Joan always had a low opinion of addicts and never imagined she could one day be a substance abuser. She judged addicts harshly, believing they lacked both character and will power. The mother of two small children, she managed to balance family life and a job until her life unraveled after an automobile accident. She suffered a back injury for which her physician prescribed a strong opioid medication for thirty days. After another thirty day period her doctor declined to renew the prescription. Suddenly, like so many other Americans, Joan found herself addicted to pain medications. When she tried to stop using the drug her body cramped and she became irritable and even nauseous. She obsessed about her supply and began seeking pills from multiple doctors, then ordering medications online from Mexico and, a year after her accident, was seeking out heroin to stave her body’s craving. Shamed at her situation and feeling the heavy stigma of addiction, Joan tried to keep her drug habit a secret despite the fact that everyone knew something was seriously wrong.
As more Americans struggle with drug use it is essential that we accept addiction as a serious and treatable medical condition. The simplistic idea that someone can “just say no” has cost countless lives and stigmatized those who seemingly refuse to assert their will power, driving them underground and further away from help. Ironically, this stigma is internalized by addicts themselves, creating shame and isolation. I have many substance-abusing clients who believe they are deeply flawed and each one, like Joan, has been bewildered that this could have happened to them.
The addictive spiral has a life of its own, generating shame,
stigma, and discrimination
Stigma and addiction are intertwined at multiple levels. Experiencing stigma, whether based on race, ethnicity, gender identity, sexual orientation, or anything else, significantly heightens the risk of addiction. Psychologists describe a form of “cognitive escapism” in which people seek to avoid emotional pain with drugs or other addictive behaviors. Frequently, this increased risk of addiction co-occurs with trauma. Once dependence sets in, the addictive spiral has a life of its own, generating shame, stigma, and discrimination.
In addition to alcohol, two different drugs are currently fueling the crisis of addiction in the United States and forcing us to address substance abuse stigma. Opioid drugs, including pain medications and heroin, are devastating entire regions. Injection drug use, long disparaged by the general population and addicts alike, is now reaching epidemic levels and increasing the risk of HIV and hepatitis. In response to this public health emergency, several states are reluctantly confronting stigmatizing beliefs about addiction, including initiating needle exchange programs, a proven life-saving harm reduction method. Additionally, some jurisdictions are permitting individuals to keep Naloxone on hand, a medication that reverses the effects of a heroin overdose.
A second drug, methamphetamine, is also wreaking havoc. In rural American this drug is known as “poor man’s cocaine,” and is used to numb concerns about poverty, joblessness, and stigma. Among urban gay men, meth is used as a sex-enhancing drug. For both populations meth quickly creates havoc by destroying dopamine receptors in the brain that are essential for emotional stability. And in both rural and urban areas, the populations most at risk for meth typically experience layers of stigma. These include multiple stigmatized identities (such as disability, welfare, joblessness, sexual orientation, having HIV or hepatitis, among others) that compound the devastating effects of addiction, keeping people from admitting their problem or seeking help.
The deadly stigma of addiction has numerous consequences. Many addicts cannot get adequate medical care because healthcare professionals refuse to treat them and, despite parity laws, insurance carriers still discriminate by refusing to pay for such treatment. The “War on Drugs,” a flawed concept that has utterly failed, resulted in the criminalization of addictive behavior. In the United States most addicts receive “treatment” through the criminal justice system. Even in recovery, addicts cannot escape the stigma of substance abuse, indefinitely experiencing prejudice and living under a cloak of suspicion.
We are an addicted society and quickly need to face the realities of this healthcare crisis. Medical professionals need more training and we need to move the locus of treatment out of jails and prisons. Most of all, we need to understand that the addict whom we judge so harshly could very well be us.
David Fawcett, PhD, LCSW is a social worker, sex therapist, and clinical hypnotherapist with a practice in Ft. Lauderdale. He is the author of Lust, Men, and Meth: A Gay Man’s Guide to Sex and Recovery (Healing Path Press 2015). He is a trainer for the SAMHSA-funded National HIV/AIDS Training Research Center and serves on various local and national boards. He is columnist and contributor to TheBody.com, TheBodyPRO.com, The Huffington Post, and other journals. Learn more at www.david-fawcett.com.