me tell you that my family is completely against drugs so I dont know why they even let me come to [this school]Really they just have no clue about anything. Theyd be like that woman who thought that a bong was um, a horn If they knew about any of this, well I bet my dadd say that I was going to end up jumping out of a window. This type of secrecy might be generally expected among illicit users in their everyday interactions with non-users. At the very least, drug users are aware that

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their behaviors are illegal, and will always require a certain amount of discretion. Reactive Costs of Deviant Behaviors Secrecy was common among women who were involved in excessive weight control, as previous research on women with eating disorders has demonstrated (Rich 2006). Most often, women reported not wanting to be labeled as crazy, or anorexic, as reasons for hiding their weight control methods. However, if womens weight management led to excessive weight loss that became obvious to others, secrecy was not always easy to maintain. Regardless how diligent women were about hiding their instrumental substance use, many felt as though others were suspicious that something had changed. Since stimulants are very effective at controlling appetite, and were used for that purpose by all respondents, for some, weight loss eventually became evident. After a relatively short period of dramatic weight loss, Shannon, a nineteen yearold student from Wisconsin, said: I would always wear tight clothes and people would make comments like youre so skinny, and you lost weight. But I knew they knew something was up I just ignored it so I could keep my friends but not face it. Id just walk away or ignore it or whatever I guess I had some really significant weight loss. For a few women, feedback from others was inevitable. Eventually, someone said something. Participants in this research reportedly lost between five and forty pounds. Generally speaking, others might not have noticed the loss of five pounds. However, losing ten pounds may have caused people, especially close friends or

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family, to take note. Women reported that family members, especially those who saw participants at random intervals, were the most likely to notice changes in their body weight. This may have due to the fact that seeing someone everyday, as their peers did, meant witnessing small levels of change over time, whereas after a period of time between face to face meetings large changes were more evident. In addition, family members may have been more willing to vocalize their observations. For Janelle, a college junior, these questions served as positive reinforcement in the beginning of her deviant career: I loved it, seriously. Definitely people could see, but not too many people actually asked me anything about it. I would just uh, tell people that I was on a new, on some diet. I also told my friends I was running in the morning but they totally know I wasnt doing that Uh yeah, I mostly just lied and said I was on a diet. The loss of twenty pounds or more however, meant facing more questions from others. Many participants also expressed concern over their ability to continue instrumentally using drugs if somehow others became aware. Importantly, women did not want to be labeled for their behaviors. In addition, many did not want to face pressure from others to stop using. Many women reported high levels of satisfaction with their methods and were unwilling to give them up. Whether the threat was perceived or real, a lot of women were not willing to talk to others, fearing intervention. This fear was often more acute during the times women spent with their families, such as winter or summer holidays away from school. For example, Shayla, a college senior studying business, told me: My parents would make me stay home and try to force me to eat. My mom would make all this food and you could tell she was trying to get me to gain

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some weight. My Dad never did anything about it, but my mom was upset about my weight She always told me you look too skinny. Close friends were also privy to changes in womens body weight. However, participants usually did not report hostility from others regarding their weight loss unless their appearance started to resemble emaciation. Generally, women maintained body weights that were more or less accepted or praised by their peers. As a result, most women were able to keep their behaviors private, and avoid pressures from others. It was evident that social evaluations affected individuals behaviors. While womens personal feelings regarding their deviance certainly affected behavioral practices as well, evaluations from others were hugely influential. However, if individuals perceived feedback regarding a particular behavior or condition as negative, it fostered reluctance. As Bowers suggested, knowing that ones associate strongly disapproves of some behavior will make an individual more reluctant to engage in it. Such behavior may cost him the esteem or friendship of his peer (1968:370). On the contrary, Merton (1949) suggested that disapproval from others will not always have a strong relationship to deviant behaviors. Further, peer groups among deviants may shield individuals from social disapproval. On the other hand, deviant peers may also be the ones giving negative feedback directly (Turner 1959). The ways in which participants organized their behaviors was shaped in part, by these social realities. Many women felt as though the nature of their particular form of deviance, in terms of the potential reactive costs, demanded complete social isolation.

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SOCIAL ISOLATION AMONG DEVIANTS

As a result of keeping deviance hidden from others, participants lived in relative social isolation regarding the unconventional aspects of their lives. Commonly, women in this research experienced detachment regarding their nonnormative behaviors. Unlike the self-injurers described by Adler and Adler (2005), loners who wanted to concentrate fully on themselves during the act, instrumental drug users preferred to be alone primarily so others would not find out what they were doing. Fear of stigma, which is further discussed in chapter six, was a main driving force behind this phenomenon. Some women did report that they had rituals surrounding drug use, which they enjoyed, but isolating themselves during episodes of drug use was a personal choice. Illustrating this point, Ophelia, a twenty-one year-old junior, told me: I did coke and stuff at parties, its not like I have a problem with drugs at all. I mean, I dont really care what people do, whatever, Id do stuff with my friends and drink. But mostly since I was using all the time, I ended up keeping it to myself because, uh, I dont know... I was embarrassed how much I cared about being skinny. For many instrumental users, the ability to keep non-normative behaviors private while achieving a conforming social identity was a benefit of controlling weight in this manner. Often, women feared that if others found out how women were controlling their weight, the benefits they associated with their weight control would be diminished. Generally speaking, women enjoyed the idea that others thought they were naturally thin.

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Deviant Associations of Instrumental Users Illicit drug users were required, in one form or another, to associate with deviant others (namely drug dealers) in order to obtain their preferred substances. However, the presence of the college campus and the associated lifestyle, was a significant difference between women in this research, and the average cocaine user in the United States. In contrast to the general social stereotypes that surround drug dealers, women in this research commonly bought their drugs from fellow students on campus. Sabrina, a college senior and straight-A student, described her drug dealer: He goes to school here and Ive been buying from him for like, three years, which is good cause he is easy to find and I can trust him. I know he gets his stuff from some guy in [the city]. Hes not huge big time or anything I think he does it for the money, he really likes to party but I think he is about to graduate too. Obtaining substances from others on campus complicates the common stereotypes associated with both drug subcultures and the black market. Two sociological studies have focused on drug-dealing networks on college campuses (Mohamed and Fritsvold 2006; Tewksbury and Mustaine 1998), but otherwise very little is known about this particular black market. College students who sell drugs tend to be demographically representative of their universities. In addition, they generally have privileged backgrounds, sell only during their college career, and most go on to pursue legitimate occupations (Mohamed and Fritsvold 2006). Accordingly, for many participants of this research, buying drugs meant associating with both users of illicit drugs and those involved in illicit drug sales on their campus: their peers.

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While women using illicit substances were comfortable associating with others on campus who were involved in both using and selling drugs, they were usually not comfortable disclosing to others the specific motivations for their continued use. Rarely did women tell their suppliers that they intended to use drugs as a form of weight control. Odele, a twenty-one year-old college junior, laughed as she explained her frequent interactions with her drug dealer: Now listen (laughs), I believe that he thinks that I am a total nut job. I go to the house all the, I have even asked him about this, whether I see him more in a week than other people and he says no, but I go over there all the time it feels like I have never talked to him about it really, I cant see myself doing that. Keeping this aspect of their lives private and thus omitting pieces of information about deviant actions when interacting with others, protected participants social identities. In this sense, illicit drug users relationships with their suppliers resembled licit drug users relationships with their doctors. Both types of instrumental users employed forms of deception, lies or secrecy when dealing with the gatekeepers of their chosen substances. However, women who associated with campus dealers for their drug supplies were not protected by laws of doctor-patient confidentiality. As such, at least a few people on campus were aware of womens drug use. Unlike licit substance users though, women using street drugs had access to a (relatively small) community of illicit users who could offer support or guidance.

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Normative Associations of Instrumental Users Outside of instrumental drug use, participants reported fairly average, conventional, social lives. While they remained secretive about their weight control methods, women generally resembled normative college-aged women. They attended classes, hung out with friends, worked, went to movies, attended parties, pursued hobbies, dated, and lived lifestyles that are associated with being young adults in college. However, for women using substances daily, habits and behavioral patterns often limited their activities to those in which such use was possible. Pharmaceuticals were relatively portable. As long as pharmaceutical drug users had their prescriptions, they were free to do just about anything they pleased. This included things like taking long trips home during school breaks, spending time with old friends, or traveling. For illicit substance users, this was not the case. For many women who used street drugs, finding their substance of choice while away from school was tricky. In addition, the drive to maintain the privacy of their drug use led many illicit users to avoid routine college activities, such as road trips or school breaks back home. Thus, instrumental drug use commonly constrained how individuals organized their relationships with friends and family. First of all, maintaining a daily drug habit required individuals who wished the keep behaviors private, to build walls around certain aspects of their lives. For example, many women made attempts to compartmentalize their behaviors. However, I often heard reports from participants who felt that their friends or family believed them to be reserved, or elusive about their lives. Selena related this phenomenon to me when

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she told me a story concerning someone close to her: One of my good friends told me that she knew that I was uh, a private person. She was asking me about how it was going with my boyfriend but she uh, apologized for pryingI didnt know that people thought that. Not all women reported such feedback from others, but certainly a large enough percentage to make this pattern recognizable in my data.

PRACTICAL HURDLES

As a result of keeping the majority of their unconventional behaviors private from both deviant and normative associations, women faced any practical hurdles that came along completely on their own. Generally, women had a wealth of information available to them in terms of non-normative weight management, as media on eating disorders was widely available (Adler and Adler 2005). However, womens use of drugs for weight control differentiated them from the larger social explanations, narratives, and understandings that surrounded disordered eating. The process of initiating and maintaining instrumental drug use, as discussed, was a solitary pursuit. As such, women were forced to navigate the practical problems encountered in maintaining their deviance alone. Unlike women who utilized the non-normative methods commonly described in the literature on eating disorders, women in this research had no frame of reference for their drug use. Many women certainly identified with common narratives concerning some aspects of eating disorders, but a piece of the puzzle was missing. Participants did not have access to information regarding

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substance use for weight control. Simply put, no one was talking about it because nobody knew about it. Health Consequences of Instrumental Drug Use Very little is known or discussed in the popular media concerning the weight managing behaviors described in this research. Consequentially, women were left to create their own systems for instrumental drug use. These systems included assessing the health risks of their substance use. For example, women had to determine the amount of drugs that was safe, physically speaking, as well as the dose required in order to achieve the desired results. In addition, women interpreted signs and signals regarding changes in their bodies using systems that were largely self-created. While individuals in society generally might feel alarmed at rapid or excessive weight loss, research participants celebrated it as an achievement. However, some women experienced changes in their bodies other than weight loss. For example, Carla, a twenty year-old college junior, explained: Sometimes I can uh, feel like, my heart beating a little bit faster. Like a little bit It definitely raced sometimes but not a lot And it sometimes gives you this taste, um, metal-ly, in your mouth. That happens when you really dont eat. When physical signs like these presented, women dealt with them on their own. While licit substance users could have mentioned any worrisome physical symptoms to their doctors, many didnt. Often women reported withholding negative information from their practitioners in order to protect their prescriptions. For example, Cheyenne, a twenty year-old junior and former crosscountry runner, said:

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These appointments are short ya know? So I just kinda um, say things are good, you know whatever. Its working Sometimes in the beginning he would ask me how uh, or why I thought it was working and Id give some bullshit storyBut its not like a physical exam or anythingHe doesnt ask too much about my health besides asking about how its going with my dose. Given that many women visited psychiatrists for their medications, appointments did not generally include any physical examinations. In addition, most women employed secrecy with their doctors. As such, any health problems that arose from womens drug use often went undocumented and untreated by the medical establishment. Illicit substance users, like licit users, most often dealt with any health related concerns that resulted from drug use, on their own. The types of health questions or problems that women reported varied, generally according to the amount of drugs that individuals were consuming. Higher doses, or prolonged chronic use, most commonly led to health consequences. For example, Sammy, a college sophomore, recalled an incident that was related to her drug use and health: Well, I passed out once, full on I was standing by my closet folding some laundry and I sort of uh, fell into the clothes that were hanging there. I hit the wall with my head Everything went totally black But it only lasted like, um, five seconds... It was weird but it didnt like, scare me or anything. Like Sammy, a few participants reported dizzy spells, which were sometimes blamed on caloric restriction instead of drug use. In addition, many women explained that consistent low calorie diets caused feelings of weakness or disconnection. All participants reported that using drugs had effects on their moods and energy levels. For many, this aspect of drug use was a two-sided coin. First,

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stimulants gave an initial boost, a general feeling of well-being for a period of time following consumption. However, many women reported that these substances, after time, made them irritable or cranky. Savannah, a twenty-three year-old college senior, spoke to this: Id be gritting my teeth, just so irritated with the world You know, especially in the morning, Id sometimes just feel like shit Youd want to stay away from me, trust me on that one. Reports of mood swings were quite common, and generally regarded as an annoyance by participants. In addition, stimulants interfered with womens normal sleeping and eating patterns. These factors, coupled with stimulants specific pharmacological effects, understandably led to the shifting moods reported by participants. Financing Drug Use Aside from the issues concerning health, another practical problem that women faced was how to finance their drug use. Obviously, the costs associated with this deviant lifestyle varied according to the regularity, type, and dosages of drug use. In addition, costs varied by specific substances. For example, illicit drug users, who tended to prefer cocaine, faced relatively high street costs for their supplies. On average, women using cocaine reported the drug to cost between fifty and one-hundred dollars per gram. Pharmaceutical users reported variations in cost as well. However, costs for licit substance users were generally reported as a per month estimation, whereas illicit users reported their costs by the

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drugs weight. Prescriptions tended to cost women between forty and twohundred dollars a month. Supporting a cocaine habit placed different levels of strain on womens finances based on how much and how often they used, as well as womens general financial situations. For a number of women, money flowed from their families. Some participants had hefty allowances, enough money to easily support drug use. I asked Odessa, a twenty-one year-old college student who received such an allowance, if she told her parents what she spent money on. She said: They dont really know. I mean, I think clothes and going out or whatever, they dont really ask Once my dad found shit in my bathroom though, and he asked me about it. Not money I mean, he asked about if I was using drugsI dont think they know. Some women, on the other hand, did not have parents who were willing or able to support them in this manner while they were in school. Even those who received moderate support were sometimes forced to finance drugs on their own. Specific means for securing monies ranged greatly among participants. Many women held down jobs while they went to school. Outside employment was not generally full-time, but for many, it was enough to supplement their income nicely. Sally, a junior studying biology, reported a scheme she used though out college: I sign up for eighteen credits, then my parents pay my tuition. Then I wait til school starts and drop classes, so Ive got like, uh, twelve credits I have it set up so that the refund from that tuition you know, goes into my bank...Ive done it a few times I get a chunk of money.

