Self-Stigma Impedes Recovery Process
Substance Use Disorder
Substance use disorder is an umbrella category of mental illness that includes serious abuse of alcohol or drugs, as well as alcohol or drug addiction. This larger category contains subheadings for eight specific types of substances (including stimulants, opioids, tobacco/nicotine, inhalants, cannabis and hallucinogens) and also gives doctors the freedom to identify abuse or addiction related to any substance not specifically named within a subcategory. The criteria that doctors rely on to diagnose substance use disorder come from the American Psychiatric Association (APA), an organization that has long held a prominent role in defining mental health issues in the U.S. The APA established the terms for the disorder in 2013 when it abolished separate definitions for substance abuse and substance addiction. This move stemmed from a strong scientific consensus demonstrating that issues of abuse and addiction are heavily intertwined within affected individuals.
As a rule, stigma develops when someone focuses on particular attributes of a person or a group of people and uses those attributes to largely or entirely define that person or group. Known potential consequences of the stigmatization process include workplace discrimination, social discrimination, the targeted acts of harassment and violence associated with bullying, loss of empathy or identification with others and internalized feelings of inferiority in the people who are stigmatized. In some cases, stigmatizing behaviors may be clearly evident; however, in other cases, they may manifest in subtle forms. People who are stigmatized by others or stigmatize themselves may develop strong feelings of shame regarding the particular attributes or characteristics under scrutiny. External and internal stigmatization may occur particularly often among people who get diagnosed with a substance use disorder or any other form of mental illness.
Impact on Substance Treatment
In the study published in The American Journal of Drug and Alcohol Abuse, researchers from the University of Nevada, the University of Washington and the Portland Psychotherapy Clinic, Research & Training Center examined the effects of stigma on the length of treatment for 103 people with substance use disorder enrolled in residential recovery programs. The researchers chose this line of inquiry, in part, because no studies had specifically focused on the connection between stigmatization and the well-known difficulties of the recovery process. Specifically, they investigated the impact of three aspects of stigmatization: exposure to stigmatizing behaviors carried out by others, internally generated feelings of stigma (i.e., self-stigmatization) and feelings of shame stemming from either stigma exposure or self-stigmatization. The researchers weighed the impact of each of these aspects against the impact of a number of other factors that can affect the required length of substance treatment, including general level of mental health, age, racial/ethnic background and level of social support during recovery.
After gauging the relative influences of all the relevant factors, the researchers concluded that people who stigmatize themselves for their involvement in substance use predictably spend longer amounts of time in residential treatment. However, they also concluded that the two other aspects of stigmatization under consideration—exposure to other people’s stigmatizing behaviors and internalized feelings of shame—don’t consistently determine how long residential treatment will last.
The study’s authors note that people who stigmatize themselves may have a lowered level of belief in their ability to control their substance-using behaviors. In turn, this lowered level of belief and other harmful consequences of self-stigmatization may make it more likely that affected individuals will seek treatment in a relatively isolated residential environment. In the long run, this preference for residential treatment may increase the amount of money devoted to the substance recovery process. The authors believe that treatment programs may need to develop interventions specifically designed to help recovering substance users affected by a tendency toward self-stigmatization.