The Stigma of Addiction

As one of the highest and most prevalent barriers that stand in the way of recovery, the century-old stigma surrounding addiction continues to affect those struggling with substance use disorder (SUD). It not only unfolds on a personal level, contributing to high rates of death, but also across many areas that are vital for establishing, maintaining and delivering the appropriate care for millions of people worldwide suffering from SUD. Stigma is a public health issue affecting health care, employment, and legislation.

“Junkie”. “Addict”. “Druggie”.

Three little words. But incredibly powerful ones. Together with countless other derogatory terms and sentiments related to addiction, such as “crackhead”, “clean”, and “abuser”, they perpetuate the harmful stereotypes of “the addict” that persist in our social conscience. Do you personally know anyone suffering from a substance use disorder (SUD)? Well, if you don’t, media images and widespread anecdotes must have given you  a pretty good idea of what to expect from an “addict”: They’d do anything to get their stuff, they lie, they are manipulative, right? So, remember to “never trust an addict” and in case you didn’t know: “Once a junkie, always a junkie!” Public judgement and scorn cause shame and guilt, impede access to treatment[i], and allow the cycle of addiction to continue and worsen – welcome to the world of stigmatisation.

“Stigma” – the definition

“Stigma” reached our modern vocabulary via Latin and Greek, and originally referred to a “mark made by a pointed instrument, a dot”[ii]. In extended usage, this mark, often made with a hot iron, was used to identify criminals, slaves or outcasts. In other words: those who should be avoided and could not be trusted. In the context of addiction, stigma is defined as negative perceptions and beliefs about a topic or group of people.[iii] Rarely based on facts but rather on assumptions and biased generalisation,  the World Health Organization (WHO) reports that stigma “is a major cause of discrimination and exclusion: it affects people’s self-esteem, helps disrupt their family relationships and limits their ability to socialize and obtain housing and jobs.”[iv]

From the Good Creature of God to the (D)evil on Earth

Essentially, the root of the stereotype that links addiction  to moral weakness, and that the affected person must therefore have a flawed character or personality, can be traced back to the 17th century. Back then, when even Puritans still called alcohol “the Good Creature of God”, first murmured warnings were heard that drunkards who were losing their wits to alcohol had invited the (d)evil into their lives – a fatal decision that brought physical illnesses, mental destruction and, ultimately, death upon them. These murmurs increased to cries of condemnation during the following centuries. Physicians, religious leaders, and laymen alike, promulgated a view of alcohol addiction as a condition of moral compromise. Hence, the loss of control over drinking was considered a sin, and those who gave in to the temptation were marked as sinners.

Going hand in hand with racism and xenophobia

The Gin Acts of the 18th century, designed to control the consumption of gin due to the “strong Inclination of the inferior Sort of People to these destructive Liquors”[v], set the tone for lawmakers of the future. In the US, major drug prohibition arrived in the early 20th century and included substances like opium, morphine and cocaine which up to that time had been widely accepted as common ailments for minor maladies such as headaches, teething, or menstrual cramps. Calling those laws “anti-drug acts”, however, would neglect the fact that they mainly were rooted in racism and xenophobia. The ban on opium smoking, for example, was related to the connection between opium dens and Chinese immigrants, and the use of cocaine and marijuana was associated with African Americans and Hispanic populations.

Moral judgement

Although alcohol addiction has been referred to as an “infection” or a “disease” since the 18th century, the belief that it stems from moral failure kept gaining high ground and continued to marginalise affected people economically and socially. The infamous “War on Drugs”, launched in the US in 1972 as well as the “Just Say No”-campaign of the 1980s and 90s took the same line and disproportionately exacerbated racism, unemployment, and alienation for certain groups of people. Down to the present day, drug-related law-making tends to place those who use on the same level as those who deal, thus encouraging society to pass moral judgment on those who suffer and try to heal from addiction.

Impact on treatment and harm reduction

This stigma has far-reaching effects and serious consequences. Unfortunately, not even healthcare professionals are immune to holding stigmatising views. In fact, recent studies exploring the attitude of primary care and emergency physicians show that the majority not only show dismissive behaviour towards people with addiction as they don’t view SUD as a medical disorder. Most of them also believe that employers should be allowed to deny them employment. Furthermore, public health interventions such as needle exchange or safe consumption rooms are less likely to receive public approval and financial support as long as the stigma of addiction prevails. Perceived stigma in health care facilities is a barrier to effective treatment and may even reinforce the disorder as those affected by SUD often avoid external help.

Social and Mental Impact

Stigma penalises those struggling with addiction for their condition. Many give in to a feeling of guilt, shame, and fear of social rejection or criminal punishment. As they choose to hide their SUD, stigma also contributes to the high number of drug-related deaths with people dying not from overdose but from the isolation and the self-harm that follows. However, stigma not only affects the person suffering from a SUD but also weakens the social structure that is vital for their recovery: families with an addicted family member often are held in low social regard and face stigma by association. Aside from the rising social and potentially even mental and medical issues for family members, that stigma often leads to a reluctance to ask for help for their loved ones.

Fighting back

Seeing as the harmful stereotypes survived centuries, and that laws and policies still contribute to fuel those views, dismantling stigma only can happen with sustained and unified efforts across social, political, and legal borders. We all can contribute to change.

First of all, let’s stop talking dirty. Words matter.[vi] Changing our word choice to non-judgmental terms removes negative associations of certain words.[vii] Above all, it is important to educate health professionals to not only provide care to those who seek their help in dealing with SUD but also to use inclusive, unbiased, medically accurate language. Journalists and other media professionals need to be trained in how to accurately report drug-related stories. The US National Institute on Drug Abuse supplies a list of terms to avoid and to use, such as the following: instead of “addict” use “person with substance use disorder”; instead of “junkie” use “person in active use”; instead of “alcoholic” use “person with alcohol use disorder”.[viii]

Secondly, we need to educate ourselves and help promote awareness of addiction as a medical condition. Too many people still view addiction as a moral failing, so understanding the possible genetical and environmental causes of SUD and how it affects the processes in the brain is the key.

Last but not least, we need to push addiction out of the shadows and talk openly about it as a medical condition which is treatable. Rather than feeling the need to hide their addiction, people with SUD should feel comfortable and supported in seeking treatment.

Get help

If you need help with your SUD, please do not hesitate to contact us. At NEOVIVA, we understand that addiction is not a choice and provide evidence-based, individualised treatment programs with strong mental health therapies and cutting-edge techniques.