Stigma against people who use drugs

By Tauni Malmgren, OT/S

Trigger Warning

Stigma against people who use drugs (PWUD) has been surprisingly common in my experience as an occupational therapy student. In class, I have heard students unwittingly describe people seeking health services as “drug addicts” during presentations. In fieldwork, I have heard jokes about “meth heads stealing copper” and people being “locked in padded rooms.” While these statements may not be said to intentionally hurt others, they are indicative of a stigmatized health care environment. Experiences like these leave me with questions I believe are worth exploring further. 

What is stigma?

The textbook definition of stigma is “a mark of shame or discredit.” Stigma against PWUD can be thought of in these simple terms. To many, drug use is a mark of shame that discredits the act of seeking healthcare services. Stigma consists of social processes that label, stereotype, and separate PWUD, leading to disempowerment and a loss of autonomy while increasing marginalization. In the experiences I have had as a student, stigmatizing language put labels and stereotypes on PWUD while separating them from other types of clients. 

There are different layers of stigma affecting PWUD. Self stigma is when people internalize the negative feedback that they hear commonly. Courtesy stigma, or ‘stigma by association,’ affects people who love and help PWUD. Structural stigma is on a societal level impacting culture and policies that harm PWUD. Public stigma combines all of the negative attitudes and beliefs that compel people to fear, reject, avoid, and marginalize PWUD.

There are various components of stigma

What is the impact of stigma on PWUD?

Simply put, stigma creates barriers to healthcare. It delays help-seeking, ends treatment, creates suboptimal therapeutic relationships, presents safety concerns in healthcare, and overall leads to a poor quality of mental and physical health care. In the United States, more people are dying of drug overdoses than motor vehicle accidents, yet 89% of PWUD who are in need of treatment do not seek services. This can be thought of as a “why try” effect.

From Wisconsin Initiative for Stigma Elimination

According to the Harm Reduction Coalition, key elements of drug-related stigma include:

  • Blame and moral judgement
  • Criminalizing the illness
  • Pathologizing the client
  • Patronizing therapy
  • Fear and isolation

Language surrounding PWUD suggests that drug use is a moral failing and a personal choice. This is a harmful approach as research shows that healthcare professionals are more likely to assign punitive rather than therapeutic measures (e.g., jail vs. therapy) when stigmatizing language is used to describe the person (e.g., ‘addict’ vs. PWUD). 

What can we do to help PWUD?

In 2017, the Office of National Drug Control Policy sent out an executive memo asking healthcare professionals to change the way we talk about substance use disorder (SUD). There are resources that we can use such as free trainings to address stigma surrounding drug use and free tools like the Addictionary to help us reframe the way we talk about and approach PWUD.

In looking towards the literature, a review looks at several ways that we can reduce stigma:

  • Teach PWUD about their condition or stigma and its impact on health (e.g., overdose prevention education)
  • Create opportunities for healthcare professionals to develop skills needed to work directly with PWUD (e.g., Motivational Interviewing, harm reduction)
  • Participatory learning where PWUD, healthcare professionals, or both are actively engaged in therapy (e.g., peer mentorship)
  • Involving PWUD in the delivery of therapy in order to develop empathy, humanize PWUD, and break down stereotypes
  • Empower PWUD with coping mechanisms to overcome stigma that they experience when they try to receive healthcare

When working with PWUD, occupational therapists can and should seek out resources on the topic of stigma that they can reference in practice. By addressing stigma on many levels, we can finally help PWUD when they are at their most vulnerable instead of causing them further harm. 

The anti-overdose medication Naloxone from Public Radio International

By Tauni Malmgren, OT/S

Northern Arizona University

Interested in helping PWUD through the lens of harm reduction? Join the private group for Occupational Therapists for Harm Reduction: https://www.facebook.com/groups/OTsforHarmReduction/

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