The Issue of Stigma and Substance Use Disorder

The stigma of substance use disorder is an issue that has been propagated for decades. Stigma negatively affects a person and is a serious public health issue. According to the National Institute of Drug Abuse, stigma contributes to high rates of death, incarceration, and mental health concerns among affected populations.1

Stigma is defined as “a set of negative beliefs that a group or society holds about a topic or group of people.”1 According to the World Health Organization, “stigma is a major cause of discrimination and exclusion and contributes to the abuse of human rights.”2

There are instances in which compassion fatigue, the indifference experienced by those helping people in distress, can promote stigma. Recently, a fire fighter was interviewed in the local media indicating the people who received naloxone to reverse opioid overdoses were repeat customers; the same people receiving doses of naloxone again and again.

While rarely based on facts, stigma is often based on assumptions, preconceptions, and generalizations and its negative impact can be prevented. A study published last year in the International Journal of Addictive Behaviors found no evidence of increased drug use with access to naloxone.3

There are many things we can do as everyday citizens to reduce the stigma associated with substance use disorder. First, using person-first language is critical. Person-first language defines the person as a human being first and does not define them by their disease. We do not encounter people who have diabetes and introduce them as “the diabetic,” but can we say the same for people who have substance use disorder? Person-first language substitutes terms like substance use disorder in place of “drug habit” person with substance use disorder in place of “addict,” and positive drug screen instead of dirty drug test.

A paradigm shift from thinking “what is wrong with you” to “what has happened to you” is another important step in reducing stigma by considering trauma-informed care. Understanding where a person has been and what they have been through can help the lay person take into consideration the reasons they have found themselves in this place. While people may initially use substances to experience pleasure or mask pain, over time, they receive less of the desired effect and eventually, they use to stop cravings and to keep from feeling “dope sick.” The disease of addiction makes physiological changes in the brain that impacts the reward system, impulse control and decision making.

As with any type of behavior change, shifting our way of thinking about stigma associated with substance use disorder may be difficult, but perhaps if we change our language, it will be easier for people with substance use disorder to change theirs and to seek the help they need.

If we do not make this important change to reduce and ultimately end stigma, we will continue to witness people who are hesitant to seek treatment. For every fatal overdose, there are 30 nonfatal overdoses.4 We need to engage people in treatment as soon as possible when naloxone is used to reverse an overdose. Each interaction with naloxone is an opportunity. In fact, the only person we have no hope in saving is a dead one.
1 Lauren Villa, MPH. “Shaming the Sick: Addiction and Stigma.” American Addiction Centers Resource

2 “Stigma and Discrimination.” World Health Organization: Regional Office for Europe, 2013. 

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