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Chapter 13 - Reducing Substance Use Stigma in Health Care

Published online by Cambridge University Press:  23 June 2022

By
Sven Speerforck  and
Georg Schomerus
Edited by
Georg Schomerus  and
Patrick William Corrigan
Georg Schomerus
Affiliation:
Universität Leipzig
Patrick William Corrigan
Affiliation:
Illinois Institute of Technology
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Summary

Although health care is generally designed to help people, it has the potential to effectively impede recovery for people using substances by obvious and subtle discrimination. Stigmatizing attitudes among health professionals are common, regularly expected by people who use substances and potentially reduce quality of delivered clinical care. The power gradient that drives stigma and discriminatory behavior is particularly palpable in the healthcare setting and prevalent within different clinical situations like emergency medicine, primary care, and the psychiatric ward as within language. Comprising the current evidence of interventions, specific clinical settings and language regarding substance use stigma, we suggest recommendations for changes in clinical practice. Professionals need to avoid inflicting very real harm by increasing shame and reducing self-worth through stigmatizing settings, language, and concepts. Reducing substance use stigma is an integral and profoundly important part of caring for people who use substances and should be considered as such.

Keywords

Addictionhealth carealcoholprofessionalsinterventionlanguage
Type
Chapter
Information
The Stigma of Substance Use Disorders , pp. 232 - 251
Publisher: Cambridge University Press
Print publication year: 2022

