Alkohol bei Frauen auf den Azoren

This paper, presented at the Conference Women in the Azores and the Immigrant Communities held in July of 2001, analyzes some current problems related to the personal identity formation and social integration of Azorean women in relation to stress and substance abuse. It deals with psychosocial and cultural factors, specially those that are more significant to the development of personal identity. The cultural and conflictual fragmentation so characteristic of this Post-modern period generates not only freedom to make choices, but also the tendency toward stress and dependencies. The current situation of women is analyzed in relation to these two tendencies. Also highlighted are the added difficulties of about 5% of the population affected by genetic and environmental factors. Current cultural trends are considered as a source of opportunities and risks for women, since they can enrich the process of personal and social identity formation or promote risky consumption and jeopardize this process. The third part presents other sources and data related to the risky consumption of alcohol, tobacco and drugs in the Azores. Three situations are emphasized: women as victims of the consumption of others; women as victims of their own consumption and women as victimizing others due to their habits. The conclusion proposes more research on risky consumptive behavior and the implementation of a system of preventive measures.

The development of personal and social identity is a complex personal process, which is at times intuitive-affective, and at others verbalized, and which involves:

• personal enrichment through the development of new knowledge and values.

• affirmation of similarities that are favourable to one’s self-image.

• affirmation-integration of the qualities and values of the group or groups one belongs to or wishes to belong to (See Table 1).

The attitudes, behaviour, and values of significant persons and groups, and the recognition of primary and secondary groups are basic to the development of one’s personal identity. The multiplicity of culturally different people and groups that provide elements of identification is always a decisive factor in terms of personal development.

Rapid socio-cultural and economic changes provide advantages but pose problems to the formation and consolidation of personal and social identity and personal balance. (See Table 2)

1. The multiplicity and contradiction of messages and the conflictual dynamic relationship between opinion groups, pressure groups and behavior have never had so much impact and so simultaneously. The media, television, cinema, theatre, shows, advertising, newspapers, and the Internet are seen as sources of identity in competition with the traditional sources and propose contradictory cultural fragments simultaneously. Children and young people are subject to unstable, dissonant and incoherent models.

2. The synchronicity and syntopy of different cultural models from different times and places characterizing this Post-modern period are another factor to consider. Layers of cultures from distant times and places compete with the cultural matrix of a people, fragment models and lead to freedom, pressure and anxiety. All who live in cities and villages are pressured by this information and by mobility to live according to culturemas1 from different periods and countries.

3. Competition exists between the various traditional sources of personal and social identity. The family, school, religious group and acquaintances exist on a par with synchronic layers of other different cultures. These contradictory culturemas make the sedimentation of personal identity difficult. The various sources of identity referred to function without consensus and in conflict, often creating insurmountable barriers to the identity process.

4. More serious problems appear when peer group pressure manipulates young people in order to make them think that it is scientific and fashionable to change everything and accept the view that no foundation of permanent values exists.

5. In the Azores, this fragmentation and multiplicity of cultural content has been intensified with the increasing interchange between the nine islands and those from the tenth one living on the other side of the Atlantic Ocean. In addition, about 500 Azoreans with North American culture have been deported to the Azores, many of them affected by several genetic frailties and with deviational behavior.

All of these rival sources of identity affect children and young people on a daily basis. We must not forget that about 5 to 10% exhibit fragile identity due to genetic, family and environmental factors, which make them more conformist and more easily manipulated and which influence the identity formation of their partners in a negative way. We can conclude that, today, most children and young people grow up with more opportunities. At the same time, however, there has been an increase in risk factors, such as cultural conflicts, psychological insecurity, stress in decision making and problems of consumption and substance abuse.

2. Current Cultural Opportunities and Risk Factors for Women

All of these situations are having an even greater impact on women. Being a woman was never subject to so much change. Women have never had so many different roles available to them (See Table 3).

