Effects of Stigma on Drug Users
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Keywords: drug user stigma, discrimination effects
In this essay I will demonstrate my understanding of stigma and labelling. There are certain people who are stigmatised and substance users often have a negative stereotype. This negativity will often not allow the substance user to seek the help and medical treatment that they need due to the stigma and labelling. I will be discussing the research around the impacts of stigma and labelling that will affect not only their treatment but in housing and employment.
The term stigma originates from the ancient Greek word and signifies that he or she could be a slave, criminal or traitor and was used as a sign of disgrace and shame. It is now used to describe people who are stereotyped because of their social identity (Pierson & Thomas, 2010). According to Goffman, when a person is not able to meet expectations because their behaviour or attributes are undesirable or unacceptable, then stigma disqualifies a person from social acceptance. Goffman suggests that stigma is, "an undesirable attribute that is incongruous with our stereotype of what a given individual should be" Goffmam (1963:3). Stigma is a use of negative labels and is about disrespect. It is not just a matter of using the wrong word but labels that person who has the substance use disorder. Stigma results in discrimination and abuse and is damaging to the lives of many people. The fear of stigma discourages families and many individuals from getting the support and treatment that they may need to lead normal healthy lifestyles. Stigma deprives people their full participation into society which then reinforces negative stereotypes (Goffman, 1968). The way of coping with stigma is to conceal behaviours and internalize these negative views and as a result will be subject to discrimination and exclusion within many areas. Drug problems will remain entrenched if substance users are seen as "junkies". Landlords will be reluctant to let out their properties and employers will be wary of giving them jobs. Employment and housing are important to substance users as it can be vital in establishing themselves back into society (UKDPC, 2008). Research studies show that 80% of drug users are unemployed. Being employed is shown to be an important component into the reintegration into society. Once in work, it will help in building their self-esteem and back into normal life (UKDPC, 2008). Family members feel shame and stop trusting them and in some cases, disown him/her. Community's will "finger point", try to avoid contact and will gossip about them. Many would argue that society's disapproval of drug use; especially cannabis and heroin will say stigma is necessary to demonstrate disapproval (UKDPC, 2010). Stigma can also make the substance user stigmatize themselves, make them feel alone, rejected and destroy their self-esteem. Seeking help is very difficult for the substance user and will prevent them from doing so. They will often feel that quitting would be no use and returning to normal life would be impossible because people in society will no longer trust them and so will join in with other drug users, start criminal activities to pay for their use and accepting the blame of society (UKDPC, 2010).
Stigma discourages families and individuals from getting the support and treatment they require. Families suffer the impact when another family member has a drug use (UKDPC, 2009) and it alters all their social invitations and friends that they once had. Other family members will often withdraw and children will often be targeted by bullies. Stigma deprives people of their full interaction into society. The UK Drug Policy Commission (UKDPC) suggests that 1.5 Million people in the UK are affected by a relatives drug use. Supportive relationships are key to a successful recovery. Carers UK commissioned a study which estimated that carers in the UK made a contribution of £87 billion in total economic value in one year. This may have excluded many who have not come forward with coping with a relative who has a drug problem but this gives us some indication of the social contribution likely to be made by the supporting families (DrugScope/Adfam, 2009). The drug user must have determination and faith in reaching their goals and there will probably be setbacks and barriers but with the support and contribution of social workers, support groups, family and friends, this will help towards the recovery process (HM Government, 2010). Families and relationships are key issues for recovery and drug users improve when their family is behind them. They are more than likely to complete treatment and maintain their new lifestyles (Best & Laudet, 2010).
DrugScope published research in 2009 by interviewing a random sample of over 1000 people aged 18 plus. The research published showed that one in five adults had a personal experience of drug use, either direct or indirect. The findings where:
19 % have "personal experience of drug addiction" either directly or among family or friends;
1 in 10 adults have a friend who has experience of drug addiction;
1 in 20 have experienced drug addiction in their family;
1 in 50 has personal experience of drug addiction.
77 % agree investment in drug treatment is "sensible use of government money".
The poll found that 19% either had direct or indirect personal experience of a family member or knowing someone within their circle of friends. 11% were likely to have a friend who has experienced drug addiction. 6% had family members who were drug dependant, yet 2% experienced the drug dependency themselves. These figures do suggest that drug misuse and the dependency do affect many people's lives and is a social problem (DrugScope, 2009).