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References

Ashford, R. D., Brown, A. M., & Curtis, B. (2018). Substance use, recovery, and linguistics: The impact of word choice on explicit and implicit bias. Drug and Alcohol Dependence, 189, 131–138. https://doi.org/10.1016/j.drugalcdep.2018.05.005Google Scholar
Bertholet, N., Daeppen, J.‑B., Wietlisbach, V., Fleming, M., & Burnand, B. (2005). Reduction of alcohol consumption by brief alcohol intervention in primary care: Systematic review and meta-analysis. Archives of Internal Medicine, 165(9), 986–995. https://doi.org/10.1001/archinte.165.9.986Google Scholar
Biancarelli, D. L., Biello, K. B., Childs, E., et al. (2019). Strategies used by people who inject drugs to avoid stigma in healthcare settings. Drug and Alcohol Dependence, 198, 80–86. https://doi.org/10.1016/j.drugalcdep.2019.01.037Google Scholar
Botticelli, M. P., & Koh, H. K. (2016). Changing the language of addiction. JAMA, 316(13), 1361–1362. https://doi.org/10.1001/jama.2016.11874Google Scholar
Brener, L., von Hippel, W., von Hippel, C., Resnick, I., & Treloar, C. (2010). Perceptions of discriminatory treatment by staff as predictors of drug treatment completion: Utility of a mixed methods approach. Drug and Alcohol Review, 29(5), 491–497. https://doi.org/10.1111/j.1465-3362.2010.00173.xGoogle Scholar
Broyles, L. M., Binswanger, I. A., Jenkins, J. A., et al. (2014). Confronting inadvertent stigma and pejorative language in addiction scholarship: A recognition and response. Substance Abuse, 35(3), 217–221. https://doi.org/10.1080/08897077.2014.930372Google Scholar
Corrigan, P. W., Watson, A. C., & Barr, L. (2006). The self-stigma of mental illness: Implications for self-esteem and self-efficacy. Journal of Social and Clinical Psychology, 25(8), 875–884. https://doi.org/10.1521/jscp.2006.25.8.875Google Scholar
Crowley, R. A., & Kirschner, N. (2015). The integration of care for mental health, substance abuse, and other behavioral health conditions into primary care: Executive summary of an American College of Physicians position paper. Annals of Internal Medicine, 163(4), 298–299. https://doi.org/10.7326/M15-0510Google Scholar
Curtis, J., & Harrison, L. (2001). Beneath the surface: Collaboration in alcohol and other drug treatment. An analysis using Foucault’s three modes of objectification. Journal of Advanced Nursing, 34(6), 737–744. https://doi.org/10.1046/j.1365-2648.2001.01803.xGoogle Scholar
Dannatt, L., Ransing, R., Calvey, T., et al. (2021). The impact of stigma on treatment services for people with substance use disorders during the COVID-19 pandemic: Perspectives of NECPAM members. Frontiers in Psychiatry, 12, Article 634515. https://doi.org/10.3389/fpsyt.2021.634515Google Scholar
Deans, C., & Soar, R. (2005). Caring for clients with dual diagnosis in rural communities in Australia: The experience of mental health professionals. Journal of Psychiatric and Mental Health Nursing, 12(3), 268–274. https://doi.org/10.1111/j.1365-2850.2005.00830.xGoogle Scholar
Earnshaw, V. A. (2020). Stigma and substance use disorders: A clinical, research, and advocacy agenda. The American Psychologist, 75(9), 1300–1311. https://doi.org/10.1037/amp0000744Google Scholar
Earnshaw, V., Smith, L., & Copenhaver, M. (2013). Drug addiction stigma in the context of methadone maintenance therapy: An investigation into understudied sources of stigma. International Journal of Mental Health and Addiction, 11(1), 110–122. https://doi.org/10.1007/s11469-012-9402-5Google Scholar
Feeney, L., Jordan, I., & McCarron, P. (2013). Teaching recovery to medical students. Psychiatric Rehabilitation Journal, 36(1), 35–41. https://doi.org/10.1037/h0094745Google Scholar
Flanagan, E. H., Buck, T., Gamble, A., Hunter, C., Sewell, I., & Davidson, L. (2016). “Recovery speaks”: A photovoice intervention to reduce stigma among primary care providers. Psychiatric Services (Washington, D.C.), 67(5), 566–569. https://doi.org/10.1176/appi.ps.201500049Google Scholar
Fogler, S. (2020, December 8). As a physician and a patient, I’ve seen the damage caused by the stigma of addiction. It must end. STAT. www.statnews.com/2020/12/08/stigma-weaponized-helps-fuel-addiction-crisis/Google Scholar
Goodyear, K., Haass-Koffler, C. L., & Chavanne, D. (2018). Opioid use and stigma: The role of gender, language and precipitating events. Drug and Alcohol Dependence, 185, 339–346. https://doi.org/10.1016/j.drugalcdep.2017.12.037Google Scholar
Hannah Arendt Center for Politics and Humanities. (2015). Benjamin Lee Whorf’s thoughts on thinking: On language. https://hac.bard.edu/amor-mundi/benjamin-lee-whorfs-thoughts-on-thinking-on-language-2015-03-25#:~:text=%E2%80%9CLanguage%20shapes%20the%20way%20we,what%20we%20can%20think%20about.%E2%80%9DGoogle Scholar
Hayes, S. C., Bissett, R., Roget, N., et al. (2004). The impact of acceptance and commitment training and multicultural training on the stigmatizing attitudes and professional burnout of substance abuse counselors. Behavior Therapy, 35(4), 821–835. https://doi.org/10.1016/S0005-7894(04)80022-4Google Scholar
Hazell, C. M., Koc, Y., O’Brien, S., Fielding-Smith, S., & Hayward, M. (2021). Enhancing mental health awareness in emergency services (the ENHANcE I project): Cross-sectional survey on mental health stigma among emergency services staff. BJPsych Open, 7(3), E77. https://doi.org/10.1192/bjo.2021.37Google Scholar
