Canadian sociologist James Livingston and his colleagues examined 13 studies on the effects of stigma on addiction and concluded that certain stigmas negatively affect those seeking help for drug use. Although society attempts to discourage unhealthy behaviours through the use of these stigmas, they actually contribute to problems in employment, housing, and social relationships, with consequences such as poorer mental and physical health, higher drop out rates in treatment, delayed recovery, delayed reintegration into society, and increased involvement in risky behaviours. According to studies, stigma was also a barrier to accessing healthcare and treatment services. To make matters worse, Livingston and colleagues pointed out that addiction is more stigmatized than other mental health issues.
The Canadian public tends to link addiction to negative behaviours, such as infection with HIV/AIDS and Hepatitis C, impaired driving, poverty, and crime. Such views typically guide government policies in Canada as a whole and in the provinces such as British Columbia, Alberta, etc., on how to deal with addiction, social action, and public funding. Given the public stigma, it isn’t all that surprising that most of the Canadian drug budget is given to enforcement, not healthcare. As many researchers have pointed out, the stigma is not factually accurate if we examine addiction as a whole, although there are individuals who fit the stereotype.
It’s not just the public. Even healthcare providers often have a negative view of those with drug problems. Although their education emphasizes that addiction is a health issue, professionals typically complain that those suffering from addiction overuse the system, are not invested in recovery, abuse the system through drug-seeking behaviour, and do not follow recommendations. It remains the case that many medical doctors do not prescribe standard medications for other conditions that a drug-using patient may have, such as chronic pain, on the argument that the patient may abuse the medication.
In reaction to this public and professional stigma, those suffering from drug use problems often do not ask for help. In fact, for some, stereotypes of those who use services lower their likelihood of asking for help.
In this blog, we’ll take a look at some of the research on these stigmas.
Historical Differences in Interpreting Drug Use
Many researchers have pointed out that a remarkable number of addiction experts and the public believe they operate in a vacuum, as if there were no history to guide how we interpret and treat addiction. The reality is that different societies at different times interpret intoxication differently. Here are some examples:
• About 2500 years ago, the Greek thinker, Euripedes, wrote a famous play about drunkenness: The Bacchants. The play is a cautionary tale for those naïve enough to believe they could defeat drunkenness. Euripedes warned them that this was not possible, because intoxication was one of the few activities that helped people feel alive and vital. The same argument was made 2300 years later by the famous philosopher, Friedrich Nietzsche.
• In the medieval world, the stigma of drunkenness focused on behaviour that was sinful, but it was a relatively minor sin and not paid a lot of attention. Other excessive behaviours were considered far more sinful, such as gluttony.
• Different societies today interpret the user differently. For example, in Canada, the government sees heavy drinking as atypical behaviour by a minority of drinkers and not part of the culture. By contrast, the Scottish government embeds problem drinking within the Scottish culture itself.
Researchers have pointed out that how addiction is defined and treated has to do not so much with some objective measure or the truth, but how the society interprets it.
Stigma Affects Scientific Research
Some addiction experts have complained for years that the stigma severely influences how researchers conduct their studies.
For example, a recent study examined “subjective aggression during alcohol and cannabis intoxication before and after aggression exposure”. With a growing number of American states legalizing or decriminalizing marijuana and Canada legalizing it in 2017, researchers are curious if the expected increase in marijuana intoxication will result in social problems.
The study was designed in a curious way. Researchers gave participants alcohol or marijuana (or a placebo) and then had them play a money game that was designed to stimulate aggression (or escape). The researchers concluded that marijuana does not increase aggression. However, and this is the point for us, alcohol did.
The stigma attached to alcohol links it with aggression, and this seems to have biased the study. The researchers neglected a key finding in previous research on alcohol, which indicates that drinkers become absorbed into whatever is going on around them. Although this is a bit simplistic, the idea is that if you put the drinker in a room where people are laughing, they’ll have a great old time. If you put them in a basement room, with the lights dim and sad music playing, they’ll be crying in their beer.
And if you put drinkers in an aggressive environment, they’ll become aggressive. In other words, it’s not necessarily alcohol intoxication itself that leads to aggression, it’s the environment that promotes it.
So why didn’t the researchers account for this finding? Likely, the stigma of drunkenness today has interpreted intoxication as a “cause” of fighting, criminal behaviour, and domestic abuse.
Stigma Tells a Person How to Make Sense of Self
Addiction is attached to what psychologists call “embodied memory”. It’s curious that the various effects of intoxication – pleasure, time distortions, side effects, and perceptual distortions – are often not even recognized by the intoxicated person until he or she thinks about and labels them (It’s as if the body has its own awareness of the experience even if the person cannot describe it).
So how does someone think about and label drug experience? They learn to do this from watching TV, parents and community, and addiction experts. For example, Alcoholics Anonymous says that a person’s body is “alcoholic”. Getting over drinking is always hinged to certain requirements, such as participating in a community of like-minded people. Any benefit that the drinker might think alcohol provides is an illusion and false. On the other hand, the medical profession says those suffering from substance disorders have a brain disease. Law enforcement says they are criminals.
Out of control, diseased, criminal behaviour, and a host of other interpretations are typical of the addiction stigma that the war on drugs promotes (Imagine how upset supporters of the war on drugs were when Betty Ford, wife of the former president of the US, came out publically and said she was one of them!).
In an interesting experiment, a group of male marijuana users were shown research evidence that cannabis negatively affects their ability to think. Another group of users were not shown the research. Both groups then completed a test measuring their ability to think. Results showed that those who read the research did significantly poorer on the test than those who were not shown the research (BTW, female marijuana users actually did significantly better than their male counterparts!)
Research has confirmed that a person usually shapes intoxication through rituals and through certain ways of thinking about drugs such as “the intoxicated self is different from the real self” or “the intoxicated self is more genuine than the real self”. In other words, the self is an integral component of the drug high. So how does a person with addiction interpret self? A great deal comes from how he or she interprets messages from society.
Stigma in Addiction Treatment
Sadly, the stigma of addiction remains quite powerful even in treatment programs. For example, in a study of a Toronto methadone clinic, the researcher discovered that the root of many behavioural problems with clients was actually the attitude of the clinic’s staff members.
The staff members typically saw their clients as not serious about overcoming their addictions. They also saw them as deserving to be miserable, because they inflicted the problems on themselves.
Other studies have shown that those who drop out of treatment or who are discharged for rule infractions are often forced to defend themselves against charges that they are, for example, wasting resources or cheating the system.
If you or your loved one are struggling with drugs, alcohol, or other types of addictions in Vancouver, Edmonton, Calgary, and other Canadian cities, reach out to us for a consultation or help in finding treatment services that fit your needs.