Stigma, Addiction and Recovery

Here is the section ‘Overcoming Stigma’ in my article Factors That Facilitate Addiction Recovery on this website. I have followed it with links to various of my blog posts relating to other people’s work on stigma which I have featured on this website. I hope you find this content of interest and help.

‘Stigma can be defined as social disapproval of personal characteristics, actions or beliefs that go against the cultural norm. It can occur at a variety of levels in society, i.e. individuals, groups, organisations and systems. A person can be labelled by their problem (e.g. addiction to drugs and/or alcohol) and they are no longer seen as an individual, but as part of a stereotyped group, e.g. a ‘junkie’, ‘alkie’, etc. Negative attitudes and beliefs toward this group create prejudice which leads to negative actions and discrimination.

For example, people addicted to heroin are often considered to be carriers of hepatitis C and other blood-borne viruses, thieves who rob old ladies of their handbags, and dirty, weak-willed junkies who will never get over their problems.

‘Once a junkie, always a junkie’ is a saying I’ve even heard in discussions amongst drug treatment agency workers. Our Wired In research has not only shown the strong prejudice that exists towards heroin users, but also towards recovering heroin addicts.

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The Four Walls: Mark Ragins

Here’s another great blog from one of my favourite psychiatrists, Mark Ragins of The Village fame. I first posted this article that Mark wrote on Recovery Stories back in October 2013.  Mark wrote the original article in 1998. [NB. I have broken up some of the original paragraphs to make it easier to read online.]

‘In 1989, the California State Legislature authorized the funding for three model mental health programs, including the Village Integrated Service Agency in Long Beach, in part to answer the question, “Does anything work?”

We created a radical departure from traditional mental health services basing our entire system on psychosocial rehabilitation principles, quality of life outcomes and community integration. Arguably, we have created the most comprehensive, integrated and effective recovery based mental health program anywhere.

In recent years, encouraged by our success, both our attention and the legislature’s have turned to the further question of “How can our whole system be more like the Village?” Undoubtedly, there are numerous serious beaurocratic, funding, and system design issues relevant to that question, but I would like to focus on the personal issues staff must face.

I believe that basing mental health services on recovery is the paradigm shift that can finally make the dream of deinstitutionalization a reality.

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It’s Not Just About the Drug

The effects of a drug depend on an interaction between drug, person (set)  and social context (setting). These three factors also influence the likelihood of addiction and recovery from addiction (2,662 words).

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Stopping Heroin Use Without Treatment

Research by Patrick Biernacki reveals important insights into how people recover from heroin addiction. It also illustrates the major challenges that people with a heroin addiction face on their journey to recovery (2,283 words). 

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Bill White on Stigma and the Recovery Advocacy Movement

Here is a powerful 2014 film clip on the Faces & Voices of Recovery Vimeo channel from leading addiction recovery advocate Bill White about stigma and how we can tackle the problem.

‘Almost everyone in America know someone in recovery. The problem historically is that they did not know they were in recovery which means that they can continue to maintain incredible stereotypes about who are the people who develop alcohol and other drug problems in this country and who are the people who recover and don’t recover.

There are a lot of issues about stigma that I cannot educate you out of. I can give you all the facts. I can read all the books to you. I can show you documentaries but nothing is going to change that embedded prejudice until you encounter personally someone in recovery who means something to you and hear their story.’

William (Bill) White is Emeritus Senior Research Consultant, Chestnut Health Systems. He has served as a volunteer consultant to Faces & Voices of Recovery since its founding. He has a Master’s degree in Addiction Studies and has worked in the addictions field since 1969. He has authored or coauthored more than 350 articles and monographs and fifteen books including Slaying the Dragon: The History of Addiction Treatment and Recovery in America and Let’s Go Make Some History: Chronicles of the New Addiction Recovery Advocacy Movement. Check out an online library of his writings at williamwhitepapers.com. Faces & Voices of Recovery, 2014. [5’44”]

Kevin and Kerry’s Recovery Story: ‘A Family’s Journey’, Part 2

Kevin’s hospitalisation with septicaemia acts as a turning point and a process of recovery begins for the family as a whole. (6,933 words)

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Fighting Stigma and Discrimination When Recovering From Problem Drug Use

Yesterday, I described the difficulty that people recovering from problem drug use face in becoming accepted by mainstream society. They are shunned and socially excluded at a time they need to reintegrate into mainstream society in order to facilitate their recovery and allow them to live a normal life. Here is a related story.

Early in February 2008, I attended with my colleagues Lucie James and Kevin Manley, the first Drink and Drugs News (DDN) / Alliance Service User Conference, which was organised by Claire Brown and Ian Ralph of DDN and held in Birmingham. Around 500 people attended, two-thirds of them service users, a very successful conference.

