Revisiting the need for feminism and afrocentric theory when treating African-American female substance abusers
Journal of Drug Issues
Fall 2000

Authors: Amelia Roberts
Authors: Mary S Jackson
Authors: Iris Carlton-Laney
Volume: 30
Issue: 4
Pagination: 901-918
ISSN: 00220426
Subject Terms: Feminism
Substance abuse treatment
Black culture


African-American women who are addicted to illicit substances are disproportionately over-represented in jails, prisons, and treatment programs. In addition, this group suffers greater deleterious physical and mental health effects of alcohol and drug abuse (McNeece & DiNitto, 1998).

Copyright Journal of Drug Issues Fall 2000

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African-American women who are addicted to illicit substances are disproportionately over-represented in jails, prisons, and treatment programs. In addition, this group suffers greater deleterious physical and mental health effects of alcohol and drug abuse (McNeece & DiNitto, 1998). When African-American female substance abusers enter treatment or are the focus of intervention research, clinicians and researchers have a distinct opportunity to serve these women in a culturally competent manner and assist in the healing and recovery process. Black feminist theory and Black family theoretical perspectives are explicated as the theoretical underpinnings of the Afrocentric treatment paradigm, which is beneficial in developing culturally sensitive interventions for this group of women. Culturally appropriate treatment tools and interventions are suggested as a means of empowering substance dependent African-American women.


The misuse of alcohol, prescription drugs, and illicit drugs among women has been recognized as a serious and complex social problem that wreaks havoc on many American families. The National Institute on Drug Abuse (1996) reported that approximately 200,000 women in the United States regularly use cocaine. In addition, a large number of young women are entering criminal justice facilities with chronic substance abuse problems (Kassalbaum, 1999). As usually reported, women of color, and African-American women in particular, are disproportionately represented, and the deleterious physical and mental health effects of alcohol and drug abuse on this group have been grave (McNeece & DiNitto, 1998). Much of the research in the past decade has focused on cocaine-addicted women in treatment, primarily in low income, urban communities, with the majority of these women of African-American descent (Boyd, 1993; Wallace, 1990; Roberts, 1998). A few researchers (Wechsberg & Cav! anaugh, 1998; Wechsberg, Dennis, & Stevens, 1998; Sterk, Dolan, & Hatch, 1999) are beginning to examine women who are out of treatment. Again, a large proportion of these samples are African-American females who are addicted to substances. When African-American female substance abusers enter treatment or are the focus of intervention research, clinicians and researchers have a distinct, and perhaps a one-time, opportunity to serve these women and assist in the healing and recovery process.

The recent multi-cultural literature that addresses the emic or culturally specific perspective of groups of people as diverse as the gay and lesbian populations, Native Americans, Hispanic Americans, African-Americans and other groups who abuse substances is a welcome addition to the addictions literature. Although Afrocentric treatment principles have been reported in the literature as useful to African-American populations (Jackson, 1995; Poiter, Nilwaambieni, & Rowe, 1997; Rowe & Grill, 1993), the theories underlying these important conceptualizations have not been explicated. Cheun (1991) noted the lack of theoretical perspectives underlying the interventions for diverse groups. Without a clear theoretical perspective, clinicians may be limited in understanding the importance of moving to an emic, or, in particular, an Afrocentric perspective when serving African-American females. If practitioners acquire a thorough understanding of this theoretical perspecti! ve, it will provide the underpinning for programs designed to create a vision for African-American women who abuse substances. Creating a vision for this group is critical to the development of strategic interventions and the sustenance of their success during treatment and at post-discharge. This paper will explicate the Black feminist theory and Black family theoretical perspectives as the theoretical underpinnings of the Afrocentric treatment paradigm for this population of drug-addicted women. In addition, several culturally appropriate treatment interventions will be discussed as a means of empowering this group.


Most individuals would agree that it is acceptable for females to define their role in society, but controversy surfaces when decisions and policies are made and implemented pertaining to females without their input. In the drug treatment subculture, this phenomenon has frequently occurred, leaving many females without treatment alternatives and subjecting them to laws and interventions that have, in many cases, been biased and inappropriate. These laws have often had deleterious effects on African-American female substance abusers.