The other side of the coin is also unavoidable; more options bring more risks. (See Table 4) Some of these are:

The etymology of the word stress comes from the Latin “stringere” and “strictum,” which mean to press and refer to the condition of a person being pressed. This can be defined as the bio-psycho-socio-spiritual condition of those who live under prolonged tension and conflict and can no longer return to their initial state of being. In the long term, the result is exhaustion, burn out and loss of health. Stress can result from what is unexpected or uncontrollable, or from the person’s way of being (personality). Stress starts when the person is no longer able to deal with the problem.

Emotional instability, identity conflicts, insecurity and the continuous efforts to find satisfactory personal and social identity frequently result in stress in adolescents, young adults and adults. Today, this stressful condition is aggravated by the continuous fragmentation of culture, which results in pressure to make new choices in the face of multiple, unexpected situations. For many, returning to their initial state before stress set in becomes a problem which affects their health.

The person with an unstable identity quickly falls prey to stress and becomes burned out. When a genetic predisposition exists, as happens in 5 to 10% of persons affected by stress, the capacity to adapt satisfactorily is even more reduced or suppressed and the disturbance emerges.

Female adolescents and young adults today, maybe more than the males,2 are constantly asking themselves: who am I, what is my place in the family, in society? The struggles of feminists movements, along increasing opportunities, provoke perplexity, insecurity, difficult decision-making and problems of belonging. How should I behave? What’s the right job for me? What should I wear, when, where? How should I be a woman today? These choices can accentuate problems of identity and stress.

The wider the range of choices is, the more uncertain and insecure the person feels. A silly example would have to do with the choice between wearing a skirt or pants. When the only option for women was skirts/dresses, they felt more secure than when the choice became one skirts/dresses or pants. Today, some women have already found themselves, while others are still looking for their self-image.

Other examples would have to do with the sexual identity of women before and after the separation between the sexual and procreative dimensions, or between the alternatives to either work at home or outside the home, to pursue a college degree or not, etc. The increase in alternatives available implies opportunities and advantages, but also implies the cognitive and emotional costs of making those decisions. Do what? Be who, for what and for whom? Before, the choices, meanings and directions were fixed. Now, each one has to give meaning and direction to life. Even if one is not aware of it, emotional stress is very strong in the process of decision making.

Emotional complexity and stress increase in relation to cultural fragmentation and the choices available. The weight of the choice falls upon the individual, except when the adolescent or young adult falls into robot-like behavior and does not take on responsibility, conforming to their partner or peer group and letting them take control.

Conscience: A Guide or a Brake That Sometimes Doesn’t Work

When making a choice, the female adolescent is usually alert to such questions as: Who do I follow? With whom should I conform? For how long? With what risks? She is living at the crossroads of choices involving “consumer culture,” “group consumption” and risky consumption. In such conditions, the capacity to discern critically is put to the test.

By aligning moral conscience to cognitive and emotional capacities, most women choose that which contributes to a positive identity based on self-esteem and a valid project for development. In minor cases, these capacities are reduced and dominated by group pressure and by the attempt to avoid feeling bad or ashamed for not belonging if she doesn’t conform to the group, and this if can be truly devastating when risky behavior is involved. In this way, young girls and boys are caught between the proposals and pressures of groups when it comes to:

2. Stagnation and cultural rigidity that threatens positive identity development.

Cultural change leading to personal and social development and to the economic and political promotion of women, point to adequate choices to be made. There is, however, an overabundance of deviant behavior leading to hesitation: Work inside or outside the home? Proceed with studies or stop early? Become involved in society or remain passive? Experiment with risky behavior or not? Follow the example of my mother, my aunt, or this friend and colleague? Follow models of balanced development or those involving drugs, alcohol or tobacco?

Problems become more acute in personalities suffering from genetic, environmental, intellectual and emotional problems. One of those conditions, for example, is described by Antonio Damásio (5th ed. 1995 p. 221-230)3 as having “a myopic view of the future” in order to explain the behavior of “individuals under the influence of alcohol and other drugs.” These persons are controlled by the present and are insensitive to the future. We can say that cultural conditions lead a considerable minority of young people to function according to this weakness, and end up being led to problems of dependency on tobacco, alcohol or drugs.

