Addiction stigma – Making addiction recovery, and addiction treatment entry, even harder

When people think about drug addicts, they often bring-up the negative stereotypical hippie, or homeless, image that movies, television, and much of our daily experience has left us with. Its usually not a successful business man, doctor, or lawyer that comes to mind.

This is an issue because many addicts attempt to disassociate themselves from this negative stigma, often resorting to denial of their drug problem or secrecy coping,  and not seeking the addiction treatment they need.

The truth is that addicts are found in every socioeconomic class and within every ethnic group and gender. On this site we have talked about doctors with addictions, the reality of behavioral addictions, and the science behind the compulsive behavior that addicts are so well known for. We have attempted to destroy myths about addictions, by informing our readers about the neuroscience of addiction, and allowing people “to come out” about their addictions. By doing this we hope to encourage openness about addictions, and not allow stigma to get in in the way of recovery.

Addiction stigma hurts addiction treatment success

The center for Addictions and Substance Abuse Technologies, at The University of Nevada, did a study on the affects of stigmatization on 197 drug users. The findings indicated that there is a direct correlation between the degree to which drug users are perceived negatively (stigmatized) and whether or not they overcome their addiction. The study suggested that addicts become more dependent on the substance they use because of the stigma (actual or perceived).

Researchers looked at six questions regarding stigmatization which were:

  1. To what degree do drug users experience stigma?
  2. Were the metrics of stigmatization conceptually distinct?
  3. Is the perceived stigma related to the number of previous addiction treatment episodes?
  4. How does secrecy as a coping strategy affect drug users?
  5. Do intravenous drug users have higher levels of perceived stigma than non-intravenous users?
  6. Do people with current contact with the legal system report higher levels of stigma?

The study found that there are varying degrees of stigmatization and that the most prevalent stigmas were; drug users felt that people treated them differently after finding out about their drug use (60%), felt that others were afraid of them when finding out about their drug use (46%), felt some of their family gave up on them after finding out about their substance use (45%),  felt that some of their friends rejected them after finding out about their substance use (38%), and felt that employers paid them a lower wages after finding out about their substance use (14%). My own personal experience certainly supports the first three findings – I have encountered people who stopped talking to me after finding out about my drug addiction past, and during my addiction there were long stretches of time during which my family completely gave up on the possibility that I would ever recover. At the time I simply shrugged these things off and pretended like they didn’t matter, but they certainly didn’t give me a good reason to stop using drugs.

The results of the study indicated that the measures of stigma are conceptually unique. These measures included Internalized shame Perceived stigma, and stigma-related rejection, all of which were correlated with one another to some extent.

Users with a higher number of addiction treatment episodes also engendered higher levels of stigma and had a more difficult time succeeding in treatment. These results  support earlier findings (Sirey et al. 2001) that showed that users with higher levels of perceived stigma were more likely to prematurely discontinue treatment, confirming that stigmatized drug users are not likely to seek addiction treatment and are more likely to relapse after starting treatment.

Addicts have a sense of shame associated with seeking treatment for their problem

The current addiction treatment system has produced a seeming paradox within the mind of the struggling addict – By owning up to their addictions, addicts reduce the invisibility of the problem, helping others claim back their lives from the secrecy of substance abuse and behavioral addictions. Unfortunately, that process takes far longer than the stigma the confessing addict has to immediately confront.

The study showed that secrecy coping is associated with lower quality of life because of the drug user’s inability to openly discuss their addiction. Subjects  that dealt with their addiction alone had poorer mental health, decreasing their chances of recover due to the stigma of addiction. Much like with many other chronic mental, and physical, conditions, the stigma attached to addiction, and addiction treatment seeking, can often lead to poorer outcomes in the long run and less successful treatment development due to low participation rates in the kind of groundbreaking research necessary. By reducing the shame associated with confessing to an addiction, society could drive forward the advancement of addiction treatment, helping us treat addiction like we treat cancer, parkinson’s disease, and many other chronic diseases.

Surprisingly the results from the study showed that the legal system does not increase the  level of stigmatization, yet subjects that used intravenous drugs felt a higher level of stigma.

Citations:

Sirey, J. A., Bruce, M. L., Alxopoulos, G. S., Perlick, D., Raue, P., Friedman, S. J., et al. (2001). Perceived stigma as a predictor oftreatment discontinuation in young and older outpatients with depression. American Journal of Psychiatry, 158, 479−481.

Luoma J.B., Twohig M.P., Waltz T., Hayes S.C., Roget N., Padilla M., Fisher G. (2007) An investigation of stigma in individuals receiving treatment for substance abuse.

5 Replies to “Addiction stigma – Making addiction recovery, and addiction treatment entry, even harder”

  1. Wow this is so true there is alot of stigma and it hurts the addict they might act like they dont care but I think deep inside they hurt It’s embarrasing I think talking about addiction to someone and I think some people out there dont really understand I live with a addict and when some of my family members and friends found out about the problem they stoped coming around and even talking to me and Im not even the addict that’s why it’s even harder for the addict because they can feel the shame.

    1. Definitely true Esemralda,
      most addicts have completely internalized the stigma and to some extent probably believe themselves that they are losers that will never, and can’t ever, amount to anything. In my upcoming webinar I intend to talk quite a bit about the difference between the concept of choice and control over the choices we make. I hope that people will begin to really grasp this difference and understand that while addicts do “choose” to use drugs, they are often much less able to control their own choices, especially without help in the form of treatment, support, etc.
      Thanks for always reading and contributing and I hope things are getting better over there.

  2. Here is the problem: Stigmatization of substance use is formalized in our society and established by law in every civilized country of the world. This “world-wide prohibition” (described very well by Harry Levine – http://www.heroinhelper.com/angry/DRCnet/harry_levine.shtml). To truly eliminate this stigmatization we would have to repeal most drug laws that proscribe the use of “illicit drugs” (similar to what is currently being done for homosexual behavior in most western countries – first the law changes, then the general social attitude changes). However, this is very unlikely. Over half of all referrals into treatment are the result of criminal justice action. The very nature of being ‘sentenced” to treatment indelibly places a stigma on the person as one who engages in criminal behavior – that is, not a nice person. One can discuss endlessly about the “disease of addiction” but it will never trump the reality of actually takes place in the real world.
    A possible solution is to find a new socially-acceptable paradigm for the use of intoxicating substances, one that defines use as a normal behavior – perhaps tied to a personal achievement of social, intra-psychic, or spiritual experiences. In addition, there would need to be reasonable boundaries of use, specifically regarding appropriate setting and the personal circumstances of the individual user that protects him or her and especially others from harm.
    However, this change will never happen as long as the use of certain substances are defined as “deviant” by policymakers, medical doctors, treatment professionals, and especially, researchers who keep looking for brain chemicals or psychological aberrations that “makes these people different.” Perhaps they are not – perhaps we have met the enemy and they are us!

Leave a Reply