Stigma is a set of negative, often unfair beliefs that a society or group of people have about something. It is a mark of disgrace associated with a particular circumstance, quality, or person.
How is stigma harmful?
Substance use disorder (SUD) is a deeply stigmatized illness. Stigma has only negative effects:
- it restricts the funds advanced for research and treatment of SUD, resulting in long wait lists for treatment and slow progression of new treatments;
- it acts as a barrier to treatment as persons with SUD may avoid treatment because they experience judgement (blaming and shaming) and/or poor treatment;
- people with SUD often internalize the stigma; they see themselves as bad, weak, lazy or sinful, somehow deeply flawed, which can drive further substance use;
- people with SUD may isolate themselves and socialize only with others with SUD to avoid the judgement of their communities, which can make recovery that much harder as they must leave their social circle and reintegrate into a society where they may have been judged and treated badly;
- families of people with SUD also may isolate themselves to avoid the judgement of their communities.
How does it happen?
It is human nature to categorize people. It allows for normal social interactions; you will behave differently towards the retail clerk, the doctor in the emergency room, the police officer. How you behave depends on how you see that person and yourself. The problem comes when persons categorize others as undesirable, thus stigmatizing them.
What kinds of stigma are there?
- Stigma based on perceived defects: disability or deformity.
- Stigma based on tribal values: race or religion.
- Stigma based on behaviour. This is the most powerful type of stigma, because it is still socially acceptable. Our society will not accept a racist, but will accept the stigmatization of groups that are blamed for their behaviour, like persons with SUD, obesity or criminal conduct.
How does society stigmatize someone?
The person is labelled, stereotyped, ostracized, blamed, shamed and/or rejected.
Why does society stigmatize people?
Human nature is built on survival principles that evolved thousands of years ago. Humans needed to see the world as “us” and “them”, those who can be trusted and cared about and those that can’t. We have to learn to overcome this natural drive to judge.
Everyone has experienced both sides of stigma. We can all remember some event in our lives where we were negatively judged by others. And we have all done it ourselves. It is human nature to assume that certain bad things wouldn’t happen to us, because we wouldn’t behave in a way that would result in that happening. Or so we tell ourselves.
Stigma changes all the time, and varies from culture to culture. Prior to 1972, it was illegal to attempt suicide in Canada. Today, we recognize that depression is a medical condition needing treatment. It seems inconceivable that it was once criminalized. And in years to come, that is how society will view our treatment today of persons with SUD and other mental health disorders who are so often blamed, shamed and criminalized for their illness instead of receiving the treatment they require and deserve.
What can families do?
Support, don’t judge. It is very easy to be angry at a loved one who is using and who has hurt you many times. But anger drives your loved one away and judgement makes them feel worse about themselves, making it harder and harder to recover.
Remember that substance use is a universal human practice. Problematic substance use can happen to any one of us. It is a result of many factors: the drug itself, our genetic makeup, our childhood and life experiences, the company we keep, when we first started using. The majority of problem opioid users, for example, started using in adolescence, when the brain’s executive functions are not yet fully developed. And once regular use is established, there are changes in the brain structure and function that drive the behaviour of dependent substance users.