With the implementation of more stringent drug legislation (Owen & Bloom, 1995) "and three strikes you're out laws" (Kassenbaum, 1999, p. 3), females have been placed in a situation where they now may face far more severe punishment for ingesting illicit drugs. If we look back at the "crack baby boom" (e.g., the identification of infants born in hospitals to mothers addicted to crack cocaine) of the 1980s, we see that some states enacted laws that leveled a charge of manslaughter against a female if she ingested cocaine while pregnant (American Bar Association, 1989; Chavkin, 1991; Gustavsson & MacEachron, 1997). The rationale behind this was that females who engaged in drug activity while pregnant were endangering the life and development of the fetus. However, once a mother is incarcerated, the provisions made for the infant after birth are limited, and little consideration is given to the mother-child need for ongoing bonding.

The enactment of laws against crack cocaine users in 1986 was the catalyst for growing numbers of females to enter the criminal justice system. In the 15 years from 1980 to mid-1995, the number of incarcerated women in United States prisons rose by 460 percent, compared to an increase of 241 percent for men (BJS, 1995). Kassebaum (1999) noted that "the incarceration of women offenders has had a particularly grave impact on poor women of color" (p. 4). By 1994, the proportion of African-American females who were incarcerated was seven times higher than that for White females.

As the trend of greater numbers of females entering the criminal justice system continues, there is growing recognition by the Center for Substance Abuse Treatment (CSAT) that women would significantly benefit from comprehensive, gender-specific treatment programs designed specifically to meet their needs. Specialized services for women must, at a minimum, include addressing issues of sexual, physical, and emotional abuse, as well as comorbid disorders, physical health issues, child and family relationships, and issues of domestic violence (Beckman, 1994; Boyd, 1993; Cole, 1990; Finkelstein, 1994). We propose that Black feminist theory can provide some insight.


Feminist theory, in general, promotes the idea that gender oppression, power inequities, and the subjugation of women's voices are commonly expressed in American society. Feminists recognize the impact of the social contexts that surround women and how these factors may lead to the devaluing of a woman's personhood and experience. Feminists promote the reality that women are rational, intelligent, thinking individuals who should have the opportunity to define who they are as well as what their role is in our society. They also advocate that women be afforded the opportunity to share in the decision making and policy implementation that will impact their lives and the lives of their families.' The Black feminist perspective generates an underlying primary theory for moving to a culturally appropriate or Afrocentric model. Black feminists assert that the pejorative images of Black women that originated during the slave era have been used to justify the oppression of Black w! omen (Staples, 1973; Stack, 1974; Lorde, 1984; Collins, 1991). Essentially race, class, and gender oppression could not have continued, in the past or in contemporary society, without powerful ideological justifications for its existence (Collins). Black women have been portrayed by four controlling negative images: mammy, matriarch, welfare mother, and jezebel. These images worked to make racism, sexism, and poverty appear to be natural, normal, and an inevitable part of everyday life for African-American women (Collins; West, 1996). The enslaved Black woman became the basis for the definition of our society's "other" (different and deviant from their White counterparts, authors' comment) (Christian, 1985, p. 160). Viewing Black women as "the other" provides fertile ground and justification for discriminatory practices. The four negative stereotypes are explicated below.


The mammy is the faithful, obedient, domestic servant. She is the symbol of warm, nurturing, and patient motherhood, as she mothers the children in her White "family." She is perceived as the normative yardstick in evaluating the behavior of other Black women but is indeed aware that her "place" is one of subservience and deference to the White society (Collins, 1991; West, 1996). Black women who internalize the mammy image (i.e., obedient, deferential, subservient) could potentially become effective conduits for communicating and modeling this attitude to their children and as a consequence could perpetuate racial oppression and its acceptance.

The matriarch symbolizes the bad Black mother who fails to fulfill her traditional "womanly" duties. She is portrayed as one who spends too much time away from home, does not properly supervise her children, and is domineering and emasculating of her husband or male companion. Thus, she is blamed for the deficiencies and lack of achievement in Black children. In contrast to the mammy who is portrayed as loving and kind, the matriarch fails to model appropriate womanly behavior because she is loud, boisterous, and domineering (Staples, 1973; hooks, 1981; Collins, 1991).