Stigma to substance users will possibly make addiction recovery and treatment more difficult. Substance users often manage in secret and would rather not seek out the treatment and live in denial. The University of Nevada studied 197 drug users on the affects of stigmatization. This research identified that because of the use of stigma they would become more dependent on their drug use due to the perceived negativity that the society had on drug users. 60% of drug users in this study felt that they were treated differently after people knew that they were a drug user. 46% felt that others became afraid of them once they found out and 45% felt that their families gave up on them and wanted nothing more to do with them. 38% of their friends had rejected them and finally, 14% of employers paid a lower wage (Addiction, 2010). Users have no good reason to stop using when you look at this research study. This research identifies that stigma is conceptuality unique. Drug users also had a more difficult time in treatment at succeeding when there were higher levels of stigma. The study also showed that drug users often cope in secret due to their inability to openly discuss their addiction; this caused poor mental health and decreased their chances of recovery. By reducing shame the society could help in driving forward in helping the treatment of drug users who are not coming forward due to stigma (Addiction, 2010).
Stigmatising is not only found amongst the public but also by the professionals who may be working directly with them. Professionals, such as doctors and nurses, who work directly with drug users, will have a greater insight into the problems that drug users face on a day to day basis. Miller et al (2001) mentioned in UKDPC (2010:30) summarised research from the USA which showed an increase in negativity towards drug users. Two studies of the treatment of problems with drug users and drinkers both in the inpatient care and 'safety net emergency department' showed that negative views during training, continued when they became qualified and working within their practice (UKDPC, 2010). Stigma between health professionals and the drug user will prevent them from seeking help and may be one of the reasons as to why the drug user will not seek out the help or medical treatment that they require (Kelly & Westerhoff, 2010).
Everyone knows that it is wrong to discriminate, whether it is because of their race, culture or religion. Substance use is very common and is widely misunderstood. It is essential that we learn about the person and treat with dignity and respect. This will then help in emphasizing their abilities (Mental Health and Recovery Board, 2009). Public attitudes to drug addiction were explored in the UK in 2002 (Luty & Grewal, 2002). Results showed that 28% regarded drug users as having a mental health problem. 38% assumed that drug users were criminals and 78% to be deceitful and unreliable. 30% said that they deserved the misfortune that fell upon them. 62% thought that the law were too soft on drug users and 40% believed that their children should be taken into care. It was concluded by Luty and Grewal, 2002, "the results clearly indicate a negative view of drug addicts" (Luty & Grewal, 2002:94).
Yet, DrugScope in 2009 wanted to find out the attitudes of the public towards drug users and drug treatment. They commissioned a poll and the findings suggest that the public to be very sympathetic than sometimes often assumed. 80% of the people surveyed agreed that 'people can become addicted to drugs because of other problems within their life'. 35% agreed that it was the individuals fault for drug use and that there is no excuse. A large amount of respondents 88% agreed that for the drug user to get back on track, they needed help and support and 77% agreeing that the investment of government money towards drug treatment is sensible. This research showed a sympathetic response of the majority of the people surveyed.
Drug users are the most marginalised people in society where discrimination and stigma are key into the barriers of receiving recovery. Two thirds in a recent poll showed that employers would not employ anyone with history of drug use, even though they were suitable for the job. Stigma and discrimination still remains a barrier to recovery and will clearly impact of them finding work. It will also affect being housed appropriately and accessing the healthcare that they need (DrugScope, 2009)
The things that we can do as practitioners in helping to overcome the stigmatisation is to have a better understanding of how difficult it is for people to change who may have low self-efficacy. First impressions count and for a substance user, coming through the door is hard enough. The substance user will have come because they are in a crisis and has realised it is time for change (Lecture Notes, 2012). As social workers we have to realise that engaging with the substance user will help in the first steps to recovery and help in building relationships. Building respect and trust will prevent misunderstandings that may lead to conflict. Having good communication skills is effective and at the heart of social work. It is only through our communication skills that we are able to understand the knowledge of others and work effectively (Trevithick, 2009). It is important to communicate as it helps in exchanging our thoughts and feelings and in forming the foundation of a good relationship. Communication allows you to help the substance user to be more receptive to the new ideas by creating an environment that they can trust and help in developing resolutions. To have an open and honest relationship, trust is important in succeeding this. An agreement ideally should be met with the substance user about confidentiality. They have a right to know who will be able to access any information about them (Koprowska, 2010).
Motivational Interviewing is a well known model developed by William Miller in 1982. It is a model used with people to evoke change, especially people who have problematic substance misuse. Motivational interviewing is a client-centred counselling style and helps the service user to reach their decisions about potential behaviour change (Nelson, 2012). This model helps in identifying and understanding the substance user's motivation to change and highlight to the client their perceived negatives and benefits of change. The principles of motivational interviewing are to express empathy, develop discrepancy by helping the client in increasing their awareness of the consequences of their behaviour. Avoiding argumentation as it is them who are the expert. Roll with resistance by encouraging the client to develop their own arguments. Resistance is normal if you are uncomfortable about something and lastly self efficacy by highlighting the skills and the changes they have already made (Lecture Notes, 2012).