Henderson, C., Noblett, J., Parke, H., et al. (2014). Mental health-related stigma in health care and mental health-care settings. The Lancet: Psychiatry, 1(6), 467–482. https://doi.org/10.1016/S2215-0366(14)00023-6Google Scholar
Horner, G., Daddona, J., Burke, D. J., Cullinane, J., Skeer, M., & Wurcel, A. G. (2019). “You’re kind of at war with yourself as a nurse”: Perspectives of inpatient nurses on treating people who present with a comorbid opioid use disorder. PLoS ONE, 14(10), e0224335. https://doi.org/10.1371/journal.pone.0224335Google Scholar
Kelly, J. F., Dow, S. J., & Westerhoff, C. (2010). Does our choice of substance-related terms influence perceptions of treatment need? An empirical investigation with two commonly used terms. Journal of Drug Issues, 40(4), 805–818. https://doi.org/10.1177/002204261004000403Google Scholar
Kelly, J. F., Saitz, R., & Wakeman, S. (2016). Language, substance use disorders, and policy: The need to reach consensus on an “addiction-ary.” Alcoholism Treatment Quarterly, 34(1), 116–123. https://doi.org/10.1080/07347324.2016.1113103Google Scholar
Kelly, J. F., Wakeman, S. E., & Saitz, R. (2015). Stop talking ‘dirty’: Clinicians, language, and quality of care for the leading cause of preventable death in the United States. The American Journal of Medicine, 128(1), 8–9. https://doi.org/10.1016/j.amjmed.2014.07.043Google Scholar
Kelly, J. F., & Westerhoff, C. M. (2010). Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms. The International Journal on Drug Policy, 21(3), 202–207. https://doi.org/10.1016/j.drugpo.2009.10.010Google Scholar
Khenti, A., Bobbili, S. J., & Sapag, J. C. (2019). Evaluation of a pilot intervention to reduce mental health and addiction stigma in primary care settings. Journal of Community Health, 44(6), 1204–1213. https://doi.org/10.1007/s10900-019-00706-wGoogle Scholar
Link, B. G., & Phelan, J. (2014). Stigma power. Social Science & Medicine, 103, 24–32. https://doi.org/10.1016/j.socscimed.2013.07.035Google Scholar
Livingston, J. D. (2020). Structural stigma in health-care contexts for people with mental health and substance use issues: A literature review. www.researchgate.net/profile/james-livingston/publication/341945036_structural_stigma_in_health-care_contexts_for_people_with_mental_health_and_substance_use_issues_a_literature_review/links/5eda7dcc299bf1c67d42177e/structural-stigma-in-health-care-contexts-for-people-with-mental-health-and-substance-use-issues-a-literature-review.pdfGoogle Scholar
Livingston, J. D., Milne, T., Fang, M. L., & Amari, E. (2012). The effectiveness of interventions for reducing stigma related to substance use disorders: A systematic review. Addiction (Abingdon, England), 107(1), 39–50. https://doi.org/10.1111/j.1360-0443.2011.03601.xGoogle Scholar
Luoma, J. B., Kohlenberg, B. S., Hayes, S. C., Bunting, K., & Rye, A. K. (2008). Reducing self-stigma in substance abuse through acceptance and commitment therapy: Model, manual development, and pilot outcomes. Addiction Research & Theory, 16(2), 149–165. https://doi.org/10.1080/16066350701850295Google Scholar
Marchand, K., Beaumont, S., Westfall, J., et al. (2019). Conceptualizing patient-centered care for substance use disorder treatment: Findings from a systematic scoping review. Substance Abuse Treatment, Prevention, and Policy, 14(1), 37. https://doi.org/10.1186/s13011-019-0227-0Google Scholar
Martins, R. K., & McNeil, D. W. (2009). Review of motivational interviewing in promoting health behaviors. Clinical Psychology Review, 29(4), 283–293. https://doi.org/10.1016/j.cpr.2009.02.001Google Scholar
Mejia-Lancheros, C., Lachaud, J., O’Campo, P., et al. (2020). Trajectories and mental health-related predictors of perceived discrimination and stigma among homeless adults with mental illness. PLoS ONE, 15(2), e0229385. https://doi.org/10.1371/journal.pone.0229385Google Scholar
Mendiola, C. K., Galetto, G., & Fingerhood, M. (2018). An exploration of emergency physicians’ attitudes toward patients with substance use disorder. Journal of Addiction Medicine, 12(2), 132–135. https://doi.org/10.1097/ADM.0000000000000377Google Scholar
Morawska, A., Fletcher, R., Pope, S., Heathwood, E., Anderson, E., & McAuliffe, C. (2013). Evaluation of mental health first aid training in a diverse community setting. International Journal of Mental Health Nursing, 22(1), 85–92. https://doi.org/10.1111/j.1447-0349.2012.00844.xGoogle Scholar
Nieweglowski, K., Corrigan, P. W., Tyas, T., et al. (2018). Exploring the public stigma of substance use disorder through community-based participatory research. Addiction Research & Theory, 26(4), 323–329. https://doi.org/10.1080/16066359.2017.1409890Google Scholar
Nyblade, L., Stockton, M. A., Giger, K., et al. (2019). Stigma in health facilities: Why it matters and how we can change it. BMC Medicine, 17(1), 25. https://doi.org/10.1186/s12916-019-1256-2Google Scholar
Paquette, C. E., Syvertsen, J. L., & Pollini, R. A. (2018). Stigma at every turn: Health services experiences among people who inject drugs. The International Journal on Drug Policy, 57, 104–110. https://doi.org/10.1016/j.drugpo.2018.04.004Google Scholar
Peckover, S., & Chidlaw, R. G. (2007). Too frightened to care? Accounts by district nurses working with clients who misuse substances. Health & Social Care in the Community, 15(3), 238–245. https://doi.org/10.1111/j.1365-2524.2006.00683.xGoogle Scholar