The third image, the welfare mother, is the updated version of women who were considered breeders during the slave era. The welfare mother is viewed as having too many children, and the focus on perinatal substance abuse is current justification for efforts to harness her fertility (Collins, 1991; West, 1996). In some states, there are laws currently being enforced that will deny any increase in welfare payments if a mother becomes pregnant while in the system. The image of the welfare mother also promotes the myth that Black women can produce children as easily as animals. The welfare mother is considered to be lazy and shiftless, shunning work while collecting welfare and passing on bad values to her children. She is portrayed as a woman alone, and this challenges the belief that a woman's truth, worth, and financial security occurs only within a heterosexual marriage (Collins; West).

The Jezebel is considered to be a sexually aggressive woman, portrayed as being ready and willing to respond to the master's beck and call without any resistance. Not always willing participants, many slave women acquiesced in order to survive and to protect their more vulnerable family members or simply out of a lack of wherewithal to resist (Collins, 1991; hooks, 1984; Staples, 1973).

The current counterparts of these stereotypes are often seen in the lifestyles of women who are addicted to illicit substances. Women who are in the throes of addictions are often unable to properly 'mother' their children. They may trade sex for money, drugs, food, baby supplies, etc., as well as manifest other inappropriate and aggressive behaviors. By so doing, they are reinforcing stereotypes already held by American society while concomitantly internalizing these stereotypes for themselves. Clinicians who work with African-American drug dependent women must acquire new information about this population and attempt to facilitate the creation of a new vision of these women that will enable them (the clinicians) to see past these negative stereotypes and behaviors and incorporate a more positive, healthier, strengths-- perspective viewpoint.

Black feminist theory challenges these negative images and advocates for African-American women to define themselves. Black feminists have focused on recovering information that has been suppressed and deconstructing the sexist and racist views about Black women. Rearticulating an AfricanAmerican women's standpoint offers African-American women a different view of themselves and their world from that forwarded by the dominant group. Integrating an Afrocentric worldview into one's consciousness can potentially be a critical protective factor in an African-American woman's selfimage, self-esteem, and centeredness. Identifying and sharing the suppressed literature that has been uncovered by Black feminists can provide significant historical African-American female role models, vital to the development of self pride. Understanding Black feminist theory, which stresses the need for redefinition of self as a source of empowerment, is critical to providing treatment and interven! tion research in a culturally competent manner.


One of the basic underlying assumptions of Afrocentric theory emanates from the school of thought delineated in Black family literature. The literature on the Black family elucidates two contrasting approaches to the study of Black families. One group views Black Americans from a pathological perspective; the other, from a strengths perspective. Jualynne Dodson (1988) labels the two approaches as 1) The Cultural Ethnocentric School and 2) The Cultural Relative School.


The Cultural Ethnocentric School was first espoused by E. Franklin Frazier (1948) and later, to a lesser extent, by Daniel P. Moynihan (1965). These scholars viewed the Black family as pathological and dysfunctional. The basic assumption purports that the Black family is unstable, disorganized and unable to provide its members with the social and psychological support needed to assimilate fully into American society. Frazier and Moynihan viewed American society as culturally homogeneous, with universal norms for behavior to which all groups were to conform. Any deviation from these cultural norms pointed to pathology and presumed inadequacies. Since Black Americans are frequently portrayed in the media and other communications in a negative manner and as "different" from the majority of White middle-class Americans, Black Americans are construed as the "other" in a pejorative sense.


In contrast to the Cultural Ethnocentric perspective, the Cultural Relative School of thought advocates that the Black family is a functional entity. This conceptualization is advanced and supported by many renowned scholars (Billingsley, 1992, 1968; Brisbane, 1992; Hill, 1972, 1997; Nobles, 1974; Staples, 1973; Young, 1970). There is a consensus among these scholars that African-American cultural patterns are different from White cultural patterns and that this difference is related to the African heritage. These scholars also agree that "the Black American cultural orientation encourages family patterns that are instrumental in combating the oppressive racial condition (at times subtle, but other times covert, authors' comments) of the American society" (Dodson, 1988, p.81). The Cultural Relative School does not promote assimilation as its primary goal but recognizes the need for some level of acculturation.

