Stigma is lethal


Conjure up an image of a drug addict or an alcoholic. Chances are (and this is not your fault), you are seeing the kind of rundown reprobate that inspires you to tuck your wallet deeper into your pocket. Or clutch your handbag tighter.

That’s not your fault, you were taught to respond that way. Despite all the proof to the contrary, the prevailing social image of addiction is, well, not pretty. That’s partly because active addiction of any sort is certainly not pretty, but mostly because many people still think of it as a moral failing.

So, an addict is somehow a bad person – a meth freak, a crackhead, a drunk – all who have made wrong choices along the way, are rightly paying the price for it and deserve no sympathy. And the reason, depressingly, is ‘that’s the way it has always been.’

An addict or alcoholic on the whole is therefore defective in character, stigmatised and shunned. Even in recovery, that person is under suspicion – they may fall off the wagon any moment and jobs, insurance, comfy social networks, are much harder to get. The very stuff that gives recovery the best chance at taking hold is stigmatised right out of reach.

But here’s the thing, not only is the ‘moral failing’ view an outdated hangover from the bad old days of mental health (think smelly and damp basement dry-out tanks), but it still dominates in social lore. The result is a stigma that actually contributes to addiction, making it more lethal. I’ll show you how.

But first, a comprehensive understanding of addiction is that it’s a complicated medical condition with behavioural, biological, social and spiritual symptoms that require treatment. And it affects everybody, regardless of so-called moral stature. A reasonable comparison would be to, say, heart disease or diabetes; both are chronic, last a lifetime and are fatal if not treated. But do you see diabetics being scorned by nurses in hospitals? No.

Dr Raju Hajela, who chaired the American Society of Addiction Medicine’s committee on defining addiction, puts it simply: “Addiction is not a choice. Addictive behaviours are a manifestation of the disease, not a cause.”

Now to the real damage. Here’s how stigma hurts people with substance misuse problems and, by default, the people who love them.

If an addict or alcoholic is actually a regular guy with a medical condition, he ought to be able to access the available help with ease. But he doesn’t, because huge and pervasive stigma get in the way, and badly so. Here’s how it goes down.

If I feel I’m a defective (bad morals) person and I need help but getting that help means I must in effect admit to being bad, then I’ll think three times about it. Many people with substance misuse problems fail to seek help because of stigma, or they wait until there’s nothing left to lose. And their families suffer all the while too.

Sometimes a user can be ruled out of a mental health programme, even therapy, if he is discovered, and told to go ‘get clean’ first – a hundred percent abstinent. Well that about shuts the door for most. This attitude can even suffuse primary care rehabs, where an addict gets blamed and shamed for relapse. Remember that patients have spent a lifetime with a hard-to-escape pervasive sense of not being good enough, and more flagellation is surely not conducive to healing.

Politicians are people too, and liable to be encumbered by similar prejudices as others. I wonder how that affects government funding for research into comprehensive plans to help people out of active addiction?

Imagine if we removed the guilt and shame, as far as is possible, and tore down the roadblocks to treatment, how many more would find help.

Imagine if the culture and language of treatment were such that it created a healthy substrate for self-respect and lifelong recovery. And people learned self-empowerment through being intrinsically involved in their own treatment planning, choosing goals and interventions that work best for them.

Imagine that, in taking the stigma out of addiction, how many more resources would be diverted into prevention and treatment as opposed to prosecution and incarceration.

Author: Robert Jean-Jacques is an Addiction Recovery Coach in Cape Town and dedicated to helping clients strengthen recovery, remove obstacles and create a life worth staying clean for.

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