Oh My. Is there a more reviled word? Is there any other noun so fervently avoided? I would be interested in your feedback if you can think of one.
A heavy load of symbolism surrounds substance use. Substances can be prestige commodities, but one or another aspect of their use seems to attract near–universal stigma and marginalization. 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.
Processes of stigmatization include:
– Decreased social support from family and friends
– Discrimination in important life areas such as employment, housing, justice, and access to healthcare
– Decisions by social and health agencies and governmental policy decisions
Too often society is unfair to people with addiction—a fact that disturbs most people with active addiction, most people who are recovering from addiction, and most people who advocate for those groups. Fortunately we can do something about it. Don’t be daunted—small steps can have a powerful impact.
Social stigma exists within culture. Stigma occurs when a characteristic of a person or subgroup is perceived as different from others, is labeled, and the label becomes associated with a negative stereotype.
We are frequently, and not subtly, inundated with sensationalistic tales of debauchery by the latest “outed” celebrity behaving in very unflattering ways, refusing treatment, disrespecting the justice system, and so on. Naturally, this has the cultural effect of intensifying the moral judgement of individuals living with substance abuse, regardless of their desire for, and commitment to, recovery.
But, it is essential to remember that for every Lindsay Lohan, Charlie Sheen and Anna Nicole Smith, none of whom ever let the negative publicity spark personal introspection, there are dozens of famous people who had the courage confront their addiction and successfully regain social acceptance and high regard. Jamie Lynn Curtis, Drew Barrymore, and perennial fan favorite Robert Downey Jr. all struggled publicly, and each has since embraced the role of sobriety advocate.
Lastly, perhaps the most courageous of all, Former First Lady Betty Ford. Imagine, the First Lady. Back in the 1970s scrutiny of the private lives of public figures was relatively un- invasive by today’s standards.
Ms. Ford helped create a new sobering reality for America by lending her name, energy and experience as a recovering addict to the center.
In 1982, after her recovery, she established the Betty Ford Center (initially called the Betty Ford Clinic) in Rancho Mirage, California, for the treatment of chemical dependency. She served as chair of the board of directors.
In 2005, Ford relinquished her chair of the center’s board of directors to her daughter Susan. She had held the top post at the center since its founding. Her husband joked about how she had been chairperson of the board while he had only been a president.
“The fact that Betty Ford lent her name to the center had a profound effect on the treatment of alcoholism,” said Dr. James West, a medical director at the Betty Ford Center from its opening until his April 2007 retirement.
“When she made it clear that she was the head of this place and a recovering person herself, that had a very profound effect on the whole system throughout the country.”
Stigma recedes as people focus more on what they have in common and focus less on their differences. It doesn’t matter whether incremental positive changes take place in society or in the individual; everything interacts. As people become more real and human to one another, stereotypes become irrelevant.
Here are some options.
1. Get Help. If you are actively addicted, stop feeding society’s negative stereotype and get sober. Seek detoxification if needed, and then take responsibility for the details of recovery management (relapse prevention) and the use of recovery supports. Don’t defend past addictive behaviors; accept them for what they are. Feel and express remorse. Over time, make amends. (Okay, maybe these are bigger than small steps.) If you are not actively addicted, you may still have work to do. If, for example, you feel diminished and “less than,” deepen your commitment to a way of growth, such as psychotherapy, Twelve-Step recovery in Alcoholics Anonymous or a related program, or a spiritual practice (perhaps self compassion, which is drawn from Buddhism). All can help you feel and act less different from others.
2. Reach out. You have a right to privacy, but you are also free to share your story, which allows others to become more comfortable with their own story and helps them feel less different—more comfortable with their own humanity. Young people told singer and actress Demi Lovato that public disclosure of her mental health and substance abuse problems helped them face their own.
3. Network. There is strength in numbers, and you may multiply your impact if you add your perspective and energy to an established advocacy organization such as NCADD.
4. Be normal. If it is important to your comfort or safety, for instance, to have wine glasses removed from a restaurant table and to find out whether a dish has been prepared with alcohol, remind yourself you are really no different from the person who is allergic to nuts and insists that a nut bowl be removed and questions the server about the ingredients of an entrée or dessert. In both situations it is embarrassment and reticence that are out of place.
5. Be heard. How fair or unfair society will be in the future to people with addiction will be determined in part by the outcome of multiple public policy issues, including health care reform. If you hold a stake and a point of view, legislators and other policymakers deserve to know what they are.
“Stigma is shame. Shame causes silence. Silence hurts us all.”
[Room R. Stigma, social inequality and alcohol and drug use. Drug Alcohol Rev 2005;24:143 – 155]