Alcoholism/ addiction-related social stigma constitutes a major obstacle to personal and family recovery, contributes to pushing addiction professionals to the fringes therapy and their organizations, and limits the funding and community provisions allocated to AOD-related problems.
Efforts to develop “recovery-oriented systems of care” inevitably confront social stigma as a barrier to shaping community attitudes and policies supportive of long-term addiction recovery.
Stigma is the experience of being held in contempt (shunned or rendered socially invisible) because of a socially disapproved position. It involves processes of labeling, pigeonholing, social exclusion and squeezing out—the essential ingredients of discrimination.
There are three types of personal stigma:
- enacted stigma (direct experience of ostracism and discrimination, e.g., social rejection; professional disrespect; difficulty acquiring employment, housing or services; denial of governmental benefits—student loans, public housing, small business loans);
- perceived stigma (perception of stigmatized attitudes held by others toward oneself); and
- self-stigma (personal feelings of shame)
Stigma and Recovery
Addiction/ alcoholism-related social stigma extends to people who have achieved stable recovery from addiction.
- Courtesy Stigma:
The social stigma attached to addiction can be experienced by families, organizations (e.g., addiction treatment programs), neighborhoods and whole communities.
Irving Goffman referred to this stigma by association as “courtesy stigma.”
The social stigma attached to families affected by addiction carries the implication that the family somehow failed to prevent this problem, contributed to its onset and/or played a role in failing to prevent or inciting relapse episodes.
Children may be socially shunned due to the perception that they have been contaminated by the addiction of their parents or siblings.
- Multidimensional Stigma:
The weight of addiction-related social stigma is not equally applied.
Its burdens fall heaviest on those with the least resources to resist it, e.g., those for whom stigma is layered across multiple conditions (addiction, mental illness, HIV/AIDS, incarceration, minority status, poverty, homelessness).
People experiencing such layered, multidimensional stigma are less likely to seek addiction treatment than people experiencing a single discredited condition.
The most intense social stigma attached to addiction begins at the point of admission to treatment (a social signal of problem severity) and intensifies with multiple treatment episodes (a social signal of treatment failure).
Stigma by Type of Substance
Alcoholism and nicotine addiction have less social stigma than illicit drugs.
The social stigma attached to illicit drug use varies by drug and method of ingestion, with use of heroin and crack cocaine being the most stigmatized substances and injection the most stigmatized method of ingestion.
Stigma by Treatment Type
Greater addiction-related stigma may also be extended to people in particular treatment modalities.
Stigma is particularly severe for persons whose treatment and recovery is supported by methadone, in spite of the well-established scientific legitimacy and effectiveness of methadone treatment.
Methadone-related stigma generates a wide span of discrimination—spanning employment, child custody, access to other forms of addiction treatment and even denial of the privilege to speak at some recovery fellowship meetings.
Stigma and Long-term Health
Stigma can elicit social isolation, reduce help-seeking and compromise long-term physical and mental health. Social stigma is a major factor in preventing individuals from seeking and completing addiction treatment.
Social stigma increases the service needs of persons with substance use disorders, but that same stigma decreases access to such services by fostering social rejection and discrimination.
Personal Responses to Stigma:
Individual strategies to deal with stigma include:
- social withdrawal
- preventative disclosure
- compensation (using personal strengths in another area to counter the imposed stigma)
- strategic interpretation (comparing oneself to others within the stigmatized group rather than to those in the larger community); and
- political activism.
These personal responses contribute greatly to denial of the problem.
Is it any wonder that 12 Step Fellowships seized on personal and family anonymity as an essential part of their programs.