Let us now consider problems related to the consumption alcohol, drugs, and tobacco, with special emphasis on alcohol. In this respect, women appear as being victimized by the consumption of others and of their own consumption, and as victimizers of others due to their own consumption. It is difficult to say whether women today suffer more from their own stress and risky behavior, or if they are more in a position of being victims of the aggressive and risky behavior of others. It is more probably, as we will see, that they are more often than not the victims of the alcohol and drugs abuse of others, and more victims of their own smoking habits and of aggressive behavior toward their children. There is, nonetheless, an overabundance of situations in which their abuse of alcohol hurts their children, especially during periods of pregnancy and breastfeeding.

Traditionally, however, men have been more prone to aggressive behavior, possibly due to genetic weaknesses and to the macho tendencies of a patriarchal society than to defending female victims. Almost everything seems to impede these victims from defending themselves and finding alternatives leading to liberation and self-fulfillment.

There are increasing signs that some changes are occurring, at times amidst stress, personal identity dilemmas, pressure groups and risky choices, and sometimes with no return possible. While adult women tend to take refuge in the past and stay in situations where they are victimized and under stress, young women, along with being victims, tend to react by evading and selling-out their future through risky behavior and consumption.

Recent Data About Risky Consumption on a National and Azorean Level

We are only beginning to do research in terms of the effects of alcohol on third parties, especially women and children. The data is still scarce and dispersed. The effects of smoking on non-smokers is the area that has been most studied, while studies on alcohol involve more and more research projects. Drug abuse has been the most visible area and the one attracting the most funding. Not being able to review all of the material, I will present some data pertaining to the Azores in relation to alcohol, tobacco and drug abuse.

1. Alcoholics Anonymous Questionnaire. 25 to 30% of AA declare that they jeopardize themselves and jeopardize others.

A recent poll conducted by Alcoholics Anonymous (1999) included 413 members from 70 groups in all of Portugal, including the Azores and Madeira Islands,4 presents some pertinent data (See Table 5). Of the 413 interviewed, 94 were women (23%) and 314 (77%) men, which gives us a ration of 3 to 1. Boys began to consume alcohol at an earlier age, that is 55% before the age of 17, while 23% of the girls also started before 17 and 58.6% after 20. Of the women, 25.5% and 34.8% of the men indicated that their reason for starting to participate in AA meetings had to do with family presure, indicating that they were already jeapordizing the family. On the other hand, 31.9% of the women and 19.7% of the men indicate emotional problems, while 8.5% of the women and 9.1% of the men point to physical deterioration.

77% 23%

M % Age F %

Problems 15 Before 20 8

2. Alcoholics under treatement. From a small sample of 100 alcoholics undergoing treatment in the center where I worked until 1998, the majority recognized alcohol as a co-factor in their family’s problems. (See Table 6).

Awareness of 100 alcoholics under treatment having the notion that they provoked problems to their

3. About 5.0% of male alcoholics in the Azores jeopardize their wives and children.

In the study we conducted in the Azores in 1999,6 only 5.0% of alcoholic men declared that their drinking affected others. Of these, 70% indicated their wives and 20% indicated their children as being affected. On the other hand, only 1.8% of women alcoholics admitted that they affected their husband and children, their parents and siblings. In both cases, it is probable that these numbers are underestimated for reasons of self-defense and negation of the problems, both very common in problems of dependency.

1. About 6.72% of women in national study were victimized due to the alcohol abuse of the aggressors.

In the Study Alcohol and the Family (EUROCARE-SAAP/COFACE-CNAF 1997), there is a study (Violence Against Women 1997 p.87-89) with samples representing 1,000 women above the age of 18 in which the victims declared that 16% of their aggressors consumed alcohol and 84% did not consume. When asked if there was a relationship between alcohol or drug abuse and the violence they had suffer, 42% responded affirmatively and 10% said they didn’t know, which results in 6.72% of those victims having perceived the relationship.

