Stigmatization of Substance Abuse: The Story After Rehabilitation
To begin this article, I would like to bring your attention to an organization I visited as part of my clinical objective—AAS, the Alleviate Addiction Suffering trust. AAS is a nonprofit organization that serves to provide treatment, rehabilitation and aftercare to both adult and younger victims of substance abuse.
Our faculty gave us a brief introduction about the organization which was established to help people recover from addiction. Before visiting this organization, I had preconceived thoughts in my mind that addicts must be poor, unkempt, vulgar, illiterate and disrespectful.
However, after getting the chance to interview them, I was surprised to see that they were neat and tidy, educated, and belonged to sound economic backgrounds. This was the first time I noticed that it is we who stigmatize such affected people with our opinion. It is not just the society—it is we who should initiate change.
The significance of highlighting this issue is that, even though stigmatization with substance abuse is very common, little is done to intervene on a national scale. Moreover, much research has been done related to mental health and HIV-related stigma while little has been contributed to drug-use related stigma (Kulesza, 2013). Furthermore, there is a need to raise our voices for this unsolved issue, because the life of drug abusers after treatment and recovery is affected by our attitudes on a long-term basis; society discriminates against drug users which makes it difficult for them to actively participate in the world. As a result, these individuals end up with psychiatric problems and their consequences, most notably depression and suicide.
Through this initiative, awareness can be increased on both individual- and society-level. This writing aims to aid in changing the negative attitudes people have regarding substance abusers.
The concept of stigma is well-explained by Erving Goofman (1963). He viewed stigma as discrediting an individual on the social construction of identity. Thus, the stigmatized individual is labeled as a spoiled identity (Kleinman & Hall-Clifford, 2009). Stigma is categorized into several types including self, public, perceived and enacted.
Self-stigma is defined as pessimistic feelings and thoughts about oneself as a result of recognition with stigmatized groups and anticipation of denial from society. Public stigma refers to negative attitudes and beliefs against individuals sharing common characteristics with a stigmatized group. Perceived stigma has been defined as people sharing the same negative stereotypes about an individual who belongs to the stigmatized group. Lastly, enacted stigma has been described as the denial and discrimination experienced by an individual from the members of the larger society. (Luckey, 2016).
In Pakistan, according to the recent Drug Technical Summary Report 2013, in the past twelve months, an estimated 6.45 million (5.8%) people aged from 15-64 years used prescription drugs or synthetic drugs for non- therapeutic purposes. The most commonly used drug is cannabis, estimated at 4.03 million users aged between 15-64 years. Other frequently used drugs are heroin estimated at 813,000 (0.7%), opiates at 1.02 million (0.9%), and painkillers at 1.69 million (1.5%). Apart from this, injecting individuals were at 423,000 (0.4%), of which 73% were regular opiate users injecting drugs by sharing a common syringe (Yaqub, 2013).
A theoretical framework which can be integrated is the Social Reaction theory constructed by Becker and Tannenbanum in 1950; it focuses on society’s negative reaction towards drug abusers. Sending them to prison for a minor mistake at a very young age may lead to further criminal acts in future. Similarly, when I interviewed a client at Alleviate Addiction Suffering trust, the patient shared that he indulged in this behavior after he saw his elder brother smoke. Soon after, he was given his first chance to smoke with his friends, and as time passed he developed an addiction to drugs like heroin.
Later, he admitted to being concerned about his future due to stigma. This theory further states that the stigmatized individual is labeled as ‘deviant’ and is further categorized into primary and secondary deviance. In primary deviance, the stigmatized person is labeled as a criminal but does not accept it.
Likewise, my patient refused to realize it because his brother was also a drug addict. He also stole money to fulfill his drug needs. Ultimately his family forced him to join this organization for treatment, but as it was difficult to live without drugs, he ran away.
On the other hand, when a person blames himself as a criminal after rejection from society, it is known as secondary deviance. He is criticized by both his family and society, consequently ending up in isolation. Likewise, my patient felt guilty and shameful, and blamed himself for this unacceptable behavior. After realizing the thoughtlessness of his actions, he returned to the trust and is now under treatment.
In literature, stigmatization in substance use disorders is higher than in any other health condition. Their behaviors are also symbolically linked to stigmatization with other health conditions, such as Hepatitis C virus, Human Immunodeficiency virus, unsafe behaviors, social behaviors including criminality, and poverty. These cases are usually treated as ethical and moral issues rather than as health issues. As a result, people with substance abuse disorders become socially isolated, which dreadfully impacts all areas of life including social relationships, housing and employment (Janulis, Ferrari, & Fowler, 2013).
Similarly, my patient was also worried about his employment and relationships. Would society accept him moving forward to live a normal life again? Researchers have shown that stigma potentiates adverse reactions in substance abusers with disturbed mental and physical health, non-fulfillment towards their treatment regimen, delayed recovery, and higher chances of indulging in risky behaviors. Perceived, self and enacted stigma show a positive relation with symptoms of anxiety and depression, and a negative relation with overall psychological well-being.
Drug users have become prone to chronic stress as a result of stigma attached to their lives. In addition, stigma becomes a barrier to accessing healthcare services for substance abuse treatment. Healthcare professionals also hold negative attitudes towards people suffering from substance abuse disorders, due to which such individuals mask their problems in order to avoid stigma. Such impressions result in unfair and poor provision of care towards these drug abusers (Livingston, Milne, Fang, & Amari, 2012).
Stigma attached to drug abuse is supposed to have devastating effects on an individual and their ability to cope with their situation. Hence, there are certain recommendations that should be incorporated at individual-, community- and public-level. At individual level, one should advocate to bring about a change in their own perception and come out of this crisis situation, which would also help in enhancing their self-esteem.
This technique will allow clients to empower themselves in the community to survive in terms of employment at community resource centers. Self-advocacy would also be helpful in counseling sessions where affected and recovering people can share their stories and therefore influence other affected people, as well as the community, to simultaneously initiate change in the way of thinking.
Besides this, strong counseling sessions are highly recommended to fasten the recovery process and prevent remission. With that, advocacy at community-level can be promoted by increasing public awareness and media coverage to encourage treatment and recovery. A process should be planned to keep recovering patients motivated by initiating community participation programs. Furthermore, proper training and education should be arranged to improve the services given to affected people.
At public-level, knowledge and awareness should be spread about drug dependency and recovery. This can be done through various campaigns collaboratively working with government departments, drug treatment and offender service providers. Families should be counseled about the importance of family support in helping the individuals in adopting effective coping mechanisms. The media also plays a significant role in helping the public to understand the depth of these social challenges, especially stigma.
Research should be promoted to identify stigmatized cases so that interventions can be planned accordingly to achieve effective outcomes. In accordance, more research is needed to better understand the stigma associated with drug users (UK Drug Policy Commission, 2010).
Through the above write-up, I learned that if we collaboratively work with our society, we can help these individuals with recovery and moving forward to bring their lives back to normal. Stigma can be reduced if we establish a change in ourselves by curbing negative thoughts and perceptions about substance abusers. For this purpose, education and awareness is significant in bringing change in our community.
In conclusion, it is obvious that people affected with drug abuse face stigma in every aspect of their lives. As a result, they become isolated and non-functional in society. There is a grave need to feed our efforts into this issue and to initiate strategies to overcome this problem. The labeling theory focuses on how drug abusers have transition phases from denial to acceptance with stigma attached to them.
Hence, recommendations should be appreciated at the levels of individuals, community and public so as to strengthen our approach to helping these people. All in all, further research is recommended to root out the problem more thoroughly and thereby recognize and plan effective interventions.
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