There is no doubt that substance use is stigmatized.[1] Research has shown that the general public holds unfavorable views about words such as ‘alcoholic’ and ‘addict’, so it follows logically that this transposes into how they treat them in real life[2]. The weight of stigma has the ability to negatively affect a person’s sense of self-worth[3], personal relationships, and even someone’s recovery journey.

Untreated drug and alcohol misuse contributes to tens of thousands of deaths each year, in the US alone.[4] The fallout of this is not limited to the individual – it also affects the lives of family, friends, and colleagues. Stigma places people who are affected by alcohol and drug dependency at a considerable disadvantage[5] when it comes to seeking help and much-needed treatment.

So, what is stigma and how can we prevent it?

Stigma is characterized as an assortment of negative beliefs and attitudes that an individual, group or society holds surrounding a certain topic, ways of behavior, or a specific group of people that are not perceived as ‘normal’. The toxicity of stigma comes from the simple fact that this disapproval isn’t person-specific nor the actions of an individual, but rather the perceived assumption of “somebody like that”.

Stereotypes also serve to dehumanize people, as the individual’s identity and personality are no longer their most prominent or defining feature. This generally leads to bias and prejudice in almost all societies regarding drug users[6]. This can cause anger, shame, and guilt within the family, between spouses and also friends[7].

Stereotyping can also alter the way in which people perceive themselves, which can be very hard to change. This is known as ‘self-stigma’. This is when people start to believe negative stereotypes about themselves and causes low self-worth and motivation to change. This can lead to a snowball effect, where the shame and perceived isolation leads the person to increase their use, which in turn furthers the stigma.

How can stigma contribute to continual addiction?

Not only does stigma affect people who suffer from substance use disorder, but it also negatively affects the people immediately around them. People can be worried that y associating with a substance user it could damage their reputation, and they may even be worried that they might come to physical harm.

Stigma can be a vicious cycle. It can lead to job loss[8], homelessness[9], and antagonism from those close to the individual and society as a whole. It is often said that the opposite of addiction is connection; it is less likely that a person is going to reach out for help if they feel that society is against them.

This can lead to further stigmatization when the individual reintegrates back into society. Low self-esteem can be a barrier to recovery[10]. Landlords may be hesitant to give them tenancies, employers may not hire them due to their history, and family and friends may be hesitant to be involved with them. The public stigma associated with drug and alcohol dependency places blame on the people suffering from addiction and creates a society where these people are to be feared, rather than viewed as people who need help.

Many individuals who are in recovery have also found that they are discriminated against.

This can have a detrimental effect on the individual[11], as they feel that they are defined by their past – this can increase the risk of relapse.

How can we prevent stigma affecting addicts and the recovery process?

Fear and misunderstanding are usually the cause of stigma. Many people hold a deterministic false view that “once an addict, always an addict”. The fact is that substance or alcohol abuse disorder is a medically recognized condition. Many people who discriminate against the people who suffer from them wouldn’t dream of doing so to any other illness.

In changing people’s mindsets, education is the key. It will foster a non-judgmental environment, which will in turn encourage people to seek recovery.

While it has always been necessary for society to have norms for behaviors and a perfectly reasonable expectation for individuals to take responsibility for their own actions, judging substance use as a moral failing rather than an illness that needs compassion only serves to further it.

It is essential that the public understand the many causes of drug and alcohol dependency and the process of drug treatment and recovery. If people were informed about the neurological changes which take place in the brain during addiction[12], and how childhood trauma[13] can predispose someone to substance use later in life, they would be less inclined to judge those who are suffering from it.

How can I reduce stigma?

As individuals, there are many ways we can prevent stigma and influence others to prevent it. We can be wary of using labels such as ‘addict’ or ‘alcoholic, and especially avoid terms such as ‘junkie’. If we use terms such as ‘substance abuse disorder’ it frames these medical conditions positively, may foster a more open-minded response from others. Be wise with your words – they have the power to ignite emotions that can start a change.

Medical science, and our understanding of habitual drug and alcohol use, has progressed a great deal in the past 50 years. Unfortunately, many of the old values and judgments surrounding it are still prevalent in society. Through educating yourself, and gently sharing it with others, you can serve to reduce stigma. Although it might seem small, it really is a matter of life or death, and your contribution could help to save someone’s life.

