By Maddie Lepore, undergraduate nursing student at the University of Pittsburgh School of Nursing
It’s no secret that drug use is looked down on by society. The War on Drugs has created a negative and stigmatizing environment for those who struggle with addiction. Can the stigma that surrounds people with addiction cause them to experience discrimination by society? No doubt about it.
In fact, this form of discrimination is so powerful and prevalent that minority drug users have reported drug use discrimination as the most common and influential discrimination that they face. While much of society is sensitive to discrimination based on race and ethnicity, we have yet to become aware of the issue of addiction.
Stigma Can Be Internalized
The stigma of drug use can be harmful in many ways. One of these is self-stigma, when prejudice and discrimination lead a person to internalize feelings of powerlessness and inferiority. Internalized stigma fallaciously causes people who struggle with addiction to blame themselves for being susceptible to a disease. Self-stigma negatively impacts quality of life by lowering self-esteem and self-efficacy. This can cause a decrease in satisfaction with various domains of life, such as work, relationships, family, housing, health, and spirituality.
And self-stigma can counteract attempts toward improved health and recovery. According to a research study on self-stigma and mutual help programs, self-stigma and personal empowerment are on opposite ends of a continuum.
Stigma and Addiction Treatment
Harm reduction programs are an important response to addiction that have proven to reduce infectious disease transmission. Harm reduction focuses on minimizing the damage people who inject drugs inflict upon themselves and society at large. A major facet of harm reduction is needle exchange programs. In addition to providing clean needles, harm reduction programs offer health education, wound care, and a variety of resources and connections that support recovery.
While needle exchange programs are known to be beneficial, those who have internalized stigma related to their addiction are less likely to access them. As a nursing student, for me, this research underscores the importance of health care services creating a less stigmatizing and more supportive environment for those struggling with addiction.
Another important response to addiction is medication-assisted treatment. This approach involves the use of medications alongside therapy and mutual aid programs. The benefit of medications like methadone and buprenorphine in addiction treatment is that they decrease cravings and suppress withdrawal symptoms, which can be serious or fatal. Some medications also block the effects of opioids, such as buprenorphine (the film or pill, Suboxone) or naltrexone (the injection, Vivitrol or the pill, ReVia). Additionally, naltrexone can reduce cravings for alcohol.
Stigma has been associated with all forms of medication-assisted treatment, but none more than methadone. How can we ask patients to seek effective treatment at a methadone program when the treatment itself has such negative connotations?
There is a long history of NIMBY-ism when it comes to methadone clinics, which means they are often located in poorer neighborhoods where minority populations live. However, when I visited a methadone clinic in a predominantly African American community, I learned that of its 405 patient population, 83% are white. A crucial step in overcoming some of the stigma associated with methadone treatment is acknowledging what the data tells us, that opioid addiction is primarily a “white problem.” Therefore, methadone clinics should also be located in white, middle class neighborhoods.
Pushing Stigma Aside and Facing Addiction Head On
The relationship between stigma and decreased use of needle exchange programs is just one example of the harmful impact stigma has on access to services. One way to help decrease the negative aura around addiction is through mutual aid programs and support groups that promote self-empowerment and decrease self-stigmatization. Another important means for overcoming stigma is through appropriate language regarding addiction. Inappropriate language negatively impacts society’s perception of drug use, and consequently propagates stigma.
An editorial confronting inadvertent stigma and pejorative language in addiction recommends four guidelines to follow when discussing addiction. The first principle commends the use of person-first language to respect the worth and dignity of all, and to avoid presumption of homogeneity. Terms such as “a person with addiction” or “a person who injects drugs,” rather than “an addict” or “an injection drug user” are examples of this language. Likewise, slang and idioms reinforce stigma; avoidance of such sayings are essential in appropriate language use. Furthermore, the use of language should promote recovery by focusing on resilience and healing, not pathology and suffering. Last but not least, concentration ought to be on the medical nature of addiction, and no longer frame addiction as a lack of willpower and failure of personality. Addiction is a complex health issue affecting the physical, psychological, social, and genetic realms of health and wellness, and that’s how we should speak about it.
To view a list of alternative terminology when speaking towards addiction and recovery and the most respectful ways to refer to people, please click here.
Stigma Isn’t Working
While the propagation of stigmatizing messages may have helped reduce cigarette smoking across the country, rates of opioid addiction–especially heroin–have risen dramatically since 2002. However, treatment rates have not increased at the same pace. Clearly, stigmatizing drug use is not the solution to the problem. Millions of people in the U.S. are struggling with addiction at this very moment. It is time society stops discriminating against people with addiction and makes it easier to get help. Addiction is a disease, and like any health problem, it requires intervention, not incarceration.
Maddie Lepore will graduate from the University of Pittsburgh School of Nursing in April 2017. In Spring 2017, she participated in IRETA’s preceptor program for community nursing students.