Stigma

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Stigma

• Dr. Oliver Aldridge
• Edinburgh, Midlothian East Lothian DTTO I and
  DTTO II

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Outline

• Theory
• Client
• Communication
• Agency
• Conclusions

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Stigma is here to stay

• Ancient Greeks physically scarred people to
  permanently mark them
• Today amputation of a finger to denote someone
  who is deemed to be a grass
• May be part of the survival mechanism of group
  living
• Some of the original driving force behind drugs
  legislation San Francisco 1865

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Stigma needs to be Managed
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Why do we stigmatise?

• Reciprocity
• Threat housing, benefits, treatment/support,
  theft, infecting others by introducing to
  drugs.
• Downward comparison
• Belief in a Just world/ Protestant Work Ethic
  you get what you deserve and you deserve what
  you get

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Stereotyping

• Drug users are bad parents
• Drug users are dishonest
• Drug users are manipulative
• Drug users are self-indulgent
• Drug users are wasters
• Drug users destroy communities
• Drug users choose to be drug users

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Linking Stereotyping Stigmatisation

• Stereotyping facilitates stigmatisation
• Stigmatisation encourages stereotyping
• May be linked to depersonalisation

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Client
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Individualise Management

• Needs to be openly discussed so that it can be
  managed on an individual level.
• Differing levels of stigma sensitivity between
  clients
• Cannot make automatic assumptions about the
  effect on a client
• Cannot make automatic assumptions about the main
  sources of stigma

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Complex Origins of Stigma

• Usually drug use is only one factor
• Poverty
• Poor education
• Unemployment
• Criminal record
• Drug taking
• Injecting
• Parenting

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Pre-drug History

• Difficult childhood
• Learning difficulties
• May contribute to feeling excluded
• Social acceptance may be sought in a marginalised
  peer group
• As part of that group, drug taking/experimenting
  may be the norm
• Effect of criminalising groups?

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Managing Stigma

• Physical Signs
• Treatment Stigmata
• Social Stigmata

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Physical

• Visible signs of drug use includeInjection
  sitesPoor dentitionPoor nutritionAppearing
  intoxicated/withdrawn
• Managing these appropriately may increase the
  range of options in managing stigma

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Kenny Rogers

• Youve got to know when to hold em..Know when
  to fold em..
• Managing disclosure is a highly individual,
  situation specific problem
• If stigma is not overtly discussed, it is not
  possible to devise an effective, individualised
  strategy to deal with it

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Risk of Entering Treatment

• Exposure of a previously, largely hidden level of
  drug use
• Loss of employment
• Peer group rejection
• Relationship breakdown
• Increased intervention e.g. Children Families
• Labelling
• Disempowerment
• Social Isolation

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Treatment Associated Stigma

• Local vs. Centralised treatment services pros
  and cons
• Failing to treat people holistically
• Perpetuating or increasing stigma in the
  treatment environment
• Recovery Abstinence
• Information sharing vs. raw data being
  communicated to people without specialist
  knowledge

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Treatment Options

• Some treatment options may feel less stigmatising
  to the client e.g. DHC vs. Methadone
• Treatment needs to have a solid evidence base and
  be effective and appropriate for the client at
  that time

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(No Transcript)
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Supervised Consumption of Methadone

• May be stigmatising
• Alterations to pharmacy may impact positively
• May reduce stigma
• Effect is individual and, therefore, policy
  should allow individual assessment/decision making

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Testing

• Method supervised urine collection processes
• Rationale is it being done to catch people?
• What is the context of a result?
• May help to combat negative attitudes

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Social Stigmata

• Complex issue
• Multilayered
• Stigmatisation may predate drug use
• Identity may be sought and found in a
  marginalised community
• Entry into treatment may risk stigmatisation by
  society at large and the marginalised community
• Social isolation may result

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Social Stigmata

• Wraparound care essential
• Helping people integrate into new social groups
• The role of ex-user does not work for everyone

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Education Communication
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• As specialist agencies we have a responsibility
  to provide good quality, objective information
  to
• Communities
• Media
• Government
• Professionals
• Students

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Aetiology of Addiction

• Views/hypotheses may impact on stigmatisation
• Is it better to be viewed as someone with a
  genetically determined problem or as someone with
  a social problem?

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Dissonance

• Facilitating appropriate contact with people who
  dont conform to stereotypical views may catalyse
  change
• Caveat Stigmatisation may paradoxically be
  increased by contact with someone who is
  massively different to the stereotypical view
• Does the exception prove the rule?

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Agency Stigmatisation
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Agency

• May be stigmatised by the communities in which it
  works NIMBYism
• Workers may need support e.g. outreach, needle
  exchange workers
• Related professionals/disciplines may stigmatise
  those who work in this field
• We may stigmatise each other by perpetuating
  false debates e.g. Harm Reduction vs. Abstinence
• Funding wars may increase stigmatisation by
  threatening survival

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Conclusions

• Stigma is here to stay we have to learn to
  manage it effectively
• Management of stigma has to be individualised
• Stigma cannot be dealt with if its not openly
  addressed
• Treatment can contribute to stigmatisation
  agencies need to consider this in service
  planning/delivery
• Commissioning needs to look at the range of
  treatment services available to increase choice
• Agencies have to play a positive role in
  educating/communicating