Assessing motivation with the substance user and finding out at which stages they may be will help in me identifying where the substance user is in their dependency. A well known model called the cycle of change developed by DiClemente and Prochaska (1982) represents the point at which the substance user passes during their change in behaviour. The different stages are:
Pre-Contemplation, this is where the service user has no desire to change.
Contemplation, this is where the service user may be considering their situation and is more aware of it.
Preparation is where the service user makes a decision to change their substance misuse.
Action and this is where the service user takes steps in bringing about change.
Maintenance is where they have stopped using the drugs and moved to a more controlled and less harmful way of using and is maintaining that change.
Relapse is where the service user will go back to their old behaviour and will have to start the Cycle of Change again (Teater, 2011:122).
The substance user may slip back or relapse in to their old behaviour because permanent behaviour is very difficult to change, particularly with people who want to make change in substance misuse. This is very difficult and may take several attempts (Nelson, 2012). Motivational interviewing will help the substance user move through the stages of change.
Having good active listening skill is important and will help in making the substance user feel that he/she is being helped. Many people will feel encouraged when they have been truly listened to without interruption and will often become encouraged and empowered (New Jersey Self-Help Group Clearinghouse). A good listener allows the person to get their own stories and opinions across, which active listening will allow them to do so. If you interrupt, the person will feel that they may not have been listened to. They will not feel respected and may hold information through being cautious. It is important to allow them to know that you were listening and will help in encouraging them to continue talking. Leaning forward, maintaining eye contact will also show them you are interested in what they have to say (MindTools, 2012). You have to remember to not let environmental factors distract you as this could make you lose focus. Giving the substance user your undivided attention and acknowledge what they are saying. Using body language either by nodding occasionally, smiling and encouraging the speaker to continue by saying verbal comments, such as 'yes' and 'go on' will encourage the speaker to continue by knowing you are listening. Giving positive feedback by paraphrasing e.g. "What I am hearing is" and "It sounds like you are saying", are good ways of reflecting back and help in clarifying certain points that the substance user may have said and helps towards getting more background information. Paraphrasing also helps in allowing yourself to really understand what has been said and helps the substance user know that they have been heard und understood correctly (Koprowska, 2010). Having the three core conditions of counselling of empathy, respect and congruence will help to enhance the substance user's motivation to change. Empathy allows putting you in another person's shoes and having a better understanding of their feelings and emotions. You must ignore your own perception of the situation and accept their feelings and thoughts. By doing this does not mean that you accept the behaviour they are doing but means that you understand them. Congruence allows you to be yourself and that you are only human and a real person. This will help in reducing the stress the substance user may have. Having respect is accepting the person for who they are regardless of what the person says or does. When others have possibly made that person feel negative, it is very hard for them to feel positive. Showing the substance user respect will show willingness that you want to work with them, which will allow them to grow confidence (Trevithick, 2009).
Change is difficult, so it is normal for the substance user to feel ambivalent. Using the Decisional Balance will help in identifying the positives and negatives of their behaviour. If you are going to change, you need a reason to and people change when the positives outweigh the negatives. We always have to be aware of the short term or long term risk factors including their level of usage and what type of drugs they are using (Miller & Rollnick, 2002). Motivational interviewing helps the substance user in identifying the importance of their behaviour change and also helps the practitioner help in doing so by enhancing their motivation. This model works well alongside the 'cycle of change' as it is useful to assess where the substance user may be in their cycle of change and help in identifying the strategies you may use (Nelson, 2012).
In conclusion, if a person does not conform to social stereotypes, they are more than likely to be marginalised and bear stigma. People with substance misuse are of all types and come from different backgrounds (Pycroft, 2010). Working with individuals who are experiencing substance use, it is important to remain focussed. Providing constant feedback and offering support will help in engaging the drug user towards solving the crisis the substance user may have. Having a non-judgemental attitude underpins social work along with empathy and advocacy (Trevithick, 2009). People with substance misuse are often viewed as less worthy and deserving. Stigmatisation can cause prejudice, marginalisation, discrimination and oppression and is often reinforced by the media and even our own families (Theory and practice, 2011). People who substance use are often stigmatised and feel shameful of it and can happen if the substance user has had several attempts. When you are ashamed of something and you disclose it, it is very hard especially if you're unsure as to how the other person is going to respond. It is important for myself to reflect upon my own value base and prejudices that I may have.
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