Stigma and Substance Use Disorders

Addiction therapist Robert Gill confronts stigma around substance abuse disorders.

For centuries, people believed that substance abuse was a moral problem, that a person made the choice to continue using a particular substance. It was believed that such a person had weak willpower and low moral strength; the blame was exclusively with them. This propelled the war on drugs. The stigma created guilt and shame and became a significant barrier preventing people from getting appropriate help to recover.

The consequences of this belief are still true today. A person may choose to experiment with a substance for the first time, but compulsive use even in the face of serious negative consequences is not a choice. Scientific research indicates that substance abuse causes changes to the brain over time, triggering cravings and compulsive behaviour.

Stigma's effects on our beliefs

Substance use is stigmatised more than any other health issue. Its initial intention may have been to prevent substance use, thus making it more difficult for people to develop these problems. However, this failed miserably. If a person has a history of substance use, it may affect their chances of gaining employment or finding a home. They are seen by society in a particularly negative way. The consequence of this stigmatisation causes poor mental wellbeing, ultimately delaying their re-integration with family, friends and society. People tend to internalise these beliefs; they say things like “I deserve to be this way” or “I need to hit rock bottom in order to get better”. This sense of humiliation has driven people to continue to use.

The problems associated with substance use are widespread. GPs, caregivers and treatment centre staff can be effective in helping with the physical and mental recovery of a person after substance use problems, but they are not effective at breaking the stigma attached to the problem. Even in the recovery community, it is not uncommon for a person with alcohol use difficulties, for example, to stigmatise another person using different drugs - “I only drank; I never ever injected heroin used cocaine or tablets”.

Slow change

Substance use is a big part of our culture in Ireland, as it is in many countries around the world. Here, alcohol use is connected to many of our celebrations, from christenings to funerals, and most families can relate to feeling ashamed of a loved one who misused alcohol. There has been a significant change over the past ten years in society’s perception of mental health difficulties such as depression and anxiety, but the same cannot be said for substance use difficulties.

The language we use around substance use is stigmatising. Words like "addiction", "junkie", "addict" and "drug user" are just a snap shot of some words used to describe a person actively using substances. While "alcoholic", "reformed addict" or "clean" are words associated with a person who is in recovery, does “clean” suggest that, while the person was using, they were “dirty”?

The reality of substance use

In reality, nobody really chooses to compulsively take harmful chemical substances into their body on a regular basis. In my 17 years of working with people experiencing these difficulties, I have yet to meet a person who really wanted to become hooked on a drug.

There are many reasons why people find themselves on this path. It may have given them temporary relief from anxiety when speaking to a person of the same or opposite sex, and it may have been used to cope with negative thoughts about oneself or feelings of pain and heartbreak from life traumas. Initial substance use could have been extremely effective at an early stage, acting as an anaesthetic for the discomfort. However, for a person who has committed to using this avenue to cope, they often find themselves trapped and isolated, chasing that initial temporary relief to the extent of even losing sight of the reason it all began.

So we thought substance abuse was caused by the substance, because that was the story we heard for hundreds of years and it became part of our common sense. Of course, substances are dangerous, but that doesn’t explain why only certain people face difficulties. I believe the core of the problem is pain.

Human beings have an instinctive need to develop bonds and connections around them. If we are happy and healthy, we will bond with the people around us or seek new connections; if we can’t do that because we are isolated, traumatised, or have not had a role model in our life to show us how to connect, then we will connect with something else that will give us a sense of relief in our life. This is one of the big reasons people turn to substances.

Our responsibility to end stigma

Stigma creates guilt, fear and shame that lead people to isolation. Stopping our prejudice against people with a substance use difficulty is the only way to start helping on the collective journey to recovery, and we all need to recover.

Social connection is a key part of this change. We have a responsibility to question the information we receive and how it shapes our beliefs about substance users. This can be achieved through education, by treating those affected with respect and correcting those who have misconceptions.

If you or a loved one is experiencing substance use difficulties, then the first step is to reach out and ask for help. Recovery is possible one step at a time, creating the opportunity to break free from the chains of that substance to a new version of you, a version of you that will desire to create new bonds and connections in your life. 

#stilljustme

Robert Gill is an addiction therapist and Addiction Services Coordinator at St Patrick’s Mental Health Services.