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Contrary to my expectations, participants did not report engaging in illicit drug sales in order to fund their drug use. While a few women had acted at one point or another as a middle-man hooking friends up with drugs, regular systematic dealing was not reported. Although women did not become sellers themselves, many reported that the more time they spent immersed in drug subcultures, hanging out with their dealers or fellow users, the less money their drugs eventually cost them. However, given that most illicit users were relatively secretive about the regularity of their use meant that dealers were privy to more information than were womens fellow drug users. Close relationships with dealers were useful for some women, but price structures for cocaine were still largely set by the local black market. Accordingly, even though frequent contact with the drug world may have sometimes yielded lower prices, drugs ended up being a major financial liability in illicit users lives. Pharmaceutical users reports of financial strain were very different from street drug users experiences. Since women did not obtain their substances from the black market, their costs remained relatively stable. Women were able to forsee their drug costs depending on how many prescriptions they were filling, and what types of pills they received. In addition, many women were able to, at least partially (if not wholly), cover the costs of their medications with health insurance. A thirty day supply of Adderall cost one women roughly forty dollars. That same supply, same brand, same dose, cost another participant around one hundred dollars. The former had health insurance, the latter paid out-of-pocket.

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Financing drug use certainly put constraints on many women, regardless of their substances of choice. At times, individuals use patterns would be affected by their pocketbooks. For many women, times of plenty called for more frequent, or heavier use. Likewise, when money was scarce, many women were forced to use less. Plenty of participants reported a regular system for funding drug use. Women used certain amounts regularly and figured out how to continually pay for their supplies. While women did report shifts in their use patterns, many participants maintained fairly stable habits for significant periods of time. The relative privilege of women who participated in this research may have accounted for their ability to fund continued drug use. In addition, these types of weight managing behaviors may have been largely self-selected by those who were able to support consistent drug use in the first place. For example, there could have been women who employed extreme weight control techniques who would have adopted drug use as well, if not for the cost. Instrumental users reports of financial strain were common during interviews. However, most did not report money to be the cause of much concern. While one might think that, especially for illicit drug users, finances would eventually force them out of the deviant career, this was generally not the case.

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CHAPTER SIX Stigma and Identity Among Instrumental Drug Users

Within the sociology of deviance, researchers have shifted their focus from the structure of deviant acts (Akers 1968), to the consequences that social reactions have on individuals non-normative behaviors (Gibbs 1966). While extreme weight control was deviance that many women deliberately chose and often described as lifestyles, the lived experiences were contradictory in nature, coupling rewards with pain and anxiety. Much of the anxiety and secrecy surrounding womens drug use centered on the avoidance of stigma. Goffman described stigma as an attribute that is deeply discrediting (1963a:3). Lemert (1967) suggested that stigma was a negative label. In addition, Goffman suggested that for stigma to exist, a language of relationships, not attributes is really needed (1963a:4). As such, stigma results from social meanings placed upon individuals attitudes, behaviors, or conditions, it is never inherent. From the perspective of labeling theory (Becker 1963), deviant behaviors were largely affected by the processes leading to the stigmatization and isolation of individuals. Stigma marked individuals as somehow negatively different, and consequentially less than. In society, stigmatized individuals were reducedfrom a whole and usual person to a tainted, discounted one (Goffman 1963a:3). Often, stigma resulted in discrimination, as individuals bearing the mark were deemed not quite human (Goffman 1963a:5). First, knowledge that

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drug use could result in stigma affected the way that participants organized their deviant behaviors, as discussed in the chapter five. In addition, the potential for stigmatization affected the ways in which women constructed their identities and accounted for their deviant behaviors. As such, this chapter analyzes instrumental drug use through the lenses of stigma, social identity, and deviant accounts.

INSTRUMENTAL DRUG USE AND STIGMA

Previous research has demonstrated that women were largely correct in fearing stigma, as individuals in our society have generally labeled those with disordered eating as deviant (Mond, Robertson-Smith, and Vetere 2006; Rich 2006; Rich, Holroyd and Evans 2004). In addition, women were very aware of the dominant cultural messages regarding the potential negative social connotations of drug use, as danger messages concerning drugs were ever present in society. In this context, Claire, a nineteen year-old college sophomore, said: How the hell am I not supposed to think that people would shit all over me for it? Oh, I know the way... never say anything about it, its impossible otherwise... They wont notice, its hard to You have to hold off on people or they really will think that you are bad... Its a game, and um, I think that I am pretty well-played... For me, you gotta understand that uh, I have sampled a few drugs, and they are, you know, they are fine, its uh, all good The chicken-shit people that wont ever do it get to tell me all about it. Participants were raised in the D.A.R.E. generation, a cohort that was subject to more intense and frequent anti-drug messages than ever before. However, historical warnings from authority figures concerning drugs were grossly exaggerated, and were identified as such by many women. Over the

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course of time, these cautionary warnings lost their credibility. In fact, danger messages on drugs were often likened to urban legends. This was supported on the interpersonal level, given the evidence concerning drug use that women witnessed in their everyday lives. As a result, many participants discounted social messages concerning drug use that originated from authority figures altogether. In other words, women knew that drug use was not wholly conventional or acceptable, but many did not believe it was as detrimental as people often made it out to be. Like a lot of young drug users, participants shared some counter-cultural ideologies that supported the continued behaviors. For example, Sabrina, an academically focused twenty-one year-old senior, told me: Hey, well, newsflash I know that its not cool So like, I mean, what do you think? What do you think your friends, or uh, your parents, what would they think? ... Theyd hate, I mean, look, its like, face it, drugs are bad... But I think its ridiculous... As I said, its not that bad, its not ridiculous at all... I hate the thought that people really believe its that bad, I mean seriously, drugs have their place too, like, for some things. This thought pattern was common among participants, and served as a means by which women were able to lessen the negative impacts of their behaviors, especially to themselves. However, regardless of womens personal adjustments to their ideologies concerning deviance, many were cognizant of the potential for acquiring stigma for both their drug use and disordered eating. Parsons (1964) suggested that accountability was an important dimension in the study of deviance. For example, individuals suffering from illnesses may be less likely to acquire deviant labels, as the sick were not considered as responsible for their actions. While drug abuse and disordered eating were

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diagnosable syndromes within the medical field, generally speaking the public would stigmatize individuals participating in these behaviors. Participants were acutely aware of this social fact. For example, Sorin, a twenty-four year-old recent college graduate who had gone through medical treatment for her instrumental drug use, explained: In [the treatment center], we were always talking about how its a disease, yeah... Maybe its what we needed... Its not your fault, its no time for placing blame but... But what we do, its a medical problem and youve got to stop cause youre making it worse... Yeah, I suppose I thought that anorexia is a disease, but I was the only one who ended up there because of a drug addiction. There were all these young girls and they got me down, I mean... First of all they were thinner than me (laughs) They thought that they were different from me. Instrumental drug users did not generally believe that others would excuse their behaviors because they were sick, and couldnt help themselves. Instead, women assumed that if others were aware of their behaviors, stigma would result. Becker (1963, 1982) reported that individuals must learn not only the motivations and conventions for deviance, but also how to navigate these negative reactions and labels. Goffman suggested that stigma resulted in spoiled identities (1963a). Individuals with spoiled identities felt less control over their lives, as well as decreased ego integrity and self-derogation. However, researchers should expect variance in how individuals react to stigma. For example, Olicia, a twenty-one year-old college junior studying fine art, told me: I am not always even trying to give two shits about what other people have to say about me (laughs), dont get it wrong... Check it out, Im talking big ideas here, what people dont know is that it doesnt matter... See, it doesnt really matter what other people think at all... Could you use some freedom? Sure. Choose to think whatever you want... I dont want to care what everybody

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thinks, and I mostly dont. What a waste of uh, energy I mean, I care uh, about my weight and all that, but I dont care about everything everybody says. Harris and Hill suggested that, far from being passive receptors of deviant and stigmatic labels, individuals and groups display various and versatile responses to labeling (1982:164). Womens means for handling the reactions of others were personal and complex, never universal. However, is it important to note that generally speaking, most people who engaged in deviance denied it, as discussed in chapter five. As a result, non-normative behaviors were often of transitory social significance in individuals lives (Scheff 1966). Womens focus on conventional social goals and the achievement of social acceptance could suggest perhaps, that participants would be rule followers and not norm-breakers. However, the instrumental users described in this research wished to appear normative. For example, Claudia, a nineteen year-old college freshman told me: Partly that everyone might find out... Anyway, people wont though, and thats good uh, I mean, my friends they uh, would, um, huh, I dont know but it makes it hard... Once uh, people leave I can do whatever I want in bliss, but, not in front of them, I mean dont mention it, not this... Otherwise its a bust... My friendsd be mad, or weirded out, or whatever... I guess Id feel uh, um Exposed. However, the desire to appear normative did not require that individuals behaved normatively, although it did require discretion when dealing with others, as discussed in the previous chapter. The goals that women strived for were based on social constructions of outward beauty, and thus governed solely by appearance. Like gender, age, or race, beauty was something seen and judged from the outside, and was readily

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visible in any and every social interaction. While others were witness to individuals outward appearances, they were not able to discern anything about the processes involved in their creations. What appeared normative seemed normative. Consequentially, deviant behaviors were usually not openly evident. Generally, participants were able to pass as normative in their everyday lives (Goffman 1963a). However, the ability to pass was differentiated between women using illicit versus licit substances, as well as between women who maintained a relatively normal weight range, versus those whose weight loss was dramatic and therefore more apparent. For example, Savannah, a twenty-three year-old college senior, reported that others noticed changes in her body, and discredited her appearance: Like, hmmm. Lets um, go with that, its fine, it good... Honestly though, its all hanging out there... Its like when you wake up after a long night of partying, and uh, its like the night before you thought you werent drunk, or uh, that drunk. But then when you wake up in the morning, sober, its so different... I was so thin and I must have been dreaming to think that my friends didnt notice. And now Im like, oh suddenly Ive got it all wrong and Im an idiot... I feel so stupid to think that I really believed that no one knew anything. Savannahs roommates eventually intervened in her instrumental career. She was surprised and disconnected by others reactions. As illustrated in Savannahs explanation, she was unaware that her behaviors were detectable. Instead her construction of how her friends perceived her was incongruent with others realities. Whether women were confident that their deviance was detectable or invisible affected participants identities and accounts concerning their deviant behaviors. As such, these components should also be considered in terms womens instrumental drug use. First, I begin with a

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discussion of womens identities, and then move on to discuss participants accounting strategies. Instrumental Drug Use and Identity Theories concerning individuals identities have been influential in sociological research on both drug use and eating disorders alike. In this research, identity development was strongly affected by deviant behaviors and vice versa. For example, Jane, a nineteen year-old college freshman, told me: Im just always trying to figure out how. Without making everyone think, um, think Im crazy, but I dont think Im crazy... I mean, what is it that Im thinking? ... You know, uh, so its like, definitely important to me... to be skinny, or svelt, thats my favorite... But I really like, dont want my friends to find out... It shouldnt be the major part of, um, me... Im not really flawed, or uh, really scarred and looney. Im not like those insane, uh, really crazy, oh, you know, anorexic girls. Janes deviant behaviors raised questions for her, concerning the construction and integrity of the self. Hoskins suggested that the symbols, images, and metaphors of a culture become integrated into girls identities (2000). However, despite the accompanying hardships of instrumental drug use, many women did in fact choose extreme weight control techniques as a means of constructing the body and ultimately the self, which certainly encompasses identity. The concepts of identity and the self linked actions to social structures, which precede individuals and provide potential social roles. These roles include sets of acceptable attitudes, behaviors, and conditions. Womens various social roles, interpersonal characteristics, personalities, and action patterns comprised their selves. The self has been likened to a reflection of society, in that it is an

