Everyone has heard the terms used to describe people who are dealing with drug addiction. Junkie. Stoner. Crackhead. These words are meant to be dismissive and show contempt. They are holdovers from the time when our understanding of addiction was limited compared to today. Many people thought that addiction was a moral failure that should be a source of shame, and many still do.
Our society tends to stigmatize behaviors that are viewed as different and less desirable than what is usually considered the acceptable norm. The prejudice associated with substance use and mental health problems creates obstacles to accessing care and support for people and their families.
Stigma refers to the negative ways in which society generally views individuals with addiction and mental health issues. But if we were referring to racism, sexism, homophobia, or ageism, the words discrimination and prejudice would be used.
The Dangers of the Addiction Stigma
Substance addictions are typically accompanied by a feeling of shame. This comes from the public stigmatization of people with substance use disorders that the individual may come to accept as true. Name-calling and stigma give users a sense of shame for a disease that has taken control of them physically and psychologically.
Some of the reasons why stereotypes create risks are:
- Most people don’t fit the stereotype of a person with addiction, so they fool themselves into thinking that they don’t have a problem.
- Since they don’t appear to fit the stereotype, family and friends don’t put pressure on them to quit.
- The addict will be too ashamed to admit the problem because of the negative stereotype.
- Family and friends may be worried about the stigma on them and feel the need to hide the addiction.
- In general, the public tends to feel less sympathy toward their suffering and may view addicts as bad people who are responsible for their problems.
- People who are experiencing the stigma regarding drug use are less likely to get treatment.
Drug rehab is considered so uncool that there was a top 10 song about it. The song “Rehab” was written and performed by Amy Winehouse, who struggled with addiction throughout her life and lost the battle when she was just 27.
Unfortunately, that hit song helped to contribute to the stigma of rehab, particularly among teenagers. Rehab is commonly seen in a negative light. Individuals with substance use disorders are sometimes seen as selfish, untrustworthy people with no self-control. That misunderstanding helps drive the stigmatization of drug treatment.
The Language of Stigma
Several studies reported by the Recovery Research Institute related to the stigma of substance use disorders showed that depicting opioid use as treatable might help to reduce the stigma associated with the condition. The study was undertaken to find out whether the language used to describe people with substance-related problems might elicit different types of stigmatizing attitudes.
The study authors specifically tested whether describing a person as a “substance abuser” increased the likelihood of provoking more punitive attitudes from the respondents than describing the same person as having a substance use disorder. The term “abuse” may give the idea that the person has control and is engaging in willful misuse. On the other hand, the term “disorder” conveys the idea that there is a medical impairment. This increases the chance of invoking a more healing attitude.
In the study, 314 people were asked 35 questions about how they felt about two hypothetical individuals described as “actively using drugs and alcohol.” One person was referred to as” having a substance use disorder,” and the other was referred to as “a substance abuser.” No other information was given.
Participants believed that the “substance abuser” was:
- Less likely to benefit from treatment.
- More likely to benefit from punishment.
- More likely to be socially threatening.
- More likely to be blamed for their substance-related problems and less likely that their problem was the result of dysfunction they couldn’t control.
- That they were more able to control their substance use without help.
The study shows that the term “substance abuser” evokes a punitive bias, but the term “substance use disorder” is less stigmatizing.
In a large group of individuals with alcohol use disorder, those that believed that alcohol-related problems were stigmatized by people they knew in their everyday lives were less likely to seek treatment. Those who felt alcohol-related problems were less stigmatized by people they knew were more likely to seek treatment.
If we can begin to change the language of substance abuse disorder, we can change the stigma and help increase the rates of treatment. Dropping the term “abuser” and using terms more consistent with a medical and public health approach will help.
Changing the Conversation
In spite of the recognition that addiction is a health condition, terms used by the average person and scientific publications are often inaccurate and stigmatizing. There are new efforts to encourage the use of terminology that can improve accuracy, reduce stigma, and improve care.
Scientific progress has helped people understand that addiction, also referred to as a substance use disorder (SUD), is a chronic disease of the brain. It is a disease that can be successfully treated, similar to other chronic diseases like diabetes and hypertension.
No one chooses to develop a SUD. A combination of genetic tendencies and environmental stimuli can result in physical changes to the circuitry of the brain. This leads to tolerance, cravings, and the typical compulsive and destructive behaviors of addiction that have become a public health burden.