The proponents of the Cultural Relative School believe that slavery did not totally destroy traditional Black family functioning. Rather, the Black family is viewed as having a rich cultural heritage that provides continuous strength and endurance in the midst of an unfriendly society. Billingsley (1991) states "When looking at African-American families through the lens of what it has done, against all odds, to sustain its coherence brings one to a very different conclusion than looking at it merely as a deficit model" (p.11). Scholars who hold to the cultural relative viewpoint respect and demonstrate the resourcefulness and resilience of the African-American family. The perspectives of the Cultural Relative School are the underpinnings to the contemporary ideology of Afrocentricity as explained by Asante (1990) and Asante (1987). Afrocentricity is a liberating ideology that dispels the myths about African-Americans and offers a positive, strength-focused perspective. It! is deeply rooted in the notion of embracing the heritage, the strengths of clients, and the culture and rejoicing in the beauty of positive AfricanAmerican attributes. Afrocentrism defines Africans and people of African ancestry in terms of their history, spirituality, and African personality; their social, economic, and political organizations; and their community well-being, lifestyles and health, creativity, values, and practices.

Unfortunately, all Americans have been exposed to the Cultural Ethnocentric School of thought and are predisposed (albeit sometimes unconsciously) to view African-Americans in a negative or pejorative manner. Unless constantly challenged, these conscious and unconscious beliefs will manifest in discriminatory practices, however slight or unintentional.

As a result of the cultural ethnocentric model, African-American women who are addicted to drugs are daily confronted, along with the rest of America, with the controlling images of the mammy, the matriarch, the welfare mother, and the Jezebel. The manifestations of these images and stereotypes compound the difficulty of recovering women who are already suffering with internal (i.e., shame, guilt, etc.) as well as external barriers while in the process of acquiring a positive image for themselves (Wallace, 1995). Several treatment suggestions for African-American drug dependent women who are incarcerated or in other treatment programs are suggested below.


Many correctional facilities have incorporated drug treatment programs into their rehabilitation plans; however, the drug treatment models continue to be largely male-oriented with very little attention to the needs of the female in treatment. With ever increasing numbers of females being incarcerated on drug-related charges, there is a real need to offer drug treatment services that are race and gender focused. One of the major issues that emerges in discussions focused on improving drug treatment programs for females is the notion that it will cost a great deal of money to train or retrain drug counselors and social workers to be sensitive to gender and cultural issues. Some individuals may even wonder if White male counselors will be discriminated against if the focus is to address gender and cultural issues in treatment sessions.

Culture and gender matching is not proposed here. Cultural matching occurs when there is the suggestion that the counselor's culture and gender should be the same as that of the client with whom he or she is working. What is proposed is that drug treatment programs should adhere to the National Association of Social Workers (NASW) Code of Ethics and federal and state drug treatment codes. The codes stipulate that the counselor (regardless of culture, race, or gender) should make every effort to be sensitive to the cultural and gender needs of the client. Program directors should ensure that their counselors and social workers are sensitive to cultural and gender needs by verbalizing their sensitivity and by incorporating treatment components into the program that demonstrate cultural sensitivity (e.g., Kirkpatrick's 13 Steps). This can also be accomplished by using an Afrocentric component such as inviting the community to the graduation celebration of clients who success! fully complete the drug treatment program. This gesture allows the entire community to celebrate their success and demonstrates to the clients the community's support of them and their struggle to remain drug free.


Recognizing the need for gender-specific and gender-sensitive treatment models, Unterberger(1989) and Kasl (1990) suggested revising the traditional 12 steps to recovery to make them consonant with the theme of empowerment for women. Both authors emphasize that women have been socialized to believe that they are subordinate to males and that they frequently experience feelings of hopelessness and helplessness. These negative affective states may reinforce the feeling of being "less than" and can lead to the escalation of drug use to escape these emotions (Folkman & Lazarus, 1988; Folkman & Lazarus, 1986). In addition, when undergoing drug treatment, feelings of hopelessness and helplessness are exacerbated when women are required to recite the "disempowering"12 Steps as originally written. Allport (1958) and Becker (1963) have theorized that when individuals and groups are constantly told or led to believe that they possess negative qualities (e.g., inferior, of l! ow intelligence, evil, etc.), they will soon begin to believe it and live up to that expectation. Kasl and Unterberger suggest that the language of the traditional 12 Steps (such as "unmanageable") is too negative and actually reinforces a woman's belief that she is worthless.

