C4 Innovations

Addressing Stigma in Recovery Services

By Elizabeth Black, MRC, Licensed Drug and Alcohol Counselor

Approximately 20 million people in the United States have a substance use disorder (SUD). Annually, nearly 70,000 Americans die from drug overdoses, while another 95,000 are lost to complications from alcohol use disorder (CDC, 2018; NIAAA, 2019). Though effective treatment exists for SUDs, less than 20% of those in need are able to access it (SAMHSA, 2018).

Among the many barriers to treatment–such as overstretched resources, lack of insurance, racism, logistical issues, among others–perhaps one of the most impenetrable barriers is stigma. Though we have come a long way in understanding SUDs, stigma remains pervasive (NIDA, 2018).

Evidence shows that people with SUDs are as likely to adhere and respond to treatment as people with other chronic medical conditions such as hypertension or diabetes. However, people with SUDs still tend to be viewed by the public as weak-willed or lacking in moral character (Schomerus et al., 2011). They are more likely to be held personally responsible for their disease than people with other physical or mental health disorders.

In an analysis of research between 1980 and 2011, stigma-related fear about the consequences of disclosing a SUD was ranked the fourth highest barrier to seeking help (Clement et al., 2014). Further, the impact of stigma can exacerbate substance use. Addiction is increasingly seen as a disease of isolation and disconnection. Social rejection and shame can perpetuate and worsen addictive behavior.

Eliminating stigma is no small feat. Stigma stems from the perceived violation of social mores associated with substance use. People may act in ways that are not normally condoned by society. This may be due to intoxication, adaptive behaviors needed to cope with trauma or distress, or actions taken to maintain an addiction (e.g. stealing, lying, absenteeism). Additionally, many believe that people with SUDs are simply choosing to misuse alcohol or other drugs; this lays the groundwork for further discrimination and marginalization.

Research has shown that lack of knowledge related to behavioral health disorders creates higher levels of fear and avoidance (Ross and Goldner, 2009). Efforts to educate the public on the factors that lead to SUDs, many of which are beyond a person’s control, can help to shift public opinion, create accessible pathways to treatment, and reduce internal shame.

Reducing or eliminating stigma can occur at macro, meso, and micro levels. On the macro level, increasing visibility of people with SUDs and challenging false narratives can happen through TV, movie, and other mass media. At the meso level, educating stakeholders about the disease of addiction and advocating for pro-recovery policies and practices can help to change the conversation from the “problem” of addiction to the promise of recovery. At the micro level, we can reduce stigma and shame by encouraging people to be open about their lived experience—when they feel it is appropriate—and the benefits they have experienced during recovery. Self-disclosure helps to normalize SUDs, lets others know they are not alone, and dispels the myth that addiction only happens to “other” people and families. One of the tremendous values of peer staff, or staff who are in recovery themselves, is that they show recovery is possible. In addition to supporting people through their recovery processes, peers also serve as a beacon of hope and can work across different systems and settings to change hearts, minds, policies, and practices.

Changing how we talk about addiction is another important anti-stigma strategy. In addition to obviously stigmatized terms such as “junkie,” “crackhead,” or “drunk,” other more traditionally used terms such as “addict” or “alcoholic” are being left behind. Instead, person-first language places the person first and the disease or disability second. It describes what a person “has” instead of asserting what a person “is,” as defined by their condition. For example, an “addict” becomes a person with an addiction or an “alcoholic” becomes a person with alcohol use disorder. Person-first language acknowledges that there is more to a person than their disorder or condition and, as such, they should not be defined by it.

These are just a handful of strategies, but the opportunities for action are endless. Changing the conversation around addiction comes from continued, concerted efforts to combat misinformation. Change is possible. Societal views do shift. If we all see ourselves as change-makers and stigma-busters, we can replace ignorance, fear, and discrimination with truth, tolerance, equity, and inclusiveness.

Learn more about how C4 can partner with you to address stigma in your selves, programs, agencies, and communities.