SA300

1. STIGMA
How do we address ongoing stigma

2. Stigma in addiction
DEF:
◦ Dehumanization of the individual based on their social identity or participation in
a negative or an undesirable social category.
◦ Gets a lot of discussion, but what is the real impact and what can we do to
address stigma/marginalization/barriers

3. Stigma
◦ Persistent stigma still creates barriers to treatment and recovery.

4. 7 Types of stigma
Public Stigma
◦ This happens when the public endorses negative stereotypes and
prejudices, resulting in discrimination towards individuals belonging to that group
Self-Stigma
◦ Self-stigma happens when a person with mental illness or substance use disorder internalizes
public stigma and develops negative thoughts, feelings, and diminished self-image resulting from
identification with the stigmatized group and anticipation of rejection from the larger society.
Perceived Stigma
◦ Stigmatized individuals think that most people believe common negative stereotypes about
individuals belonging to the same stigmatized category.

5. Types of stigma
Label Avoidance
◦ This is when a person chooses not to seek treatment to avoid being assigned a stigmatizing label.
Label avoidance is one of the most harmful forms of stigma.
Stigma By Association
◦ Stigma by association occurs when the effects of stigma are extended to someone linked to a
person with SUD or other stigmatizing disorder.
Structural Stigma
◦ Institutional policies or other societal structures that result in decreased opportunities for people
with SUD

6. Types of stigma
Health Practitioner Stigma
◦ This takes place any time a health professional allows stereotypes and prejudices about SUD to
negatively affect a patient’s care.
◦ Negative attitudes among health professionals have been found to adversely affect quality of care
and subsequent treatment outcomes.
◦ Healthcare providers often avoid discussion about SUD, in particular alcohol when assessing
depression, or other patient identified MH symptoms
◦ Benzodiazepines and SSRIs are often prescribed without assessment of SUD

7. Impact
◦ Researchers found that even highly trained substance use disorder and mental health clinicians
were significantly more likely to assign blame and believe that an individual should be subjected to
more punitive (e.g., jail sentence) rather than therapeutic measures, when the subject of a case
vignette was referred to as a “substance abuser” rather than as a “person with a substance use
disorder.” In a public perception study the term “abuse” was found to have a high association
with negative judgments and punishment.

8. Impact
◦ People with SUD are more negatively perceived than those with mental health disorder (public
stigma) due to the concept of choice in using

9. Public stigma
Reinforced by legislative initiatives and community perceptions such as :
◦ Drug testing for welfare legislation
◦ Charging women who use illicit substances while pregnant with child abuse legislation
◦ Media portrayals
◦ Funding cuts to treatment

10. Language matters
◦ The real stigma of substance use disorders - Recovery Research Institute (recoveryanswers.org)
◦ Commit to universal use of person-first and recovery-centered language*
*without minimizing client choice

11. Language examples
◦ Person-first
◦ Medication assisted treatment vs replacement therapy
◦ Substance use disorder vs abuse
Other examples?

12. other interventions
◦ Establish regular communication on addiction topics with staff and peers – do not assume other
professionals do not have bias or stigma supporting behaviors
◦ Use evidence-based educational efforts and tools to address stigma in the community.
◦ Write letters to the editor, op-ed pieces and engage in dialog with media representatives- locally,
Erin Rhoda has done a great job of educational pieces and stigma reducing articles
◦ Encourage your agencies to have legislative reviews and dialog with local state reps

13. Discussion
Other ways of reducing stigma?
How is stigma impacted by current events?
◦ In the public
◦ Within our profession
◦ Referral sources- DHHS, healthcare providers, attorneys, MH providers