July 17, 2019
Stigma and people who use drugs
This is the second in a series of four articles which explore the social phenomenon of stigma and how it impacts people who use drugs. For background information, read the first piece: Understanding the impact of stigma.
Experiencing stigma can have a significant negative impact on a person’s quality of life.
It can affect their self-esteem and mental health, their relationships with others and the support services and resources they can access. The social disadvantage and stress people experience can lead to inequalities and impact on health and life expectancy.1
Dependence on illegal drugs has been ranked as the most stigmatised health condition globally, with alcohol dependence ranked as the fourth most stigmatised.2
A person who has a dependence on alcohol and other drugs can be subject to not only the stigma related to alcohol and other drugs but also to one or more additional stigmas. This can be particularly harmful as it results in overlapping layers of discrimination.3
Additional stigmas can stem from an individual’s perceived social identity; that is the groupings within society in which they or others believe they belong. These social identities can include gender identity, sexual orientation, ethnicity, religion, experience of homelessness, disability and mental illness, among others.
Stigmatised people are often not recognised as complex human beings. Instead, stigma can turn an individual into a stereotype.
Impact of stigma on individuals
These impacts on the individual can include:
- discrimination, bullying, and harassment
- self-doubt, shame, isolation and hopelessness
- a lack of empathy from others
- limited opportunities for work, housing and socialising.4, 5
The effects of stigma can also prevent or delay someone from seeking alcohol or other drug help and result in people leaving treatment or support services early.6 It can also lead to poorer mental and physical health outcomes.7
In these ways, stigma can push people to the edges of society, reinforcing differences in socio-economic status and creating lasting disadvantage such as fewer social, educational and employment opportunities.
The notion of blame can drive many people’s prejudices and attitudes towards those who use illicit drugs or are dependent on alcohol or other drugs.
The impact of blame
Surveys of public attitudes have demonstrated that many see people who have an alcohol or other drug dependence as being to blame for the conditions and circumstances they may experience.8, 9
There is a perception that people are lacking personal responsibility for individual behaviour and have chosen their path.8
This harmful misconception that being dependent on a drug is an act of “personal choice or moral failure”, rather than a medical condition, can lead to people who are dependent on alcohol or other drugs not receiving enough social support and internalising blame.8, 10
Mental health repercussions
People who experience a dependence on alcohol or other drugs often try to suppress, avoid or overcome stigmatising thoughts and feelings, however they may also come to believe these stigmatising thoughts themselves.5
This internalised stigma – or self-stigma - can impact a person’s mental health and self-esteem, leading to greater potential for increased severity of an alcohol or other drug dependence.11,12
Anxiety about experiencing stigma from others is often greater in people who also experience self-stigma.13 This anxiety can lead to an individual withdrawing from society, avoiding treatment or not pursuing life goals as they expect to receive rejection or disapproval by other people.13,14
Stigma in health care
Some health care providers hold negative attitudes about people who use illicit drugs, or have a dependence on alcohol or other drugs, which can lead to insufficient health care support.15 These attitudes have the potential to influence the quality of treatment that practitioners provide to their patients, resulting in:
- poor communication between patient and carer
- diminished relationship between patient and carer
- attributing physical symptoms to a person’s alcohol or other drug use or dependence rather than to an unrelated health condition, leading to incorrect diagnosis and treatment.15
These experiences can result in people avoiding health services, even when they might need or want help.
Stigma in the workplace
Stigma can vary in workplace settings from discriminatory hiring practices to excluding or marginalising people.16 These actions can have lasting effects on wellbeing.16
For example, fear of experiencing discrimination may deter people who have an alcohol or other drug dependence from seeking work.16
Individuals who use daily medication to manage dependence (e.g. methadone) may avoid telling their employer, to circumvent potential negative repercussions.17 This can result in a person having to source their prescription at difficult and inconvenient times due to pharmacy dispensing hours.17
Providing the same allowances for staff members who are experiencing alcohol or other drug related issues as those who have other health related conditions, or challenging personal circumstances, is one way in which alcohol and other drug related stigma can be reduced in the workplace.16
Stigma can vary depending on the type of drug
There is a long and complex history surrounding why certain drugs, and the groups of people who use them, are stigmatised. In the next Insights piece of this series, we will explore the history of how certain drugs have become stigmatised in Australia.
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- Hatzenbuehler ML, Phelan JC, Link BG. Stigma as a fundamental cause of population health inequalities. American Journal of Public Health. 2013 May;103(5):813-21.
- Kelly JF, Westerhoff CM. Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms. International Journal of Drug Policy. 2010 May 1;21(3):202-7.
- Grzanka, PR. Intersectionality: Foundations and Frontiers. 2nd Edition. s.l. : Routledge, 2019.
- The Better Health Channel. Stigma, discrimination and mental illness. 2018.
- Luoma JB, Twohig MP, Waltz T, Hayes SC, Roget N, Padilla M, et al. An investigation of stigma in individuals receiving treatment for substance abuse. Addictive Behaviors [Internet]. 2007 Jan 1 [cited 2019 Jun 17];32(7):1331–46.
- Lancaster K, Seear K, Ritter A. Reducing stigma and discrimination for people experiencing problematic alcohol and other drug use. Sydney: UNSW. 2017.
- Lancaster K, Santana L, Madden A, Ritter A. Stigma and subjectivities: Examining the textured relationship between lived experience and opinions about drug policy among people who inject drugs. Drugs: education, prevention and policy. 2015 May 4;22(3):224-31.
- Lloyd C. The stigmatization of problem drug users: A narrative literature review. Drugs: education, prevention and policy. 2013 Apr 1;20(2):85-95.
- National Academies of Sciences, Engineering, and Medicine. Ending discrimination against people with mental and substance use disorders: The evidence for stigma change. National Academies Press; 2016 Sep 3.
- Adlaf EM, Hamilton HA, Wu F, Noh S. Adolescent stigma towards drug addiction: Effects of age and drug use behaviour. Addictive behaviors. 2009 Apr 1;34(4):360-4.
- Paquette CE, Syvertsen JL, Pollini RA. Stigma at every turn: Health services experiences among people who inject drugs. International Journal of Drug Policy. 2018 Jul 31;57:104-10.
- Cama E, Brener L, Wilson H, von Hippel C. Internalized stigma among people who inject drugs. Substance use and misuse. 2016 Oct 14;51(12):1664-8.
- Kamaradova D, Latalova K, Prasko J, Kubinek R, Vrbova K, Mainerova B, et al. Connection between self-stigma, adherence to treatment, and discontinuation of medication. Patient Preference and Adherence. 2016;10:1289.
- Luoma JB, Nobles RH, Drake CE, Hayes SC, O’Hair A, Fletcher L, et al. Self-Stigma in Substance Abuse: Development of a New Measure. Journal of Psychopathology and Behavioral Assessment. 2013 Jun 1;35(2):223-34.
- Van Boekel LC, Brouwers EP, Van Weeghel J, Garretsen HF. Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. Drug and alcohol dependence. 2013 Jul 1;131(1-2):23-35.
- Roche, A, Kostadinov, V, Pidd, K. The stigma of addiction in the workplace. 2018.
- Lives of Substance. Dealing with Stigma and Discrimination. 2016.