In conclusion, alcohol and drug-dependent people are almost always expected by society, as a whole, to change their behavior and exhibit better responsibility for themselves and their actions. However, in return, society has to begin to challenge the negative attitudes and barriers that keep those with addictions and drug dependency problems trapped in dysfunctional habits, behaviors, and overall lifestyles. Change is possible, but it has to be a collaborative effort.

[1] Earnshaw, Valerie et al. “Drug Addiction Stigma In The Context Of Methadone Maintenance Therapy: An Investigation Into Understudied Sources Of Stigma”. International Journal Of Mental Health And Addiction, vol 11, no. 1, 2012, pp. 110-122. Springer Science And Business Media LLC, doi:10.1007/s11469-012-9402-5. Accessed 10 Oct 2020.

[2] John F. Kelly, Richard Saitz & Sarah Wakeman (2016) Language, Substance Use Disorders, and Policy: The Need to Reach Consensus on an “Addiction-ary”, Alcoholism Treatment Quarterly, 34:1, 116-123, DOI: 10.1080/07347324.2016.1113103

[3] Crocker, Jennifer. “Contingencies Of Self-Worth: Implications For Self-Regulation And Psychological Vulnerability”. Self And Identity, vol 1, no. 2, 2002, pp. 143-149. Informa UK Limited, doi:10.1080/152988602317319320. Accessed 10 Oct 2020.

[4] “Overdose Death Rates | National Institute On Drug Abuse”. National Institute On Drug Abuse, 2020, https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates.

[5] Ritson EB. Alcohol, drugs and stigma. International Journal of Clinical Practice. 1999 Oct-Nov;53(7):549-551.

[6] Paquette, Catherine E. et al. “Stigma At Every Turn: Health Services Experiences Among People Who Inject Drugs”. International Journal Of Drug Policy, vol 57, 2018, pp. 104-110. Elsevier BV, doi:10.1016/j.drugpo.2018.04.004. Accessed 10 Oct 2020.

[7] HARBIN, HENRY T., and HOWARD M. MAZIAR. “The Families Of Drug Abusers: A Literature Review”. Family Process, vol 14, no. 3, 1975, pp. 411-431. Wiley, doi:10.1111/j.1545-5300.1975.00411.x. Accessed 10 Oct 2020.

[8] Dillon, Erin M. “Addressing Persistent And Intractable Employment Problems In Individuals With Histories Of Drug Addiction”. Substance Use & Misuse, vol 39, no. 13-14, 2004, pp. 2621-2623. Informa UK Limited, doi:10.1081/ja-200034623. Accessed 10 Oct 2020.

[9] Royse, David et al. “Homelessness And Gender In Out-Of-Treatment Drug Users”. The American Journal Of Drug And Alcohol Abuse, vol 26, no. 2, 2000, pp. 283-296. Informa UK Limited, doi:10.1081/ada-100100605. Accessed 10 Oct 2020.

[10] Room, Robin. “Stigma, Social Inequality And Alcohol And Drug Use”. Drug And Alcohol Review, vol 24, no. 2, 2005, pp. 143-155. Wiley, doi:10.1080/09595230500102434. Accessed 10 Oct 2020.

[11] Buchman, Daniel, and Peter B. Reiner. “Stigma And Addiction: Being And Becoming”. The American Journal Of Bioethics, vol 9, no. 9, 2009, pp. 18-19. Informa UK Limited, doi:10.1080/15265160903090066. Accessed 10 Oct 2020.

[12] Martin-Soelch, C. et al. “Changes In Reward-Induced Brain Activation In Opiate Addicts”. European Journal Of Neuroscience, vol 14, no. 8, 2001, pp. 1360-1368. Wiley, doi:10.1046/j.0953-816x.2001.01753.x. Accessed 10 Oct 2020.

[13] Cuomo, Chiara et al. “Aggression, Impulsivity, Personality Traits, And Childhood Trauma Of Prisoners With Substance Abuse And Addiction”. The American Journal Of Drug And Alcohol Abuse, vol 34, no. 3, 2008, pp. 339-345. Informa UK Limited, doi:10.1080/00952990802010884. Accessed 10 Oct 2020.