What is stigma?
Stigma is negative attitudes and beliefs about an individual or a group of people due to their circumstances in life. It includes discrimination, prejudice, judging, labeling, isolating and stereotyping.
Stigma can be based on attributes (e.g., income, education, housing, race) or behaviors (e.g., substance use, sexuality). Consequences associated with stigma include isolation, low self-esteem, and poor mental health. Stigma for a particular individual or group can change overtime as societal beliefs and attitudes change.
Check out the links and information below to learn more about substance-related stigma.
What are the different types of stigma?
What are the five key elements to substance-related stigma?
What type of impact does substance-related stigma have on people who use substances?
The language we use can promote and increase stigma. How can I ensure I am not using stigmatizing language?
How can community members and organizations help address substance-related stigma?
I want to learn more about substance -related stigma and how to address it. What resources do you recommend?
What are the different types of stigma?
There are several different types of stigma. These include:
- Stigma from individuals: develops and sustains negative stereotypes and assumptions about individuals (can be verbal or physical). Examples include locking up valuables when a person who uses substances visits or calling people junkies.
- Institutional stigma: occurs when assumptions and stereotypes are translated into public policies, practice and funding decisions. For example, treatment guidelines or hiring practices that exclude people who use substances.
- Self-stigma: occurs when people who use substances adopt negative stereotypes and assumptions about themselves. Deep-rooted feelings of shame are felt, which results in the individual feeling they are “bad” or don’t “deserve” services or respect from others. It often results in a “why bother” attitude because people will just think they are liars.
- Stigma by association: occurs when assumptions or stereotypes are made based on association with stigmatized individuals or groups. This could include service or harm reduction workers who work with people who use substances or having a family member who uses substances.
What are the five key elements to substance-related stigma?
There are five key elements that contribute to substance-related stigma. These include:
- Blame and moral judgement: This is the belief that substance use is a choice. People who use substances are often told “just say no,” and are blamed for bringing on substance use and any associated infectious diseases acquired through substance use.
- Criminalization of substance use: People who use substances receive poor treatment, and are judged and labelled as a result of the criminalization of substances. Substance use is treated as a criminal matter in society rather than a public health issue. People who use substances are often incarcerated for non-violent crimes rather than providing them with the resources and supports they need.
- Pathologizing substance use: Pathologizing people who use substances implies they are sick, diseased and cannot help themselves. This leads to people thinking they know what is best for people who use substances. Pathologizing substance use also implies that generic treatments work (one size fits all model) and that there is something wrong with people who use substances.
- Patronizing people who use substances: People who use substances are often patronized, spoken down to or treated as a lower class citizen. This emerges though language as well as presumptions about needs and experiences of people who use substances. People such as service providers, family and/or friends feel that they know what is best for individuals who use substances and often tell the person what to do, instead of asking for input and involving individuals in the decision making process.
- Fear and isolation of drugs: This works in two ways and includes fear of substance use which stems from fear-based messaging and campaigns like “this is your brain on drugs” as well as fear of people who use substances. People become afraid to talk about substance use and believe that people who use substances are aggressive and/or dangerous.
What type of impact does substance-related stigma have on people who use substances?
Substance-related stigma impacts people who use drugs in a number of ways. These include (but are not limited to):
- Shame and internalized judgement
- Isolation
- Fear of being identified as a person who uses drugs
- Low self-esteem
- Decreased sense of autonomy
- Hiding use due to fear of being arrested
- Incarceration for non-violent crimes
- Increased participation in risky behaviours since they are already seen as criminals
- Have fewer services available to them and/or are fearful of accessing services
- Frustration with self if unable to change behavior
- Discourages people from talking about substance use which further isolates people who uses substances
- People who use substances find community with other people who use substances, which can make behavior change more difficult
- Diminished job, education or health care opportunities
The language we use can promote and increase stigma. How can I ensure I am not using stigmatizing language?
A lot of stigmatizing language exists around substance use. This language is negative and dehumanizing. Some language has become so commonly used that we often do not realize that we are using stigmatizing language. When interacting or working with individuals who use substances, it is important to be aware of the language you use and how you use it. Body language is also important to consider and often can send different messages. There are four key guidelines that can help guide our language use and reduce the use of stigmatizing language when talking about substance use. These include:
- Use person-first language (e.g., “person who uses substances” instead of “drug user”)
- Use language that reflects the medical nature of substance use disorders (e.g., “substance use disorder” instead of “junkie”)
- Use language that promotes recovery (e.g., “opted not to” instead of “non-compliant”)
- Avoid slang and idioms (e.g., “positive” or “new” instead of “clean”)
For resources specific to non-stigmatizing language use, please see the resource section below.
How can community members and organizations help address substance-related stigma?
Addressing substance-related stigma can take place at multiple levels including the individual, staff or agency, and community level.
Individual level:
- Use non-stigmatizing language
- Invite open and honest conversations with people who use substances
- Treat all people with respect and as individuals
- Avoid using “cookie-cutter” approaches when working with people who use substances
- Learn and start a conversation about the root causes (e.g., housing, support, income, abuse) of substance use
- Participation in education and personal development opportunities around substance use
Staff or Agency level:
- Offer and participate in staff education and training sessions around substance use
- Offer outlets for staff and clients to provide feedback on services, policies and experiences with staff
- Assess workplace policies and procedures to ensure they are non-stigmatizing and inclusive
Community level:
- Develop a participant advisory board (PAB) in your community
- Support and develop education and awareness campaigns
- Advocate for policy changes that breakdown institutional stigma
- Participate and host community events around stigma
- Engage people with lived experience with substance use to support community work
I want to learn more about substance -related stigma and how to address it. What resources do you recommend?
Check out the following resources for more information on substance -related stigma.
Adapted with permission from North Bay Parry Sound District Health Unit.
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