Unterberger suggests incorporating Kirkpatrick's 13 Steps of Women for Sobriety, excluding the 13th step for its "New Age spirituality" (p. 1151). Unterberger's revised 12 steps (Figure 1) provides females with more positive thoughts while eliminating the old stereotypes.


Clinicians, even those who are growing in their own cultural sensitivity, must consider that shedding their own stereotypical thinking is a process that continues throughout their professional development. Understanding the need to first recognize, and then shed, the common stereotypes of mammy, matriarch, welfare mother, and Jezebel is critical to providing opportunities for African-American women that are broader than the options limited by the scope of one's own thinking. Many of these stereotypes are portrayed daily through the American media in both subtle and overt ways. Labels or thoughts of being weak-willed, lazy baby breeders (why does she keep having children?), unfeminine, and morally promiscuous are stereotypes associated with these images. We must be alert to constantly challenge the subtle nuances of these stereotypes that are often held in our own minds.


Presenting information about unknown African-American heroines can contribute significantly to self-pride and can be a catalyst in creating a vision which will lead to a path out of the bondage of drug addiction. Many of these heroines (i.e., Sojourner Truth, Elizabeth Ross Haynes, Birdye Henrietta Haynes, etc.), brought to light in much of the work completed by Carlton-- LaNey (1997, 1994a, 1994b), are women who were enslaved, poor, and had limited opportunities; yet their spirits could not be contained! These stories of African-American heroines could be incorporated as daily vignettes, shared in treatment groups around the country for women in residential programs in jails, prisons, and therapeutic communities, as well as in community outpatient programs. Many women addicted to drugs were raised in poverty, violence, and dysfunctional families where parents may have also been addicted to substances (Beckman, 1994; Boyd, 1993; Finkelstein, 1994). Thus, exposing this gro! up to role models who have successfully negotiated difficult challenges in their lives and communities may be a bridge to providing hope and a vision.


[IMAGE TABLE] Captioned as: FIGURE 1

Exposing clients to literature and videos that portray African-Americans in a positive light can also be useful sources of self-pride. A wonderful example, viewed annually on national television, is the video of the Morehouse and Spellman Christmas Concert. Morehouse is the historically Black college for men, and Spellman is the counterpart for women. Both of these colleges have long, rich histories and are located in Atlanta, Georgia, literally across the street from each other. This video provides a vision of African-American young men and women singing classical and Afrocentric music and performing African dance. Creating this vision enables a recovering woman to see opportunities beyond her own community. It may also provide a glimmer of hope for her children, about whom she may experience some guilt for her lifestyle while addicted.

Exposure to literature that demonstrates the significant contributions that African-Americans have made to our society also creates a sense of pride. Materials such as the poster "101 Inventions of Black Americans" and the book Black Inventors of America (Burt, 1989) can provide information about African-American inventions, like the fire escape ladder, gas mask, railway switch, tricycle, doorknob and doorstop, fountain pen, golf tee, ironing board, refrigerator. blender, air conditioner, baby buggy, and traffic light. These innovative technological achievements and contributions to American industry and American households that are used daily in most American homes.

Reviewing excerpts from Robert Hill's (1997) book, Strengths of AfricanAmerican families: Twenty-five years later, places in perspective the current struggles and difficulties of some Black communities with a focus on the inherent strengths in this population that continue today. Uncovering this kind of information and sharing it with clients will enhance their pride and sense of worth as citizens of the United States. This information contradicts the daily onslaught of negative messages and provides some hope for recovering women. It also provides a different view for the general American public. Uncovering and sharing this information will begin to correct the miseducation of both Whites and African-Americans living in this country.


Teaching clients how to think critically about what is written in magazines, news reports, and newspapers can provide an opportunity for discussions that empower, revealing different choices and different viewpoints. Critical thinking is the ability to reason well, evaluate evidence provided, consider other alternatives, and recognize the fallacy in someone else's reasoning. "Critical thinking involves the use of standards such as clarity, accuracy, relevance, and completeness" (Gibbs & Gambrill, 1999). Assisting clients in critical thinking is part of the process of empowerment. It provides clients with the ability to screen, evaluate, and think clearly about what they hear from others. However, teaching the concept of critical thinking forces treatment providers to have a thorough knowledge base and healthy respect for the particular culture they are addressing. The incorporation of the above suggestions (use of literature, videos, and books) provides the basis to a! ccurately contradict the negative messages that are projected daily in our culture about African-American people. Providing occasions for clients to make suggestions and think critically about their treatment program is another source of empowerment. Sharing their needs, assessing their satisfaction as a client, and asking for input about their treatment experience provides another occasion to think critically about things that influence their lives.