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organizational construct with many facets. Viewed in this way, the self is not a single psychological entity, but a dynamic role taking mechanism, capable of interaction in many social settings. Mead (1934) and Cooley (1902) theorized that people come to know the self and construct identities through interactions with others. According to labeling theory, individuals concepts of the self emerged, and were maintained, through their social relationships (Thoits 1991). Individuals evaluated themselves from both the perspective of their peers, as well as others in society generally (Mead 1934). Stryker and Serpe (1982) described these self-evaluations as individuals social identities. However, the processes leading to the creation of womens social identities were not strictly bound by reactions from others. As Thoits explained: A crucial symbolic interactionist insight is that social control is largely a product of self control (Shott 1979). That is, role-taking abilities enable individuals to view themselves from the imagined perspective of others reactions regarding contemplated courses of action (1991:222). Despite the fact that social identities resulted from how women perceived others real or potential reactions, women remained partially in control of shaping their interactions. Accordingly, individuals retained some power over their social identities. Thus, women were often able to control their self-concepts and identities by controlling how others viewed them. For example Cady, an eighteen year-old freshman Adderall user, explained: You can tell that I dont look like, that bad or whatever... I uh, why spoil it? ... There are inconveniences I guess, but its not really bad... There are a lot of things that most people dont know, but thats always true, right?... What if I

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wonder what Im doing, but thats my crap, and uh, Id probably feel worse... Its better this way, thought you should know I know its probably not the best solution but it would be so much worse, you know, Id feel worse I dont want to see what happens if other people know. Id feel so horrible. Important to this concept was the notion of taking the role of the other. Since individuals interacted with many others, it followed that they would have numerous selves and others whose evaluations were of consequence. However, despite this level of personal control regarding self-concept and potential stigma, individuals nonetheless faced the risk of deviant labeling by their peers. In other words, women remained partially in control of the processes leading to stigmatization, but they did not retain total control. Individuals who were successful in their social roles and evaded stigma, secured their statuses as conventional. This process often resulted in solidifying womens positive self-concepts. For example, Jessica, a twenty-two year-old college senior studying psychology, said: Anyway you might not understand but, its different, um, the details... I read that girls who starve themselves are depressed, and they said that its because your mom pushed you oh, hard, and uh, Im like, how is this true? I mean, Im not depressed, Im not going whoa is [Jessica], or like I have low selfesteem... I think that that is a myth... I feel just fine, seriously, uh, yeah I mean, I feel good about myself. Where do you see that? However, failures concerning social roles often resulted in the degradation of individuals self-concepts (Callero 1985). Consequentially, individuals may have changed their behaviors in order to align themselves with cultural expectations, as lowered self-concepts caused psychological distress (Thoits 1991). In this way, expectations in terms of identity exerted pressure on individuals to act in accordance with their identity standards. Stress was reduced when role standards

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were met and as a result, individuals enjoyed positive self-concepts. For example, many respondents did not self-identify as having an eating disorder. Generally speaking, conventional identities were common among women with problematic eating patterns. In addressing this phenomenon, Degher and Hughes explained that often women with disordered eating felt as though they were not anorexic enough, not skinny enough to warrant the label (1991:215). In this research, when I asked respondents whether their drug use negatively affected their sense of self, many said no. For example, Christine, a twenty year-old college junior, explained that she never worried about having a drug problem, she was just too wrapped up in how well it worked and how great [she] looked. Often it was not until worried friends or family members intervened that women acknowledged that their behaviors were affecting their normative social relationships. However, as previously discussed, interventions from others were rare. This was especially true of licit drug users, as a pill habit was easy to hide, and the general public was not as concerned with drugs prescribed by the medical establishment. However, it was evident for some women that others were, at one point or another, aware that participants engaged in deviant behaviors to some extent. As such, womens identities may have been influenced by the knowledge of others. This led a few women to experience certain daily interactions through a socially stigmatized identity. For example, Selena, a twenty-two year-old college senior who was treated for an eating disorder while still in high school, explained what it felt like to have peers know about her private behaviors:

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One of the awful parts was that um, A. For one thing, my parents put me in that situation, and B. Everyone knew what was going on... It was so embarrassing, I didnt want to go to [the treatment center] and then I didnt want to go to school ever again too. Plus at school I felt like, um, everyone was talking about me... I promised my friends that I would stop... But then we never really talked about it again... They would talk behind my back about it. However, for the most part, the nature of these deviant behaviors, coupled with individuals chosen secretive lifestyles, shielded women from severe stigmatization, even from themselves. Cote and Levine (2002) explained that individuals explanations for their behaviors were offered when action patterns threaten identities. In order to understand how women neutralized these behaviors through their explanations, which heavily influenced individuals identities, I move on to analyze participants accounts for their non-normative behaviors.

ACCOUNTING FOR DEVIANCE

It was no secret that participants faced the risk of stigmatization for their behaviors. Despite this fact, most women chose to forge ahead and remained committed to their deviant careers. For many, the ability to do so was strongly supported by personal understandings of, and accounts for, deviant behaviors. Efforts to explain and neutralize unconventional behaviors to others and oneself through aligning actions was often the focus of sociologically framed deviance research (Fritsche 2002; Hunter 1984; Mills 1940; Orbuch 1997; Scott and Lyman 1968; Stokes and Hewitt 1976; Sykes and Matza 1957). Offering accounts

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normalized deviance to others as well as to oneself, and affected the development of individuals social identities. At some point, those who viewed deviant actions as advantageous must have rationalized, if only to themselves, reasons for actually adopting the behaviors. For example, Opal, a twenty year-old college sophomore and cocaine user, said: I didnt have to think about it in the beginning, like I said... I mean I thought about it but what I mean is that I was doing coke already, like with my friends and stuff... But its not oh yeah, easy, sure no problem to just suddenly try to turn it up a notch. You know, like, I didnt already know where to get coke for awhile and that was not easy... I guess you could say that I kept after it, and for a lot of time... Because, um, because it was worth it. The ability to rationalize behaviors has been credited for individuals decisions regarding whether or not to participate in deviance. For example, many women in our culture are aware of the potential benefits of thinness, but are unwilling to cross normative boundaries to achieve this ideal. They may be unable to neutralize, even to themselves, the consequences of particular norm violations. As a result, many women choose not to adopt such practices. In contrast, Fritsche (2002) suggested that those who were able to neutralize the potential negative consequences of non-normative behaviors were more likely to initiate deviant actions. This was heavily influenced by individuals abilities to construct accounts. Through accounting strategies, women felt increased amounts of control over any stigma they perceived to be associated with their deviance. In addition, the drive to account was often based on how individuals perceived the potential benefits, both socially and to the self, of their specific behaviors (Fritsche 2002).

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This phenomenon was ever present in participants narratives, as many women perceived that social perks were associated with their weight management. For example, Cadence, a nineteen year-old college athlete, explained: Anymore, its not a random thing, its um, based on a plan... Hands down being skinny is so much better than being, not skinny? But any old freak cant pull it off I mean everyone wants to be skinny, like seriously, but I dont know, people are so freaky... When you think of it, its no big deal, Im not sitting around thinking about what it all means... If I have to explain myself its to uh, my doctor, and thats just for the pills. The notion that maintaining a low body weight had significant positive impacts on both self-confidence and self-presentation, was commonly reported throughout this research. The process of accounting for ones behaviors has been shown to affect individuals identities (Foote 1951; Schlenker, Weigold, and Doherty 1991; Scott and Lyman 1968). Offering accounts for deviance in order to normalize actions was a routine part of everyday life for participants in this research. In fact, many instrumental drug users seemed focused on their accounting strategies during research interviews. For example, a handful of interviews were dominated by narratives that worked to neutralize disordered eating and drug use through accounts. Jamie, one such participant, asked: Is it like your other people in this study so far? Its weird to ask, but you know, I uh, just never heard of it and its weird... But really I dont even take that much, Im sure that you have already heard, I dont know, worse... Im not as bad as I could be, Im like, I have friends that do drugs that are way worse... [Its different] because it comes from my doctor What do other girls say?

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During these sessions, women consistently referenced various interview questions back to their personal accounts for deviance. As such, women were negotiating their identities and navigating the waters of stigma, even through their interactions with me as a researcher. Accounting for Instrumental Drug Use The cultural messages transmitted to women regarding their bodies had significant consequences for individual behavior. This was true of women with a history of eating issues as well as those whose problematic eating developed after the discovery of drugs. This research suggests that instrumental drug use, which hyper-conformed to a specific set of cultural goals through non-conforming means, was often rewarded in society with positive evaluation, despite its seemingly deviant nature. For example, Jane, a college freshman said: Better have to lay it on thick, its just, whats it supposed to be like? Well, I guess its all like, positive... It is a big deal, your weight does matter. People try to say that it doesnt but oh man, let me tell you that its not in my head... I could prove it, people treat you so differently Now its like, I dont even know how to explain it, its just way better. This positive evaluation was generally based on false assumptions from others regarding how women achieved their thin bodies. Consequently, the type of deviance portrayed here was treated differently by others than negative deviance (Heckert and Heckert 2004a), or behaviors that strayed away from cultural expectations and were negatively evaluated. Through reinforcement, society effectively communicated to women that being thin was a critically important cultural ideal, potentially overriding health

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concerns. For example, Sonya, a nineteen year-old college sophomore laughed a bit when she said, Id rather die young and skinny than old and fat. However, respondents who resorted to deviant means to reach this cultural goal were aware that their actions were not socially acceptable. Generally speaking, the social ideals concerning the deviant behaviors that women engaged in were overwhelmingly negative, and would be responded to accordingly. For many instrumental drug users there was a strong resistance to the stereotypes that surrounded disordered eating, most of which pathologized the individual. According to Scott and Lyman (1968), individuals who participated in deviant behavior usually tried to maintain positive self-images through the use of accounting strategies. Respondents who resorted to deviant means in order to achieve a cultural thinness ideal were very much aware that their actions were not altogether socially desirable. Thus, participants offered many explanations for their non-normative behaviors. In fact, most women felt compelled to account for their non-normative behaviors. However, these accounts may have applied only to the self, as many women successfully kept their weight management private. Importantly, womens accounts that were aimed at neutralizing deviance generally, were foundational for the construction of womens social identities.

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Types of Accounts Sykes and Matza (1957) proposed a typology of accounting strategies that they termed techniques of neutralizations, which offered unique insights into the disparities between individuals attitudes and actions. Often times, there was a disparity between what individuals said, and what they actually did (Adler and Adler 2005). For example, Savannah, a college senior who was prone to analogies to explain herself during interviews, said: Strange things happen in your head, ya know? ... Its like smoking, see Ive been smoking for, um forever, and Ive tried, like trust me, Ive tried to quit. But the thing is that, like every time, no matter what, and Id quit for like, weeks or something, and then just watch. In my head, Ill come up with any reason to buy a pack of cigarettes, always... I remember I could sit in front of the gas station just trying to talk myself out of it... Yeah, I know what I should do, but I dont anyways, it doesnt matter. At the basic level, accounts were either excuses or justifications (Scott and Lyman 1968). Excuses were statements in which individuals admit the wrongfulness of their actions but distance themselves from the blame (Adler and Adler 2002:245). On the other hand, deviants using justifications, accept responsibility for their actions but seek to have specific instances excused (Adler and Adler 2002:245). As a graduate instructor I commonly heard accounts, such as my printer broke or my computer crashed, as explanations for missing school work. While I generally labeled this behavior plain old poor academic performance, offering excuses or justifications seemed to alleviate the apprehension and anxiety that students felt in confronting me concerning coursework. Individuals accounts worked for them, even if they did not work for me. In some instances it seemed

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that it was not even important whether or not I accepted their stories. This suggested that accounts were functional for individuals regardless of others subscriptions. This observation, rooted in my teaching career, heavily translated to this research. Some women reported that it was more important to maintain a positive self-image than it was to maintain others perceptions of their personhoods. Accounts were specifically useful for instrumental users in the quest to develop positive identities and self-concepts. Accounting Among Conventional Over-Conformists Commonly, conventional over-conformists used justifications in order to neutralize their deviance. Justifications were meaningful for women whose eating disorder led them to instrumental prescription drug use for two main reasons. First, respondents often voiced anger towards a culture that idealized thinness but offered no proper tools for its achievement. Many saw their behaviors as a rational response to an irrational cultural goal. For example, Cindy, a twentyone year-old college sophomore, said: When I was younger, I was fat. Fat. It was completely gross, how could anyone even look at me it felt like... All these pretty, thin, girls in my classes had their boyfriends and all of the attention, like all of it... So I wanted that I guess... I started making pacts with myself to stop eating sugar and I cut out all of this stuff like bread for awhile, and snacks I threw out my lunches... I was blowing everyone away with how I looked... One summer I came back to school tan, and thin, and pretty, people spazzed I loved it. These women often explained that their deviance was not the result of abnormal psychology, but instead represented a set of behaviors that were justifiable (even if deviant), rational responses to particular cultural goals. In other words,

