Stigma of addiction
The stigma of addiction refers to the negative attitudes and stereotypes that result in the social exclusion of individuals struggling with substance use or behavioral addictions. This stigma manifests in various forms, including self-stigma, social stigma, and structural stigma. Self-stigma involves an individual's internalized negative beliefs about their addiction, leading to shame and reluctance to seek help. Social stigma encompasses the unfavorable judgments and treatment individuals with addiction face from friends, family, and society, which often overlook the fact that addiction is a disease. Structural stigma involves institutional policies and societal norms that perpetuate discrimination against those with addictions, making it harder for them to access necessary treatment. Research indicates that stigma significantly impacts an individual's willingness to seek help, with many perceiving addiction as a less legitimate condition compared to other mental health issues. Efforts to combat this stigma require both individual reflection on biases and broad societal changes that promote understanding and empathy for those affected by addiction, ultimately fostering a more supportive environment for recovery.
Stigma of addiction
DEFINITION: Stigma refers to negative attitudes and stereotypes that lead to the exclusion of a person from social acceptance because of some characteristic, including being addicted to a substance of abuse or having a behavioral addiction.
Theories of Stigma and Addiction
No single theoretical model of stigma guides empirical work on the phenomenon, even though there exists a substantial body of theoretical and empirical work on stigma in general and the stigma of addiction in particular. Canadian sociologist Erving Goffman’s 1963 analysis emphasized the effect of the stigmata (the devalued marker) on one’s sense of social identity and the negative effect of stigma on social interaction with others, including healthcare professionals. The stigmatized person may not feel fully human, and the responses of avoidance and disdain by others serve to confirm this compromised humanity.
In their 1984 work, psychologist Edward Jones and colleagues considered the social-cognitive response of others to a person marked by stigmata. The researchers’ basic claim was that the stigma engenders consensual social attributions about the person’s dispositions. An individual with an addiction, for example, may be consensually judged as weak, out of control, and possibly immoral. Research in 1982 proposed that social stigma legitimizes the social exclusion of a person and that social norms governing everyday social interaction do not apply to the stigmatized person. In the workplace, for example, a person with hypertension may be encouraged by coworkers and supervisors to use stress-reduction strategies, exercise, and avoid salt. An individual with an addiction may not be afforded such normative support, and plans may be laid to exclude the employee from the workplace.
Social psychologist Jennifer Crocker and colleagues (1998) took a social-psychological perspective on stigma and focused on group membership that may be a basis of stigma. From the perspective of individuals who have not experienced addiction, those with an addiction are devalued, likely to be judged negatively, and likely to be seen as interchangeable entities. That is, the individual will be judged as inferior and will be undifferentiated; people will use the “they’re all the same” bias when evaluating individuals with addictions.
Another theoretical approach to stigma, explored by researchers Robert Kurzban and Mark R. Leary in 2001, conceptualizes this phenomenon from the perspective of evolutionary theory. Their theory assumes an evolved brain mechanism that functions to avoid exposure to those who may carry pathogens that can compromise one’s adaptive potential. This mechanism may have a propensity for false positives such that those who are different on a broad array of dimensions (for example, people with substance use disorder, mental health disorders, obesity, members of the LGBTQ community, persons with cancer, and those from traditionally marginalized racial and ethnic backgrounds) are evaluated negatively and avoided. For example, this avoidance might occur when one discovers that a potentially attractive romantic partner is in the process of addiction recovery, leading the discoverer to change their mind about pursuing the relationship further. While distinct, all theories of stigma acknowledge the negative effects on the self-assessment of the person with the stigmata and the social avoidance it promotes in others.
Three types of stigma are most commonly discussed in the context of addiction—self-stigma, social stigma, and structural stigma. Self-stigma refers to an individual's negative feelings about drug and alcohol use, including their own use of substances. Individuals who are ashamed of their addiction and perhaps never saw themselves as an individual with a substance use problem may have internalized, unconscious judgments that they apply to themselves. Self-stigma leads to hiding drug abuse and avoiding seeking treatment. Social stigma refers to the negative thoughts, poor treatment, and judgment that friends, family members, the media, and the population, in general, may have of individuals with an addiction. These pervasive messages circulate in the news, online, on social media, and in conversations, and they generally fail to recognize addiction as a disease. Structural stigma refers to the laws, social services, criminal justice, healthcare, workplace, and first responder policies that perpetuate drug use and discourage mental health and substance use disorder treatment. To limit the impact of stigma on addiction, each person must objectively evaluate their attitudes and behaviors. Unconscious bias plays a detrimental role in the stigmatization of individuals. Societal changes are a bottom-up process, meaning that changing attitudes, policies, and laws concerning addiction begins with individuals.
Adverse Consequences
Stigma can adversely affect entry into treatment for substance abuse. Research published by Katherine M. Keyes and colleagues found that persons with an alcohol use disorder who believe that alcoholism is a stigmatizing condition are less likely to seek clinical treatment. In a large national sample of 34,653 people with an alcohol use disorder, those who judged their disorder as stigmatizing were 37 percent less likely to seek treatment. Further research found that individuals with addictions were perceived as less desirable to employers, landlords, and potential romantic partners than individuals with conditions traditionally thought of as mental health concerns, like depression. Less than 30 percent of individuals surveyed believed recovery for individuals with addictions is possible. Social interventions are needed to reduce the stigma associated with addiction because of the barriers posed for those who need clinical intervention to recover from a substance use disorder.
Bibliography
Avery, Jonathan D., and Joseph J. Avery. The Stigma of Addiction: An Essential Guide. Springer, 2019.
Crocker, Jennifer, et al. “Social Stigma.” The Handbook of Social Psychology, edited by Daniel. T. Gilbert, et al., vol. 2, 4th ed., McGraw, 1998, pp. 504–53.
Goffman, Erving. Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs: Prentice, 1963.
Jones, Edward E., et al. Social Stigma: The Psychology of Marked Relationships. New York: Freeman, 1984.
Keyes, Katherine M., et al. “Stigma and Treatment for Alcohol Disorders in the United States.” American Journal of Epidemiology, vol. 172, no. 12, 2010, pp. 1364–72.
Room, Robin. “Stigma, Social Inequality and Alcohol and Drug Use.” Drug and Alcohol Review, vol. 24, no. 2, 2005, pp. 143–55.
Smith, Sharon M., et al. “Examining Perceived Alcoholism Stigma Effect on Racial-Ethnic Disparities in Treatment and Quality of Life among Alcoholics.” Journal of Studies on Alcohol and Drugs, vol. 71, no. 2, 2010, pp. 231–36.
"Stigma and Discrimination." National Institute on Drug Abuse, June 2022, nida.nih.gov/research-topics/stigma-discrimination. Accessed 20 Sept. 2024.
"Stigma Related to Substance Use Disorder." American Addiction Centers, 14 Sept. 2022, americanaddictioncenters.org/harm-reduction/stigma-of-addiction. Accessed 20 Sept. 2024.
Volkow, Nora. "Addressing the Stigma That Surrounds Addiction." National Institute on Drug Abuse (NIDA), 22 Apr. 2020, nida.nih.gov/about-nida/noras-blog/2020/04/addressing-stigma-surrounds-addiction. Accessed 2 Dec. 2022.