The New England Journal of Medicine recently published an interesting perspective on addiction stigma reduction. While considerable research has been devoted to understanding the negative effects of stigma on people suffering from alcoholism and addiction, this article focuses on strategies to improve the efficacy of anti-stigma campaigns. Why?
“Stigma manifests in labeling of people, negative stereotyping, status loss, and discrimination. Public stigma … involves pervasive negative attitudes and beliefs that lead to societal rejection of persons with addiction. It contributes to and is perpetuated by structural stigma, which manifests in discriminatory institutional practices and policies. Self-stigma occurs when people with addiction internalize society’s negative views.”
At New Paradigm Recovery, we understand both professionally and experientially the harsh and lethal effects that stigma can have on people and families struggling with alcoholism and addiction. Individuals may fear or internalize stigma so much that they avoid life-saving treatment. It is this public stigma which leads to an underfunded addiction treatment infrastructure and thus the lack of widespread access to treatment. There are also profound and far-reaching societal problems stemming from stigma including housing, employment, and legal discrimination. Stigma reduction is necessary to make life-saving addiction treatment accessible for all.
While several public health campaigns have been implemented to combat stigma, these authors note evidence-based strategies should be implemented and messages should be pre-tested before campaigns are released. This article points to the “Disease Like Any Other” campaign as a disappointing case study of the negative consequences of publishing untested content. This campaign tried to reduce public stigma about mental illness by comparing it to other chronic diseases, but the comparisons to incurable physical illnesses made it seem like all mental illness was permanent and incurable. The effort actually increased stigma, fostering pessimism about mental health treatment. It could be suggested that this is entirely because we try to create connections to things that others cannot relate to personally, or understand.
It behooves those of us working in addiction treatment to heed this cautionary tale. This research suggests a few strategies for combating public stigma related to addiction, taken from randomized message testing experiments, a standard evidence-based approach for testing the effects of anti-stigma communication.
The first of these strategies is using “person first” language. Instead of referring to someone as a “substance abuser,” which is a label that equates a diagnosis with an entire identity, we might refer to him or her as a “person experiencing substance abuse,” which places the person first because nobody can be defined solely by an illness. This article posits that even the terms “addict” and “clean” may have negative connotations to general society; at New Paradigm Recovery, we understand these are terms that people in recovery often embrace as an important part of stigma-reducing identification in twelve-step programs, but it is interesting to consider that these terms have a different effect in the context of messages to the general public. We should be careful that what we experience as empowering language in one context might do the cause a disservice elsewhere.
Afterall, every alcoholic and addict is someone’s son or daughter; someone’s brother or sister; someone’s mother of father; and someone deserving of the same level of compassion and love as anyone else.
Another very powerful way to reduce stigma is to make it known that treatment works! We at New Paradigm Recovery understand that learning about the efficacy of treatment is vital for both our clients and their families. By incorporating family counselling into our clinical treatment program, we foster a climate of hope by reducing family stigma (which can create an atmosphere of resentment and pessimism), aiming to create a positive support structure for each client in his or her home environment.
Research shows that narratives have mixed results in the tides of public opinion. While personal narratives can create sympathy for addiction and recovery, “negative attitudes about addiction are inextricably linked to stigma against certain races and socioeconomic classes.” Test groups were much more willing to sympathize with affluent people experiencing substance abuse and much more willing to blame people with lower socio-economic status for their substance abuse. We look forward to seeing more research into this particular point, particularly on structuring positively perceived stigma-reduction narratives that feature diverse individuals, especially those from underserved communities; the goal of stigma reduction is for all people to have fair access to quality recovery.
The final strategic point in this research is that stigma-reduction communications work best when they focus on societal causes of addiction, rather than personal choices. Professionals understand that trauma, family history, and socioeconomic factors contribute to mental health in general, not just addiction. When we share this understanding with the general public, they may correct the misconception that people with addiction simply make bad choices.
New Paradigm Recovery was founded by men and women in recovery from alcoholism and addiction, for men and women who seek recovery. We understand not just clinically, but personally the stigma associated with our struggle, and we have suffered much of the societal judgment that creates negative self-thought and feelings of despair. We founded New Paradigm Recovery explicitly to combat these feelings, and share a sense of hope that can bring lives to levels that no one could ever have dreamed. We have seen these promises come true for us, and endeavor to share that hope with others.
By using these strategies and by testing responses to our messages before launching campaigns, we can stop the stigma, dispel the myths, and encourage an outlook of hope when it comes to treatment and recovery. At New Paradigm Recovery, we look forward to the day when nobody believes that old lie, “once an addict, always an addict.” So many people have died from addiction and alcoholism that this work is more important now than ever before; more importantly, so many people are recovering from addiction that there is no excuse for those old stigmas to continue.
Treatment works. Words matter. There is hope.
McGinty, E. E., & Barry, C. L. (2020). Stigma Reduction to Combat the Addiction Crisis — Developing an Evidence Base. New England Journal of Medicine, 382(14), 1291–1292. https://doi.org/10.1056/nejmp2000227
