Stigma, social inequality and alcohol and drug use

Abstract

A heavy load of symbolism surrounds psychoactive substance use, for reasons which are discussed. Psychoactive substances can be prestige commodities, but one or another aspect of their use seems to attract near--universal stigma and marginalization. Processes of stigmatization include intimate process of social control among family and friends; decisions by social and health agencies; and governmental policy decisions. What is negatively moralized commonly includes incurring health, casualty or social problems, derogated even by other heavy users; intoxication itself; addiction or dependence, and the loss of control such terms describe; and in some circumstances use per se. Two independent literatures on stigma operate on different premises: studies oriented to mental illness and disability consider the negative effects of stigma on the stigmatized, and how stigma may be neutralized, while studies of crime generally view stigma more benignly, as a form of social control. The alcohol and drug literature overlap both topical areas, and includes examples of both orientations. Whole poverty and heavy substance use are not necessary related, poverty often increases the harm for a given level of use. Marginalization and stigma commonly add to this effect. Those in treatment for alcohol or drug problems are frequently and disproportionately marginalized. Studies of social inequality and substance use problems need to pay attention also to processes of stigmatization and marginalization and their effect on adverse outcomes.

Drug treatment clients' readiness for hepatitis C treatment: implications for expanding treatment services in drug and alcohol settings

“…28 These issues are likely to affect the ability of clients to consider or participate in hepatitis C treatment. Other bodies of work also point to the widespread discrimination experienced by people who inject drugs or who seek drug treatment, [29][30][31] especially in health care settings. 32 When discrimination forms a routine part of their everyday experience, we think it is unlikely that drug treatment clients will necessarily identify discrimination as a major barrier to their access to hepatitis treatment.…”

The Relationship between Drug User Stigma and Depression among Inner-City Drug Users in Baltimore, MD

“…26,27 Several studies have examined the public's attitudes toward drug users. 28,29 These studies generally find high levels of social disapproval and stigmatization. Palamar and colleagues 30 found that individuals who reported using illicit drugs in the prior year held less stigmatized views of drug users, whereas those who self-reported greater exposure to drug users had higher levels of negative attitudes toward drug users.…”

Recurrent suicidal ideation in young adults

“…10 Few participants with recurrent SI in this current study reported help-seeking behaviour in the past year. Possible reasons for not seeking professional help include, among others, perceived stigmatization (i.e., fear of what people think), 20,21 fear of hospitalization, reluctance to share personal information about mental health problems, not accepting/admitting mental illness, limited access to services, and long waits for mental health services. 17,22,23 In addition, young people often have a strong sense of self-determination and autonomy which influence their desire to manage problems on their own.…”