Probst, C., Manthey, J., Martinez, A., & Rehm, J. (2015). Alcohol use disorder severity and reported reasons not to seek treatment: A cross-sectional study in European primary care practices. Substance Abuse Treatment, Prevention, and Policy, 10(1), 32. https://doi.org/10.1186/s13011-015-0028-zGoogle Scholar
Rehm, J., Mathers, C., Popova, S., Thavorncharoensap, M., Teerawattananon, Y., & Patra, J. (2009). Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. The Lancet, 373(9682), 2223–2233. https://doi.org/10.1016/S0140-6736(09)60746-7Google Scholar
Renner, J. A. (2019). Counteracting the effect of stigma on education for substance use disorders. Focus (American Psychiatric Publishing), 17(2), 134–140. https://doi.org/10.1176/appi.focus.20180039Google Scholar
Richter, L., & Foster, S. E. (2014). Effectively addressing addiction requires changing the language of addiction. Journal of Public Health Policy, 35(1), 60–64. https://doi.org/10.1057/jphp.2013.44Google Scholar
Schomerus, G., Bauch, A., Elger, B., et al. (2017). Das Stigma von Suchterkrankungen verstehen und überwinden [Understanding and overcoming the stigma of substance use disorders]. SUCHT, 63(5), 253–259. https://doi.org/10.1024/0939-5911/a000501Google Scholar
Schomerus, G., Baumann, E., Sander, C., Speerforck, S., & Angermeyer, M. C. (2021). Some good news for psychiatry: Resource allocation preferences of the public during the COVID-19 pandemic. World Psychiatry: Official Journal of the World Psychiatric Association (WPA) [accepted for publication].Google Scholar
Schomerus, G., Corrigan, P. W., Klauer, T., Kuwert, P., Freyberger, H. J., & Lucht, M. (2011). Self-stigma in alcohol dependence: Consequences for drinking-refusal self-efficacy. Drug and Alcohol Dependence, 114(1), 12–17. https://doi.org/10.1016/j.drugalcdep.2010.08.013Google Scholar
Simon, R., Snow, R., & Wakeman, S. (2020). Understanding why patients with substance use disorders leave the hospital against medical advice: A qualitative study. Substance Abuse, 41(4), 519–525. https://doi.org/10.1080/08897077.2019.1671942Google Scholar
Stone, E. M., Kennedy-Hendricks, A., Barry, C. L., Bachhuber, M. A., & McGinty, E. E. (2021). The role of stigma in U.S. primary care physicians’ treatment of opioid use disorder. Drug and Alcohol Dependence, 221, 108627. https://doi.org/10.1016/j.drugalcdep.2021.108627Google Scholar
Stone, R. (2015). Pregnant women and substance use: Fear, stigma, and barriers to care. Health & Justice, 3(1), 1–15. https://doi.org/10.1186/s40352-015-0015-5Google Scholar
Toftdahl, N. G., Nordentoft, M., & Hjorthøj, C. (2016). Prevalence of substance use disorders in psychiatric patients: A nationwide Danish population-based study. Social Psychiatry and Psychiatric Epidemiology, 51(1), 129–140. https://doi.org/10.1007/s00127-015-1104-4Google Scholar
van Boekel, L. C., Brouwers, E. P. M., van Weeghel, J., & Garretsen, H. F. L. (2013). Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: Systematic review. Drug and Alcohol Dependence, 131(1–2), 23–35. https://doi.org/10.1016/j.drugalcdep.2013.02.018Google Scholar
van Boekel, L. C., Brouwers, E. P. M., van Weeghel, J., & Garretsen, H. F. L. (2016a). Experienced and anticipated discrimination reported by individuals in treatment for substance use disorders within the Netherlands. Health & Social Care in the Community, 24(5), e23–e33. https://doi.org/10.1111/hsc.12279Google Scholar
van Boekel, L. C., Brouwers, E. P. M., van Weeghel, J., & Garretsen, H. F. L. (2016b). Inequalities in healthcare provision for individuals with substance use disorders: Perspectives from healthcare professionals and clients. Journal of Substance Use, 21(2), 1–8. https://doi.org/10.3109/14659891.2014.980860Google Scholar
Wakeman, S. E. (2013). Language and addiction: Choosing words wisely. American Journal of Public Health, 103(4), e1–e2. https://doi.org/10.2105/AJPH.2012.301191Google Scholar
Wakeman, S. E. (2017). Medications for addiction treatment: Changing language to improve care. Journal of Addiction Medicine, 11(1), 1–2. https://doi.org/10.1097/ADM.0000000000000275Google Scholar
Wakeman, S. E., Kanter, G. P., & Donelan, K. (2017). Institutional substance use disorder intervention improves general internist preparedness, attitudes, and clinical practice. Journal of Addiction Medicine, 11(4), 308–314. https://doi.org/10.1097/ADM.0000000000000314Google Scholar
Wakeman, S. E., Pham-Kanter, G., Baggett, M. V., & Campbell, E. G. (2015). Medicine resident preparedness to diagnose and treat substance use disorders: Impact of an enhanced curriculum. Substance Abuse, 36(4), 427–433. https://doi.org/10.1080/08897077.2014.962722Google Scholar
Wakeman, S. E., Pham-Kanter, G., & Donelan, K. (2016). Attitudes, practices, and preparedness to care for patients with substance use disorder: Results from a survey of general internists. Substance Abuse, 37(4), 635–641. https://doi.org/10.1080/08897077.2016.1187240Google Scholar
Wang, P. S., Angermeyer, M., Borges, G., et al. (2007). Delay and failure in treatment seeking after first onset of mental disorders in the World Health Organization’s World Mental Health Survey Initiative. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 6(3), 177–185.Google Scholar

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