Much of the literature indicates the need to develop and enhance the sense of self-esteem and self-identity as key components of treatment (Jackson, 1995; Gordon; 1984; McNeece & DiNitto, 1998). Helping clients to establish concrete examples of their strengths can be done with "calling cards." The concept of "calling cards" (developed by Roberts) is similar to that of business cards carried by many professionals. Business cards are generally distributed with a source of pride because they convey an attachment to some positive asset, whether it is an organization or product. Information on the calling cards for clients is designed as a means to identify some positive aspects of the recovering women. Labeling and building on strengths identified through contact with African-American women can create a needed sense of selfesteem. Women in treatment programs can readily recite a litany of negative labels, but few can recite positive strengths or assets about themselves. W! ith modern technology, via computers, making calling cards would be a simple accomplishment in most treatment programs, but it could have far-reaching future effects for clients.


As we enter the 21st century we are still faced with the problem of drug use among African-American females and the overwhelming number of issues (health problems, incarceration, family difficulties, etc.) arising from it that were just as prevalent in the 20th century. The problems are the same and, in some situations, worse: reports of increased drug use among African-American females, increases in the incarceration rates among this population, limited drug treatment services, and ineffective and inefficient drug treatment for this population.

Having a strong theoretical basis for one's decision-making has long been a tenet espoused in schools of social work. The Afrocentric perspective, Black family and Black feminist theory have not been included in most syllabi provided by academicians, largely because this literature is sometimes unknown and/or simply ignored. Social workers in the academy currently have the unique opportunity to add culturally specific theories to their syllabi, theories that are more salient and relevant for specific groups.

Feminist theory offers positive reinforcement to the female drug user's psyche as she struggles toward recovery. However, because recovery is a tedious, long-term process, it is equally important for the female drug abuser not only to receive family support but also to develop an understanding of the interrelationships between family, society, and her world. The drug counselor can assist the client in placing this thinking into a comprehensible paradigm through the use of a culturally sensitive approach along with the feminist perspective. Feminist theory, used in combination with an Afrocentric approach, would prove very beneficial to the client in her struggle to recover.

No theory is complete in itself, thus limitations must be acknowledged. Even though Black family theory acknowledges that society influences families and that families influence societies, this view may tend to place an inordinate amount of blame on societies for difficulties experienced within Black families. Common to most theory development, they are espoused and developed by middle- to upper-class Americans. This is no different in the African-American population; thus, this information needs a broader dissemination to the masses of African-American persons as well as to the greater American society. Knowles and Prewitt (1974) cogently noted that miseducation causes both Whites and Blacks to suffer.

The social work profession has become more sensitive to the needs of diverse groups. Frameworks have been given to assist in thinking about multicultural issues (Sue & Sue, 1992; Ho, 1994; McGoldrick, 1984, 1998), but the theoretical underpinnings of thinking about each group have not been well explicated. The social work profession continues to increase its focus on cultural sensitivity and must strive for cultural competency in the treatment of all individuals. Having a strong theoretical perspective will provide a solid foundation for cultural competency to develop and thrive.


1 The terms Black and African-American are used interchangeably. The authors wanted to accurately cite the work of earlier authors who utilized the term Black exclusively.


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Dr. Amelia Roberts is an Assistant Professor in the School of Social Work at the University of North Carolina, Chapel Hill. She has 20 years of experience as a clinical practitioner, consultant and trainer. She has extensive clinical experience and research with African-American female substance abusers. Dr. Mary Jackson is a Full Professor at the School of Social Work at East Carolina University, North Carolina. She has extensive experience and research in the area of criminal justice and substance abuse with a focus on African-American women. Dr. Iris Carlton-- LaNey is a Full Professor in the School of Social Work at the University of North Carolina, Chapel Hill. She has performed extensive research on the historical contributions of African-American women to the field of Social Work. Her other interests include African-American rural elderly and social support.

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