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conventional over-conformists were able to construct their behaviors as necessary, or at least highly favorable, for social survival. Often, women accepted the responsibility for their actions, meaning that participants felt that they were in fact doing this to themselves. However, participants usually did not define their actions as altogether wrong, even considering that so many felt compelled towards secrecy. Many conventional over-conformists described feelings of pride for achieving what they perceived to be cultural demands. For example, Cassie, a nineteen year-old part-time student who worked and balanced college-life, said: I was all, welcome to the fast lane. This is what its all about. It shook everything up, I mean, people acted like I was, just cooler. It was like, the best thing that happened to me... Oh, no, Especially at first... I mean, I go back and forth cause its not like it was easy, but I know I became really obsessed with my weight... I felt like everyone thought I was so much prettier, I looked better. A few respondents, Cassie included, suggested that appetite-controlling medications should be prescribed for this type of instrumental use. This assertion suggested that some women felt that their weight control methods had the potential to be legitimated in society. In essence, they had constructed a value system that framed their behaviors as normative, regardless of whether or not society in general held these beliefs. However, until others shared this view, their behaviors remained generally regarded as deviant. The second main justification for prescription drug use among conventional over-conformists centered on trust in the medical establishment. For example, Charlotte, a twenty-one year-old college senior and aspiring lawyer, reported:

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No, I dont really think its that bad... Youve talked to girls about cocaine, you know what I mean? Huh, seriously, compared to that, this is all kinds of different... Because its a pill, I get it at [the pharmacy]. In contemporary culture it is not uncommon to have a daily prescription for health ailments. In the case of those with an eating disorder, the perception was commonly that concern over weight was a health ailment and ADHD/ADD medication could conceivably be prescribed for its treatment. In fact, one woman compared the desire to be thin to the desire to enhance sexual performance, which suggested that she viewed pharmaceuticals like Viagra to be not unlike prescription stimulants. In the absence of the possibility that licit stimulants could be used routinely in a sanctioned manner, women chose to self medicate, instrumentally using medicinal substances for off-label purposes. Accounting Strategies of Scroungers Scroungers were more likely to account for their deviant behavior with excuses in order to restore their self image or repair relationships (Scott and Lyman 1968). Respondents often admitted that using drugs instrumentally was wrong (or at least not altogether proper), but placed the blame in a variety of places (Scott and Lyman 1968). For example, Sonya, a nineteen year-old college sophomore and habitual cocaine user, said: I might be just making excuses, but please dont say it. Its just that its this one thing. You heard my speech, I dont plan to do it forever... Sometimes I wish I could quit now, but at the same time I dont really wanna and I think that as long as Im here, I recognize thiss the way it is... I want it, because I like it... it works. Examples of these areas included the college environment (which was full of drug use and abuse), friends who introduced them to drugs and got them hooked on

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the idea of psychoactive substances, and again, a culture that demanded that women be ultra-thin. These areas of blame looked very similar to those used in the justifications of the conventional over-conformists, but in this case, women admitted that their drug use was wrong whereas prescription drug users were not likely to view it as problematic. Accounting Strategies of Journeyers Journeyers, like conventional over conformists, largely offered justifications in order to account for their deviant behaviors. Also like conventional over-conformists, journeyers accounts centered predominantly on their trust in the medical establishment. One such justification given by Jade, a twenty-one year-old college junior, echoed those given by many journeyers: Probably I go to the doctor more than the average person anyways. Being obese is clearly worse than being on the skinny side They have other drugs people can use for losing weight, skimping, and I think that even though I dont always take the best care of myself but I know I am definitely healthier than most people. Besides my doctor told me things look good, blood pressure, cholesterol, all that. What Jade failed to vocalize, like many other journeyers and conventional overconformists, was that despite the fact that she seemed to be attentive to her medical needs through consistent visits with the doctor, disordered eating practices put her at risk for long term damage to her health (Sischo, Taylor, and Martin 2005). Justifications proved so effective at neutralizing journeyers concerns over their drug use that often women were willing to overlook the potentially

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damaging effects of their behaviors. For example, Jamie, an eighteen year-old, somewhat quiet college freshman, said: Wait, okay? I think it is kind of normal, I mean maybe beyond that... But I talk to the doctor, uh and have appointments all the time And uh, you know, hes asked, hows your appetite? or are you able to maintain your weight? and I just say yes... He doesnt weigh me but they do sometimes, and it is fine you know, Im not like way too skinny... Hed stop giving me the pills... If uh, he thought I had a problem. As discussed in chapter five, some health cues, or the potential for health problems, was quickly accounted for, and pushed out of the forefront of womens daily lives. Accounting Strategies of Opportunists Opportunists, like scroungers, offered many excuses when accounting for their instrumental drug use. Oceana, a twenty-two year-old college senior and habitual cocaine user, explained that she probably actually used less once she made the transition from recreational to instrumental use. She described herself as more in control of her instrumental versus recreational drug use, saying that she used less, even if she did use more often. In this account, Oceana admitted that her drug use was problematic, but minimized the impact of the deviant behavior by explaining that at least [she] used less than when she was a recreational user. Other opportunists excused their behaviors by citing college as the time in life to experiment with, if not use routinely, riskier drugs. For example, Ottavia, a twenty year-old sophomore and amphetamine user, stated I am a college student. I wouldnt be doing this if I had kids or a job or anything like that. Opportunists

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however, were systematically less successful at excusing their behavior to themselves as well as to others over the course of time. Although college may be constructed as a tolerable time to experiment with street drugs, participants who used instrumentally were outside of the normative boundaries for acceptable use. Most women reported a daily drug habit, one that was substantially more difficult to hide than those of the conventional over-conformists or journeyers. Differential Power of Accounts Scroungers and opportunists, who used street drugs, did not account for their deviance as easily (to themselves or others) in comparison to the conventional over-conformists and journeyers. Their common use of excuses certainly neutralized to an extent, the potential negative consequences of deviant behaviors, but these accounts never had the same lasting effects that justifications held for the former. Justifications may be used repeatedly over time, whereas excuses generally only apply to one situation at a time, and still define behaviors as deviant. As such, I suggest that the types of accounts participants offered can be analyzed in order to understand their entrenchment in, and commitment to, the deviant lifestyle. Findings from this research suggest that justifications are a more useful type of account than excuses for minimizing the potential for self or social stigmatization. Silva (2007) suggested that accounts are bounded by what the author believes will be culturally acceptable to her or his audience. By denying the wrongfulness of the act, justifications offered a more positive spin than

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excuses, on situations that would usually be deemed undesirable (Austin 1962; Cody 1990; Schonbach 1990; Scott and Lyman 1968). Therefore justifications were more likely to be culturally accepted by others or respondents themselves. The effectiveness of accounting strategies offered by many instrumental drug users hinged on their abilities to create justifications. For the instrumental licit drug users discussed in this dissertation, justifications were not difficult to construct. By combining the pressures women faced to be ultra slim with a deep trust in our medical establishment as rationalizations, users built deviant worlds that were extremely livable. Although participants in this research focused on achieving shared cultural goals and were thus conforming, individuals means to reach their goals represented various degrees of deviance. The more deviant the behaviors were, the more difficult it was for participants to construct effective accounts. Womens accounts were based on the degree and nature of their deviance. Generally speaking, pharmaceutical drug users were perceived both by themselves and others as less deviant than street drug users. As such, prescription drug use was more easily justified than illicit drug use. The normative goal of weight loss was the same for both categories, however, pill poppers limited themselves to drugs that were used legitimately in the practice of medicine, even if their use of the substance was illegitimate. This allowed many women to feel as normal about their drug use as others who took medications everyday for various health ailments. Women utilizing street drugs on the other hand, who offered excuses, were more likely to perceive their behaviors as potentially

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dangerous. Accordingly, they were more invested in hiding their deviant behaviors from others, and did not account for their instrumental drug use as successfully, or as vigorously. Justifying Deviance In order to create justifications for deviant behavior, women often relied on partially normative social scripts. For pharmaceutical users, a legitimate narrative was available for several reasons. First, the substances that they used were regulated by the government and legally available for medicinal purposes. As previously mentioned, some licit drug users suggested that pharmaceuticals could be routinely indicated for weight management. Social change of this nature would legitimate these weight control methods. Martins (2000) work on collective stigma management described members of the National Association to Advance Fat Acceptance (NAAFA), an organization that sought to redefine social perceptions and evaluations concerning body weight. NAAFAs members viewed social stigma as directly linked to the internalized oppression of shame (Martin 2000: 150). In order to minimize stigma, these individuals worked as a group to combat the status quo. Women who instrumentally used prescription substances, and advocated for medicinal use specifically for weight control, shared a similar ideology with NAAFA members, in that they located the problem of their behavior within dominant scripts concerning the body. However, instrumental users had no such organization with which to rally for their cause. So while I heard this idea asserted during a few interviews, this notion manifested as a personal opinion, not an organizational

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ideology. Nonetheless, this opinion highlighted the extent to which women viewed licit drug use as a normative and perhaps justifiable pursuit. Second, the drug education programs that many women went through while still in school were largely ineffective in defining licit substances as drugs. While participants were certainly aware of the negative connotations surrounding street drugs, pharmaceuticals specifically received little attention during their socialization. In the last few years the phenomenon of prescription drug abuse has received increased coverage in the mainstream media, but this was not historically the case. Accordingly, many participants were not socialized to deeply fear substances from the doctor, making their deviant means seemingly less illegitimate. Pills from the doctor were constructed as medicine while substances found on the street were defined as drugs. Third, pharmaceutical companies began to advertise directly to the public during participants childhoods, potentially normalizing the regular use of prescriptions. These combined factors represent the structural supports that were available to women instrumentally using licit drugs, supports that were not available to illicit drug users. Excusing Deviance Illicit drug users, the scroungers and opportunists, were more likely to account for their deviant behaviors with excuses. Excuses effectively alleviated womens anxiety regarding drug use, at least for the time being. Often, participants excuses centered on their personally projected time limit for the instrumental drug using lifestyle. Many women were not quite ready to part with

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their instrumental drug use yet, but suggested that eventually they would stop. This notion lessened to some extent, the potential negative impact that deviance could have on womens social and self-identities by suggesting that deviance would not always define and constitute who they were. Instead, their behaviors were a phase, and rather unrepresentative of their true selves. Consequentially, even if women felt that their drug use was wrong, placing time constraints on the behaviors lessened much of the perceived negativity. The Role of Social Evaluation Powerful as accounts may have been, the narratives from each type of instrumental drug user illustrated how influential social evaluation was. Even conventional over-conformists, the least likely to define their drug use as deviant, worked to justify their behaviors. These justifications were effective at normalizing womens deviance, but on some level, the need to do so in the first place indicated something problematic. It is possible that increased negative evaluation from others would pull many of these instrumental users out of their non-normative behavioral patterns. Barring that, respondents identified too many benefits, namely positive evaluation, resulting from the product of these practices. For many women, the benefits of using drugs for weight management outweighed the drawbacks. I suggest that negative evaluation may pull many women out of their deviant behaviors because their overall goals were conforming. Women in this research reported heightened sensitivity to social feedback, and often worried

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about social evaluation regarding not just their weight, but other spheres of life as well, such as general appearance, status, academic work, reputation, amorous relationships, friendship skills, personality, achievement and intelligence. Many women continually hid their weight controlling means from those around them. Generally speaking, participants expressed fear and anxiety over the possibility of being caught and labeled by others. As a result, much of their deviance went unnoticed and therefore unevaluated by those around them. In this context, instrumental drug use for weight loss was conceived of as rational, and was often enacted in a meaningful, calculated manner. Individuals who strived for cultural ideals, and over-conformed to social norms via secretive means, were often rewarded for it. Consequently, patterns of behavior that were potentially harmful to individuals continued as long as womens positive social and personal evaluations regarding weight management conveyed the message that the results were worth the (albeit deviant) battle, especially when the means were hidden from public scrutiny. Concerning Behaviors that Elicit Stigma The women in this research did not represent the only drug users to conceive of substances as a tool for the achievement of conventional goals. In other words, instrumental drug use was not invented here. Dabney (1995a, 1995b) reported that drug use among nurses was accepted, even common, as long as use was instrumental in nature. Nurses generally used pharmaceuticals as a means to improve their work performance, a practice that was largely accepted

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among their peers. In addition, researchers have found similar motives and rationalizations for instrumental drug use among physicians (Carlson, Dilts, and Radcliff 1994; Hughes, Conrad, Baldwin, Storr, and Sheehan 1991; and McAuliffe et al. 1984). In addition, college students who used prescription stimulants have been also largely accepted by their peers, as long as use was centered around academic pursuits (Wish, Falls, and Nakamura 2005). Steroid use, another drug that was commonly used instrumentally, while frowned upon by the general public, has been widespread and normative among professional athletes (Haupt and Rovere 1984). Therefore, it seemed that drug use (even for illicit substances) was accepted among diverse groups of individuals, to the degree that use was a tool for achieving normative goals. Despite these instances of subcultural approval for instrumental drug use, women in this research consistently felt that others would denounce their particular behaviors. As such, stigma, or its potential, significantly affected participants lives.

