The concept of stigma describes the powerful, negative perceptions commonly associated with substance use and dependence. Stigma has the potential to negatively affect a person’s self-esteem, damage relationships, and prevent those suffering from accessing treatment.
Stigma is a public health issue — it contributes to high rates of death, incarceration, and mental health concerns among dependent populations.
Stigma is defined as a set of negative beliefs that a group or society holds about a topic or group of people. According to the World Health Organization (WHO), stigma is a major cause of discrimination and exclusion and it contributes to the misuse of human rights. When a person experiences stigma they are seen as less than because of their real or perceived health status. Stigma is rarely based on facts but rather on assumptions, preconceptions, and generalizations; therefore, its negative impact can be prevented or lessened through education. Stigma results in prejudice, avoidance, rejection, and discrimination against people who have a socially undesirable trait or engage in culturally marginalized behaviors, such as drug use (Link, 2001).
Understanding the Impact of Stigma
Two main factors affect the burden of stigma placed on a particular disease or disorder: perceived control that a person has over the condition and perceived fault in acquiring the condition. When we believe a person has acquired their illness through no fault of their own, and/or that they have little control over it, we typically attach no stigma to either the person or the illness. Consider hard-to-treat cancers, for example. By contrast, many people mistakenly believe mental health conditions, including substance misuse disorders, are both within a person’s control and partially their fault. For these reasons, they frequently attach more stigmas to them. The potential for stigma is greater still when someone is using an illegal substance, which carries the additional perception of criminality. (SAMHSA, CAPT)
People with substance use disorders, in particular, are viewed by the public as weak-willed (Schomerus et al., 2011) although evidence shows that they are as likely to adhere to treatment as people with other chronic medical conditions, such as hypertension or diabetes (McLellan et al., 2000).
For people with a substance use disorders, stigma disproportionately influences health outcomes and mental well-being. Fear of being judged and/or discriminated against can prevent people with substance use disorders, or who are at risk of substance use disorders, from getting the help they need. It can also prevent caregivers and others in the position to help from providing needed services, including medical care. Consider the following:
Substance use disorder is among the most stigmatized conditions in the US and around the world.
People who have substance use disorders are often treated differently, including lower expectations for health outcomes.
People with a substance use disorder who expect or experience stigma have poorer outcomes. People who experience stigma are less likely to seek out treatment services and access those services. When they do, people who experience stigma are more likely to drop out of care earlier. Both of these factors compound and lead to worse outcomes overall. (SAMHSA, CAPT)
“Protest any labels that turn people into things. Words are important. If you want to care for something, you call it a flower; if you want to kill something, you call it a weed.” – Don Coyhis
Words have immense power to wound or heal. Person-first language emphasizes the person, not the disorder, in an attempt to avoid marginalization or subconscious dehumanization (also known as implicit bias).
Person-first language (for example, reference to “a person with substance use disorder”) suggests that the person has a problem that can be addressed. By contrast, calling someone a “drug misuser” implies that the person is the problem.