By Julie Bender and Carly Hill

What do we already know?

Ever since childhood, we’ve been told the same things about drugs. We have been taught by teachers, parents, and the media that drugs are bad and that we should never use them. Our society views drugs and  substance use disorders in a very negative light. Therefore, people who have experienced addiction to drugs, regardless of whether or not they are in treatment, experience stigma from many sources. In the past, research has mainly focused on the stigma experienced from healthcare workers as this can be a deterrent to successful substance use treatment. However, people who with substance use disorders experience stigma from a variety of sources, each of which may affect them in different ways.

What do we want to find out?

Earnshaw and colleagues wanted to investigate additional sources of stigma beyond healthcare providers and how they impact people in treatment for substance use disorders. They recruited 12 participants from a treatment center who were all receiving Methadone Maintenance Therapy, a medication-based treatment approach for individuals with opioid use disorders. Participants had to be 18 years or older, English speaking, and willing to have their interview audio-taped.

What did they find?

Participants in this study reported a great deal of anticipated and experienced stigma from family and friends. Anticipated stigma is when someone believes that others will discriminate against them or reject them in the future whereas experienced stigma is when they actually have done this in the past or are doing this in the present. Participants stated that their families no longer trusted them and sometimes rejected them. For example, participants said that parents didn’t trust them not to steal regardless of whether or not they had stolen from them in the past.

Participants also reported anticipating or experiencing stigma in the workplace, which included from employers and coworkers. Participants feared that their employers would find out about their substance use disorder and fire or discriminate against them in the workplace. If co-workers knew about their  substance use disorder, participants stated that they have been treated like they are less of a person due to their chronic illness.

 

Participants had mixed responses when it came to reporting stigma from healthcare workers. Some found that healthcare workers were extremely understanding and caring when working with them. Others found that certain professionals were frustrated when they would see them more than once. They thought that because their jobs are to keep people healthy, they might be frustrated with people who are addicted to drugs because “they’re trying save lives and [the patients are] just doing something stupid and being selfish and stuff, like, you know, being reckless with their lives,” said one participant. He continued on to say, “it’s frustrating to them, but they don’t have a hate or an anger.”

Although these experiences of stigma were the most commonly reported from this study, they were not the only ones. Participants also reported stigma from dating partners, fiancés, and government employees. In addition they mentioned experiencing stigma from the general population. On participant stated, “Once you start talking about your… experiences with drugs and alcohol, they tend to look down on you.” Participants also reported that the people around them did not believe that they could change their ways and that even after they stopped using drugs, they were still stereotyped as drug addicts.

So what?

This research shows that people in recovery may continue to experience stigma from many others. The participants reported anticipating and experiencing stigma despite being in treatment for their substance use disorders. These participants were not simply stigmatized by one person or category of people, but rather from a variety of sources. Because many people who have experienced a substance use disorder use drugs as a way to cope with stress, being stigmatized by a variety of people while in treatment could cause unnecessary stress that could lead to a relapse. Experiences of stigma need to be addressed by clinicians so they know how to help their patients avoid the possible negative outcomes of these stressors.

Reference: Earnshaw, V. A., Smith, L. R., & Copenhaver, M. M. (2013). Drug use stigma in the context of methadone maintenance therapy: An investigation into understudied sources of stigma. International Journal of Mental Health & Addiction, 11, 110-122. PMC3743126