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CHAPTER SEVEN Gender and the Body

The human body as an object of analysis has been variously claimed by academic disciplines. While the medical establishment classically retained authority on studies of the body, fields such as sociology, anthropology, philosophy, cultural studies, and geography have increasingly staked their claim (Csordas, 1990; Lupton 1995; Nettleton 1995; Shilling 2003; Synnott 1993; Turner 1984, 1992; Williams and Bendelow 1998). Disciplines that newly analyzed physical bodies brought fresh perspectives to the academic table. Sociological focus on the body specifically, followed feminist critiques of academic scholarship (Shilling 2003). For example, Haraway (1991) was central to the identification of problematic boundaries concerning the natural and the social. For Haraway, entities such as human bodies were not biologically determined and static in nature, but rather culturally malleable. Individuals social existences influence their real, physical bodies through direct, indirect, internal, and external mechanisms of control. Sociology, like medicine and psychology, was historically Cartesian in nature, meaning that theorists largely assumed a disconnect between mind and body (Turner 1984). Academic scholarship anchored from this perspective generally privileged the mind and rational thought over the body in theoretical understandings of human behavior (Burkitt 1999). Yet, practical application of scientific knowledge concerning the body generally took the opposite approach.

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For example, when diagnosing disorders or illness, medical practitioners have been taught to clinically favor physical signs and symptoms over individuals psychological or social life-worlds. In fact, the DSM-IV (APA 1994) directed medical doctors to rule out physical causes for individuals conditions, such as physiological or medical problems, before assessing any psychological or social variables (Wylie 1995). As such, scholarly understandings of human behavior continue to offer no consensus regarding the relative importance of the mind or the body. It is important to consider both mind and body as critically joined entities, neither or which has the capacity for existence or survival alone. Instead, the mind and body shape, and are shaped by, each other. Individuals sculpt their bodies and work to transform their appearances through various deliberate and pointed processes. In this way, many individuals feel ultimately responsible for the shape and form their bodies take. For example, Cailyn, a twenty year-old junior, explained the effectiveness of her intentional efforts to shape her body: Yeah, I guess you could say that Im in control of it. I mean like, I know how to lose however many pounds in like, however many days... I always pay close attention to things like that... Say if I have a formal or something, and I want to wear a certain dress, stuff like that. Consequentially, it is never viable for the theorist to consider a natural body, one that is unmapped by human actions, conditions, values, or ideals. As such, sociological scholarship began to conceptualize bodies as important variables, essentially subjects that were molded by social, cultural, and historical processes (Dellinger and Williams 1997; Gagne and McGaughey 2002; Howson and Inglis 2001; Lorber and Martin 1998; McCaughey1998). In turn,

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sociological inquiry has transformed from operationalizing individuals as disembodied (Surgenor et al. 2002), to embodied (Williams 1998), carnal (Crossley 1995a), and corporeal (Burkitt 1999) (Howson and Inglis 2001:298). Recent and current sociological scholarship engages with the concept of embodiment, and how bodywork is intertwined with subjectivity (Schrock, Reid, and Boyd 2005:317). For example, Leder (1990) suggested that embodiment represents individuals viewpoints of the world. Crossley (2007) explained that: My body is not merely the perceptible material that you can see, smell and touch, nor even the internal organs that medical science can measure, weigh and monitor. It has another inside that surgeons and neuroscientists cannot access; an inside comprising lived sensations which form the coherent and meaningful gestalt structures that are my consciousness of the world. Embodiment encompasses both physical and mental realms of how individuals daily existence is experienced, and is the condition of possibility for our relating to other people and to the world (Cregan 2006:3). As such, this chapter addresses embodiment in terms of gender, eating disorders, body modification, and instrumental drug use.

GENDER AND EMBODIMENT

As reflexive beings, individuals are able to shape and maintain some level of control over their gendered selves and embodied experiences. Featherstone (1991) suggested that modern culture has transformed the body into a commodity to be managed. As a result, the body has been increasingly constructed as a

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perfectible entity, one that requires attention and maintenance throughout the life-course (Featherstone 1991; Hall 1996). Advertisements for diet pills, home gyms, beauty products, and athletic training supplements represent just a few of the social cues regarding body management that are transmitted to the average person on any given day. The implications are clear: there are a multitude of means, ranging from the sensible to the absurd, at everyones disposal for the modification of their bodies. Thus, individuals have been taught that they can actively mold their embodied experiences by exerting control over their bodies. Given that there are social rewards for embodying appropriate gender ideals, many individuals have been drawn to body modification techniques which shape the self in what they perceive to be a culturally appropriate manner. The Gendered Body Gender is a dynamic role-taking mechanism that involves performance in everyday life (Davis 1997). Doing gender, or enacting and representing cultural scripts concerning proper womanhood or manhood, is an ongoing process (West and Zimmerman 1992) The performance of gender has the cumulative result of not only gendered identities, but gendered bodies as well (Dellinger and Williams 1997; Gimlin 2002; Klawiter 1999). For example, Connell (1995) suggested that regimes of exercise were gendered, in that they were designed to produce bodies that were appropriate in terms of cultural ideals of masculinity or femininity. Dominant discourses on athletics and the body offer many illustrations of this phenomenon. For example, women in advertisements for athletic gear commonly

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voice the desire to lose weight or build muscle tone, but do not want to bulk up as a result of their exercise routines. In these advertisements, womens concerns are quelled with assurances that their bodies will remain feminine, only better. Scholars have suggested that feminine body ideals are culturally embedded, and that these social ideals have negated womens abilities to reach their full bodily potentials. For example, Young suggested that: Women in a sexist society are physically handicapped. Insofar as they are led to live out their existence in accordance with the definition that patriarchal culture assigns to them, they are physically inhibited, confined, positioned and objectified (1990: 153). As young girls, women were taught how to properly behave, walk, sit, and gesture, generally in a physically constraining manner (Young 1990). For many, the embodied experience of being a woman includes elements of confinement and control, as defined by social gender ideals. Thus, womens bodies are partially shaped by their social existence, as cultural expectations, ideals, norms, and values exert various levels of internal and external pressures over individuals to control their physical beings.

EMBODYING FEMININITY

Representing gender is a constant work in progress, one that certainly involves the production and maintenance of the female body. Scholars have explored the ways in which feminine gender identity helps to shape, and is shaped by, individuals intentional transformation and maintenance of their bodies (Bordo 1993b, 1997; Brumberg 1997, 2000; Fallon et al. 1994). Generally

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speaking, theorists have argued that portrayals of ideal womanhood in our culture at large have resulted in high rates of female body dissatisfaction, a sort of not good enough syndrome (Bordo 1993b, 1997; Hoskins 2002; Potter 1998; Strasburg 1995). Women, more so than men, have responded to cultural ideals and pressures concerning the correct or proper means of representing gender in terms of the body (Bordo 1993b). While men are certainly subject to gendered social ideals concerning the body as well, their response thus far, appears both less intense and widespread. Orbach spoke to this when she said: The receptivity that women show (across class, ethnicity, and through generations) to the idea that their bodies are like gardens, arenas for constant improvement and resculpturing, rooted in the recognition of their bodies as commodities, creates all sorts of body image problems for women (1986:17). For many women, straying from cultural expectations, especially those concerning the female body, was highly correlated with feelings of shame and stress (Efthim et al. 2001). Feminine Body Ideals Social constructions of the ideal feminine body emphasize thinness, delicate features, and petite statures (Wolf 1991). Many women echoed these ideals in their descriptions of personal body management goals. For example, Jody, a nineteen year-old sophomore, described what represented for her, the ideal feminine body: I think Ballerinas have the perfect body, Id like to look like that... They are real small and light with these long legs. And theyre really graceful...

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Ballerinas can probably wear whatever they want and look really good. Id be so happy with my body if I looked like that. While Jody romanticized female dancers, many ballerinas have experienced heightened levels of strain concerning the size and shapes of their bodies, as compared to the general female population. For example, ballet dancers face copious amounts of pressure to control their weight. In fact, the aesthetic ideal that ballerinas use as a yardstick for measuring their own bodies worth has been related to unusually high rates of eating disorders within the profession (Aalten 2007). Yet the ethereal, slight form of ballerinas has long been celebrated as an archetype of feminine beauty and grace within our culture (Turkel 1998). Over the last few decades, the idealization of thin bodies and the corresponding derogation of heavy bodies has proved to be most intense for women (Striegel-Moore 1997). For example, Christy, a twenty-two year-old college senior, described early feelings of social pressure concerning her body: I definitely felt like losing weight was something I had to do... I dont know, mostly because all the cool girls (laughs) had great bodies... Oh, and one day one of my friends goes something like, hey dont you wish we could wear those kinda pants? or whatever, talking about those pants that had the strap on the bottom... I guess she was saying that we were too fat... I dont know, I dont think I ever really thought about it before then, but that was definitely the year that I started weighing myself and dieting, not that that was her fault or anything. Dominant cultural messages successfully conveyed to women that inferior, petite, thin bodies were of the up-most value. Consequentially, many women viewed their bodies as a gendered project, one which demanded constant improvement (Wesely 2001). Calista, a twenty-

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two year-old college senior, who referred to herself as a girly-girl, spoke to this idea when she said: Its like they say, you cant be too rich and you cant be too thin. I think the thinner the better, except for scary thin, but I think thats pretty hard to do. Id have to like, not eat at all for weeks. Chernin (1983) described such ideals and representations of women as the tyranny of slenderness, in which achieving thin bodies promised success in a variety of life goals. Scholarship has consistently demonstrated that exposure to thinness ideals resulted in womens body dissatisfaction, lowered self-esteem, and increased negative emotions (Cash and Henry 1995; Groesz, Levine, and Murnen 2002; Polivy and Herman 1987). For many women, falling short of body management goals, as set by gender ideals, caused feelings of self-derogation (Sischo, Taylor, and Martin 2005). For example, Shannon, a nineteen year-old sophomore, talked about time periods when she experienced negative emotions: Sometimes its hard to always stay motivated... If I dont eat for a long, long time, I end up way over-eating, and then I feel like crap... Im all fuck me, and I have to use all my will power to make up for it... It doesnt matter if other people think Im not fat, if I feel fat, it sucks... I dont know how to describe it. I feel like a fat lazy pig. Like my clothes are tight and I can feel this extra weight... Yeah, I can literally feel it jiggling when I walk. Chelsea, a twenty-one year-old college junior, also voiced negative emotions concerning time periods in which she felt unsuccessful at controlling her body: No, I wouldnt say that it makes me feel great all the time or anything. Its more like it can be worse on the other side... I mean, it feels great to lose weight and all that, but I just mean like when I feel like I have gained a few pounds, I feel like a total slob. I hate feeling fat. But when Im at that point that I want to be, it can be so easy for me to slip up.

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Many women who aimed for social ideals concerning the body, and perceived the product of their efforts to be subpar, have reported feelings of stress and failure (Wolf 1991). Bem (1993) suggested that women, as compared to men, maintained consistent focus on interpersonal relationships, and were thus more likely to seek the approval of others. However, the degree to which women in society at large view impossibly thin beauty standards as challenging or threatening to their selfconcepts varies greatly. For example, a few participants voiced recognition of the fact that others did not place as much emphasis on weight as they did. One such participant, Christine, a twenty year-old junior, spoke to this when she said: I think that people just go for whatever makes them comfortable. Some people look better thinner, and I know girls that look pretty no matter what. I think it just depends on your body and your style... I feel more confident when Im like, a hundred pounds. Its the only time I wear skirts and I love to wear skirts... Everyone wants to look nice... As such, womens responses to social constructions of gender and body ideals take various forms. Scholars have suggested that eating disorders represent one way in which individuals work to embody gender ideals.

GENDER AND EATING DISORDERS

Many scholars in the field have understood disordered eating behaviors as a feminine response to cultural constructions of gender and the ideal feminine body. As such, analysis of eating disorders must thoroughly consider the relationship between being a woman and the desire to be thin. For example,

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Calista, a twenty-two year-old college senior, expressed gendered body ideals in the explanation of her eating disorder when she said: Im totally a girly girl, like I love dressing up, and pink, and makeup, and I think that girls look better when theyre thin. So, uh, I like being small... I dont know, its like, petite and dainty and girly. I think its more attractive. Given that eating disorders have presented most often in women (Hesse-Biber et al. 2006), many theorists working from feminist perspectives have concerned themselves with the ways in which eating disorders are produced by and within contemporary capitalist, patriarchal, and consumer cultures (Bordo 1992; Chernin 1983, 1986; Fallon et al. 1994; Garner et al. 1980; Lawrence 1984; Orbach 1986; Shaw 1995). While the construction of eating disorders within the medical establishment heavily relied on discourses of normal and pathological, feminist perspectives have illuminated from a number of different angles, the inherent problems with understanding behavioral phenomenon in this way. Instead, many theorists conceptualized disordered eating as a manifestation of cultural distress. Most commonly among feminist theorists, women were conceptualized as though their eating disorders resulted from social (versus individual) pathology, mainly the subordinated women. For example, Bartky (1990) suggested that representations of women have produced an enslaving fashion-beauty complex, which was generally controlled and structured by men. In fact, many theorists have argued that constructions of gender, which assign women a secondary status in society, are of central importance to the understanding of non-normative weight management.

