Written By: Fiona Stockard
Why is There an Addiction Stigma?
Addicts and alcoholics are misunderstood people. I don’t even understand them and I’m an addict and alcoholic myself! There are a bunch of different types of addiction stigma. What are they? Why do they exist?
Stigma can be understood in terms of how it manifests at the self, social, and structural levels. Self-stigma is defined as “a subjective process that is characterized by negative feelings (about self), maladaptive behavior, identity transformation or stereotype endorsement resulting from an individual’s experiences, perceptions, or anticipation of negative social reactions on the basis of a stigmatized social status or health condition” (Livingston, 2011). This basically means the judgements addicts and alcoholics carry about themselves.
Social-stigma “describes the phenomenon of large social groups endorsing stereotypes about and acting against a stigmatized group” (Livingston, 2011). So, social-stigma refers to how a society, and various subcultures within that society, view addicts and alcoholics.
Structural-stigma “refers to the rules, policies and procedures of institutions that restrict the rights and opportunities for members of stigmatized groups” (Livingston, 2011). So, structural-stigma refers to the negative attitudes held by institutions. Think the government, the healthcare system, and the criminal justice system.
An Addiction Stigma to the Power of Three
All three manifestations of stigma influence one another. For example, social-stigma has a deep effect on self-stigma. In turn, self-stigma can affect social-stigma. It’s a vicious cycle.
Several studies have identified these stigmas as significant barriers to addicts and alcoholics accessing treatment. An example of this is former President Richard Nixon’s famous term “War on Drugs.” This phrase allows the public to view those suffering from addiction as enemies of the state, rather than as sick people in need of help. It makes anything related to addiction a crime. Substance use disorders are treated as moral and criminal issues, rather than health concerns.
Livingston echoes this idea. He states, “criminalization of substance-using behaviors exacerbates stigma and produces exclusionary process that deepen the marginalization of people who use illegal substances.” Therefore, the social processes and institutions that manage substance abuse may actually contribute to its continuance (Livingston, 2011). With all three stigmas working together as one comprehensive addiction stigma, the stereotypes that follow become difficult to overcome.
Substance use disorders are also linked to, and overlap with, a large amount of other stigmatized health conditions (HIV/AIDS, HCV, etc.), unsafe behaviors (impaired driving, unsafe sexual practices, etc.), and social problems (poverty, criminal activity, etc.) (Livingston, 2011). The stigmas and addiction stereotypes attached to these health conditions, unsafe behaviors, and social problems, make substance use disorder even more stigmatized! Additionally, as there’s truth to some stereotypes (for example, many people suffering from addiction do drive under the influence) it becomes even more challenging to counteract these stigmas.
Combating the Addiction Stereotypes
Some measures have been found to be effective when combating addiction stigma and other stereotypes associated with drug abuse. For example, self-stigma can be reduced through therapeutic interventions in drug abuse treatment. These are things like group-based acceptance and commitment therapy.
Interventions found to be successful for reducing social-stigma include motivational interviewing and communicating positive stories of people with substance use disorders.
Changing stigma at a structural level can be achieved through contact-based training and education programs targeting medical students and professionals (police officers, counselors, etc.) (Livingston, 2011).
Livingston, J. (2011). The effectiveness of interventions for reducing stigma related to substance use disorders: a systematic review. Addiction Review , 107-39-50.