In terms of 80 women assisted by SOS Vitima (Angra 2001), the aggressor is a male alcoholic in 50% of the cases, and dependent in 9% of the cases, with no indications as to whether the victims perceived the relationship to alcohol and drugs (See Table 7).

S.O.S. Vitima (Angra, March 2001)7

Characteristics of the Aggressor N %

In the book The Situation of Women in the Azores (1999), 6.5% of the 2000 women recognized some relationship between the violence they suffered and the alcohol problems of their aggressors. This percentage is near the 6.72 referred above. From this study, we include Table 8 (p.185).

Relationship Between Violence Suffered and Alcohol and Drug Abuse8

Itens %

As the authors state, the high percentage of 72.1% of the women who do not know or do not respond, pointing to a “reserved attitude,” means that this can not be understood as lack of knowledge or perception. In our estimation, these point to the tendency to negate, hide and feel ashamed of the situations in which they find themselves due to affective ties or to their own substance abuse. When the questions pertain to less affective issues, the percentages pertaining to these same women are much higher, 62.9% totally disagree with alcohol and 27.7% simply disagree, a total percentage of 90.6% (p.69 and 70). The authors point out that “Alcoholism is more prejudicial, perhaps it has been more a part of the daily life of many women because of their husbands, fathers, brothers or other close acquaintance.” (p.69-70) and that “We know how alcoholism in women of all ages, including adolescents and children, has increased in the last few years.” (p.70) Based on the last three sources, we can conclude that about 5-7% of women are beaten by their husbands because of alcohol.

In a telephone interview, 200 women from São Miguel Island (See Table 9 for technical information) were asked about their own habits in terms of alcohol consumption and the consequences, and were also questioned about the habits of their male partners and the results of this behavior.

Method: Telephone interview (73.1%) (27% of the homes were excluded because they had no telephone)

Of the 200 women, 43.5% admitted to consuming alcoholic beverages and 73.5% to having a husband, companion or boyfriend who consumes; 54% of these last women also drink. (See Table 10). The level of consciousness women have of the damage brought about by their own consumption and by that of their husbands is indicated in Table 11. In all, 19.6% of the consumers feel that alcohol is prejudicial to their health, (17.2%) to their lives, and (5.7%) to the lives of their family members and others (1 to 3.5%).

Do not consume 33.5

Total 100.0 100.0

Of the husbands who drink (54%), 26.2% are perceived by the women to be prejudicial to: his health (25%), to her health (10%), 7.5% to the children’s health and 3.8% to the life of others. The conclusion was that 10% of the alcoholic aggressors cause some kind of damage to women due to alcohol.

In the area of Ribeira Grande, 45% drink and 33.4% of the women state that this is jeopardizing their health and 14.3% the life of others, while in the Lagoa area 41.2% drink and 14.3% declare this to be prejudicial to their lives. The husbands who drink in the City of Ribeira Grande (42.5%) are the ones who are seen as jeopardizing their health most, 23.5 as jeopardizing the woman’s life and the family. The highest percentage seen as not jeopardizing (47.1%) also occurs in Ribeira Grande.

In terms of schooling, women with Higher Education are those who consume alcohol most, at 80% and 53.8% for those who have attended junior high school. In accord with this, 50.0% of their husbands with similar educational levels also drink

Who Jeopardize Who Jeopardize

% %

Total: No answers 80.4 Total: No answers 73.8 Total yes answers 19.6 Total yes answers 26.2

Urban areas (Ponta Delgada and Ribeira Grande) present the highest percentages of female consumption of alcohol, at 52.6%, compared to 39.9% in rural areas. However, when it comes to the smaller villages, women drink even more (62.5%) with an average of 43.5%.

Note: All of this data may be below real levels since 27% of the homes were not included because they did not have telephone service.

