The concept of stigma describes the powerful, negative perceptions commonly associated with substance abuse and addiction. Stigma has the potential to negatively affect a person’s self-esteem, damage relationships with loved ones, and prevent those suffering from addiction from accessing treatment.
Stigma is a public health issue — it contributes to high rates of death, incarceration, and mental health concerns among dependent populations.
Stigma is defined as a set of negative beliefs that a group or society holds about a topic or group of people. According to the World Health Organization (WHO), stigma is a major cause of discrimination and exclusion and it contributes to the abuse of human rights. When a person experiences stigma they are seen as less than because of their real or perceived health status. Stigma is rarely based on facts but rather on assumptions, preconceptions, and generalizations; therefore, its negative impact can be prevented or lessened through education. Stigma results in prejudice, avoidance, rejection, and discrimination against people who have a socially undesirable trait or engage in culturally marginalized behaviors, such as drug use (Link, 2001).
Family, friends and the general public can carry negative feelings about drug use or behavior. They may even use derogatory terms such as “junkie,” “alcoholic,” or “crackhead.” These thoughts, feelings, and labels can create and perpetuate stigma.
How Prevalent is Addiction Stigma?
We live in a society where millions of Americans are dependent on drugs or alcohol and only a small percentage receive treatment at a facility. In fact, the 2014 National Survey on Drug Use and Health found that 21.5 Americans age 12 and older had a substance use disorder in the previous year; however, sadly only 2.5 million received the specialized treatment they needed.
Stigma affects all of us – and nearly everyone has felt stigmatized or has stigmatized others at some point in their lives. In a study done by Johns Hopkins Bloomberg School of Public Health, the general public was more likely to have negative attitudes towards those dealing with drug addiction than those who were dealing with mental illness. Additionally, researchers found that people don’t generally support insurance, housing, and employment policies that benefited people who were dependent on drugs (JHU, 2014).
A Picture of Stigma
Becoming dependent on drugs can happen to anyone. It’s important to keep in mind that we can all do a better job of decreasing stigma around drug use.
Recovery Brands conducted a survey of people who use drugs, and respondents provided written reflections about what they wished people or society at large understood about addiction. Their responses help illustrate the importance of remaining kind, compassionate, and human. The image below includes quotes from some of the respondents.
How Stigma Hurts
Stigma can negatively impact a number of areas, including:
- Willingness to attend treatment and access to healthcare.
- Harm reduction.
- Self-esteem and mental health.
Impact on Treatment
Unfortunately, people who experience stigma regarding their drug use are less likely to seek treatment, and this results in economic, social, and medical costs. In the United States, costs associated with untreated addiction (including those related to healthcare, criminal justice, and lost productivity) amounted to a whopping $510 billion (Harwood, 2000).
Perceived stigma in hospitals or doctors’ offices can discourage people from accessing needed healthcare services. Having a trusted primary care doctor is associated with maintaining well-being and a good quality of life. However, studies have found that some healthcare providers feel uncomfortable when working with people who are dependent on drugs. In a study of nurses’ attitudes towards patients, the majority of nurses held negative views about people who used drugs (Howard & Chung, 2000). In another study of nurses in the UK, most of the nurses had a stigma against injection drug users (Monks, Topping, & Newell, 2013). When health providers carry a stigma towards people with drug dependencies, it can affect their willingness to assess or treat the patient for substance abuse, how they approach him or her, and it may prevent addicted individuals from seeking healthcare altogether.
In order to better support people with substance use disorders, the Affordable Care Act (ACA) includes benefits for addiction treatment. People who have Medicaid or purchase plans through the health exchanges are eligible for treatment services, including psychotherapy and counseling. Plans vary, and some have limits on the number of days or visits covered, how much of the deductible and copayment will be covered, and whether or not you need authorization for treatment. Despite these limits, more Americans have access to care than they did before. Due to social factors such as stigma, however, whether or not they gain access to treatment still remains a major public health issue.
The problem of access to treatment even extends into the criminal justice system. A study conducted by The National Center on Addiction and Substance Abuse (CASA) found that of the 2.3 million people incarcerated in the United States, more than 65% of them met the criteria for a substance abuse disorder, yet only 11% of those people received treatment (CASA, 2010).
Impact on Harm Reduction
Unfortunately, stigma can affect the public’s perception of evidence-based harm reduction strategies. Harm reduction refers to public health interventions like:
- Needle exchanges.
- Substitution therapies.
- Safe drug consumption rooms that are designed to decrease the risk associated with drug use (e.g., infected needles).
Due to widespread stigma about those who use drugs and who suffer from addiction, however, these interventions are not usually supported by the public and believed by some to facilitate and encourage drug use – despite evidence demonstrating that they actually decrease drug use (Logan & Marlatt, 2010).
Social and Mental Impact
Perceived stigma can cause major harm to people in their social lives. The chronic stress of discrimination may affect the mental and social health of individuals who use drugs. People who use drugs can feel pushed to the outskirts of society and may lose touch with their community and family and experience profound loneliness and isolation.
