About Laurel Sindewald

Laurel is an alumna of Warren Wilson College with a BS in Conservation Biology and a BA in Philosophy. She is a writer for Rural System, Inc.

Impossible Identities: The Double-Binds on Drug-Using Women in Rural Appalachia

On March 13, 2017 I settled into my chair in room 220 in the New Classroom Building at Virginia Tech. I was there to listen to a guest lecture by Lesly-Marie Buer, a doctoral candidate at the University of Kentucky. Two overhead screens on either side of the room displayed the title of the lecture: Paradoxical Treatment: Drug-Using Women’s Navigations of Impossible Identities in Rural Appalachia.

Addicted. Pregnant. Poor. book coverWomen in American society are often haunted, to different degrees, by the possibility of pregnancy. Kelly Ray Knight notes in Addicted. Pregnant. Poor. that, “The biological nature of pregnancy, specifically in reference to the potential for shared illicit substance use through shared blood between a fetus and mother, shifts the ontological status of the woman and initiates legal, technical, and political limits on her as an individual” (Knight 2007: p. 12). Due to the specter of pregnancy, women who suffer from addiction are maligned as child abusers or potential child abusers – as those who have failed to meet the ideal of the selfless mother.

Buer’s study looked at programs for women with SUDs in a 5-county area in rural Kentucky. Her aim was to determine what these programs are doing to help and also marginalize women, and their limitations. Buer interviewed 32 “gatekeepers,” or treatment providers and community leaders from different organizations. She also spoke with 40 women who went through the programs, many who did so several times.

The women in rural Kentucky have three treatment options: drug courts (which don’t believe in treatment with medications), buprenorphine clinics, and community mental health centers (such as Horizons). In Horizons, Buer reported that women are in contact with the state on a daily basis through law enforcement and Child Protective Services (CPS). Most of the women in Horizons have lost custody of their children after testing positive for illegal drugs once. Not all of the women in Horizons suffer from addiction. In fact, the women exhibit a wide range of drug use, from having smoked marijuana once or only on weekends to severe addiction to methamphetamine or opioids.

The dominant understanding of addiction at Horizons is that addiction is both a disease and a moral failing. Staff believe that the women made choices that caused a disease, that they will then pass on to their children through exposure to the drug and through genetics. Buer’s research revealed that some professionals selectively cite studies that appear to justify this concept.

Women in Horizons are thus doubly stigmatized by this “moral failure rooted in genetics and passed through generations.” They are categorized as “bad” mothers. This prevailing belief extends to all women as potential mothers, and asserts that women who use drugs “put all children in danger,” not only their own. Buer described a presentation she attended in which women using drugs were blamed as the cause of all disorders in the education system, without evidence.

As an example of the stigma women face, legislators and media have continually emphasized a notion of “babies born addicted,” where infants exhibit withdrawal symptoms at birth. The concept of “addicted babies” is a misunderstanding of addiction itself. The babies may be born dependent on an opioid, for example, but they do not persist using despite negative consequences so they are not addicted. Babies born dependent to substances are weaned off, and there is no evidence of adverse effects later in life. Yet, the myth of “babies born addicted” persists and stigmatizes mothers who do suffer from addiction.

Women who lose their children also lose human connection, and exchange their identities as “mothers” for “addicts.”

Women in rural Kentucky also suffer from another stereotype, that they are coping poorly with a “hyper-violent Appalachian culture that victimizes women.” The women are doubly dis-empowered as having no control over addiction, or over the presumed violent culture of which they are “victims.”

“The idea of these women as victims is used as a target for coercive state intervention,” Buer reported. Women must agree to urine tests for drugs, and if they do not agree, CPS will be called immediately. Buer, when hospitalized for an early delivery, underwent this urine test herself, and later her blood was tested for drugs without her consent.

Funding is a huge issue for Horizons. Administrators of Horizons recognize that stigma is a problem, but they do not have enough money to change the behavior of their clinicians. Sometimes they knowingly perpetuate stigmatizing practices in order to qualify for limited funding. More funding is clearly needed for these programs to combat the stigma that is causing so many problems for women in poverty. Unfortunately, funding is likely to be lost if the ACA is repealed.

The stigma isn’t limited to Horizons or to the medical system, however. Buer told the story of a program called CRACK that was started by a woman, a community member, who admitted to having race-related motivations. CRACK payed women $300 to get sterilized. An advertisement saying, “attention drug addicts & alcoholics,” targeted low-income neighborhoods, and especially those of people of color.

Women with addiction in poverty in rural Kentucky, beyond stigma, are subject to a practical double bind. They are forced to choose between childcare and self-care for addiction. Buer documented that men in NA groups criticized women for not doing more in the programs, though women needed to leave early to care for their children. The women were thus either “bad moms” for neglecting their children or “bad citizens” for neglecting to seek help for their “disease.”

