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Stamping out stigma is not a hopeless cause

April 24, 2018
by Mark Lamplugh
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Mark Lamplugh

Would a large-scale educational and awareness campaign about substance use make a difference in destigmatizing addiction? Let’s look at what we can learn from the example of breast cancer awareness.

Did you know that in the 1950s The New York Times refused to publish an ad for a breast cancer support group because it didn’t think that it was appropriate to print the words “breast” or “cancer” in a major media publication? Today, Susan G. Komen Race for the Cure events are being advertised all over the world. That’s the difference that education and awareness about a disease can make.

A 2016 report by the U.S. Surgeon General showed some interesting comparisons between the prevalence of substance abuse and cancer. More people have substance use disorders than have cancer. The report also showed that more people misuse prescription opioids than use tobacco. Currently, the U.S. is spending more than $420 billion related to substance use disorders every year. The report makes it clear that substance abuse has become a large enough problem that it’s time to tackle the issues that prevent people from seeking treatment.

Unfortunately, our society generalizes people who struggle with substances as people who make bad choices, or who were victims of poverty or poor upbringing. We have stigmatized addiction to a degree that we’ve overlooked the fact that substances such as alcohol, prescription drugs or street drugs can quickly lead to strong addictions that people can’t break on their own.

The role of stigma

Since substance abuse can lead to legal troubles and incarceration, many who are struggling avoid social situations where they feel judged. The stigma associated with substance abuse makes them feel as though they are rejected by society.

Stigma is rooted in assumptions, preconceptions and generalizations, rather than fact. Labels such as “pothead,” “junkie” and “crackhead” communicate a powerful, negative message that perpetuates stigma. Because of the lack of understanding that addiction is a disease rather than a choice, society discriminates against people with substance use issues and excludes them by virtue of oppression. This discrimination can cause people to lose many of the support services they need to remain addiction-free, such as jobs, medical care and housing.

The pervasiveness of stigma within our society causes people to hide their addictions. Fear of being judged prevents many people with addictions from seeking or enrolling in treatment.

Schools of every kind are good places to educate the public with facts about stigma and its effect on substance abuse and treatment options. There are many ways to offer anti-stigma programs. Elementary schools, high schools, college campuses and community programs are excellent forums for disseminating factual, evidence-based information about substance use and stigma. Online webinars and in-person presentations are also good forums for communicating anti-stigma messages.

Start with early intervention

Beliefs and values begin forming during the earliest stages of child development. Much of what we teach children at early ages becomes part of their adult belief system. How do we start the process of educating children about substance abuse?

Children are naturally inquisitive. They are never too young to be taught about the effects of substance use. We need to address their questions honestly and openly, using age-appropriate language and responses, just as we would approach any other topic such as sex, death or illness.

A good place to start formal education with children about substance use involves talking about how to manage stress in a healthy way. Stress is a major reason that many people abuse alcohol and drugs. By teaching children stress reduction techniques at early ages, we are giving them one less reason to seek unhealthy coping strategies when they get older. It’s also helpful to teach young children language and social strategies for refusing substances if they feel pressured to experiment.

This sample of an anti-stigma toolkit offers many suggestions for how to incorporate anti-stigma activities and events to help educate the public and create awareness about substance use. Here is a sampling of some easy-to-use suggestions:

  • Learn more about substance abuse so you can share it.

  • Speak out about stigma.

  • Keep hope alive for people with addictions and their families.

  • Treat people with dignity.

  • Think about the whole person.

  • Don’t define people by their disorder (for example, use a “person with addiction” rather than an “addict”).

  • Watch your language and avoid stigmatizing slang terms.

  • Don’t sensationalize addiction or recovery.

  • Don’t make generalizations.

  • Don’t use substance abuse terms as metaphors, such as “recovery from being a chocoholic” or “addicted to exercise.”

Don’t expect to win everyone over with your first attempt at using anti-stigma activities or presentations. Some people will need multiple exposures to facts and education before you can get them on board with changing deep-seated beliefs.

Familiarize yourself with the types of objections that you are likely to hear so that you can answer them confidently, using fact-based information.


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It's always a surprise to me that so much effort is spent on anti-stigma campaigns when fighting legal and regulatory discrimination yields more powerful results.

Our country's continuing struggle to expand civil rights focuses on discrimination faced by various groups, not on the stigma associated with being a member of those groups.

For example, campaigns to "ban the box" and end prohibitions on student loans for persons with felony drug convictions result in concete wins for people in, seeking or in need of recovery.

Subway posters that exhort people to destigmatise drug users have only limited utility. 

The civil rights movement of the 50s and 60s was not based on changing the attitudes of whites about African-Americans. Instead it agressively attacked discriminatory practices that undergirded both overt and covert segregation.

With limited time and resources recovery advocacy focusing on discrimination yields much more bang-for-the-buck than anti-stigma efforts.