Exclusion and hospitality: the subtle dynamics of stigma in healthcare access for people emerging from alcohol and other drug treatment

Abstract

This article explores the role of drug use‐related stigma in constraining access to healthcare services. Drawing on interviews with 20 people conducted shortly after leaving an Australian alcohol and other drug withdrawal management unit, the article explores their willingness and ability to access primary care, hospital and further services. It finds repeated descriptions of feeling ignored and shamed during efforts to access care, with some descriptions relating to subtle signs of disapproval or condemnation, and others to being ignored or dismissed. Some accounts additionally emphasise unwelcoming atmospheres, and exclusion by omission of signals of welcome and encouragement. The article goes on to consider, for the first time in this field, contemporary notions of welcome and hospitality as outlined within the cosmopolitanism tradition, asking whether they offer insights into how healthcare may become more accessible for people who regularly experience stigmatisation. In concluding, the article considers the need to think further about forms of exclusion that occur when social and individual histories of stigma are not institutionally recognised, and measures to counter these histories are not actively adopted.

Stigma towards dependent drinking and its role on caregiving burden: A qualitative study from Goa, India

“…Weiss et al [19] recognise stigma as a 'social process' that includes not only the experience of devaluation or exclusion, but also the perception and anticipation of it. With regards to substance-use related stigma, recent research has positioned stigma as both the cause and the effect of poor access to health services as it not only lowers the standard of care provided, but also lowers user willingness to access services [20]. As pointed out by Fraser et al [20], stigma is not always located within interpersonal interactions but is 'socially produced' and often implicated within larger institutional structures and systems.…”

“We’re supposed to be a family here”: An ethnography of preserving, achieving, and performing normality within methamphetamine recovery

“…Given the ongoing and widespread stigma and discrimination towards PWUD within Australian healthcare services ( Fraser et al, 2017 ; Fraser, Moore, Farrugia, Edwards, & Madden, 2020 ), increasing awareness of these complex and dynamic repertoires of normality may promote a less homogenising or coercive approach towards treatment and policy. A more flexible and responsive perspective on what can constitute ‘normal’, and a critical awareness of how this ideal is constructed and can impact service interactions may reduce the risk of delegitimising some people’s experiences and prompting disengagement from services.…”

Assessment of stigma and prejudice in the organization of care networks for drug users

“…Stigma and prejudice towards drug users are related to a number of factors, such as the perception that drug use leads to people committing irrational acts, racist historical associations between certain drugs and certain populations, religious objections, and perceived interference in the neoliberal values that blame individuals and exempt the state from responsibility, with the exception of actions aimed at people who abuse psychoactive substances (7)(8)(9) .…”