Understanding Stigma and the Consequences for Patients and Families
By Jessica Hulsey
Addiction Policy Forum
While much stigma is associated with health conditions like mental illness, HIV, and obesity, addiction is the most stigmatized health condition globally. A multi-country study conducted by the World Health Organization (WHO) examined levels of stigma associated with highly stigmatized conditions, such as homelessness and HIV, and found that substance use was the most stigmatized condition while alcohol use was ranked fourth. The effects? Individuals struggling with an addiction or recovering from a substance use disorder (SUD) are subjected to harsh moral judgments and frequent discrimination.
So, what is stigma? Negative attitudes and behaviors toward individuals with a specific characteristic, like addiction, are also known as stigma. The consequences of the stigma around addiction are substantial. Research has found that individuals who experience stigma due to a SUD are more likely to continue engaging in substance use and manifest greater delayed treatment access and higher dropout rates. Stigma prevents struggling people from reaching out for help and isolates families affected by the disease who fear being judged by their communities. The public and many professionals continue to view SUDs as a moral failing, reinforcing discriminatory policies and practices and further isolating and deters those struggling to seek help.
According to Dr. Valerie Earnshaw, a leading stigma researcher at the University of Delaware, the three major domains of stigma include:
- Stereotypes, the inaccurate beliefs or thoughts about a particular group of people.
- Prejudice, negative feelings, or emotions towards a specific group.
- Discrimination includes negative or unjust treatment of a particular group.
Discrimination towards individuals with a SUD or in recovery can be found in healthcare services and quality, employment opportunities, decisions around child custody, and housing.
The National Academy of Sciences highlights five effective stigma reduction strategies in their 2016 report on stigma:
- Education and awareness where the intervention replaces myths around addiction with accurate information.
- Literacy programs to improve knowledge, attitudes, and help-seeking behaviors.
- Contact strategies that engage individuals with lived experience to reduce prejudice.
- Protest/advocacy efforts.
- Policy and legislative change to protect and improve services for stigmatized individuals.
All key sectors in our communities must come together to address the manifestations of stigma – from stereotypes to prejudice to the frequent discrimination experienced. Our efforts must include multi-layered interventions and collaboration that help improve knowledge and literacy while building compassion for our patient group, those still struggling, in recovery, and caregivers and families.