Worse, Buer said that women in abusive situations feared calling the police, because CPS would intervene and take their children away. One woman was charged with neglect for not being with her children while her husband was beating her. The husband was not punished, which, Buer said, is often the case. The unequal treatment women receive from the state extends beyond domestic violence. Buer reported that police officers pull women over and check their arms for track marks, as a pseudo-drug-test.

Women in Horizons are stigmatized by law enforcement, medical practitioners, and the surrounding community. To regain agency and positive identity, Buer said that the women found ways to be good mothers while using by providing food and shelter and shielding their children from their drug use. They view themselves as strong in coping with adversity, and focus on proving people wrong, affirming things like, “I neglected myself, not my kids.” Some women choose to give up custody on their own terms, finding a friend or family member willing to assume custody and visiting their children whenever possible.

The paradoxical and stigmatizing identities of “bad mothers,” “bad citizens,” and “addicts,” combined with the extra stigma associated with poverty or race make for an impossible situation for these women in rural Appalachia. Many in American society have been passionate activists for “the rights of the fetus” and to safeguard children in unstable situations. Rarer are those who focus on the needs of women and mothers, and at some point the conflicting demands placed upon women in poverty are unrealistic and counterproductive.

In Addicted. Pregnant. Poor., Knight writes that, “Addicted, pregnant women are biopolitical projects on which social and legal interventions are attempted as pregnant, addicted women travel between environments of drugs and hustling and institutions of care and coercion. whether biological mechanisms or social-psychological histories are evoked to explain addiction, the path from pregnancy to mothering a child ultimately demands stability and abstinence” (Knight 2007: p. 31). To provide that stability, the addictions treatment and criminal justice systems need massive overhaul to combat stigma, and to increase access to treatment and vital resources for women in poverty.

Components of a Rural System Group

Rural System is planned to be a corporation with over 150 diverse Groups, or small business enterprises. The Groups would work separately and together to generate stable profits on rural lands and waters over a long-term planning period. While the Groups would be highly cooperative and inter-dependent, they would also necessarily work to optimize their activities to meet objectives, including profits.

General Systems Diagram by Dr. Robert Giles

Click to view larger image.

If you are interested in starting a Rural System Group, or even in applying Rural System principles to your small business venture, there are ten necessary components to include. A Rural System Group…

1) Is objectives-oriented. No systems work can effectively be undertaken without objectives, the ends in mind. The objectives allow the systems manager to apply feedback to adjust practices in order to more accurately or fully meet the objectives. Without objectives, the feedback is meaningless and/or disorganized. Before objectives are set, Group founders should engage in standback, an activity of researching what similar enterprises already exist, whether others have been attempted in the past, and what their outcomes were. Standback also involves determining the relevant context for the system. (For a Group, standback would include market research.)

2) Is for-profit, and profitable. While some Rural System Groups are expected to be more profitable than others, no one Group should be entirely subsidized from the others. All Groups should find ways to monetize their activities in order to bring long-term stability and employment, as well as profits and benefits to the total system over time.

3) Is diverse in activity. Even within a Group, profitable and benefit-producing activities should be extremely diverse, so that if one or more do not work (perhaps a rise in costs of operation, or instability in the market), the others will continue to produce stable profits.

4) Is feedback-sensitive. The Group needs ways to continually measure the efficiency of its processes and activities at working toward achieving the specified objectives. For example, weekly or bi-weekly assessments of employee conduct combined with quarterly internal reports will allow managers to steer the Group efficiently toward objectives. Continual adjustments should be added to all parts of the Group over time.

5) Uses long-term planning. While Rural System has a 150-year planning period, individual Groups might have their own, shorter planning periods (e.g., annual) in addition to the corporate one (e.g., 20 or 50 years). Longer planning periods are made possible through prescriptive software, and provide for greater stability within the business.

6) Applies latest knowledge. Science is always advancing, and new knowledge may transform or refine practices to be more efficient. Rural System emphasizes the application of scientific research as it advances.

7) Uses prescriptive software. While it is potentially unrealistic for some small businesses to purchase or develop prescriptive software to guide business practices, Rural System holds that only computers can truly assimilate all of the data that must be considered to choose one of the best pathways to achieving objectives. (Equifinality is the concept that there are many paths to equivalent ends.) The software itself may be sold for people to use under contract for their own businesses.

8) Has backups. Every business must have multiple copies of work backed up in different places to prepare for situations in which data or other resources might be lost. In cases of essential resources, such as computers or staff-training materials, having a backup resource is recommended to prevent interruptions in Group activities.

9) Engages in futurism. A longer-term process of estimating trends in technology, economics, climate, etc., futurism involves making informed decisions based on likely futures, or best-available prognoses.

