What do we mean by “stigma” in addiction recovery?
The Society for the Study of Addiction defines stigma as “a sociocultural process in which social groups are devalued, rejected and excluded on the basis of a socially discredited health condition.” They note that it can be seen in at least three levels in addiction recovery: social, structural and self.
The social level involves groups of people maintaining and believing stereotypes.
At the social level, stigmatizing and stereotyping messages can be communicated in person or through social media or mainstream media channels. TV shows and movies frequently present a mixed message. They often show substance use itself as glamorous and normative, but people with addiction as characters to be either laughed at or feared. They can also downplay the effectiveness of treatment and the odds of recovery.
The structural level involves rules and policies that treat stigmatized populations differently than non-stigmatized groups.
The structural stigma associated with addiction can be seen in the health and insurance fields. At one time, health insurance companies frequently didn’t cover addiction treatment at all, and when they did, they applied different deductibles or copays than for other health disorders. Fortunately, legislation has addressed those inequities, but others remain.
As with other health conditions, it’s wise to screen for substance use disorders and treat them as early as possible. However, when people go to their primary care provider’s office, they’re much more likely to be screened or tested for conditions related to their heart, blood sugar or cancer risk than for drug or alcohol addiction. The failure to screen leads to a failure to treat, despite the effectiveness and importance of both.
An article in the journal Drug and Alcohol Dependence reported a program that involved screening patients in medical settings for problematic substance use. Treatment providers then followed through with brief intervention and referral to treatment when necessary. A six-month follow-up found a significant improvement in both heavy alcohol use and use of illicit drugs. Treating substance use disorders in the same way that other medical conditions are treated is likely to lead not only to improved treatment outcomes but to a reduction in the stigma associated with them.
Self-stigma occurs when the societal messages become internalized and result in feelings of low self-worth and shame.
Self-stigma begins with the awareness of the stigma in the social and structural areas. The awareness may be followed by agreement, in which people believe that the negative stereotypes are generally true for people in the category. And if it’s true for people in that category, then it must be true of them since they are in that category. Self-stigma is the result.
The Stigma Surrounding Addiction
Unfortunately, addiction is a highly stigmatized condition. There’s a degree of stigmatization for physical disabilities, mental illness and addiction. Research has shown that people with mental illness are viewed more harshly than people with physical disabilities, and people with drug addiction are viewed more negatively than both.
For people who find themselves in more than one category, the results of stigmatization may be especially challenging. Study authors note that stigmatizing stereotypes can lead others to avoid people living with addiction and fail to offer help.
One of the many negative consequences of stigma is that people hide their need for help and fail to seek it out of fear of being labeled or stereotyped; this seems to be especially true for certain groups. For example, women are more likely to report that addiction stigma is a barrier to treatment than men are, and perceived drug-use stigma is higher for IV drug users than non-IV users.
The effect of the legal system on stigma is complex. Criminalization is an indication of societal and structural stigma, so people who engage in illegal behavior, using heroin rather than alcohol, for example, may also feel more stigmatized. On the other hand, the author of a publication on the stigma of addiction notes that the law does at least partially recognize addiction as an illness and not just a choice.
Because addiction is an equal-opportunity disease affecting people from all walks of life, people who are in charge of making and enforcing laws about drug and alcohol use may themselves have substance use disorders. An article titled Addiction Stigma Within the Law notes that a survey of attorneys indicated that 21% of them have an alcohol use disorder and that most of them declined to answer questions about drug use. More than half of the malpractice claims and disciplinary proceedings against lawyers involve abuse of alcohol or drugs.
The author of the article notes that “attorneys are not only ashamed to admit they have a substance use disorder but are even more ashamed to enter into treatment. As a result, many attorneys continue to live with a substance disorder, in shame, while representing clients who may spend the rest of their lives in prison.” Similar conflicts and stigma may exist in the police force and among lawmakers.
Stigma after treatment.
Even when people do overcome their reluctance to seek treatment, the stigma of addiction can continue to produce negative effects. A study of people in treatment for substance abuse found that people who perceived more stigma experienced lower self-esteem and more anxiety, depression and sleep problems. On the positive side, the study found that social support was associated with exactly the opposite: higher self-esteem and lower depression, anxiety and sleep issues.
Humans are social creatures, and whether we perceive that others are supporting us or stigmatizing us has powerful consequences. When people are shamed at their lowest points, it increases their pain, but having support gives them the strength they need for the recovery journey.
Breaking the Stigma Cycle
Stigma has an unfortunate cyclical effect. Because people feel stigmatized, they hesitate to share their stories with others. The lack of stories leads to further stigma because, without them, people are left with only the messages they get from the media and culture at large.
People need to hear addiction stories for many reasons. They need to know the following:
Addiction can affect anyone.
Age, race and gender don’t matter, and neither does income level, education, career success or family stability. No one is immune. Everyone who is struggling needs to see someone else like them with whom they can identify.
The truth is that most people have no idea how many people they know are either in addiction recovery or are currently in the active, untreated phase of addiction to drugs or alcohol. In fact, nearly one in 10 Americans have a history of drug use disorder.
Seeking help isn’t a sign of weakness.
On the contrary, it’s a sign of strength. People need to hear from others who had the strength to overcome stigma-based reluctance and say, “I’m worth it. I’m going to do what’s necessary to get my life back.”
Addiction recovery is possible, no matter how low you are now.
People who feel that they can’t be helped because they’ve sunk too low need to hear from others who’ve been as low and are now in a much different place.
Starting over isn’t unusual and doesn’t mean you won’t succeed.
Sometimes people see relapse, either in themselves or others, as a sign that treatment doesn’t work. However, the National Institute on Drug Abuse points out that relapse rates for addiction are similar to the rates for other chronic illnesses like asthma, diabetes and hypertension.
When someone with diabetes finds their blood sugar level is no longer under control, it doesn’t mean that diabetes doesn’t respond to treatment. It means that it’s time to re-evaluate and make changes to the treatment plan. The same is true of addiction. Relapse means it’s time to modify or reinstate treatment, not give up and decide it’s hopeless. People need to hear the stories of others who’ve relapsed and gotten back on track.
People in addiction recovery live very full, happy and successful lives.
Recovery is more than surviving. It can mean thriving to the degree that’s hard to imagine when you’re in the depths of the struggle. People need to hear that message from people who’ve experienced it.
If you don’t regularly hear recovery stories as part of your everyday life, you must look for them proactively. One easy place to start is with online communities like Rooted Promises. You can read and hear the stories of people who’ve walked the recovery path.
Another online source is Faces and Voices of Recovery, a national organization with multiple goals, including reducing stigma. As part of that objective, they provide a place for people to share their stories.
Of course, local in-person meetings are also a great source of education, inspiration and support. You can be a source of hope and help for others as they can be for you. Once you start treatment, you’ll also have fellow patients you can learn from and be inspired by.
Sharing the journey with others builds strong bonds and helps you truly internalize the message that anyone from any walk of life can be affected by and recover from addiction. Sharing your own story with people both in and out of the addiction community can be very powerful.
You are more than your addiction, and we see you.
At The Right Step Hill Country, we work to remove the stigmas surrounding addiction and addiction recovery. If you or your loved one is ready to take on life without substance use, we are here to support you on the path. Our recovery specialists are ready to listen and answer all your questions.
Call us today at 844.675.1628
By Martha McLaughlin