The American Medical Association (AMA) officially called alcoholism a disease in 1956, and the American Society of Addiction Medicine (ASAM) published an extended definition of addiction in 2011 that described it as a primary and chronic disease of brain reward, motivation and memory. The National Institute of Drug Abuse (NIDA) adds that addiction is a disease because it produces long-lasting changes in the structure of the brain and how it works. Despite the preponderance of clinical consensus and data establishing addiction as a disease, stigma still abounds characterizing addicts as people of flawed moral character and weak will power. Understanding addiction as a neurobiological disease is an important step in improving treatment rates and battling stigma, but continuing misconceptions about substance abuse highlight how deeply embedded stigma is in American culture.
History of Addiction Stigma
In the nineteenth century Sears & Roebuck sold cocaine, heroin and opium, and Bayer marketed heroin as a cough medicine. At the time these substances were largely legal, unregulated and available. The Civil War dramatically increased opiate abuse, but racist associations in the media arguably played the biggest role in laying the foundation for addiction stigma. Tragically publications like the New York Times and the Journal of the American Medical Association wrote that cocaine abuse in the South drove African-Americans to commit horrible acts. Similarly expat Asian communities took the brunt of the blame for the opiate problem though opiates were widely prescribed for female health issues leading to high addiction rates and gender-related stigma.
Highlighting the racism behind early stigmatization, Dr. Hamilton Wright, an early anti-drug crusader and US Opium Commissioner, argued that cocaine drove African-Americans to sexually assault Caucasian women and opiates drove Caucasian women to cohabitate with Chinese men. Later, during World War I, the New York Times and others argued that the Germans were somehow behind the rising rates of substance abuse and sobriety, implying it was unpatriotic to consume drugs or alcohol. Media sensationalism designed to sell newspapers also played a stigmatizing role, and this continues today with media obsession over celebrity substance abuse. A well-known example of baseless sensationalism was the 1930s film Reefer Madness that suggested marijuana use led to violence, suicide, sexual assault and insanity.
Much of addiction stigma is sadly rooted in its use as a tool of racial suppression, and even today many people argue that drug-related criminal punishment is overwhelmingly aimed at ethnic minorities. With the help of testimony from Dr. Wright, the U.S. government passed the Harrison Narcotics Tax Act in 1914, which heavily regulated the availability of opiates and cocaine. More legislation and organizations followed such as the Federal Bureau of Narcotics in 1930, and drug abuse was progressively punished more severely. In recent decades the War on Drugs established the idea of addiction as a criminal act rather than a public health issue, and the unfortunate result was higher incarceration rates as substance abuse rates continued to climb. Other stigmatizing influences include improper addiction education in schools and religious faiths that condemn any substance use as morally evil.
The Dangers of Addiction Stigma
Arguably the most dangerous aspect of stigma is its power to discourage addicts from acknowledging the problem and getting help. Considering the racial roots of early stigma, this risk is particularly high with certain cultures. For example the Psychiatry (Edgmont) journal published an addiction study on Asian-American Pacific Islanders (AAPI) in 2007, and it noted that AAPI substance abuse rates are similar to the national average despite the perception that the ethnic group abuses drugs and alcohol less. The study argued that their culture strongly associates addiction with shame and discrimination, and hence they make greater efforts to hide it. Similarly the 2004 study “Gender Differences and their Implications for Substance Use Disorder Treatment” found that women are also more likely to hide substance abuse because the stigma is typically more negative for women than men especially among ethnic minorities. Contributing to gender-related stigma is the association of female addiction with prostitution. Addiction stigma also played a role in several other damaging issues including the following:
- Recent legislation was needed to stop addiction discrimination in the health care system.
- Convicted non-violent drug users are limited in future employment and benefits.
- Recovering addicts often feel shame and experience suspicion in their social circles.
- Failures to stopping using without help reinforce stereotypes about weakness.
Addicts often need social support and encouragement to enter treatment, and support networks are essential during the recovery. Unfortunately the Journal of Social Work noted in 2009 that people who embrace stigmatizing stereotypes are less likely to assist an addict and more likely to avoid them. Nevertheless the American Journal of Psychiatry in 2010 found that more people now accept that addiction is a neurological disease and are more supportive of treatment, yet the study added that stigma remains a major problem.
Substance Abuse Help
Whatever stigma might exist pales in comparison to the damage that ongoing substance abuse can cause to users, their families and society at large. Professional rehab provides the most effective recovery treatments available, which potentially include behavioral and motivational therapies, integrated mental health care, release-prevention strategies and life tools like anger/stress management. Rehab also utilizes scientific explanations to expose the baselessness of most stigmas.
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