Exposing the Stigma of Addiction

(April 2022) Scientific research has shed new light on substance use disorder (SUD), aka addiction. This long, misunderstood diagnosis is now identified as a chronic brain disease, the result of alcohol and other drug use changing the structure of the brain and how it functions.

Yet while science has demonstrated there are many similarities between SUD, heart disease and type II diabetes – they are all behavioral-related medical conditions – the experience of individuals diagnosed with SUD is vastly different from other medical conditions. For example, 67% of people say it’s okay to discriminate against people dealing with addiction. This stigma rarely occurs with other medical conditions.

When it comes to SUD, there are several factors that impact why society responds to it differently than other diseases, including

• Legacy – All things considered, understanding SUD as a medical condition is relatively new. For decades, believing that people with the disease should have the “willpower to quit using” or the ability to “pull themselves up by their bootstraps” was the norm and is still a common misconception. Unfortunately, this thinking carries the incorrect assumption that someone with this disease should just be able to stop versus understanding that they’ve lost control because of changes occurring in the brain.

• Behavioral versus physical – When someone is sick, their symptoms reflect the part of the body that is impacted. Some diseases manifest physical symptoms, like fatigue, shortness of breath and lightheadedness, as in the case of heart disease. In contrast, SUD symptoms are predominantly behavioral, e.g.,
  • impaired judgment
  • erratic behavior
  • inability to control emotion
  • lying and deceit

Unlike physical symptoms, these behavioral symptoms can evoke emotions like fear, hurt, sadness, annoyance and even anger, especially in those closest to the individual with SUD (e.g., loved ones or co-workers). These intense emotions can result in negatively judging the person versus seeing their symptoms as a manifestation of the disease.

Despite the origin of the stigma, people with SUD are often considered less than because of their health status. And this stigma can lead to feelings of shame, guilt, embarrassment, depression, loneliness and isolation – feelings that can block their willingness to confront the problem and access the help they need. A national study found that 11% of people who thought they needed treatment for SUD did not get it because they were concerned that it might cause their neighbors or community to have a negative opinion of them.

In short, stigma keeps addiction underdiagnosed, under-treated, underfunded and misunderstood.

But this can change. There are ways to combat stigma. Stigma can be reduced by truly understanding the disease, then paying attention to how we talk about it.

The adage of “sticks and stones may break my bones, but words will never hurt me” is wrong. Words do hurt. And so too do the negative associations and connotations of many of the words we’ve historically used to talk about SUD:

• The words “addict, junkie or user” are demeaning and define people by their illnesses. Instead, use terms like “person in active addiction” or “person with a substance use disorder.”

• Saying “habit” or “drug habit” ignores the medical nature of the condition and implies the person can stop or “break the habit.” Instead, use the term “substance use disorder,” which is how it is classified in the Diagnostic and Statistical Manual of Mental Disorders, a tool published by the American Psychiatric Association.

• Saying “abuse” ignores the fact that an addictive disorder is a medical condition. “Abuse” is more of a criminal justice term versus a healthcare term. We use it for domestic abuse, elderly or child abuse and animal abuse. Instead, replace the word with “misuse” or “harmful use.”

• Avoid terms like “clean” or “sober” since they imply that people with substance use disorders are “dirty.” Instead, use words like “negative test,” “addiction-free,” and “in remission.”

By replacing stigmatizing terms with words that put the person (not their disease) first, we can highlight that they are more than just their disease. That SUD doesn’t define who they are. It’s a way to be respectful and demonstrate an understanding of the fact that SUD is a chronic disease that should be treated as such.