Stigma is defined as “a mark of disgrace or infamy”. Stigma in addiction comes mostly from the symptoms of a person’s behavior and other aspects of a substance use disorder.
It is known that persons who are addicted to alcohol and/or drugs can behave aggressively or dishonestly with erratic behaviors and judgment which can lead to negative consequences including legal, employment, and relationship problems. These consequences can cause embarrassment and shame for the individual as well as others affected by the behavior. They also create stigmatized attitudes and beliefs about addiction.
Stigma manifests in labeling of people, negative stereotyping, status loss, and discrimination. Public stigma involves pervasive negative attitudes and beliefs that lead to societal rejection of persons with addiction. It contributes to and is perpetuated by structural stigma, which manifests in discriminatory institutional practices and policies. Self-stigma occurs when people with addiction internalize society’s negative views. Dr. Nora Volkow, National Institute for Drug Addiction (NIDA)
Dr. Volkow also says that public stigma contributes to the under investment in a high-quality addiction treatment infrastructure and less than optimal care for people with substance use disorders. This is commonly seen in the “not-in-my-backyard” attitudes when building treatment centers and providing community-based services. Furthermore, public opinion is often shaped in favor of punitive rather than health-oriented solutions.
Stigma Among Health Professionals
Even the most well educated (and well-meaning) health professionals evince stigma when treating patients. A study done in 2010, at a conference of trained mental health professionals, found that referring to an individual as a “substance abuser” instead of a person having a “substance use disorder” evoked different judgments among mental health professionals.
Respondents perceived “substance abusers” to be guilty of drug misuse, believing that punitive measures should be taken.
In this study, researchers asked a group of mental health and addiction specialists to read one of two written passages. One group read a passage that referred to an individual as a “substance abuser.” The other group read a passage that referred to that same person as “having a substance use disorder.” The results show that even a seemingly small difference in wording, has a tangible impact. The group who read the “substance abuser” passage were more likely to see the person as deserving of punitive action (like a jail sentence). They were more likely to see the person as personally responsible for their condition. This way of thinking is a barrier to providing real medical treatment.
Addiction Stigma in the ER and MAT
Studies have also shown that in emergency departments, some health care professionals may be dismissive of someone with an alcohol or drug problem. Because they don’t view it as a medical condition, they don’t see its treatment as part of their job. Emergency department staff might deny care to people who inject drugs, because they believe them to be drug-seeking.
Furthermore, some health practitioners have indicated that even the opioid antagonist treatment, known as Medication Assisted Treatment (MAT), is more of an adjunct to treatment instead of a life -saving intervention. Talking about evidence-based treatment options, like medications, in stigmatizing ways—claiming that it’s just replacing one drug with another, that it’s not “real” recovery—fuels the harmful stigma that keeps people with addiction from getting the help that they need. Such stigmatizing attitudes include the misconceptions that addiction is a willful choice and not a disease, the separation of addiction treatment from the rest of the medical system, and the language used for addiction.
First Person Language …
The use of “person-first” language is important for stigma reduction. Person-first language is not about being polite or sensitive or politically correct. It’s about not defining an individual based on a medical condition. Person-first language strives to be neutral and non-judgmental. The Office of National Drug Control Policy recommends the following terms and phrases:
Words to Use – Words to Avoid
Substance use disorder not addict
Alcohol use disorder not alcoholic
Substance use disorder not drug problem, drug habit
Drug misuse, harmful use not drug abuse
Person with a substance use disorder not drug abuser
Not actively using not clean
Actively using not dirty
Testing negative for substance use not a clean drug screen
Testing positive for substance use not a dirty drug screen
A person in recovery or long-term recovery not former or reformed addict/alcoholic
Medications for addiction treatment not opioid replacement, methadone maintenance
How language influences the public …
Language not only influences what the public thinks about substance use and recovery. Language can also affect how individuals think about themselves and their own ability to change. More importantly, language intentionally and unintentionally propagates stigma: the mark of dishonor, disgrace, and difference. Stigma depersonalizes people, depriving them of individual or personal qualities and personal identity.
Mental Health vs. Substance Use Disorders
Another study performed in 2014 by researchers at Johns Hopkins Bloomberg School of Public Health found that Americans were more likely to have negative opinions of people with substance use disorders than they are of those with mental illness. Participants were also less likely to approve housing, insurance or employment policies. Here are the results of the 709 survey respondents:
62 percent would work with someone with a mental illness
22 percent would work with someone with a substance use disorder
64 percent believed employers should be able to deny employment to people affected by addiction
25 percent believed employers should be able to deny employment to those affected by a mental illness
43 percent opposed giving individuals with substance use disorders the same health insurance benefits granted to otherwise healthy individuals
21 percent opposed giving individuals with mental illness the same health insurance benefits granted to otherwise healthy individuals
How to Stop the Stigma of Addiction
There are strong links between lack of education and understanding and stigma of addiction. While there is no simple way to halt stigma, there are steps to take to make progress. One of the most important ways to prevent and reduce stigma is to speak up.
Each person’s struggle with addiction is different. When individuals join together to share their experiences, strengths, and hopes, it can help to combat stigma. Education is another vital aspect in reducing and preventing stigma for both addiction and behavioral health issues. Providing accurate information about the preventable and highly treatable nature of addiction can help to inform the general public. And using person-first language can mitigate generalizations, stereotypes and negative assumptions, by focusing on the person, not the disease.
For more information on combating stigma, resources from SAMHSA and Shatterproof.org are excellent in providing concrete ways to address stigma in individuals, families and communities.