(Picture: drug user, posed by model Rex Features)
Social worker Jo Rees reviews research on the stigmatisation of substance misusers
KEY WORDS: Drug Use ❙ Stigmatisation ❙ Problem use ❙ Recovery
AUTHOR: Charlie Lloyd
Aim: To examine what the research evidence informs us about the stigmatisation of problem drug users, the reasons for its existence and the impact it has on people.
Methodology: This report is a literature review on the general topic of stigma. Key texts, mainly qualitative in nature, and literature with a particular focus on the stigmatisation of drug users are identified and emergent themes are discussed.
Conclusion: Problem drug users can be profoundly affected by stigmatisation, which is often characterised by personal blame and can act as a barrier to behaviour-change. It is suggested that education is required across the board about the nature and causes of addiction in order to demonstrate that problem drug users are unfairly treated and discriminated against. This may in turn encourage society to take a more empathetic approach to this strongly stigmatised group, promoting social reintegration and recovery.
This report aimed to review the research evidence relating to the stigmatisation of problem drug users. It was published by the UK Drug Policy Commission and funded by the Paul Hamlyn Foundation, the Scottish Drug Recovery Consortium and the Esmée Fairbairn Foundation.
A key aim was to examine whether stigma itself acts as a barrier to rehabilitation. The report also considered the efficacy of support explicitly designed to target stigmatisation, a model used by some current initiatives designed to support people experiencing mental distress.
The author, Charlie Lloyd, helpfully notes at the start that the definition of “problem drug use” used to inform this report covers “injecting drug use or long-duration/regular use of opioids, cocaine and/or amphetamines”. However, it is also noted that the report’s content is dependent on the definitions used by the other studies that are drawn upon to inform it. This does result in some muddying of the water with no clear definition able to be adhered to; for example, literature is included that covers people who experience difficulty controlling their use of alcohol.
In addition to descriptions of the findings and conclusions of the material used to inform it, the report allows the voice of the service user to be heard through the use of direct quotes. This results in a very user-friendly, accessible approach.
A range of literature is drawn upon to evidence the report, mostly UK material but some comparisons are also made with experiences from the US.
Lloyd identifies the importance of the use of language in connection with this group of people. While in the UK policy context the term “substance misuse” is frequently used, the media remains attached to more attention-grabbing labels such as “junkie” or “abuser”. The author notes the negative effect that labels such as these have on the perceptions of society in general, and the knock-on effect it can produce on the availability of support services.
Meaning of stigma
The report describes how the term “stigmatisation” is intrinsically-linked with stereotyping, discrimination and prejudice. It then focuses on the understanding and application of stigmatisation in other fields, such as those who experience mental distress and minority ethnic groups.
In the context of drug misusers, the exploration of the role played by blame, danger and perceptions of the deservedness of stigma (as epitomised by groups such as paedophiles) is useful. Lloyd demonstrates that those perceived to be responsible for their own stigma, and who may demonstrate dangerous behaviour because of it, are treated even more harshly; for example those who become involved in crime and disorderly behaviours as a result of heavy drinking.
Status and power imbalances are also dealt with: while some differences between people are acceptable, others are clearly not and those groups perceived to have power retain dominance over those perceived to have little or none. This appears to exist even within stigmatised groups themselves; for example, the report illustrates how those who use drugs responsibly attempt to dissociate themselves from those who “do it in front of anyone”.
Lloyd concludes that stigma can be addressed, but the approach required is vast and requires behaviour change in almost every possible forum: language, education, increased contact between people who experience difficulty controlling their use of substances and the general public, a more respectful approach from the police, targeted campaigns (as seen in the US) and the management of physical signs of stigma, such as the removal of needle marks. The only element where change is not recommended is the law because, it is suggested, by itself the law does not change attitudes. However, this fails to acknowledge the central representative and figurative role that is often played by law and policy in influencing perceptions.
This report is both comprehensive and accessible, and also important because it identifies further areas for research. These areas include a focus on the language used within media reporting styles, and how the perception of blame can be addressed and altered.
Importantly, the report recommends that research is required about the influence of stigma on the availability of support services; for example, the experience of stigma while collecting medication in pharmacies (individuals being told to wait and stand in the corner), and discrimination experienced from services such as housing or employment following recovery.
What is stigmatisation?
Stigmatisation is often identified with the work of Canadian sociologist Erving Goffman, who in the 1960s wrote about how some people could be considered less desirable than others simply due to the presence of one particular attribute. This attribute then becomes the central identifying feature of the individual concerned, leading to a damaging label (junkie) and obscuring all other potentially attractive features. Goffman further described how a stigmatised person might try to avoid revealing their status to others, and how people close to the stigmatised person may also experience discrimination simply as a result of that relationship.
● Attention must be paid to the important figurative role played by legislation and policy, and how this can be used to influence attitudes.
● Consideration should be given to the use of campaigns, such as those in the US, which are specifically designed to raise levels of education and awareness about problematic substance use within the general public.
● Training for staff in health, social care and other services should focus on raising levels of education about addiction, to challenge the assumption that users are exclusively responsible for their situation, and also to develop an awareness of the importance of a considerate use of terminology.
● Focus on the individual as a whole person, rather than focusing exclusively on the problem behaviour.
For frontline staff:
● Assisting the family of service users to better understand addiction (nature, causes and consequences) may result in less self-blame.
● Use of pejorative language and terms must continue to be challenged.
● Anitha S (2007). “A cultural approach to understanding the stigma of drug use: The experience of prisoners in England and Wales.” In: Korf D (ed), Drugs in Society: European perspectives, Radcliffe.
● Buchanan J and Young L (2000). “The war on drugs – a war on drug users?” Drugs: Education, prevention and policy, 7 (4), 409-22.
● Conner K And Rosen D (2008). “You’re nothing but a junkie”: Multiple experiences of stigma in an aging methadone maintenance population. Journal of Social Work Practice in the Addictions, 8 (2), 244-64.
● Goffman E (1963). Stigma: Notes on the Management of Spoiled Identity. Prentice-Hall.
● McKeganey N (2010). “Bad stigma…good stigma?” Drink and Drugs News, 15 February.
● Simmonds L and Coomber, R (2009). “Injecting drug users: A stigmatised and stigmatising population.” The International Journal on Drug Policy, 20 (2), 121-30.
About the author: Jo Rees is a qualified social worker, PhD student specialising in substance misuse and a tutor on the BSc social work course at Swansea University
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