One of the biggest barriers to going into recovery from a substance use disorder (SUD) is stigmatization. Although now widely described as a chronic disease, addiction still carries a significant stigma for patients—even among healthcare professionals.
“Stigma on the part of healthcare providers who tacitly see a patient’s drug or alcohol problem as their own fault leads to substandard care or even to rejecting individuals seeking treatment,” warned the director of the National Institute on Drug Abuse (NIDA), Nora Volkow, M.D., on her blog in 2020. “People showing signs of acute intoxication or withdrawal symptoms are sometimes expelled from emergency rooms by staff fearful of their behavior or assuming they are only seeking drugs. People with addiction internalize this stigma, feeling shame and refusing to seek treatment as a result.” Health conditions ranging from cancer and AIDS to many mental illnesses may lead to some people avoiding those patients but addicted individuals are all too often actually blamed for their disease, “even though medicine long ago reached a consensus that addiction is a complex brain disorder with behavioral components,” as Dr. Volkow points out. But too many Americans, including many in the healthcare sector and the justice system, continue to view addiction as the consequence of moral weakness and flawed character.
Sean Fogler—a physician in recovery himself—encountered this prejudice firsthand.
“The stigma of addiction comes from the negative feelings that many healthcare professionals harbor for people struggling with substance use disorders, and their beliefs that poor personal choices, ‘moral failing,’ and defects of character are to blame for the disease. These feelings and beliefs mirror those of the general public,” wrote Fogler on Stat News in 2020.
Although they should know better, healthcare workers may actually shame people with addictions more than others do, according to Fogler. “A recent study exploring emergency physicians’ attitudes toward patients with substance use disorders found that the majority had lower regard for patients with substance use disorders than for patients with other conditions affecting behavioral health. Among physicians participating in the survey, only 10 percent agreed that they ‘enjoy giving extra time to patients like this.’ These physicians found it more rewarding to treat patients with obesity, diabetes, trauma, and even those with COPD who smoke.”
This is an unfortunate situation because addiction continues to be a significant health crisis in the United States and emergency departments can play an important role in referring SUD patients to appropriate treatment programs. For example, ERs could implement a screening process called SBIRT (screening, brief intervention, and referral to treatment). SBIRT can be performed in a variety of settings and does not have to be performed by a physician. SBIRT incorporates screening for all types of substance use with brief, tailored feedback, and advice. Simple feedback on risky behavior without judging can be a powerful impetus for changing patient behavior and engaging them with treatment programs.
“No one chooses to develop this disease,” explains the American Society of Addiction Medicine (ASAM). “Instead, a combination of genetic predisposition and environmental stimulus—analogous to other chronic diseases like diabetes and hypertension—can result in physical changes to the brain’s circuitry, which lead to tolerance, cravings, and the characteristic compulsive and destructive behaviors of addiction that are such a large public health burden for our nation.”
Stigmatizing people with addiction as morally derelict on the other hand is counterproductive and unprofessional.
“Stigma violates the right of people with addictions to be human, strips us of our dignity, and says to us that we have no value,” writes Fogler. “It evokes feelings of shame so deep they are hard to know unless you’ve experienced them. This isn’t the kind of shame that guides us or tells us we’ve made a mistake. It’s toxic shame, the shame that tells us we are the mistake—something those of us with this disease come to believe.”
Shaming and punishment are detrimental and will not address the needs of the patient or promote recovery. Addiction is a complex biopsychosocial disease requiring comprehensive evidence-based treatment methods. Many people with addiction misuse substances in an attempt to self-medicate underlying mood disorders.
Harmony Foundation is a dual-diagnosis-capable facility serving patients with SUD and co-occurring mental health disorders. Clients who are diagnosed with mental health issues—such as anxiety, depression, and other trauma-related responses—will meet with our mental health and medical staff to address medication management. We work with our clients to teach them healthy coping skills to help them manage their co-occurring issues.
Despite difficult circumstances, Harmony continues to serve patients during the COVID-19 pandemic and we are taking extra precautions to ensure staff and client safety. If you or a loved one are struggling with alcohol or drug addiction do not delay seeking treatment. If you have questions about our programs, call us at 970.432.8075 to get the help needed as soon as possible.