10) Uses feedforward. Like feedback, feedforward is a corrective process. Feedforward uses the results of futurism work to adjust practices to try to match outcomes with desired objectives.

Warren Wilson College: a System of Diverse Enterprises

A Warren Wilson College trail in the sunRural System envisions a systems approach to land management, generating stable profits from leased lands over the long-term. Over 150 Groups, or small companies, would work together to optimize profits within constraints. Similarly, Warren Wilson College in Swannanoa, North Carolina, has over 100 work crews tasked with keeping the college running smoothly. The work program is part of what cuts costs for students attending this small, private liberal arts college.

As an alumna of Warren Wilson I immediately saw the commonalities in values and vision between Rural System and Warren Wilson College. Recently, I wrote a post for Smart College Visit sharing just what makes Warren Wilson so unique.

A small college of just over 1,000 students, Warren Wilson College boasts a Triad program of academics for the mind, work for the hands, and service for the heart.

In addition to my consistently ambitious 18 credit hour academic work load, I was employed by the college, 15 hours per week, in one of over 100 different work crews. Warren Wilson is a working farm producing high-quality, grass-fed beef, and possesses acres of carefully managed forest. I was assigned in the beginning to Campus Support, the construction crew, before choosing in my second year to help found the Fine Woodworking Crew with a personal focus on musical instruments. Other crews on campus include Library Crew, Blacksmith, Heavy Duty (the janitorial squad), Electric, Paint, Garden, Gladfelter (the cafeteria), Writing Center, Forestry, The Peal (the school magazine), and all the various crews specific to helping academic departments. In essence, Warren Wilson College is kept operational through the daily hard work of its students. We were taught that all types of work have value in keeping a community of people functional. We also learned to respect one another in our different roles, rather than to assume academic superiority over people like janitors. I personally knew students who joyed in being on Plumbing Crew, for example, relishing the obvious value of being able to clear a pipe.

Rural System includes Groups for many of the same functions. The crucial difference that sets Rural System apart, even from Warren Wilson, is that Rural System Groups would be managed based on the output from a prescriptive software program called VNodal. VNodal, informed by continuously updated data organized spatially, would determine what groups would be best suited to operate on the different Rural System leased properties. VNodal would also determine optimal management actions for each Group based on Rural System’s objectives to improve land quality and ecological health, property aesthetics, and profits in the long-term. The diversity of small business enterprises, working together, would achieve economies of scale otherwise unreachable for small rural businesses.

Personally, I would like to thank both Warren Wilson College and Dr. Robert Giles, founder of Rural System, for teaching me that values such as community, aesthetics, and ecological stability are compatible with responsible natural resource management and profit. I know I will continue to be inspired by their examples of entrepreneurship tempered by humanitarian and environmental values.

Conversations with a Founder: Constrained Optimization

Rural System is committed to:

  • Enhancing the history and beauty of the rural region,
  • Generating meaningful work with salaries and benefits,
  • Stabilizing and building the strength of small rural communities (first in western Virginia), and
  • Improving lasting natural resource management.

In speaking with the founder of Rural System, Dr. Robert H. Giles, just yesterday, I discovered that Rural System has at least three different kinds of objectives. “The first level of objectives,” he explained, such as those listed above, “is grandiose and stuff that you find in legal documents that start off the business. The second level is still very general, but sort of why you’re doing it in more specific terms. The third calls in constraints.”

With every type one or type two objective that Rural System sets, there will be type three objectives that set conditions or boundaries on how the first two types of objectives may be achieved. Rural System’s valuable operation is to use prescriptive software, drawing on data organized spatially, to find optimal solutions to type one and type two objectives within the constraints of type three objectives.

Constrained optimization is a type of mathematical operation used in a variety of fields to try to solve complex, realistic problems in the best possible way. Alex Edelman, a Ph.D. student of condensed matter physics at the University of Chicago, provided this succinct explanation of how constrained optimization works.

Dr. Giles elaborated with a helpful example as well, “When somebody says that my objective is to go to Roanoke, I have other objectives of not going too fast or too slow, not being damaged, so these are limits to every first objective. I must not speed. I must not injure any dogs or cats.”

Constrained optimization is a principle that acts on every level of Rural System. The best example of its application, perhaps, is in how Rural System approaches profits. “Rural System works on the premise that we’re not going to maximize profit, because if we maximize profit we will do exactly what has caused problems for land management in past years,” Dr. Giles stated. He elaborated that the traditional rural business approach in Virginia and elsewhere in the United States was to try to maximize profits, only to find that conditions change and soon after a maximum is reached, profits bottom out. This traditional boom and bust model makes farming extremely risky, and in fact requires a great deal of government bailout in order to support.

