Author ORCID Identifier

Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation


Arts and Sciences



First Advisor

Dr. Mary K. Anglin


Prescription opioids are associated with rising rates of overdose deaths and hepatitis C and HIV infection in the US, including in rural Central Appalachia. Yet there is a dearth of published ethnographic research examining rural opioid use. The aim of this dissertation is to document the gendered inequalities that situate women’s encounters with substance abuse treatment as well as additional state interventions targeted at women who use drugs. These results are based on ethnographic fieldwork completed from 2013 to 2016 and centered around one county seat in rural Central Appalachia. Data are ascertained through semi-structured interviews with women who have experiences with at least one of three types of substance abuse treatment offered in the area. Additional interviews were completed with program staff, institutional administrators, and community leaders. These data are supplemented with the collection of program documents, informal and follow-up communications, and participant observation in Eastern Kentucky communities, substance abuse treatment programs, and funding agencies. Social locations based on gender, income, access to quality health care, and place of residence contextualize women’s participation in illicit economies, entrance into and maintenance of drug use, particularly but not limited to opioids, and efforts to limit deleterious use. The state’s responses to drug use are manifested in these women’s lives through child protective services, incarceration, and substance abuse treatment. The sociopolitical and financial limitations on institutions often create instances in which policies exacerbate women’s marginalization. These policies are based on specific cultural understandings of women who use drugs, motherhood, Appalachia, and care. Women develop strategies, often based on care networks, to make it through these programs. Despite their navigations of marginalized and marginalizing programs, clients and institutional staff are materially and discursively constrained in their actions.

Digital Object Identifier (DOI)