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Although eating disorders have been popularly understood as womens reactions to (and over-internalizations of) our cultural fascination with thinness, Malson suggested that: Conceptualizing anorexia in terms of an over-internalization of cultural prescriptions about female beauty and the necessity of dieting only begins to understand how our socio-economic, cultural and political contexts are implicated in the production of anorexic subjectivities, experiences and body-management practices. It does not, in itself, constitute an adequate endpoint in understanding anorexia nervosa as a complex and heterogeneous culturally-produced category of distress (1999:138). Essentially, such understandings failed to explain why society in general displayed such a seemingly odd preoccupation with unnaturally thin female bodies (Bordo 1992). One possible explanation available in this discourse rooted cultural fascination with excessive thinness in patriarchy, and the coercive power of the erotic desires of heterosexual men. The Male Gaze Many methods of body modification, such as makeup, cosmetic surgery, dieting, and eating disorders, have been described as womens attempts to conform to hegemonic ideals of feminine beauty (Bartky 1997; Bordo 1993, 1997b; Morgan 1991; Wolf 1991). Scholars have suggested that women predominantly perceived themselves through the male gaze (Mulvey 1989), a perspective that sexually objectified women, and assessed female value according to physical attractiveness. Theorists have argued that women regulate and produce femininities within normative heterosexual standards of desirability (Renold 2000:312), as perceived through the male gaze. By extension, many

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women judged their bodies against standards of beauty that were designed to serve the interests of men (Morgan 1991). The concept of male gaze emphasized masculine desire and the objectification of women in the construction of feminine subjectivities (Gagne and McGaughey 2002). As such, scholarship from this perspective largely conceptualized women as though they incorporated aspects of being erotic objects into their sexual and gender identities. Theorists have rooted womens strain concerning social expectations of feminine beauty in this patriarchal objectification of womens bodies (Fredrickson and Roberts 1997). Calogero (2004) argued that this phenomenon was problematic for many women: The primary psychological consequence of sexual objectification is the development of an unnatural perspective of self-objectification. Women who self-objectify have internalized observers perspectives on their bodies and chronically monitor themselves in anticipation of how others will judge their appearance, and subsequently treat them (2004:16). For many women, anticipation of the male gaze increased shame and anxiety concerning the appearance of their bodies (Calogero 2004). From this perspective, womens intentional transformations and management of their embodiment was related to individuals attempts to catch or maintain the attention of the opposite sex. Instrumental Drug Use and the Male Gaze For many research participants, the male gaze was ever present in daily life. During quite a few interviews, women responded to questions concerning their motivations for instrumental drug use with accounts that included explanations relating to how they perceived their physical attractiveness to men.

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Interviews in which women cited amorous relationships as a variable in their deviant careers spoke of past boyfriends, current boyfriends, specific young men of romantic interest, men in general, and the idea of future relationships, in their narratives of body management. Accounts from instrumental drug users which incorporated the male gaze included concrete examples of social feedback from men concerning appearance, as well as womens imposed constructions of male desire. In other words, women responded to both the actual desires of men, as well as their perceptions of male desires. Given that college is a period of life when many women feel pressure to date (Hesse-Biber and Marino 1991) or find a husband (Jacobs 1996), womens narratives which included the male gaze were perhaps not surprising. Mickelson (1989) suggested that women have long been drawn to college for the improved access to potential husbands who possessed relatively higher earning potential and social status. Certainly it would be inaccurate and unfair to suggest that women attend college solely for their Mrs. degree (Goldin 1992). However, for many women, mate selection is an important aspect of the college experience (Guzzo 2006). There were several ways in which women in this research spoke of the male gaze. Generally, these narratives focused on catching or maintaining the erotic interest of the opposite sex. Some women felt that in order to capture mens attention, it was necessary to maintain a certain shape and size of the body. For example, Cindy, a twenty-one year old college sophomore, explained how one particular romantic interest influenced how she felt about her body:

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See, the whole thing with him was that I was straight-up crazy about him. It was a tough situation at first cause he was sort of like, casually seeing this girl... I feel like I have a lot to offer, Im generally pretty likable and whatever but guys really hit on me more now... since I lost weight... He noticed it too. Many women perceived that weight loss or gain greatly impacted their value on the college dating market. Occasionally, women voiced concern over the loss of a specific love interests attention. For example, Opal, a twenty year-old sociology student, said: I really started obsessing about my weight after my boyfriend. Well, now hes my ex. But he cheated on me... It was definitely after that. But he got with someone else... I lost all my confidence, and uh, I started to worry that I didnt look good enough all the time... I was partying all the time... It was a really hard breakup. In another example, Jackie, a twenty-two year-old college senior who routinely took higher doses of pharmaceutical stimulants than she was prescribed, said: Last year I was seeing this guy... it was like I wasnt hot enough for him. Its not like he said that or anything, only every single time wed to a party or whatever he got hit on by dumb blonde girls, oh, sorry (laughs). Anyways, he loved it... He ended up dumping me for this one skanky looking chic with big hair and big tits. He went to high school with her I think... I was totally broken-hearted. In both of these cases, women reacted to the end of their relationships by focusing attention on appearance and body weight. This suggests that perhaps women believed that if they improved their appearance by losing weight, they could prevent the loss of their boyfriends attention in the future. This phenomenon may illustrate what scholars in the field have described as control issues among women with eating disorders (Bruch 1973; Siegel, Brisman, and Weinshel 1988). Common among many theorists working from feminist perspectives was the notion that women with eating disorders were

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aiming to gain control within a controlling culture. Conceptually, gaining control over the physical body was a means by which women seized power over their destinies. Interesting was the notion that eating disorders transformed from a means of control, into a controlling mechanism. That is, many women eventually felt out of control of their controlling means (Orbach 1986). In other narratives, women cited maintenance of male interest as being related to their deviant careers. For example, Cadence, a nineteen year-old college sophomore and student athlete, said, I like to look beautiful for my boyfriend, you know? He tells me I look good all the time. He likes it that Im thin, its pretty clear. Jeanne, a twenty-one year-old college junior studying psychology, echoed these sentiments when she said, One time [my boyfriend] said I was getting a bit of pudgy on my belly, he was like, being all cute and playful and stuff, but I just about lost it... I dont want someone to come along and snatch him up. For these women, controlling body weight was one means for insuring their partners continued attention and love. Every so often, women acknowledged the idea that perhaps the men in their lives did not place as much emphasis or value on weight as they did. For example, Charlotte, a twenty-one year-old senior who was headed to law school after college graduation, said: My boyfriend tells me all the time that Im not fat at all... It doesnt ever help. But he says sometimes that he likes me better when Im curvier... I guess maybe it makes sense, I mean my boobs get a lot bigger. This sentiment calls into question Charlottes perception of what constituted the ideal feminine body in terms of male desires. In fact, many scholars have

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suggested that there were disparities between the ways in which women understood their sexual appeal, and the ways that men defined erotic beauty. As such, scholars have questioned the accuracy and influence of the male gaze. Theorizing the Male Gaze The concept of male gaze has been problematic within scholarship for several reasons. First, the application of the male gaze within research concerning the body has been criticized for downplaying the role of womens agency (Renold 2000; Snow 1989). For example, the concept seemed to suggest that women did not actively construct the feminine self, but were instead the passive subjects of gender ideals based on male desire. Thus, male gaze was given a powerful role, perhaps overly powerful, regarding the ways in which women experienced womanhood and perceived themselves. In addition, Pratt (1992) suggested that assumptions concerning the male gaze were overly general, and treated men as though they were a homogeneous group, with equal social power and commonly shared sexual desires. Further, womens perceptions of what constituted male desire, has been called into question (Gagne and McGaughey 2002). Finally, scholarly constructions concerning the relative power of the male gaze privileged heterosexuality in theoretical explanations of womens eating disorders. Gagne and McGaughey suggested that this debate centers on whether women are socially coerced into striving to achieve cultural standards of beauty or whether they freely choose to do so (2002:815). However, such an approach may have been overly dualistic, simplifying the relationship between social expectations and individual agency (Renold 2000). For many theorists, the

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solution to this dilemma requires understanding of how social expectations influence personal agency. While women may in fact be exercising personal agency in their constructions of the self, the ideals they intentionally conform to are socially meaningful. Individual women, while acting in accordance with cultural expectations, are not responsible for the values that are imposed onto the female body. Instead, women exist within a system of social expectations and ideals which preceded them. Although women may intentionally modify their bodies, and feel responsibility concerning their appearance, they did not create the symbolic system which guided their actions. Thus, womens action patterns may have been reportedly deliberate and symbolic, however, the motivations for their behaviors suggest that cultural expectations and ideals largely directed individuals deviant careers. Theorists have suggested that one particular social ideal, the superwoman archetype, has been an overarching gender image, which influences women on a variety of levels, beyond (although including) expectations concerning female beauty.

THE SUPERWOMAN IDEAL

Social roles and expectations for women have evolved considerably over the past few decades, yet cultural emphasis on appearance and beauty ideals have persisted (Thornton, Leo, and Alberg 1991). In fact, theorists have suggested that broadened opportunities and expectations for women have created various

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competing gender demands, perhaps resulting in an increasingly complicated and confusing notion of what it means to be a woman in this society (Emmett 1985; Orbach 1978, 1986; Palazzoli 1978). Currently, gender role expectations for women idealize attitudes, behaviors, and conditions that are both masculine and feminine (Hochschild 1989). Essentially, women have been encouraged to have it all (Borchert and Heinberg 1996:549). Having it all includes, but is not limited to, achieving cultural standards of beauty. Instrumental Drug Users and the Superwoman Ideal Crago et al. suggested that eating disorders were increasingly likely among women who desire to excel in many diverse roles (1996:802). This phenomenon is often referred to as the superwoman complex (Hart and Kenny 1997; Steiner-Adair 1986, 1989; Smolak and Murnen 2001). For example, Joanna, a twenty year-old anthropology student, explained how pharmaceutical stimulants aided in a number of aspects of her daily life: I was a star employee at my job because all I wanted to do was work, and my grades improved so much because I would sit down to study and nothing would keep me from finishing all of my work and it made me not even think about food. Generally speaking, the superwoman wishes to succeed in a variety of roles, those that are both traditionally masculine and feminine. As Crago et al. explained, the superwoman wants to be thin and attractive, a loving wife and mother, and a strong and independent career woman (1996:803). Christine, a twenty year-old college student, brushed upon this notion when she said:

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I think that I want to be the whole package... I want to be funny, and smart, and good-looking, and have a good career, and a handsome husband, and adorable kids (laughs)... I like trying to be the best, and so I try to work at it. For many women, such ambitions have been the cause of increased gender-role stress. Scholars have suggested that women who aimed to be superwoman were increasingly vulnerable to developing disordered eating (Barnett 1986; Orbach 1978, 1986; Striegel-Moore, Silberstein and Rodin 1986). However, Smolak and Levine (1996) suggested that among women generally, distress did not always accompany the desire to exceed in multiple social roles. Instead, women who were concerned with social approval, and therefore aimed to excel in multiple roles, were likely to adhere to the superwoman ideal. In turn, these women were at greater risk for developing disordered eating.

ALTERNATIVE UNDERSTANDINGS

In much academic scholarship, eating disorders were conceived of as a symbolic struggle. Depending on the perspective, this struggle might be with individual pathology, patriarchy, objectification, or social expectations and ideals concerning gender. Hegemonic beauty standards, such as ideal weight, appropriate hairstyles, fashion, or make-up expectations, have all been described in sociological literature as social mechanisms for controlling or subordinating women. Given that make-up, fashion, cosmetic surgery, or excessive dieting

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were behaviors that individuals enacted upon themselves, scholars have argued that such phenomenon illustrated womens internalized oppression. In terms of controlling and commodifying the body, society fosters numerous means of constraining or oppressing women, and scholars have suggested that through disordered eating, women essentially constrained themselves. However, discussion of how socially constructed beauty ideals act as mechanisms of oppression sidesteps the complexities of how these practices are experienced by women in their everyday lives. For example, Dellinger and Williams (1997) reported that make-up was both a source of empowerment and constraint for many women. In addition, Gagne and McGaughey (2002) suggested that women experienced cosmetic surgery as a positive, confidence building, and self-productive endeavor. While the medical establishment has largely constructed eating disorders in a negative light, participants continued to offer both positive and negative narratives concerning their non-normative weight management. In this vein, Malson suggested that there were a multiplicity of positive as well as negative subjectivities (1998:187) among individuals experiences with disordered eating and body management. For many women, intentional transformations of the self through body work was done in accordance with a philosophy of living, and was culturally meaningful (Lester 1997). As with cosmetic surgery and deviant weight control, discourses surrounding so-called disordered body management practices have included elements of womens self-production, as well as selfdestruction (Finn and Dell 1999). Regardless, dominant discourses that surround

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non-normative weight management continue to define women as medical subjects: individuals who are sick and require professional intervention. Scholarly depictions of women who engaged in non-normative weight management as sick, solidified many individuals feelings of being misunderstood (Rich 2006). Women often voiced complaints of being mischaracterized within dominant discourse on non-normative weight management. For example, many women have challenged, from a number of perspectives, medical definitions concerning their non-normative weight management techniques (Ferreday 2003). This was true among the instrumental drug users in my research as well. Camilla, a twenty year-old college junior, protested medical conceptions concerning eating disorders when she asked, how can you tell someone that they are sick cause they want to look good? In addition, Cailyn, another twenty year-old college junior, described medical definitions of eating disorders as annoying. Further, many women have rejected feminist analysis which interpreted deviant weight management as resulting from the oppression of women by a patriarchal society (Pollack 2003). In this study, many women conceived of their instrumental drug use or non-normative weight control as a rational reaction to an irrational cultural goal. This perspective placed responsibility on the shoulders of society, but did so in a slightly different manner than did scholars working from some feminist perspectives, as women did not root this irrational cultural goal in patriarchy. For example, individuals within online pro-eating disorders communities refused to identify themselves in terms of pathology or patriarchal

