Role of Stigma – A Problem Statement
"It may be argued that minimizing stigma and shame will result in better outcomes. But there we go again. Chronic diseases do not have outcomes. Treatments for acute conditions have outcomes. Treating a cold makes it go away. It's over. Chronic diseases hang around. When we measure the effectiveness of treatment by looking at the status of the disease over time, we measure up very well. " Michael Weiner, PhD, MCAP
People in Long Term recovery often disappear from view in the media, and sometimes even from the rooms of recovery, as we become successful and stable. The policymakers, families, struggling addicts, the media, school boards, NIMBY community, and your neighbors don't see images of successful recovery in a time when the opioid crisis is killing thousands of addicts a day. Frequent images of broken addicts and families contribute to the internalized stigma the alcoholic and the community carry. While we need to intervene and treatment is vital, they need to see how the story continues, and that we pay taxes and vote!!!!! People In Long Term Recovery are what successful recovery looks like.
Who are those affected?
Addicts in disease, family members, larger community. Policymakers at local and federal levels
Why is there a problem?
Stigma, and lack of successful role models which supports the stigma.
Despite widespread agreement in research that addiction is best understood as a complicated behavioral-biological scenario that requires treatment, the correctional system and popular culture continues to cling to images of the addict as weak, irresponsible, selfish and criminal. Rather than a disease, addiction is identified as a character problem, which treatment cannot change. Even when the addict gets clean they will still carry the moral labels that haunted them when they were using.
Addiction comes with a second punch in the gut: the burden of being treated like a second-class citizen and expected to act accordingly. Stigma impacts us all, both consciously and unconsciously, and is perhaps the single largest contributor to the mortality rate.
What is the impact of the problem and future consequences?
People fail to seek treatment due to fear of being labeled.
The medical profession fails to treat addicts properly often because they treat the result of addiction – head injury or pancreatitis – without addressing the underlying cause of the illness.
The mental health profession ostracizes people with addictive disorders. Due to a history of poor results, mental health counselors often feel incompetent and discontinue treatment or see additive behavior as a symptom of a mental health issue that will stop when the underlying depression or anxiety is resolved.
Funding for addiction treatment is discriminatory. Despite passage of Federal Mental Health Parity legislation, mental health and substance use disorders continue to be treated differently—and often poorly—compared to “medical” illnesses. Some coverage appears co-equal on paper, but frequently the coverage that's allowed is not authorized due to “medical necessity,” leaving people without sufficient and comprehensive treatment.
Addicts get sent to jail. Unlike diabetes, drug abuse, and behaviors connected to drug abuse are illegal, which results in incarceration. Addicts enter a system with stigmatization at its roots: blaming, punishing and making moral judgements instead of providing treatment and other help that would change behavior. The more of a stigmatizing stance one takes towards substance misuse the more likely one is to support criminalization of drug offenses and the less likely is to support insurance coverage and treatment for drug addiction.
Even when people do get to treatment, stigmatization can continue and contribute to poor treatment outcomes. It is critical to recovery that treatment programs not send messages to patients that are blaming (for relapse) because they are not “working a program,” or lack motivation. Even though treatment often proclaims allegiance to a disease model, they can be quick to judge the relapsing addict.
People in recovery are always under suspicion. When people obtain a stable recovery they are always presumed to be on the verge of relapse. The label, shame and stigma of problems with substances is always around—once an addict, always an addict. It can take years for family members to stop monitoring the recovering addict.
Recovering addicts confront stigma-based roadblocks constantly. People in recovery are faced with obstacles, especially those who have been in treatment or in the criminal justice system for chemical dependency. Employment, education, insurance and the ability to vote are all fraught with uncertainty and discrimination for those in recovery. People in recovery have a harder time finding and keeping jobs, getting licenses, food stamps, benefits that help their children. In other words, important aspects of living that are so critical to a stable recovery for persons who have been treated for addiction, such as employment, housing and providing for one’s family are that much harder to get.
In what ways can the problem be solved?
Recovering people, families, and policy makers need to see evidence that treatment works, long term recovery is possible, and treatment is worth the financial investment. They need to see that non-criminalization of addiction can open the door to faster re-connection with a productive life and positive outcomes. People in Long term recovery pay taxes, open business, raise healthy children, and build healthy communities.