The Stigma of Addiction: We Can’t Keep Ignoring It

When we published The Stigma of Addiction: An Essential Guide earlier this year, many were surprised to learn that it is one of the only books that focuses on stigma directed toward those with substance use disorders. Despite addiction’s ubiquitous impact and its prominence in the national dialogue, key aspects that surround addiction often go undiscussed. Our primary goal is to collect leading scholarly thought, which provides both the clinician and the non-expert with a comprehensive understanding of the different aspects of addiction, addiction stigma, and the arenas in which they arise.

What is stigma?

Although the word is widely used and readily understood, there is some variability in how it is defined. The classic definition, by Goffman (1963), refers stigma to an “attribute that is deeply discrediting” and that reduces the bearer “from a whole and usual person to a tainted, discounted one.” Link and Phelan (2001) embrace Goffman’s definition but also add an element of power: “[S]tigma exists when elements of labeling, stereotyping, separation, status loss, and discrimination occur together in a power situation that allows them.” For the purposes of this post, we will adopt a definition that functions as a common denominator of the above definitions: Addiction stigma refers to negative attitudes toward those suffering from substance use disorders that, one, arise on account of the substance use disorder itself and, two, are likely to impact physical, psychological, social, or professional well-being.

Consider a prototypical example of addiction stigma: A 25-year-old man named John visits the hospital emergency department multiple times over the course of a year for alcohol abuse. He eventually agrees to inpatient substance use treatment, after which he transitions to outpatient care. He does well. He has a multi-month period of sobriety. However, he relapses and, as he had many times over the prior year, arrives at the emergency room. While he’s waiting to be treated, he overhears a physician remarking to a nurse, “Oh, that’s just John. We knew he’d be back again.” Rather than seeing John as a someone with an illness, the physician viewed him as someone with deficient character, an incorrigible person.

Do such attitudes matter? They certainly do. Major and O’Brien (2005) found that stigma creates unique stressors and psychological distress, not least on account of the fact that stigma involves status loss. It threatens the stigmatized person’s standing among peers and in society (Link and Phelan 2001). Moreover, the sheer need to cope with stigma may lead to unintended and unforeseen consequences, even ones unrelated to the stereotype (Smart and Wegner 1999). For instance, the cognitive effort required to defend against self-esteem loss precipitated by stigma could lead to a decrease in cognitive functioning in other areas, including those as mundane and important as budgeting one’s personal finances. Research in social psychology has documented a multitude of adverse outcomes stemming from stigma, including poor academic performance (Crocker et al. 1998). Over the past decade, stigma has increasingly been linked to adverse mental and physical health outcomes, especially among those who are likely to suffer multiple stigmas, such as African-Americans (Williams et al. 2003).

In 2017, the opioid crisis was declared a public health emergency in the US, bringing addiction even more into the spotlight. Substance use disorders incur a large toll on individuals and on the collective society. Successful treatment requires astute care by experienced professionals. Unfortunately, stigma against those with SUDs is rampant, permeating multiple professional fields and coloring both social and familial relationships.

In future posts, we will explore these and other issues relating to addiction. In particular, we will be looking at foundational philosophical issues undergirding substance use: What is addiction? Is it a disease? Is it strictly a matter of controllable decision making? We also will be looking at how addiction affects different populations: Do attorneys use substances at rates higher than the rest of the population? Do physicians? Why are there stereotypes that link certain substances to certain ethnic groups? Does addiction differ by country? Further, we will be exploring how different groups, especially professionals, respond to others who show signs of substance use: Do attorneys stigmatize their own clients? Do physicians stigmatize their own patients? And how does implicit bias impact such attitudes? Lastly, we will be addressing the way forward: What are some ways of educating individuals about addiction stigma? What interventions might be devised—and will any of them be successful?

While these issues and questions are just a sliver of what we’ll be covering, we hope they set the stage for what’s to come. We also hope that they bring issues and ideas to your mind. If there are any topics about which you’re interested or any lines of thought that you would like to see pursued, please reach out to us and begin a conversation. We’re glad you’re reading, and we’re looking forward to exploring and unpacking addiction and addiction stigma with you.

Adapted from the introduction of The Stigma of Addiction: An Essential Guide.