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Stigma is an enduring problem for addicts, not only in active addiction, but even into recovery. Services too can be stigmatised and within the field prejudice exists between approaches.
Three things came together to focus my mind on the subject this week. The first was the important paper published in December’s Journal of Substance Use which looked at pharmacy assistant attitudes to drug users and what training needs came out of that.
In the UK, most methadone is dispensed from community pharmacies. Pharmacists and those working in pharmacies arguably have the greatest contact with patients prescribed methadone.
In the study, pharmacy support staff, not pharmacists were surveyed. 1218 pharmacies were invited to participate in the qualitative research. Just over half did.
What the authors found was that staff saw long term maintenance as failure and had mixed feelings about the framing of addiction as illness or disease. Some saw addicts as ‘bad people’ and while some staff had good rapport with clients, others had difficult relationships.
This is backed up by NTA research looking at this from the view of the service user which found that most felt disrespected by staff. Theft was perceived as a significant problem. The paper is worth a look and raises many difficult issues with problems that must be tackled.
Something the authors did not address was the role that pharmacists and their staff might have in promoting and supporting recovery.
Adopting a recovery orientation to needle exchange services and dispensing was not seen as a training need and I was left with the feeling that aspirations for clients attending pharmacies regularly could be set a lot higher.
Other items that I found interesting this week were Bill White’s paper on lessons on stigma in Philadelphia and strategies to combat it. Again there are issues with stigma of those on long term methadone particularly and perhaps a “stigma hierarchy” depending on what sort of recovery you are in.
I don’t have space here to summarise the paper, but it is essential reading.
Finally, Jason Schwartz of Dawn Farm does take time to look at this and his blog is suffused with insight, reflections and yet more questions. As he says, how we deal with the issues is not easy.
What does this mean for members of Wired In?
If you got this far, I thought I would ask for personal examples of stigma and how it felt as well as any ideas on how stigma is best tackled. We need to face up to this.
Am afraid theirs no universal panacia for addiction and a response to an individuals needs is required, i’ve found good and bad in services as you find in life, no point winging about it and to be honest some of my behaviour justified being stigmatised. to easily we can become precious in recovery avoiding the responsability of what we did as addicts, as for methadone prescribing even that has its place, if its only value is it tides you over until you score without harming someone, it has a value
Is it possible to find behaviours unacceptable, but not stigmatise the individual addict? We need boundaries and safeguards to keep services, workers and other clients safe, but we ought not let the very ‘symptoms’ of addiction prevent access to the help they need to get better.
I speak as someone whose behaviours were not very attractive in addiction, but also as someone who was suffering and badly needed help.
In my recovery I’ve also been subject to stigma which was really very unacceptable. I don’t want to be precious, just stand up for my own dignity and self-worth.
David,
I regularly see instances of stigma in my work environment.As you may know I work in a large hospital and I coordinate emergency admissions.I often hear snide remarks about the (addicted) patient and whether they deserve treatment (whether the reason for admission is related to their addiction or not )…and even though these’ caring professionals’ know my history they expect me to agree and join with them in the vitriol.
Amazing.
Well,try as I might to enlighten these bigots nothing seems to change but I do live in hope !
Kerry, it’s sad to hear confirmation that prejudice is alive and well in the caring professions. It’s also great to know that you are there with a very different perspective and serve as an active role model that there is an alternative way to manage the problem.
There might be other ways of reducing prejudice and stigma and today I was privileged to spend time with medical students where a bunch of addiction specialists and recovering alcoholics and family members delivered hopeful and positive messages. (I can feel another blog coming on)
Tony, I agree whingeing is a waste of energy, but I do feel a need both to challenge unacceptable situations as well as demonstrate how stigma is based on false assumptions. The changed lives of recovering people is evidence indeed.
Hi David, you asked for personal examples of stigma and how it felt and I describe how it felt for me below with words I still sometimes use in my share at meetings. I’ve just checked the dictionary description for stigma, just to make sure my personal understanding of it was correct – ‘Stigma – a distinguishing mark of social disgrace’ (Collins Concise) – I was spot on in my feelings at the time I share about now.
In June 2006 I came out of a 13 week stay in a treatment centre in the Highlands, back home to the town where I grew up, where a lot of people were aware of the effects of my drinking on me and my family. I remember distinctly when I first walked up the street to the shops an overwhelming feeling of shame and in my head I pictured myself wearing a sign, like a tabard, with big writing on it saying ‘this person is an alkie’. And to me, at that time, ‘alkie’ meant worthless, weak person. My response to these feelings was to go and drink and it took me almost another two years before I was able to get into recovery.
I know now that the feelings came from what I believed about myself and my ignorance about the illness of addiction. That ignorance came from my own social conditioning, I had never heard of addiction being an an illness before I went into treatment and it only took one person to tell me that was a cop out (me) and I was back on the drink. The stigma I felt was so real to me because it is there, in our society and in my experience it is a real and powerful barrier to facing addiction both for the addict and their families.
Thanks noni, for being so honest about your experience. Stigma whether socially conditioned or there by other routes can be internalised too, resulting in a harsh inner critic; a part of ourselves which undermines, bullies and ridicules.
One of the great advantages of mutual aid is the relief that comes from realising that there are others who’ve had the same sort of experiences and that they (we) are not bad people.
I’m absolutely certain that a lot of wasted energy goes into shame and self-belittling. As recovery gains momentum, this energy can better be used for gain, such as giving oneself positive messages, forgiving oneself for past behaviours and building self esteem.
In a sense, stigma from outside is harder to manage in that we can do something about our inner critic, but we need help to do something about societal and institutional stigma which is much more pervasive and persistent.
Hi david,
I think I have been affected by stigma on many different levels.
First, on a very open and obvious level was with one chemist in my local town where I used to pick up methadone. I would sit and watch as just about everyone else was seen to before me, even though they were well aware I had a limited window to collect as I used to go on my lunch break as i was working at the time. So even though they knew i was in work and on a reduction program they still had a poor opinion of me, which could only have been based on the fact that I was using methadone.
Secondly, i feel I was stigmatised in a more subtle way when i first came off methadone. I remember people encouraging me to take it easy, not to try anything too adventorous or taxing. I felt as though the subtext was: “You will relapse if you have a knock back”. Considerate perhaps, but again I think this was an assumption made because i was a recovering opiate addict.
Lastly, and part of me feels I shouldn’t say this, I have recently come to feel that i, amongst others, am being slightly exploited as cheap labour. that because of my obvious disadvantage, i.e. my past, I must work 5 times as hard to get the necaessary recognition for my work.
I hope I didn’t sound too much like someone with a victim mentality there.
