People often ask me “What can we do to stop addiction?” Considering that humans have used substances to alter their mood for thousands of years, I don’t think it is realistic to aim for a drug-free world. What we can do, however, is rethink how we approach substance use, misuse, and addiction. That starts with how we view individuals who struggle with substance use and how we talk about them. We may not be able to stop substance use altogether, but we can end the stigma, shame, and fear associated with it. Reducing stigma starts with every one of us – and it can literally save lives.
Stigma is still a major barrier for people seeking and looking to access addiction treatment. This led the Cayuga HEALing Communities team to make stigma the topic for our final public information campaign over the next few months. We designed a pamphlet with content from the National Institute on Drug Abuse that explains stigma, how damaging it can be, and how changing our language is an important step in reducing stigma. Since we all play a part in framing the discourse around addiction, every household in the county will receive an End Stigma pamphlet in the mail as part of our campaign outreach. If you are interested in displaying pamphlets at your place of business or distributing them to your staff or clients, feel free to email me and we will provide you with the print material.
What is stigma?
Stigma about people with substance use disorders (SUD) might include inaccurate or unfounded thoughts and beliefs like they are dangerous, incapable of managing treatment, or at fault for their condition.
Where does stigma come from?
Stigma around addiction may come from old and inaccurate beliefs that addiction is a moral failing or fear of things that are different or misunderstood. Today, we know that addiction is a chronic, treatable medical condition. We also know that people can recover and continue to lead healthy lives.
What are the types of stigma?
Social stigma involves the judgment and attitude of those around you, using negative labels in conversations, and discriminating against people with SUD.
Structural stigma is perpetuated by individuals who deliver public and private services by treating people with substance use disorder differently, ignoring them, or withholding treatment.
Self-stigma refers to internalizing negative messages that diminish your self-esteem, self-worth, and sense of belonging.
How does stigma affect people with substance use disorder?
Feeling stigmatized can reduce the willingness of individuals with SUD to seek treatment.
Stigmatizing views of people with SUD are common; this stereotyping can lead others to feel pity, fear, anger, and a desire for social distance from these individuals.
Stigmatizing language can negatively influence health care provider perceptions of people with SUD, which can impact the care they provide.
How can we change stigmatizing behavior?
When talking to people with SUD, their loved ones, and your colleagues, use non-stigmatizing language that reflects an accurate, science-based understanding of SUD and is consistent with your professional role.
Because clinicians are typically the first points of contact for a person with an SUD, health professionals should “take all steps necessary to reduce the potential for stigma and negative bias.” Take the first step by learning the terms to avoid and use.
Use person-first language and let individuals choose how they are described. Person-first language maintains the integrity of individuals as whole human beings—by removing language that equates people to their condition or has negative connotations. For example, “person with a substance use disorder” has a neutral tone and distinguishes the person from his or her diagnosis.
Terms to avoid, terms to use, and why
Consider using these recommended terms to reduce stigma and negative bias when talking about addiction.
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How stigma sabotages treatment
By Dr. Nora Volkow, Director of the National Institute on Drug Abuse
Untreated drug and alcohol use contribute to tens of thousands of deaths every year and impact the lives of many more. Healthcare already has effective tools including medications for opioid and alcohol use disorder that could prevent many of these deaths, but they are not being utilized widely enough, and many people who could benefit do not even seek them out. One important reason is the stigma that surrounds people with addiction: the public and even many in medicine and the justice system continue to view addiction as a result of moral weakness and flawed character. [Read more]
Addiction is a brain disease
To counter stigma, it is important to promote awareness of addiction as a chronic relapsing and treatable brain disease. There are good models for this change of thought. Historically, stigma has been a problem with many chronic health conditions ranging from cancer and HIV to many mental illnesses. Some gains have been made in reducing stigma around certain conditions; for example, public education and widespread use of effective medications has demystified depression, making it somewhat less taboo now than it was in past generations. But little progress has been made in removing the stigma around substance use disorders. People with addiction continue to be blamed for their disease.
Some societal criticisms of people who struggle with addiction point to the “revolving door” of inpatient treatment. However, it is important to note that relapse rates for drug use are similar to rates for other chronic medical illnesses, such as asthma or hypertension. Simply put, if people stop following their treatment plan, they are likely to relapse. Newer treatments for opioid use disorders, including medication, are designed to help with relapse prevention. Treatment of any chronic disease involves changing deeply rooted behaviors, and relapse doesn’t mean treatment has failed. When a person recovering from an addiction relapses, it indicates that the person needs to speak with their doctor to resume treatment, modify it, or try another approach.
Stigma in health care
Stigma can be a problem in the health care industry as well, when overworked and undertrained clinicians and first responders struggle to deal with the onslaught of opioid overdose patients in emergency settings. Note this recent statement from Dr. Nora Volkow, Director of the National Institute on Drug Abuse:
Tacit beliefs or assumptions about personal responsibility — and the false belief that willpower should be sufficient to stop drug use — are never entirely absent from most people’s thoughts when they interact with someone with a drug problem. Health care professionals are not immune to these assumptions. Indeed, they may hold stigmatizing views of people with addictions that may even lead them to withhold care. In emergency departments, for instance, health care professionals may be dismissive of someone with an alcohol or drug problem because they don’t view it as a medical condition and therefore don’t see its treatment as part of their job. People who inject drugs are sometimes denied care in emergency departments and other hospital settings because they are believed to be drug-seeking. [Perspective, New England Journal of Medicine: April 2020]
The addiction field itself has created guidelines to reduce stigmatizing language, but personal attitudes are harder to change. There must be wider recognition that the brain changes seen with addiction are substantially influenced by factors outside an individual’s control, such as genetics or the environment. Respect and compassion, with access to care, is more effective than stigmatizing and isolating patients for something they can no longer manage or control. Treating patients with dignity and understanding is the first important step.