The Many Faces of Stigma: Impact on Substance Abuse Prevention

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The Many Faces of StigmaImpact on Substance
Abuse Prevention

• Deborah M. Galvin, Ph.D.
• APHA
• Boston, Massachusetts
• November, 15 2000

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Impact of Stigma in Substance Abuse Prevention

• The Stigma of Substance Abuse Can
• Reduce Participation in Prevention
• Lessen Positive Effects of Prevention
• Widen Gap between Research Application

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Impact of Stigma in Substance Abuse

• Stigma Can
• Lead to Increased Substance Abuse Increase
  Individual, Peer Group and Community Risk
• Decrease Resiliency

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Websters Definition of Stigma

• Something that detracts from the character or
  reputation of a person, group, etc. a mark of
  disgrace or reproach a mark, sigh, etc.
  indicating that something is not considered
  normal or standard

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Definition of Stigma

• Stigma is possessing undesirable, deeply
  discrediting attributes that disqualify one
  from full social acceptance and motivate efforts
  by the stigmatized individual to hide the mark
  when possible. Erving Goffman, Stigma,
  1963, p.1

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Definition of Stigma

• For stigma to persist, a language of
  relationships is required -- beyond individual
  attributes
• Erving Goffman, Stigma, 1963, p.1

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Types of Stigma

• Abominations of the body - physical defects
• Blemishes of individual character perceived as
  weak will, domineering/unnatural passions,
  treacherous rigid beliefs and dishonesty (e.g.,
  record of mental disorder, addiction,
  unemployment, sexual orientation, imprisonment,
  radical political behavior, etc.)
• Tribal - race, nation and religion transmitted
  through lineages and contaminate all members of
  the family
• Erving Goffman, Stigma. 1963, p. 4

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Images of Stigma

• 70 respondents favored denying employment to job
  applicants testing positive for drug use.
• 56 of respondents stated if an existing
  employee tested positive for drugs, the employer
  should terminate that person.
• 61 of respondents stated there are jobs which
  exist that are so safety-sensitive that substance
  abusers should never be allowed to be employed in
  such occupations.
• www.drugfreeworkplace.com (Institute for Drug
  Free Workplace) 1997

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Primary and Secondary Deviance

• Primary Deviance - Initial stigma is applied -
  person begins to employ his/her behavior or role
  based upon the stigma or label as a means of
  defense, attack or adjustment in response to
  societal reaction to him/her
• Secondary Deviance - ultimate acceptance of the
  stigma or label.
• Lemert, 1951
  Social Pathology. New York McGraw-Hill.pp
  76-77

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Societal Response to Label

• Indifferent - do nothing avoid it
• Welcome - herald it -- a way for society to
  advance
• Punitive - deterrent retributive measures
• Progressive - advocate intervention, treatment
  and therapeutic measures
• Stanley Cohen, Images of Deviance(Middlesex,
  England Penguin Books), 1971 p. 11

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Web of Influence
Teen-age Pregnancy
Teenage Suicide
Dropping out of School
Violent Crime
Alcohol and Other Drug Use
Stigma/Labeling interfaces with the Web of
Influence
Individual Based Risk Factors
Peer Group Based Risk Factors
School Based Risk Factors
Community Based Risk Factors
Family Based Risk Factors
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Universal Prevention

• Address general audiences without stigmatizing
  potential users
• Design prevention messages not to stigmatize
  substance abusers.
• To do prevention, eliminate stigma of substance
  abuse.

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Selected Prevention

• Groups, geographic areas and individuals at risk
  for substance abuse should not be addressed in a
  way which stigmatizes.
• By categorizing certain people in certain
  situations as high risk, be careful of creating
  the reality of a stigma and how our perceptions
  of others and the world are assumed.

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Indicated Prevention

• Caution in intervening not to stigmitize
• Self-fulfilling Prophecy of entering a program or
  service.
• Social perception and definition of the situation
  of what surrounds and follows the act or actor
• Focus on situational dynamics out of which
  meaning emerges

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Attention to Stigma Increases Prevention Success

• Tailor materials dissemination plans to enhance
  effectiveness with diverse populations.
• Eliminate stigma in meeting research or
  evaluation requirements.
• Enhance capacity building for providers to
  include training on stigma.