How Stigmas Surrounding Substance Use Disorder Create Barriers for Care

A pair of drug addicts with substance use disorder that are desperate for help but the stigma of their addiction is preventing them accessing the support they need

As of 2020, the World Health Organisation (WHO) reports that about 270 million people worldwide, or more than 5% of the population, between ages 15-64, use illegal and/or psychoactive drugs [1], including cannabis, opioids and prescription pain medication, and psychostimulants such as amphetamines, cocaine, and heroine [2]. Of these 270 million, as of 2019, it was reported by the United Nations Office on Drugs and Crime (UNODC) that 35 million suffer from drug or substance use disorders.

Substance use disorder is a mental health condition that causes a person to be unable to control their use of substances, such as drugs or alcohol, due to changes occurring in that person’s brain and behavior after use. Many individuals with substance use disorder also have a co-occurring mental health condition, such as anxiety, depression, or attention-deficit hyperactivity disorder (ADHD) [4].

 

Statistics surrounding the prevalence of this disorder show that nearly 13% of people who use illegal drugs, will at some point in their lifetime, develop a substance use disorder. Of thesemillions of people, the amount that receive treatment ? is shockingly low; the UNODC reportsonly 1 in 7 people with a substance use disorder will receive treatment [3]. Given the prevalence of this disorder and the degree to which it can negatively impact a person’s life, it is tremendously important to improve the accessibility of care for these individuals. One of the primary barriers to accessing care that contributes to this low rate is the stigmas surrounding substance use disorder and seeking treatment for it.

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Stigma refers to negative thoughts, words, and views that are placed on a person or a specific situation [5]. They are a form of prejudice, often based on misconceptions and false assumptions, that leads to misjudgment, discrimination, and often the mistreatment of those being stigmatizsed [5, 6]. People with substance use disorders are some of the individuals most affected by stigma [5, 6]. Stigmas create challenging obstacles for those afflicted, making it difficult to get support from family and friends, and access other necessities for the recovery and management of their illness. There are several common stigmas and stereotypes placed on people with substance use disorders.

 

A study from 2005 asked people who have current, or had past substance use issues, what the words stigma and stereotype meant to them [7]. They responded:

 

Negative judgement
Judgement based on one aspect of a person’s life
Long-lasting labels
Disgrace
Embarrassment and shame
Something you are not proud of and want to hide
Being treated differently from the rest of society
Hating yourself
 

These stigmas have various negative effects on a person’s life and overall wellbeing. Just some of them include [5-7]:

 

A violation of human rights (i.e., lack of medical care, housing, and/or food)
A lack of ability to find employment (i.e., losing jobs because of ongoing substance use struggles, inability to get employed due to known substance use issues)
Internalised negative beliefs (i.e., self-hate, shame, believing negative things said about yourself, lack of self-esteem and worsened mental health)
Isolation (i.e., social exclusion, rejection)
Reduced willingness or effort put towards seeking treatment and accessinghealthcare
Exacerbating and continued drug use (i.e., using drugs to cope with negative feelings and attitudes placed on the individual)

 

In addition to this, there are very specific experiences of stigma and stereotypes people with substance use disorder tend to have. Some of the most damaging occur in medical settings, which in many cases results in people with substance use disorder not seeing the value in seeking treatment, directly contributing to this low 1:7 treatment statistic [3].

 

A common experience for people with substance use disorders is shaming from medical doctors and other healthcare providers [8], including dentists [9]. A frequent occurrence in hospitals and emergency rooms is the wrongful assumption by healthcare providers that the drug or alcohol problems these patients have are their own fault and a result of their own poor choices [10]. Some physicians have lower regard for these patients [8], leading to substandard care and in some cases, rejection of treatment entirely [8, 10]. People with substance use issues internalise these experiences, resulting in feelings of shame and a refusal to seek treatment in the future. This type of viewpoint and behavior is driven in part by negative labeling, a lack of compassion and understanding, demonising, and a hyper focus on criminalising drug misuse rather than viewing and treating it as a disease. All of these behaviors are driven by underlying stigma.

 

Reducing the stigmas placed on those with substance use disorder and similar conditions is one of the best and most important mechanisms for improving access to care. By reducing these stigmas through the ways we think about, speak about, and act towards those with substance use disorder, their medical treatment, societal treatment, and livelihoods can improve immensely.

 

Ways to address and reduce stigma that have been repeatedly recommended by both researchers and policymakers alike include [5-7, 10-13].

 

Educating people, including students, healthcare professionals, and the general public; addressing biases and inaccuracies about substance use disorder
Portraying people as human beings and highlighting that people with substance use issues come from many different backgrounds, and anyone can struggle with them or development this disorder
Being selective and careful about words and language
Avoiding using hurtful, dehumanising labels that mark people as less-than (i.e., druggie, crackhead, junkie, etc.)
Treating people with respect, as you would any other person
Changing the language used when discussing substance use disorder. For example: replacing bad drug habit with illness, replacing abusewith use and replacing abuserwith person with substance use disorder
Being compassionate: listen to those living with this disorder, do so without judgement, display kindness, and offer support however you can
Raising awareness within the community: show and explain to people the impact substance use disorder and the stigmas surrounding it can have on people and their communities
Speaking out against substance use stigma and speaking up when hearing or witnessing mistreatment being done towards someone because of their drug use

 

Taking these actions is one of the most impactful ways to improve life for those struggling with substance use disorder.

 

 

References

 
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