Stigma is defined as a set of negative beliefs that a group or society holds about a topic or group of people. It is any attitude or behavior that discriminates against people and is generally based on assumptions or misconceptions.
According to the World Health Organization (WHO), stigma is a major cause of discrimination and exclusion, and it contributes to the abuse of human rights.
Stigmatized people are often not recognized as complex human beings. Instead, stigma can turn an individual into a stereotype.
Dependence on drugs has been ranked as the most stigmatized health condition globally.
Stigma matters. People who use drugs, especially those struggling with addiction, face discrimination and barriers to getting help. Stigma can make people who use or have used alcohol, and other drugs feel unwelcome and unsafe, stopping them from seeking help.
Words matter. We share and spread stigma with our words, body language, and actions. Words have power. They can inspire, encourage and bring hope, or they can tear down and discourage.
Types of stigma:
- Self-stigma: when people with addiction internalize society’s negative views, this can lead to low self-esteem and feelings of shame.
- Social stigma: involving pervasive negative attitudes and beliefs that lead to societal rejection of persons with addiction.
- Structural stigma: discriminatory institutional practices and policies, including healthcare system and workplaces.
Stigma is a public health issue — it contributes to high rates of death, incarceration, and mental health concerns among dependent populations.
Some healthcare providers hold negative attitudes about people who use illicit drugs or have a dependence on alcohol or other drugs, which can lead to insufficient healthcare support. These attitudes have the potential to influence the quality of treatment that practitioners provide to their patients, resulting in:
- Poor communication between patient and provider
- Diminished relationship between patient and provider
- Attributing physical symptoms to a person’s alcohol or other drug use or dependence rather than to an unrelated health condition, leading to incorrect diagnosis and treatment.
Stigma can negatively impact a number of areas, including:
- Willingness to attend treatment and access to healthcare.
- Harm reduction.
- Self-esteem and mental health.
Untreated drug and alcohol abuse contributes to tens of thousands of deaths every year and affects the lives of many more people.
Addiction is not a choice.
A large body of research indicates that this stigma is persistent, pervasive, and rooted in the belief that addiction is a personal choice reflecting a lack of willpower and a moral failing, even though medicine long ago reached the consensus that addiction is a complex brain disorder.
Stigma is not the only factor impeding adequate treatment of people with substance use disorders, but if we are to achieve the public health goal of getting and retaining many more people with substance use disorders in treatment, we have to ensure that the health care system will not penalize people who are addicted to drugs for their condition.
Alleviating this stigma is not easy, but possible and necessary.
It is crucial that healthcare personnel, from staff in emergency departments to physicians, nurses, and physician assistants, be trained in caring competently for people with substance use disorders. Treating patients with dignity and compassion is the first step.
It is also necessary to promote awareness of addiction as a chronic relapsing (and treatable) brain disease. This effort should include promoting an understanding of the disease’s behavioral consequences as well as of the factors that make certain people particularly vulnerable.
Principles to follow in addressing stigma from healthcare professionals: changing how we talk about drug use
First, the use of “person-first” language is essential for stigma reduction. The use of terms such as “substance abuser” is more likely to exacerbate stigma than using person-first language such as “a person with a substance use disorder.”
Second, emphasizing medical solutions appears to reduce stigma. Some limited evidence suggests that such “treatment works” messaging may also mitigate addiction-related stigma.
Third, research suggests that the use of sympathetic narratives — stories that humanize people with addiction — may reduce stigma.
Fourth, stigma reduction messages should emphasize societal rather than individual causes of addiction.
Humans tend to assume that an individual’s actions depend more on intrinsic personal characteristics than on situational or societal factors. This bias may lead us to over attribute addiction to people’s poor choices as opposed to factors such as poverty, a history of trauma, or structural barriers to accessing effective treatments.
Effective ways for individuals to help reduce stigma include:
- Offering compassionate support
- Displaying kindness to people in vulnerable situations
- Listening while withholding judgment
- Seeing a person for who they are, not what drugs they use
- Doing your research; learning about drug dependency and how it works
- Treating people with drug dependency with dignity and respect
- Avoiding hurtful labels
- Replacing negative attitudes with evidence-based facts
- Speaking up when you see someone mistreated because of their drug use
- Sharing your own stories of stigma
Author: Dr. Eduardo Bianco