“We have to get away from this traditional rural approach,” Dr. Giles emphasized, “and so what Rural System is designed to do, its strength, is to set boundaries on profits according to current, ongoing ecological research in order to sustain profits in the long term. The only way that society is going to achieve success and stability by 2050 is for us to implement an agricultural system, all of us, in our nation, to provide stable profits.”

Dr. Giles likened his business model to a common strategy used by stock brokers. Brokers set the bounds for how far they will tolerate the ups and the downs of different stocks. As long as they stay within the bounds, they know they will not lose too much. They are risk intolerant. In this way, constrained optimization is just a form of risk management.

The administrative group of Rural System, System Central, would be comprised of a board of businessmen and women who would set the bounds on their projected profits, based on information given to them by Rural System ecologists.

Dr. Giles sketched it out, speaking as he drew, “So we know, here’s constraint number one here, here’s the other constraint here, and as long as our curves stay up in here, we’re ok.”

Rural System profits optimized within constraints

Constrained optimization is clearly one of the most important keys to Rural System’s anticipated success. The approach is Dr. Giles’ original answer to a problem that has plagued land managers for decades. Do we conserve natural resources, or should we use them freely? Dr. Giles insists that there will be no lasting motivation to use natural resources wisely without some profit incentive, but if it can be shown that maximizing profits is not possible without periodic ruin, perhaps a crucial balance may be found. Without such a balance, our limited natural resources are surely doomed.

“We don’t know what life is, but this is life,” Dr. Giles drew a circle. “If this is all possible life then a person’s life can be talked about in terms of constraints,” he drew lines cutting through the edges of the circle. “We can talk about how fuzzy these boundaries are and whether I can attack these constraints. Before you know it, if you see these as limitations, if you recognize these as real constraints or as constraints that can be modified, if that’s all that can exist, then in one sense life is just a bunch of constraints. If you see then that life is constraints based, it may be a thing to accept or it may be an opportunity.”

Sketch by Robert H. Giles showing life as constraints-based

Perhaps we won’t work through our lives so mathematically, but the truth here cannot be denied: when we choose how to live our lives, we need to be able to recognize the constraints we can push and those we must accept.

A Mountain View of Constrained Optimization

Written by Alex Edelman. Illustrated by Laurel Sindewald.

You are dropped on an alien planet and told to climb the highest mountain.

Constrained Optimization on an Alien Planet

This is a perfectly good optimization problem. You are given a so-called objective function – in this case your elevation, as a function of latitude and longitude – and your problem is to maximize it. In principle there is an obvious way to solve this problem: just survey every possible latitude and longitude and once you’ve covered the whole planet, name the one that was highest. For that matter you can imagine solving any optimization problem this way, by trying out all possible combinations of input parameters and choosing those that win.

You may protest that this is a bad strategy, and your intuition is right. Implicit in your mountain-climbing mission is the desire to solve the problem efficiently, meaning that your oxygen tank should not have to get exponentially large with the size of the problem. Now in general there is no foolproof trick to be efficient. Instead you must exploit the particular simplifications that your problem allows.

For one thing your objective function, elevation, is fairly simple, and generally goes up and down smoothly as you move around the planet. If you permit me to make this planet somewhat abstract, an objective like this has a simple enough mathematical structure that it can be optimized by calculus alone, without ever leaving your armchair. But the more difficult optimization problems that we often care about usually have a more complicated objective function – for instance, find the place on the planet with the best view. This is pretty hopeless to predict without actually stepping out, but there are nevertheless some regularities. If you’re somewhere on a hill, for example, and the view is good, it’s probably a good idea to walk a bit up the slope and see if it’s any better.

In this case our armchair solution also supposes that our problem is unconstrained, that is, you are allowed to go anywhere on the planet that you wish. Suppose, though, that you want to find the best view within a five-minute walk of your spaceship. Realistic optimization problems are also subject to such constraints: it is usually just not possible to push a parameter up to arbitrary values. With constraints, a lot of naive strategies, like simply climbing up the nearest hill, fail. For some problems, with simple mathematical structures, the constraint can be turned into a sort of third parameter – latitude, longitude, distance-from-spaceship-tude – while for others more exotic strategies must be adopted.

In practice there are relatively few optimization problems that can be solved efficiently. In many cases we can only hope to find a good-enough local optimum in finite search time, trading off between climbing hills in one place and looking for places that might have better hills to climb. An algorithm can be used to quantify such trade-offs, for instance the simulated annealing algorithm was inspired by a metallurgical technique, which alternates heating, to dislodge kinks, with cooling, to let the material settle down around kinks that remain, without any guarantee that the final product is completely kink-free.

There is a second trade-off, this one in modeling, between constructing a mathematical optimization problem that captures the full richness of reality though impossible to solve efficiently, and making enough simplifying assumptions to get a solvable model – better yet, a model simple enough to give interpretable statements about how reality works.