When a person does not have social ties or a person to talk to, they are less likely to reach out for healthcare or treatment. They are also more likely to be depressed and may hide their drug use from health care providers to avoid stigma and drug shaming. The mental health consequences of isolation can fuel even more drug use, leading to further isolation, and ultimately a vicious cycle that is hard to be break out of.
Perceived stigma can also be internalized. People who use drugs can view themselves as deviants; this can severely impact their self-esteem and self-worth. Historically, a dependence on drugs has been viewed as immoral or the result of a lack of self-control. These views contribute to stigma and present barriers to people accessing necessary treatment.
Fighting Back Against Stigma
People report perceived stigma from healthcare providers, loved ones, and the general public. No matter the situation, no one likes to feel judged or devalued. In order to encourage people to reach out for help and get on the path to recovery, it is important to reduce the stigma surrounding their situation. Educational programs and modeling of nonstigmatizing behavior can help people provide nonjudgmental, empathic support.
Effective ways for individuals to help reduce stigma include:
- Offering compassionate support.
- Displaying kindness to people in vulnerable situations.
- Listening while withholding judgment.
- Seeing a person for who they are, not what drugs they use.
- Doing your research; learning about drug dependency and how it works.
- Treating people with drug dependency with dignity and respect.
- Avoiding hurtful labels.
- Replacing negative attitudes with evidence-based facts.
- Speaking up when you see someone mistreated because of their drug use.
- Sharing your own stories of stigma.
Fighting Stigma Through Next-Generation PSAs
In mid-2016, Recovery Brands launched the LIVES Challenge to help fight the stigma of addiction by asking the public to create next-gen public service announcements (PSAs) that moved passed the stigmatizing announcements of years ago (think: “this is your brain on drugs”). The contest looked to find a new inspiring message for those suffering with the disease to feel supported, encouraged and motivated to step on the path to seek treatment for their addiction. The Judge’s Choice winner is shown below:
More Than An Addict, filmed and produced by Tori Utley
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- AIVL, 2011, ‘Why Wouldn’t I Discriminate Against All of Them?’ A Report on Stigma and Discrimination Towards the Injecting Drug User Community (Canberra: AIVL)
- Gray, R. (2010). Shame, labeling and stigma: Challenges to counseling clients in alcohol and other drug settings. Contemporary drug problems,37(4), 685-703.
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- Johns Hopkins HUB. (October 1, 2014). DDrug addiction viewed more negatively than mental illness, Johns Hopkins study shows.
- ObamaCare Facts. (December 2015). ext”]Does ObamaCare Cover Drug and Alcohol Treatment?
- Substance Abuse and Mental Health Services Administration (SAMHSA). (September 4, 2014). Substance Use and Mental Health Estimates from the 2013 National Survey on Drug Use and Health: Overview of Findings.
- Howard, M. O., & Chung, S. S. (2000). Nurses’ attitudes toward substance misusers. I. Surveys. Substance use & misuse, 35(3), 347-365.
- Monks, R., Topping, A., & Newell, R. (2013). The dissonant care management of illicit drug users in medical wards, the views of nurses and patients: A grounded theory study. Journal of advanced nursing, 69(4), 935-946.
- Kinsler, J. J., Wong, M. D., Sayles, J. N., Davis, C., & Cunningham, W. E. (2007). The effect of perceived stigma from a health care provider on access to care among a low-income HIV-positive population. AIDS patient care and STDs, 21(8), 584-592.
- Ronzani, T. M., Higgins-Biddle, J., & Furtado, E. F. (2009). Stigmatization of alcohol and other drug users by primary care providers in Southeast Brazil. Social science & medicine, 69(7), 1080-1084.
- Hunt, N. and Derricott, J. (2001). Smackheads, crackheads and other junkies: dimensions of the stigma of drug use. In: Carlisle, C., Mason, T., Watkins, C. and Whitehead, E. (eds). Stigma and Social Exclusion in Healthcare. London: Routledge.
- Logan, D. E., & Marlatt, G. A. (2010). Harm reduction therapy: A practice-friendly review of research. Journal of clinical psychology, 66(2), 201.
- Lloyd, C. (2010). Sinning and sinned against: The stigmatisation of problem drug users. London: UK.
- The National Center on Addiction and Substance Abuse (CASA). (2010). New CASA Report Finds: 65% of all U.S. Inmates Meet Medical Criteria for Substance Abuse Addiction, Only 11% Receive Any Treatment.
- Ahern, J., Stuber, J., & Galea, S. (2007). Stigma, discrimination and the health of illicit drug users. Drug and alcohol dependence, 88(2), 188-196.
- Marlatt, G. A., Larimer, M. E., & Witkiewitz, K. (Eds.). (2011). Harm reduction: Pragmatic strategies for managing high-risk behaviors. Guilford Press.
- Harwood, H. (2000). Updating estimates of the economic costs of alcohol abuse in the United States: Estimates, update methods, and data. Washington, DC: National Institute on Alcohol Abuse and Alcoholism.