Understanding the impact of stigma

This is the first piece of a series of four which aims to explore the social phenomenon of stigma and how it impacts people who use alcohol and other drugs.

Stigma is a mark of disgrace and difference. Generally, stigma occurs when people in society disapprove of or hold negative attitudes toward something. This means it is likely that many people have either felt stigmatised or held stigmatising beliefs at some point during their life.

Stigma can be attached to many human traits and behaviours, including sexuality, disability, ethnicity, gender and certain health conditions. People who use illicit drugs or experience a dependence on alcohol or other drugs are one example of a stigmatised group of people.

What is stigma?

Stigma is the process whereby an individual or group of people are held in contempt, “othered” or viewed in a negative way because of their behaviour or a characteristic they possess. These characteristics or behaviours are considered outside of what is generally considered “normal”.

People who are stigmatised are often generalised and stereotyped, socially excluded or unequally treated, and blamed for experiencing disadvantage.

Inaccurate information and a lack of understanding often drive the stigmatisation of individuals and groups of people. For example, fear can be a common response to the use of illicit drugs when a person has a poor understanding of the type of effect and the level of impairment they cause.¹

Language that is inaccurate and dehumanising plays a critical role in the process of stigmatisation. Consequently, when stigmatising language is circulated by the media it reaches a wide audience, creating and perpetuating negative stereotypes and attitudes.

Stigma can also result in members of a stigmatised group experiencing prejudice and discrimination. This discrimination can take the form of laws, policies and procedures.

In short, we can understand the process of stigma as both reflecting certain beliefs within society as well as influencing them.

Social, structural and self-stigma

A simple way to understand how stigma manifests is by looking at the three types of stigma.

Social/public stigma is when a person or group experiences extreme disapproval and/or exclusion because of a trait or behaviour that is not the social norm. Stigmatised people experience prejudice and discrimination which is typically ‘endorsed by the general population’.²

Structural stigma is when the policies, procedures or rules within an organisation limit the rights or opportunities for people who are a part of a stigmatised group.² Negative attitudes and beliefs toward stigmatised people are therefore spread at an organisational level and can occur within health and emergency services.

Self-stigma is when a person internalises negative feelings, such as shame and low self-esteem. It can result from an individual’s experiences and perceptions, or their anticipation of a negative social reaction in response to their social status or health condition.³

Causes of stigma

Importantly, there is no one “cause” of stigma. It is a complex social phenomenon and there are many different ideas about why stigma exists, and why stigma has been attached to different human traits, behaviours and experiences over time.

There is no clear answer as to why people who use illicit drugs or are experiencing a dependence on alcohol or other drugs are so stigmatised. It is wrapped up in a complex history that incorporates religious influences, racism, marginalisation, criminalisation, economic pressures, fear, politics and the influence of powerful individual actors in critical times and places.^4,5

Although ‘why’ is an extremely difficult question to answer, what we do know is that stigma is harming the people to whom it is attached.