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oppression. Instead, women generally described non-normative weight management as a life-style choice (Ferreday 2003; Pollack 2003). These virtual communities, which defined disordered eating as a lifestyle choice, have grown in popularity over the last several years. Generally speaking, the social responses to these websites have been swift and severe. Sanctions taken against pro-eating disorder groups have ranged from the shunning of these online communities, to institutionalized monitoring and dismantling of websites (Ferreday 2003). Saukko (2006) suggested that social backlash against women in these online communities reified cultural boundaries concerning the appropriate or acceptable ways in which individuals may talk about their deviant body management practices. First, social disapproval of these websites furthered medical discourses concerning definitions of normal versus pathological. Second, by silencing womens voices, through the destruction or shunning of these websites, social boundaries were drawn regarding the ways in which women could openly narrate their embodied experiences and subjectivities (Saukko 2006). The accepted processes involved in the creation of the self are largely dictated by dominant cultural discourse (Hoskins 2002). While there may be infinite ways that individuals can modify their bodies, social proscriptions draw boundaries around what is considered normative or deviant. Although many women have historically reported eating disorders as an intentional, even positive, means of constructing the self, many scholarly understandings of non-normative body management practices continue to center individual pathology. By ignoring

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the life worlds of women, many theorists have failed to situate women within their contextually specific standpoints and glossed over their embodied experiences. Critics of feminist theories concerning eating disorders have suggested that the perspective over-emphasized culture, specifically patriarchy and the oppression of women. For some theorists, the medical establishment overpathologized the individual body, while feminist perspective over-pathologized the cultural body. Lester (1997) suggested that medicine envisioned a disembodied self, while some feminisms constructed a de-selfed body. For example, many feminist theorists described culture as though it worked in mysterious and covert ways, without accounting for how the internal processes of real women mediated, filtered, and negotiated social ideals and expectations. Individual agency and interpersonal characteristics, such as the mind, self, and personalized consumption of culture, have significant affects on women as well. The interplay between individuals and their culture has certainly been central to theoretical understandings of deviant body management. However, in all theoretical models, the embodied experiences of women with eating disorders should also been considered.

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CHAPTER EIGHT Conclusion

This dissertation details findings from a qualitative study on young womens use of controlled substances as a means of weight management. My research offers a unique perspective on both womens drug use and disordered eating. While past scholarship has detailed disordered eating as well as drug use from a number of different perspectives, these two behavioral phenomena were generally treated as distinct lines of action. Women in this research, on the other hand, used drugs as a tool for weight control, effectively entangling substance use with disordered eating. In addition, many researchers tended to downplay the experiences, understandings, and narratives of the individuals involved in these behaviors. Given that the use of drugs for weight control, as described in this dissertation, may in fact be a relatively new phenomenon, the lack of scholarly inquiry is perhaps not surprising. The research reported in this dissertation is unique in three main ways. First, I detail a specific relationship between drug use and weight control that has not been previously analyzed, as introduced above. Much of the scholarship on drug use and disordered eating quantitatively analyzed the correlation between the two, often describing substance use as self-medicating: a coping mechanism for the hardships associated with eating disorders. In contrast, my research qualitatively analyzes drug use as instrumental, or essentially performanceenhancing.

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Second, this project focused on one particular non-normative method of weight management, the use of drugs, which has not previously been addressed in the literature. Within scholarship on eating disorders in general, numerous means of controlling weight have been detailed and analyzed. The non-normative behaviors commonly reported in this body of work ranged from severe caloric restriction to bingeing and purging. However, womens substance use for weight management has remained largely undocumented. In addition, past research on women with eating disorders tended to focus on clinical populations. My research, in contrast, includes women whose conditions and behavioral patterns did not necessarily meet the strict diagnostic criteria set forth by the medical establishment for anorexia nervosa or bulimia nervosa, the two most commonly diagnosed eating disorders. Thus, my research encompasses a behavior and a population that have not been previously analyzed together. Third, this project involved the analysis of controlled substance use in general. My research includes women who instrumental used both licit and illicit drugs. Aside from all-inclusive, national-scale, quantitative studies, such as the National Survey on Drug Use and Health (formerly the National Household Survey on Drug Abuse) or the Drug Abuse Warning Network, much of the scholarly work on psychoactive substance use has not been as inclusive. Generally speaking, drug researchers have focused on either one particular drug (such as cocaine or heroin), or one drug class (such as pharmaceuticals or street substances), at a time. This research, on the other hand, includes users of both legal and illegal substances.

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Although participants overwhelmingly used stimulants, one particular class of drugs, the specific type of stimulant could have been either legal or illegal. Within scholarship on psychoactive substance use, licit and illicit drug users have often been described in vastly different terms. This research offers a different perspective by analyzing the commonalities among substance users on either side of the law. In addition, my research paints a different portrait of drug users than is commonly found in the literature. Therefore, the research reported in this dissertation is the first sociological study to examine the relationship between substance use and weight management, to examine instrumental stimulant use across legal boundaries, and unusual in its sample and research design.

SUMMARY OF DESIGN AND MAJOR FINDINGS

The research reported in this dissertation relies on qualitative sociological research methods, as informed by ethnographic epistemology and feminist perspectives. Approximately two-thirds of women that I interviewed used pharmaceutical stimulants such as Adderall or Ritalin, as a means of controlling weight. The remaining one-third of participants used street drugs such as cocaine or illicit amphetamines, again, as a means of weight management. Over twothirds of women reported a history of disordered eating before the onset of instrumental drug use, while the remainder transformed drug use into an instrumental means for weight control after medicinal or recreational use of their

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chosen substances. All of the participants in this research were chronic substance users at one point or another, with most reporting continual daily use at the time of our interview. The purpose of my research is the analyze the relationship between the instrumental use of drugs and non-normative weight management. When I began conceptualizing this project, I had only read of one case in which a young woman used illicit amphetamines for weight control. As such, much of the empirical data gathered during the execution of this research was unexpected. Two themes presented in this dissertation were largely unanticipated at the onset of the project. First, many women reported that their focused weight control and non-normative body management followed recreational or medicinal drug use. Second, many women reported heavy, chronic use of licit or illicit substances in a relatively positive, self-constructive manner. Review of Findings Women reported habitual use of various drugs, largely stimulants, for the primary purpose of weight control. Those who preferred pharmaceutical stimulants generally secured their drug supply by persuading a doctor to write a script in their name. Participants who preferred street drugs, such as cocaine, gathered their supplies as any illicit substance user would: through the black market. Regardless of whether womens drug of choice was cocaine or Adderall, most overwhelmingly praised stimulants for their power to control appetite. For many women, focus on weight control and instrumental drug use had an

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exponential relationship with any social rewards concerning the transformations of their bodies. In other words, as social approval and positive statues cues increased alongside weight loss, women increasingly focused instrumental drug use on controlling their bodies. The people liked it, and so did they. The ins and outs of participants daily drug habits were heavily dependent upon the legal status of their substances of choice. Those who preferred pharmaceuticals regularly interacted with the medical establishment, where their drug use was protected by patient-doctor confidentiality. Street drug users, on the other hand, who participated in the black market, largely obtained drugs from others on campus who were involved in illegal distribution. The nature of these two vastly different drug markets affected the structure of womens nonnormative behaviors, their abilities to secure consistent and reliable supplies, and their perceptions of the potential for future drug use. Women who used licit substances, which are prescribed by the medical establishment, were likely to view their drug use as relatively unproblematic. As a result, the licit drug using career was relatively stable. On the other hand, women who used illicit substances faced increased strain throughout the course of their drug using careers. Their access to substances was less reliable, more expensive, and involved risky participation in the black market. Consequentially, women who used street drugs to control weight were not as committed to their deviant careers, and were more likely to foresee a time that they would stop using. The social organization of womens deviant actions was again, largely dependent on the legal status of their drugs of choice. Women who used

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pharmaceuticals were involved in the legitimate drug market, although some women did buy legal drugs from street dealers. As a result, licit drug users were not generally forced to interact with deviant others. Illicit drug users, on the other hand, were likely to interact with other drug users, and accordingly reported many non-normative associations. While women were not generally comfortable talking with others about their drug use for weight control, illicit drug users at least had access to others involved in illegal drug use. For licit drug users, the medical establishment represented a legitimate pillar of society, which provided a social script to guide their interpretations of instrumental drug use. Given that in society at large many people routinely take pharmaceuticals prescribed by the medical establishment, many women who used prescription stimulants were successful at defining their instrumental drug use as relatively normative. Street drug users did not have such social structural supports for legitimating their drug use. However, for many women who used illicit substances, the presence of a drug subculture on campus legitimated, at least for the time being, their continued habitual substance use. Generally speaking, participants engaged in their instrumental drug use privately. As a result, womens non-normative behaviors had little impact on their outwardly conventional social identities. However, when pressed for accounts of non-normative behavioral patterns, women offered a variety of explanations for their deviance. The techniques of neutralization that women offered in research interviews ranged in effectiveness, largely according to the context in which they were offered and the social scripts that were drawn upon in

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their construction. While excuses for deviance, which were generally offered by illicit drug users, were meaningful accounts, justifying non-normative weight control proved to be more effective means of neutralizing instrumental drug use among research participants. Regardless of the effectiveness of participants accounts for their nonnormative weight controlling behaviors, most women continued to pursue their substances of choice for the primary purpose of weight management. The social rewards for adhering to socially constructed ideals of beauty outweighed the negativity that was associated with instrumental drug use. That is, despite the risks associated with developing a drug habit, the risk of stigmatization, the chronic hassle of securing a drug supply, the financial burden of daily use, the necessary secrecy, the risk of law enforcement, the trials of obsessing over weight, the concern of any aware family or friends, and the impact on lifestyle and interpersonal relationships, women continued to revere drug use as a means of managing embodiment and shaping the self. For many women, the ends simply justified the means.

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THEORETICAL IMPLICATIONS

The research reported in this dissertation has a number of implications for sociological theory. First and foremost, my empirical evidence supports the general symbolic interactionist perspective, which asserts that individuals act in accordance with the meanings they assign to people, places and things (Blumer 1969; Mead 1934). These meanings result from social ideals and interpersonal interactions, and are modified through individual interpretation. Women in this research focused much of their time and energy on achieving socially constructed body ideals. These appearance ideals were culturally meaningful for many women, and held the promise of social reward. While the instrumental drug using lifestyle certainly involved its fair share of hardships, for the majority of women in this research, the benefits of managing the body in this way outweighed the associated negativity. Although many women were happy with the product of their weight controlling behaviors (thin bodies), the processes involved in their creation came at a price. While women may have praised the utility of stimulants for appetite control, the deviant lifestyle had both positive and negative impacts. As discussed throughout this dissertation, the chronic use of drugs included a number of practical hurdles in womens everyday lives. It stands to reason then, that the problems that women associated with their instrumental drug use, when tallied all together, did not outweigh the strains that drug use aimed to alleviate. In other words, although using substances as a method of weight control was not always

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easy, it was generally worth it. This suggests that as social creatures, women have shown a willingness to sacrifice personal comfort, nourishment, and peaceful relationships with their bodies, in order to achieve social success. This individual sacrifice for social gain highlights the critical role of social groups in shaping womens existence. Strain Theory The fact that women described non-normative weight management as worth the related adversity begs questions regarding what types of strain compelled women to engage in these behaviors. Although dominant psychomedical perspectives may place this strain in individual pathology, sociologists have suggested that it is social in nature. General strain theory posits that social strain or stress increases individuals negative emotions, such as frustration or anger (Agnew 1992). Agnew suggested that strain results from relationships in which others are not treating the individual as he or she would like to be treated (1992:48). In turn, individuals may feel pressure to take corrective action (Agnew 2001:319). From this perspective, non-normative weight control can be understood as womens attempts to construct and represent a self which more closely resembles a type of personhood which is likely to elicit the social treatment they desire or feel they deserve. Participants of this research intentionally worked to sculpt their bodies, continually fine tuning their representations of the self, as they strived for socially constructed ideals of feminine beauty. For their efforts, women were socially

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rewarded. Participants consistently reported that these social rewards effectively alleviated strain concerning their body-image and appearance. However, many of the benefits that women associated with instrumental drug use were highly dependent on the concealable nature of their deviant careers. Generally speaking, women felt that secrecy concerning their weight control methods was extremely important. Essentially, women wished to appear normative more than they wanted to actually behave conventionally. Often, women were proud of their bodies, and many reveled in the positive attention they received for it. However, much like a student who proudly flaunts an A paper until he or she is identified as a cheat, women worried that if others were aware of their instrumental drug use, the value of their bodies would be somehow diminished. Generally speaking, women were non-conforming in their means, but over-conforming in their goals. The overall product of these deviant behaviors was embodied by women who presented as largely conventional. Consequentially, instrumental drug users represent a rather normative variation of the types of deviants that have been previously analyzed using strain theory. Individuals who innovate (Merton 1938) in order to achieve cultural ideals have been commonly described in strain theory research. However, scholars have focused on behaviors such as drug dealing, burglary, or robbery. Individuals involved in these activities are generally regarded as criminals, and often live in subcultural underworlds. Women in this research, on the other hand,