1. From the total number, 43.5% of the women, and 54% of the husbands drink. 19.6% of the women who drink put themselves or their families in jeopardy, while the percentage for men is 26.2%, with 10% jeopardizing their own lives.

2. While of the women who drink, only 1.1% admit to jeopardizing their husbands, 10% recognize that their husband’s drinking jeopardizes them. We have here an assymetrical ratio of 1 to 10.

3. The city of Ribeira Grande, followed by Lagoa, present the highest percentages of those who jeopardize themselves and others. The highest percentage of husbands who jeopardize their wives, children and other family members occurs in the city of Ribeira Grande.

4. On the other hand, it is the women and husbands with a university level of education, followed by the junior high level, who drink more and jeopardize their own health the most.

5. And, finally, it is in the urban areas of Ponta Delgada and Ribeira Grande where women consume the most alcohol, but it is in villages with less than 1,000 inhabitants that the highest percentage of women who drink alcohol is registered.

In a study from 1999 representing 550 participants who were 15 years old or older, we came up with the following results:

1. If we consider the habit of consuming 6 to 9 alcoholic drinks per week, we come up with Table 13.

Even if we consider that women become intoxicated with about half the consumption of men, and that three drinks per day is already excessive drinking for women and for many men, only 2.8% of Azorean women abuse alcohol, compared to 24.5% of men, that is, about 1women to 8 men.

2. The same study indicates the numbers of those who have never consumed alcohol or quit and the reasons. (p. 44 and 64). (See Table 14).

For every male, 3 women totally abstain from drinking alcohol due to health reasons and recognizing that they are more sensitive to the damages of alcohol. The reasons for The reasons for quitting have to do with health and with not liking drinking. Women are most sensitive to health reasons, indicating that they may have quit because their health was already affected.

3. There is a great disparity between the opinions of men and women with respect to the number of cups/day that do not have negative effects, as seen in Table 15.

Azores – How many cups/day do not have negative effects? Cups/Day9

4 and 5 cups/day 6.8 1.4 4 to 15 8.3 0

It’s impolite to refuse alcoholic drinks? 13.6 6.7

This difference between men and women is also apparent in the answers about whether refusing alcoholic drinks is impolite and about the last drink consumed that day.

28.6% of men and 26.6% of women smoke.

According to the same study (Aires Gameiro 2000), there is a difference between alcohol consumption and the use of tobacco by women, as can be seen in Table 16.

According to this table, we can see that 2/3 of males and 1/4 of females 15 and over who have alredy smoked, about 3 men to 1 woman. Of these, about one quarter continue to smoke. This seems to indicate that smoking is more accepted by women and that it has become fashionable among young women as a way of self-affirmation.

These numbers are different from the 15% of women in a 1990-1992 study conducted in Portugal by OMS-Europa10 which also registered a tendency for the use of tobacco to decrease among men and to increase among women (p.11). At the same time, this study presents similar findings for 12-18 year olds, with equal rates for boys and girls until the age of 16 (p.13), that is, 8.2% for 12-14, and 22.7% for 15-16,

A national study11 from 1997 indicates that in Portugal 38% of men and 9.0% of women had smoked during the last month, with a percentage of 24.2% of young people of both sexes between 15-24. These are finding which show that the 1999 findings for women in the Azores are significantly above, while the findings for men are below the national average. The 15-17 year olds and the 18-24 year olds continue to demonstrate smoking levels near the national average.

Obtaining reliable data about drug abuse continues to be difficult. We have tried to organize the data that follows.

1. In the study already referred to (Aires Gameiro 2000), data was collected without separating men and women, as seen in Table 17, which indicates consumption of any kind of drug. If we consider those over 15 years of age, we have 13,400 who have already consumed and 2,170 for those who declare that they still consume some kind of drugs, except alcohol or tobaco.

2. Considering first-time hospitalization of men and women, who are drug addicts, we find that in 1998, 1999 and 2000, 248 men and 33 women came to Clínica S. João de Deus to be treated, which results in 7.5 men for every woman. Heroin users look for treatment most often. We are not including those treated in out-patient care. (See Table 18).

