Stigma Associated with Alcohol Dependence and Treatment
The Merriam-Webster dictionary defines a stigma as "a mark of shame or discredit". Whether it is real or imagined, a person may avoid treatment because of it. Because of the social stigma that has been placed on alcohol dependence (alcoholism) treatment, many people may feel that alcohol dependence is a sign of moral weakness, and shame may prevent some from seeking alcohol treatment.1 Programs try to restore the dignity and respect to the individuals who are struggling to overcome their alcohol dependence. The perceived stigma associated with seeking alcohol treatment or having a dependence on alcohol can be different depending on the individual. Both men and women must overcome the stigma associated with seeking treatment, but women are particularly susceptible to feeling stigmatized (Brady and Ashley 2005). Women are more likely to report feeling shame or embarrassment because they are in substance abuse treatment (Thom 1987).2
Stigma is one of the meanest and most difficult aspects of addiction because it makes it harder for individuals and families to deal with their problems and get the help they need. Society imposes stigma and its damage on addicted people and their families because many of us still believe that addiction is a character flaw or weakness that probably can't be cured. The stigma against people with addictions is so deeply rooted that it continues even in the face of the scientific evidence that addiction is a treatable disease and even when we know people in our families and communities living wonderful lives in long-term recovery.3
Education and outreach is key to removing the social stigma.1 The stigma of addiction costs lives. Improved public awareness of the scientific realities of addiction can powerfully save lives by encouraging people with alcohol and other drug problems to seek help early in the progression of their illness, when it is most treatable. The fear of being labeled as an "addict", fired from a job, denied insurance or ousted from a home keeps thousands of addicted people from coming forward.4
Stigma is the reason there is so much social and legal discrimination against people with addictions. It explains why addicted people and their families hide the disease. Discrimination always hurts stigmatized groups because they are excluded from the rules that apply to "normal" people. So insurance companies get away with refusing to pay for alcohol or drug treatment, or with charging higher deductibles and co-pays than for treating any other disease. People who need the help are often afraid to speak up.3 Advocates such as those who participate in the national organization Faces & Voices of Recovery believe that public education about addiction will diminish the stigma, improve public policies and save lives.4
People who are victims of stigma internalize the hate it carries, transforming it to shame and hiding from its effects. Too often, people with alcohol and drug problems and their families begin to accept the ideas that addiction is their own fault and that maybe they are too weak to do anything about it. In many ways, hiding an addiction problem is the rational thing to do because seeking help can mean losing a job and medical insurance, or even losing your child when a social service agency declares you an unfit parent because you have an alcohol or drug problem.3
The stress of hiding often causes other medical and social problems for the individuals and their families. This is especially true when an adolescent has an alcohol or drug problem. Fear often prompts kids to conceal the problem from parents. Then, when parents find out, stigma makes them feel guilty and somehow negligent. Illness and family dysfunction explode. When that happens, parents find it even harder to fight for the care and resources their child urgently needs from a social and medical system that blames the family and the child.3
"At one point, we had the stigma of leprosy. Nobody spoke about leprosy. We had a stigma of cancer at one point. There's still a significant stigma with some of the mental diseases, but much less so than there used to be. But the one that's lagging behind is addiction." – Dr. Nora Volkow, Director, National Institute on Drug Abuse
One way we can all combat stigma, is to stop perpetuating the negative connotations with the words we use. Words like addict, alcoholic, user and abuser reinforce the stigma by creating negative images.5 These terms are demeaning because they label a person by his/her illness. By making no distinction between the person and the disease, they deny the dignity and humanity of the individual. In addition, these labels imply a permanency to the condition, leaving no room for a change in status.6 These terms have been very effective when used in the "drug war" at demonizing substances and people who use them. We cannot expect the stigma to change unless we change our language. The Center for Substance Abuse Treatment (CSAT) created a guide of terms to help people find alternatives for disrespectful stigmatizing language. Substance Use Disorders: A Guide to the Use of Language
It will take more than a change in language to alter society's perceptions, attitudes, and policies. Nonetheless it is an essential component to reducing stigma, and hence the obstacles and barriers to treatment that currently exist, and is a way for everyone to contribute.
- Transitions Recovery Program. Treatment Philosophy. http://drug-rehabcenter.com/drug_treatment.htm
- Carla A. Green, Ph.D., M.P.H. Gender and Use of Substance Treatment Services. National Institute on Alcohol Abuse and Alcoholism Publication. Undated.
- David L. Rosenbloom, Ph.D. Coping with the Stigma of Addiction. Addiction. HBO, 2007
- Reducing Stigma, Increasing Treatment Options, Saving Lives. Addiction. HBO, 2007
- Salsitz, Miller, Wilford, Organizing committee for the ASAM Review Course 2002
- Substance Use Disorders: A Guide to the Use of Language, TASC, Inc. under contract for the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration
(SAMHSA), part of the U.S. Department of Health and Human Services (DHHS), 2004.
This page was last modified on : 10/28/2013