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Fighting Stigmatization Against Substance Users

It doesn’t matter who you ask: Whether it’s the first step of the 12-Step Program for Addiction Recovery (Addiction Center), the first of the 5 stages towards recovery  (CRC Health Group), or number one of the 4 stages of addiction recovery (Addiction Resource), it’s the ability to recognize that one has a problem with a substance or behavior. That one is powerless over their own desires. That they need help.

But admitting to this issue is difficult, or at least, that’s what the numbers seem to suggest: With 70,237 drug overdose deaths in 2017 (That’s more than automotive and gun deaths combined) – it would seem that thousands of Americans are hesitant to travel down the road towards recovery. 

With so many individuals with substance misuse or use disorder (SUD) not seeking or receiving substance abuse treatment, it is important to consider the role of stigmatization as a serious roadblock towards their recovery process.

In other words: When individuals with SUD are labeled as “addicts” or “abusers”, it may activate negative perceptions or stereotypes that they are deviants and looked down upon by popular media. Many Americans may be less willing to self-identify with those groups out of fear of losing public standing.

In order for an individual to seek out proper health, substance users would need to be viewed in less pejorative terms.

This is backed by a recent study from the Boston University School of Medicine.

The study, one of the first of its kind, used a cross-sectional survey to garner responses from a group of people who use heroin in Fall River, Massachusetts. Individuals were asked which of a set of terms they would choose to identify themselves as when talking to a medical professional, versus friends or family, versus a complete stranger. Terms were ranked on a frequency of 1 to 7, with 1 representing “I would never want to be called this,” and  7 representing “I would always want to be called this.” 

The survey included 263 individuals over the age of 18. Participants endorsed “person who uses drugs” as the most preferable term when being referred to by an outsider or medical professional.

Terms that most of those surveyed did not prefer included slang words such as “junkie,” “heroin-dependent,” and “heroin misuser”.

“Persons who use heroin often complain about interactions with healthcare providers, due at least in part to the unfortunate language providers use”, senior author Dr. Michael Stein told ScienceDaily in an interview.

Dr. Stein noted that this language is often taken as a sign of disrespect towards the patient and speculates that “such antagonism can’t be good for clinical outcomes”. 

Despite results found in this study, Dr. Stein suggests that medical professionals ask substance misusers what they’d like to be called in order to form the best and most productive relationship possible.

But not all facilities are aware of their prejudices. American society has constructed numerous ways to label substance misusers as problem characters and make it more difficult for them to engage in society.

One of the most common methods through which this exclusion is realized is the practice of mandatory drug testing.

According to the 2018 HireRight Screening Benchmark Report, 63% of all employers conduct mandatory drug testing on employees before granting them a position.

Failing such tests often means an applicant is automatically excluded from a position, regardless of whether or not their substance use would affect their ability to perform the role they applied for. 

And although this practice may further exclude those with SUDs from society, it’s also a perfectly sensible resource for employers looking to maintain a drug-free workplace. In a similar vein, some of American society’s stigma against substance users can be derived from tactics used to scare children away from such practices.

But scaring kids off of drugs doesn’t justify treating those who can’t control their substance use as villains. And in the midst of an opioid crisis, this country cannot justify the continued demonizing of individuals struggling with SUDs.

Written by Joseph Detrano, CAS Science Writer
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the Center of Alcohol & Substance Use Studies.