The rate of opioid-related hospital admissions has increased markedly over the last two decades across all age groups. Because the “baby boomer” group has a high rate of addiction, illicit, and nonmedical drug use among older adults is expected to continue to rise. Physicians are taking the lead in changing the course of this trend. The American
Society of Addiction Medicine (ASAM) and the American Medical Association Task Force to Reduce Opioid Abuse want action to be taken by physicians, patients, and policymakers in four ways:
- We must change the conversation about what it means to have an addiction and increase access to evidence-based treatments. This means putting an end to the stigma and improving access to medications. People with an SUD deserve to be treated like any other patient with a disease. Physicians need to help the nation understand how to do this. Today the trend is to use PDMPs as a way to discourage “doctor shopping.” But the main goal is to understand why a patient is seeking medication from multiple prescribers and offer a way towards treatment and recovery.
- A better job needs to be done with prevention. This means early intervention with teens who are beginning to use marijuana and alcohol and better efforts to encourage safe storage and disposal. Unused medications increase the risk of nonmedical use by teenagers.
- We need to recognize that screening for co-morbid (co-occurring) psychiatric disorders in all patients is a necessity since patients with psychiatric disorders are at an even greater risk than the general population to misuse drugs.
Person-first language is not about being politically correct or polite. It doesn’t describe a person based on any medical disorder he has. It is nonjudgmental; neutral. The Office of National Drug Control Policy recommends these terms and phrases:
Words to Avoid
- Drug problem, drug habit
- Drug abuse
- Drug abuser
- Former addict/alcoholic or reformed addict/alcoholic
- Opioid replacement, methadone therapy
Words to Use
- Person with a substance use disorder
- Person with an alcohol use disorder
- Substance use disorder
- Drug misuse, harmful use
- Person with a substance use disorder
- Abstinent, not actively using
- Person in recovery, person in long-term recovery
- Medication for addiction treatment
What Does Stigma Mean To You?
In Canada, the Center for Addiction and Mental Health (CAMH) conducted the Stigma of Addiction project. They set out to develop strategies to communicate anti-stigma messages to different groups of people. Through interviews and focus groups, they received input from people with past or present substance use problems as well as from service providers and family members. When asked, “What does stigma mean to you?” these were some of the responses:
- Negative judgment
- Judgment based on only one part of a person’s life
- Long-lasting labels
- Embarrassment and shame
- Something you want to hide
- Being treated differently by the rest of society
- Hating yourself
Who is Stigmatized Most?
- People who use illegal drugs (especially injectable drugs) crack and heroin.
- People who take methadone
- Women (especially if they’re pregnant or have kids)
- People of lower socioeconomic status
- Older adults or younger people
- People who use any drug a lot
Effects of Stigma
People in the study were affected by stigma in every aspect of their lives but these are the impacts that were mentioned most:
- Violation of human rights (being treated with less respect and consideration when seeking housing and medical care
- Lack of employment (losing jobs and difficulties getting jobs if substance use is known)
- Negative feelings about oneself
- Avoiding services (fear of being treated disrespectfully)
- Continuing substance use (to help themselves cope with other peoples’ negative attitudes and their negative feelings about themselves)
Three Suggestions for Reducing Stigma
As a result of the project, three suggestions emerge:
- Educate people, including students, the general public, as well as health care and other professionals.
- Emphasize the reasons people develop substance use disorders.
- Speak about media biases and inaccuracies.
- Represent people with substance use problems as human beings.
- Personalize substance use problems.
- Have people who have experienced substance use problems speak about the prejudice and discrimination.
- Use well-known spokespeople to raise awareness that SUDs can affect anyone.
- Show that people with substance use problems come from a variety of backgrounds.
- Tell positive stories.
- Show the positive face of people with substance abuse problems (the ways they contribute to society).
A study in the journal Social Science & Medicine showed that public depictions of successfully treated schizophrenia, prescription painkiller addiction, and heroin addiction led to greater belief in the effectiveness of treatment and less willingness to discriminate. The movement to make recovery visible will help create hope and a path for others to follow.
In Anne Fletcher’s book Sober for Good, the goal was to boost the addict’s belief that he has what it takes to overcome the problem of addiction and accomplish sobriety. When she asked Stanford University’s Albert Bandura, Ph.D. how to increase a person’s sense of having the ability to achieve sobriety, he said, “Show them successful role models, others who have struggled to master situations that you fear or see as difficult.”
Now You Know
Now you know that stigma is a stereotype. Now you know that a stereotype is not a fact. And now you know that you shouldn’t let a baseless stigma keep you or someone you care about from getting help. Start changing the language about substance use disorders and make an investment in yourself.
Crest View Recovery Center is a beautiful, restful space to recover, located in the mountains of North Carolina. We are equipped to design a treatment program to suit your specific needs. We are not a “one size fits all” facility, and we will treat you with the respect and compassion that you (and your family) deserve. Contact us today to get control of your life back.