Lucie, Kevin and I enjoyed our day and made some new friends. A special issue of DDN, which was the leading UK magazine focused on drug and alcohol treatment, was devoted to the conference. Prejudice towards service users was obviously an issue that was discussed during the afternoon’s discussion tables.

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Revised ‘Steps to Reintegration’ Model by Julian Buchanan

In an earlier series of blog posts starting here, I highlighted Julian Buchanan’s classic paper Tackling Problem Drug Use: A New Conceptual Framework in which he describes his ‘Steps to Reintegration’ Model, a model which I consider to be both very pertinent and important.

Julian’s paper is based on his twenty years of research and practice with dependent drug users in Liverpool, England. It draws upon three separate qualitative research studies that involved semi-structured interviews with 200 problem drug users. The studies sought to ascertain the views, suggestions and experiences of drug users in respect of what was helping or hindering them from giving up a drug-dominated lifestyle.

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‘It doesn’t work for everyone’—a take on 12-step approaches, by DJMac

Yesterday, I was going through old Recovery Stories blogs (from the period 2013/4) when I came across this gem. It’s a guest blog by a GP who gives a personal view on professional perspectives of mutual aid. No doubt, it is just as relevant today as it was then.

“‘Astonished’
I was astonished the first time I was taken to an NA meeting. I mean, really gobsmacked—you could have knocked me off my seat. The room was full of recovering heroin addicts; something I’d never seen in my 20 years (at that time) in practice.

I was both excited—at the possibilities—and ashamed at the fact that I didn’t know such places existed. It curls my toes to think of it now, but I had not referred my patients to them. That was a while back.

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Learning From Wired In To Recovery

As part of our Wired In strategy, my colleagues and I launched the Wired In To Recovery online community in November 2008. Our initial aims with Wired In To Recovery were to:

  • Highlight role models who show that recovery from addiction is possible, and illustrate the multitude of paths to recovery.
  • Provide information and tools that help people better understand and use the options they have to overcome the problems caused by their own, or a loved one’s, substance use.
  • Create an environment in which people can inspire and learn from each other and provide mutually beneficial support.
  • Establish a ‘people’s journalism’, or Voice of Recovery, which acts as a strong source of advocacy both for recovery and the Recovery Movement.
  • Identify key individuals who would join, or collaborate with, Wired In to help us realise our ambitions.

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Learning About Addiction Treatment, Part 8

In my third blog post focusing on what I learnt from the treatment agency BAC O’Connor back in 2004, I focus on two themes. Firstly, how staff deal with people who relapse during the treatment programme. Secondly, how the agency works with ‘clients’ to help them integrate (back) into their community.

BAC O’Connor were more realistic about relapse than many other treatment agencies. Relapse was considered part-and-parcel of the recovery process, and was an issue that was addressed in a pragmatic and humanistic manner. Clients who continually relapsed and left the Centres were always given the opportunity to return and receive the help they needed. Noreen Oliver said to me:

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Factors Facilitating Recovery: Overcoming Stigma

This is eighth post in this particular Series, which comes from my book Our Recovery Stories: Journeys from Drug and Alcohol AddictionIt ties in nicely with a previous blog, Nothing to mourn; just a drug addict, by Dr David McCartney.

Stigma can be defined as social disapproval of personal characteristics, actions or beliefs that go against the cultural norm. It can occur at a variety of levels in society, i.e. individuals, groups, organisations and systems. A person can be labelled by their problem (e.g. addiction to drugs and/or alcohol) and they are no longer seen as an individual, but as part of a stereotyped group, e.g. a junkie, alkie, etc. Negative attitudes and beliefs toward this group create prejudice which leads to negative actions and discrimination. 

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‘Nothing to mourn; just a drug addict’ by Dr David McCartney

When I developed Wired In and worked in the addiction recovery field, I was living in South Wales. When my daughter Annalie was in medical school in Edinburgh, I used to fly up from Cardiff to visit her. I soon came to love Edinburgh. That positive feeling for the city increased greatly when I met Dr David McCartney.

David ran Lothians and Edinburgh Abstinence Programme (LEAP), a programme that offered structured treatment based in the community using a blend of evidence-based interventions. The patient group in treatment operated as a therapeutic community. David was in recovery himself. I loved visiting LEAP every time I was in Edinburgh, and meeting the patients and staff. I’d sit in on group sessions and spend time talking to the patients. David and I became good friends and I hold him in the highest regard.

I’ve recently been checking out David’s blog on Recovery Review. He writes so well and covers a number of key themes relating to addiction recovery. Here is David’s latest post, ‘Nothing to mourn; just a drug addict’, focused on the issue of stigma.