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more closely resemble college students who cheat on their coursework, or white collar criminals who embezzle from their companies. These latter examples are comprised of individuals who maintain dominantly conventional social identities. Perhaps, individuals who are invested in conventional society may be willing to participate in deviant behaviors in order to reach their culturally valued goals, so long as their innovative means can be effectively hidden from public scrutiny, protecting normative social identities. This suggests that those who strive to be conventional, even over-conforming, may think twice about continuing deviance after being caught and labeled by others. Labeling Theory Labeling theory posits that a deviant is one to whom the label has successfully been applied (Becker 1963:78). Becker (1963) suggested that social applications of deviant labels vary over time, are dependent on who commits the act and who feels harmed by it, and are sometimes applied only if actions result in certain consequences. From this perspective, no act is inherently deviant. In addition, the social processes involved in deviant labeling do not operate on black and white terms. In other words, individuals are not assigned statuses of either deviant or conventional. Instead, social identities, perceptions, and labels are malleable, and largely depend upon contextually specific situations. Given that the majority of instrumental drug users concealed their deviance, they were usually perceived of, and therefore existed, as relatively

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conventional. Generally speaking, women were not assigned deviant labels by others, largely in accordance with Beckers (1963) labeling theory. By extension, women in this research did not usually perceive of themselves as altogether deviant. In effect, the creation of social identities is a continual negotiation, where individuals may ascribe value and status as they deem appropriate at any given time. Since others did not label instrumental drug users are deviant, it follows that many did not have deviant identities. I suggest that the application of deviant labels also relates to the overarching goals of the behaviors in question. Socially conventional or ideal goals, around which deviant behaviors are organized, may decrease the severity of labeling by others. For example, a woman who steals of loaf of bread in order to feed her children may be considered a thief, but the impact of that label is decreased by the admirable nature of her goal. A black market drug dealer who distributes controlled substances to minors in the pursuit of a hedonistic or materialistic lifestyle is not so honorable. Doctors and nurses enjoy relative social freedom regarding the use of pharmaceuticals, so long as use is instrumental for improving work performance. Professional athletes tolerate steroid use among their colleagues, who are after all, aiming to be the best. Thus, as long as individuals remain within certain boundaries, deviance aimed at conventional goals will be relatively tolerated in society. It stands to reason then, that in our culture, institutionalized goals are more important than legitimate means. This may be especially true if the nonnormative means that individuals use to achieve their goals can be considered

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victimless. In the general sense, instrumental drug users were only hurting themselves. If an instrumental stimulant user was pregnant, however, others may conceive of her actions as directly impacting another. Aside from that specific situation, which Becker (1963) might argue is an example of behaviors resulting in certain consequences, women in this research successfully kept their deviance to themselves while outwardly enjoying social rewards. White-collar criminals also present a variation of this theme. While those embezzling from companies arguably have victims, the impact of their actions is spread across many people, unlike robbers who terrorize a single person. In addition, white-collar criminals generally resemble conventional people who aim for socially valued goals, much like instrumental drug users. As our criminal justice system shows, society is not as intent on sanctioning white-collar criminals, at least not to the extent that other types of thieves are punished. In a similar vein, women in this research held relatively high amounts of social power resulting from their deviance, while escaping negative social sanctions. In effect, chronic instrumental drug use may actually be considered far less deviant than other types of daily substance use. For example, it is safe to say that a young, poor, woman of color who engaged in daily drug use would presumably face harsher social sanctions than a young, white, college student who used pharmaceuticals to stay thin. From this perspective, deviant labeling is certainly influenced by the goals of non-conforming behaviors, as well as social power variables.

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Defining Deviance Among individuals who are otherwise largely conventional, nonnormative behaviors, which are aimed at culturally valued goals, have been treated as decisively less deviant than other types of unconventional, or even illegal, behaviors. Heckert and Heckert (2004a) brushed upon this idea in their four-fold typology of deviance, which broke down non-conformity into four types: negative deviance, rate-busting, deviance admiration, and positive deviance. Negative deviance includes behaviors that are non-conforming and are negatively evaluated, for example, rape, murder, or drug addiction. Rate-busting includes behavior that over-conform to cultural norms but are negatively evaluated, as was negative deviance. Although rate-busters are in fact conforming, they are evaluated negatively by those around them. Examples of rate-busters include overachieving students (nerds), workaholics (yes-men), or blonde women (often labeled as airheads and presumed to be stupid). Deviance admiration involves non-conforming behaviors which prompt positive social evaluations. This type of deviance refers to behaviors that most people would be negatively sanctioned for, but in particular cases, deviants are revered as heroes and admired by others. Deviance admiration is evident in stories like Robin Hood. The last category, positive deviance, includes behaviors or conditions that over-adhere to cultural expectations and are evaluated positively by others, such as religious leaders, altruists, those exceeding appearance norms, and people with charismatic authority. Since instrumental drug users over-adhered to cultural expectations, and were evaluated positively by

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others, it could be argued that women represented the concept of positive deviance. Many types of deviance are evaluated positively by others, as Heckert and Heckert (2004a) argued. Positive deviants possess characteristics or statuses that are outside of normative boundaries, yet in an over-adhering (versus underadhering) manner, resulting in positive evaluation. Important to this concept was the notion that positive evaluations are possible only when structures and interpersonal relationships are not threatened (Heckert and Heckert 2002:466). Given that instrumental drug users guarded their deviance from others, they were shielded from these threats as described by Heckert and Heckert (2002). Consequentially, women were able to maintain a front that would be positively evaluated by others. However, in the case of instrumental drug users, others were not evaluating their deviance, only their over-conforming appearance. Positive deviants, as Heckert and Heckert (2002) described them, are non-normative only in their over-adherence to certain cultural goals. In other words, positive deviants did not necessarily use non-normative means in order to over-conform, as did participants of this research. Instead, instrumental drug users were secret deviants (Becker 1963). Although women who are extraordinarily beautiful have been described as positive deviants because of their outward appearance, they did not necessarily engage in deviant behavior as a means to achieve this ideal, as did instrumental drug users.

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Therefore, the types of non-normative behaviors described in this dissertation complicate Heckert and Heckerts (2004a) typology of deviance. Their typology was based on social evaluations, either positive or negative, and whether deviance was conforming or non-conforming to cultural ideals. When classifying deviance in this manner, the evaluations of others are assumed. This means that deviance was conceived of as an outwardly apparent phenomenon, in which others were able to evaluate individuals non-normativity. I would add another dimension to this typology, which considers others awareness of nonnormative attitudes, behaviors, or conditions. For most instrumental drug users, social feedback regarding their outward appearance was situated within social contexts where others were not aware of their deviant behaviors. By extension, others were never truly given the opportunity to respond to, and evaluate, womens deviance. If individuals who engage in deviant behavior maintain secrecy, negative or positive evaluations from others concerning deviance are never going to be possible. Social reactions are certainly central to the study of deviance, however, it cannot be assumed that others are always given the chance to react. However, by hiding their behaviors from others, women are essentially admitting to themselves that their actions are socially disagreeable. This internalization of definitions of deviance drove many women to attempt to neutralize their non-conformity through accounting strategies.

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Neutralization Theory The narratives reported in this dissertation also offer support for neutralization theory. Sykes and Matza (1957) suggested that despite unconventional behaviors, individuals involved in deviance maintain strong bonds to conventional society. By extension, individuals are invested in their selfperceptions as generally good, norm-abiding people. Accordingly, individuals involved in non-normative behaviors offer accounts, either excuses or justifications, in their efforts to minimize any negativity that may be associated with their particular unconventional lines of action (Scott and Lyman 1968). Generally speaking, deviant individuals are embedded in dominant conventional society, and are therefore aware of, and likely to be invested in, the socially constructed values and ideals of our society. As such, engaging in deviance requires individuals to reconcile participating in non-normative behaviors with their mainstream, conventional identities. This suggests that despite the presence of subcultural values and ideals, which may support deviance, individuals remain largely influenced by dominant culture. I suggest that justifications for non-normative behaviors are more powerful than other techniques of neutralizing deviance. Justifications, especially those relying on legitimate social institutions (such as the medical establishment), support continued deviance in two mains ways. First, they can be used over the course of time, whereas excuses generally apply to one specific situation. In addition, justifications can be used to differentiate one type of deviance from another by appealing to the normative orientation of individuals overall goals.

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Summary of Theoretical Implications This dissertation, framed from the symbolic interactionist perspective, has a number of implications for social theory. First, I suggest that social strain supports individual sacrifice. Positive social evaluations, resulting from the achievement of conventional goals, may propel individuals in their deviant pursuits, even if at a personal price. Essentially, appearing conventional and maintaining consistent social approval is more important than actually being conventional in ones everyday attitudes, behaviors, or condition. In addition, deviant labels, which may significantly impact individuals images of the self, are affected by the overarching goals around which non-normative behaviors are centered. As individuals goals become increasingly admirable or socially valued, the extent and severity of social sanctions for non-normative behaviors decreases. In other words, society has demonstrated a relative tolerance for deviance that is used in the pursuit of cultural ideals. This suggests that society places more emphasis on idealized goals than legitimate means. I also suggests that definitions and classifications of deviance should consider not only individuals goals, means, the evaluations of others, labels, and normative orientations, but also the concealable nature of deviant attitudes, behaviors, and conditions. Beckers (1963) conception of secret deviance makes this distinction. However, by adding the element of privacy concerning individuals deviant behaviors, I suggest modification to definitions of deviance which assume the awareness of others.

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Finally, I suggest that individuals who generally aim for conventionality may be more comfortable with participating in non-normative behaviors for which they can create justifications. Given that many people successfully conceal their deviance from others and thus escape negative labels, most still construct accounts in order to neutralize their deviance nonetheless. For people who are intent on achieving socially valued, normative statuses, deviant means, which are justifiable and seemingly victimless, provide a viable alternative. The extent to which justifications are founded on socially valued goals, and rely on social scripts, affects their power for neutralizing deviance. Generally speaking, conventional goals have the potential for eliciting deviant behaviors, especially those which can be justified using legitimate cultural scripts.

THE SOCIOLOGY OF DRUGS

Research on the use of psychoactive substances is continually expanding. The sociology of drugs includes work on the classification of drugs, history and prevalence of use, subcultures and the using lifestyle, drugs and crime, the politics of the drug war, and prevention or treatment of substance abuse. Scholarship on drugs commonly illustrates the constructionist nature of dominant discourses concerning the use and abuse of substances. For example, many researchers have critiqued the boundaries drawn between licit and illicit drugs, and argued against popular conceptions concerning what makes drug use acceptable or deviant.

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However, studies in the field have largely concentrated on certain types of drug users, particular motivations for use, or one specific class of drugs. First and foremost, the majority of scholarship on drugs was based on studies of men. Of the research on women and drugs specifically, many scholars focused on incarcerated women or substance use during pregnancy. Those who are incarcerated or using during pregnancy represent, in the publics eye, women who have been bad, and sociological research has reflected this popular fascination through large amounts of scholarship on these populations. In addition, many studies on women and drug use concentrated on women of color, or women who were poor. Generally speaking, much research on women and drugs has focused on populations that have been marginalized in society. The common scholarly fixation on pregnant women who use drugs highlights a gendered taboo concerning drug use generally. That is, while moderate amounts of alcohol and drug consumption are relatively normative in society, under no circumstance is a woman to engage in psychoactive substance use during pregnancy lest she be severely socially sanctioned. The massive amount of scholarship on so-called crack babies, a phenomenon which The New York Times referred to as the epidemic that wasnt (Okie 2009), illustrates this point. While the sociology of drugs has been progressive in many ways, continued focus on certain types of women, who use certain types of drugs, under certain circumstances, and for certain reasons, essentially reifies common stereotypes about patterns of female substance use.

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As college students, participants of this research represent a population of habitual drug users who are not commonly discussed in academic discourse concerning drugs. Instrumental drug users embodied relatively high levels of social power. Much scholarship on female drug use focused on dramatic case examples of inner-city crack use, heroin dependence, or women in prison, populations with arguable less social power. My research, when combined with previous works on women and drugs, demonstrates how substance use manifests in many forms among all women in general. In other words, all types of women use all types of drugs, many of them on a chronic basis for an indefinite amount of time, for all types of reasons.

CONCLUSIONS

In closing, this dissertation provides a unique qualitative, ethnographic approach to the study of both eating disorders and instrumental drug use. I draw on sociological theory concerning the modification of the body, feminist theories on eating disorders, and deviance theories, which have not previously been applied in scholarship concerning women with eating disorders and substance use. I designed and executed the project from the perspective of these theories, and worked to gather data that would represent the phenomenon in question through the voices of the actual individuals involved. The findings from my research suggest that instrumental drug use was meaningful and empowering among research participants. The deviance described herein enabled women to feel

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competent in their creations of the self, control over embodiment, responsibility for social status, and empowered in the creation of social identities. Overall, instrumental drug use provided social rewards which continually fueled womens deviant careers.

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