We began a Methadone treatment in January of 2000 for 131 men and 17 women. Of those who started then, 84 men and 7 women remain, while 57 men and 10 women dropped out. In terms of deportees, 51 men and 11 women, a total of 62, were hospitalised at the Clínica S. João de Deus. This number represents about 1/6 of the total of deportees now in the Azores.

3. We will now summarize the data collected by the Special Committee of the Regional Legislative Assemby, May 2000, and compare these findings with our study. (Please see summary Table 19 by institution, and Table 20 by island).

Social Solidarity (IPSS) 40 (18)(1) 30 8 29 48

Health Centers 230 20-25 71 22 301 her/coc/hax/alc

(2) 17 seen by other doctors or sent to Clínica SJD/Casa de Saúde S. Miguel.

Table 21 compares the estimates from our October 1999 study with the data obtained by the Special Commission in May of 2000.

Distribution of Drug Users According to Islands

M F T Type of Drug

S. Miguel 331 52 383 hax/alc/coc/her

Terceira 357 98 455 hax/her

+20(1)

Pico 2 1 3 hax/coc

Flores 3 - 3 -

1. The “generic” drug abusers (present poli-consumers) in the Region between from 1999 to 2000 numbered about 2,200.

2. The Report of the Special Commission detected less than 50% because these were the ones who sought help.

3. We can then estimate that at least 1.15% of the population of persons 15 or older consumed in 2000 and about 6.7% had experimented.

It is necessary that more research be conducted in order to reach a more objective analysis of the relationship between the victimizer who consumes alcohol and violence against women, so that we can discriminate between the various factors involved. More research should be done in the following areas:

6. awareness of the relationship between the aggressor’s drinking and the violence suffered.

1. To the common “lack of perception and tendency to hide the violence,”13 we would add the sense of shame and taboo associated with having a problem of alcohol affecting the family, the husband or the father.

2. The representations of women vary according to the consumption of alcohol and the alcoholism of the man, depending on whether the woman feels that she cannot live without the man or that she can no longer put up with him.

3. An important factor has to do with women themselves consuming excessive alcohol and living with this problem. The tendency to deny also alters their perception. The emancipation and economic independence of women is increasing the number of women drinkers, making them more tolerant of aggression resulting from alcohol.

4. There remains a need to clarify what levels of alcohol consumption are prone to cause problems in terms of the family and women, as well as what the levels of tolerance are, what the expected effects of alcohol are, and what is seen as acceptable/not acceptable in terms of drinking by men. The relationship between violence and alcohol can lead one to think of excessive consumption and drunkenness, or of light / Social drinking which alters moods and reactions. The drinker with epileptic tendencies or with psychic disturbances can become drunk or affected when medication is stopped or mixed with alcohol, even in small quantities.

5. Ideas about alcohol must also be considered in terms of those who drink in excess or in a dependent way, even when their behavior is altered, for neither they nor those around them discern any problem unless they become completely drunk. Women also deny their husband’s drinking problem until the family’s money disappears, changes in personality become repeated and threats and abuse increase. Even then, many women will continue to deny their spouse’s problem because of shame.

6. The perception of being a victim or not varies according to the concept a culture has of violence and to levels of tolerance. Does it include physical abuse, abusive language, or only physical aggression that leaves marks on the body? It can even be interpreted as not being violent by the woman who says, “My husband doesn’t beat me, and if he ever does, it’s because I deserve it.”

While it is true that alcohol can be used as an alibi for men and women to excuse their inadequacies and to relieve tension, we must not forget that many of the small-big problems with alcohol start precisely when drinking relieves tension and awakens emotions. We may conclude by saying that more research is necessary so that we can have a better idea about the dimensions of the damages caused by smoking, drinking and drug use to those who do not partake of these intoxicating substances, but are exposed to these types of behavior.

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* Participated in the Conference A Mulher nos Açores e nas Comunidades, July 16-18, 2001, University of the Azores.

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