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It’s Not Just About the Drug, Part 3

I continue my series of blog posts focused on drug, set (the person) and setting (the social context) [Part 1 is here]. Drug, set and setting is not only of relevance to addiction, but also to overcoming addiction.

The path into and out of addiction
The ‘person’ and ‘social context’ factors influence early substance use and the likelihood that a person will develop problematic use and addiction. In general, individuals are less likely to develop substance use problems if they have fewer complicating life problems, more resources (social, personal, educational, economic), and opportunities for alternative sources of reward.

One explanation is that these individuals develop a weaker attachment to the substance in that for them substance use does not serve as many emotional, psychological or social needs.

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‘Stigma and Service Integration’ by Bill White

Stigma and Service Integration ImageIn his latest blog, Bill White emphasises the importance of Recovery Stories and their value in tackling stigma.

‘One of the emerging trends of U.S. health care reform is the tri-directional integration of addiction treatment, mental health services, and primary health care.  This is evident in the growing integration of addiction and psychiatric treatment under the rubric of “behavioral health care,” efforts to integrate primary health care within addiction treatment settings, and increased delivery of addiction-related services within primary health care settings, e.g., physician offices, health clinics, and hospitals.

Considerable resources have been invested in creating policy frameworks for such integration (e.g., provisions for office-based treatment of opioid dependence) and developing technological innovations (e.g., screening, assessment, and treatment protocol) to facilitate such integration, but history would suggest a far greater obstacle to service integration:  social and professional stigma.

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‘People with psych labels suffer discrimination: mental health professionals are often guilty of such prejudice’ by Monica Cassani

Epiphany - 2014-03-23_240560_sense-of-place.jpgExcellent posting from one of my favourite blogs.

‘People with psychiatric labels suffer discrimination that is not only demeaning but can also be dangerous.

A 2007 UK study by the Royal College of Psychiatrists revealed that prejudicial treatment of mentally ill patients extends to physical medical care; they receive poorer quality of care and doctors spend less time with them possibly leading to higher rates of death and preventable disease.

Though tragic, the more scandalous aspect of the phenomena is the fact that mental health professionals apply the same prejudices to those whom they attempt to treat. The worst thing someone in mental distress can experience is dehumanizing treatment from other human beings who are supposed to be caring for them.

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Bill White on Stigma and the New Recovery Movement

UnknownHere is a really powerful film clip from Bill White. Please pass the link on.

“Almost everyone in America know someone in recovery. The problem historically is that they did not know they were in recovery which means that they can continue to maintain incredible stereotypes about who are the people who develop alcohol and other drug problems in this country and who are the people who recover and don’t recover.

There are a lot of issues about stigma that I cannot educate you out of. I cam give you all the facts. I can read all the books to you. I can show you documentaries but nothing is going to change that embedded prejudice until you encounter personally someone in recovery who means something to you and hear their story.”

‘Beautiful Boy: More Than An Addict’ by Jim Contopulos

The beauty of the Santa Rosa Ecological Reserve in southern California provides the backdrop for a father’s lament upon losing his beautiful son to addiction and mental illness.

Walk alongside him, as together, we who survive dream of a better day, sustained and inspired by the pain, brokenness and courage of those who live with the unrelenting weight of mental illness and addiction.

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The culture of addiction: Part 2

IMG_2586The second part of this series focuses on the impact of legal status on drug culture. Click here for part one.

Society makes judgements about different types of psychoactive drug. As Bill White points out in his book Pathways from the Culture of Addiction to the Culture of Recovery, the social status and value attached to a particular drug by society influence several things:

  • The risks associated with use of the drug
  • The organisation of ‘tribes’ within the culture of addiction
  • The characteristics of each tribe and the impairments that members experience from both the drug and the culture itself.

 Clearly, there are likely to be differences in a variety of factors for drugs that are legal (e.g. alcohol) and those that are prohibited by law (e.g. heroin).

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‘Standing on the outside: Looking in’ by Aurelius

P4091276‘Firstly, I want to thank all of the site [Wired In To Recovery] members who have taken the time to comment on my wife’s posts/queries (Whiplashgirlchild). Your perspective (and objectivity) have really seemed to help her on days when everything just stacks up and turns bad.

I met my partner just as she was working her way off subutex. She had a decade of hardcore use under her belt and almost another decade on MMT/Subutex.

I had (have) a lot to learn about the nature of addiction and the meandering paths of recovery. I have had a steep learning curve, trying to understand the stigma and prejudice that she has had to endure during the years of struggle to get free of ‘the fog’ as she likes call it.

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