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.