Author: John Carter

Stigma and Discrimination National Institute on Drug Abuse NIDA

As clinicians, psychologists have opportunities to promote resilience to stigma to prevent the development of SUDs, and leverage acceptance and mindfulness approaches to reduce internalized stigma among people with SUDs. As researchers, psychologists can clarify the experiences and impacts of stigma among people with SUDs over time and adapt the stigma-reduction toolbox to address SUD stigma. As advocates, psychologists can call for changes in structural stigma such as policies that criminalize people with SUDs, protest the intentional use of SUD stigma, and adopt stigma-free language in professional and social settings. Women who use drugs are stigmatized for their drug use behavior, which marginalizes them from mainstream society. Research shows that these strategies do not work well for discouraging drug use; whereas attempts to reduce the stigma related to drug use can encourage users to stop use. Using qualitative methods and grounded theory analysis, the goal of this study is to examine (1) the stigmatization of drug use through different stages; (2) how stigmatized women drug users perceive normality; and (3) barriers and challenges to recovery.

Using drugs, they were able to find an identity for themselves and, ironically, feel part of society, as discussed in the before stage. However, the difficulty they now faced was that as a drug user, they would still be stigmatized. Therefore, the women hid their use to avoid stigma and still meet the expectations of society. In addition, many of the women using meth felt “normal” since they now were meeting society’s expectations of women’s roles. They found themselves with increased energy allowing them to be more productive, as well as having increased self-esteem.

Many of the women started using drugs to help themselves recover from a break-up or separation from their significant others. For example, Linda, a 49-year-old mother, explained that drugs were what kept her sane through a divorce. She started to feel unworthy and unable to work, so she began selling and doing drugs.

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Although “hustlers” are still part of the same drug community as “junkies,” they see themselves as a step closer to being “normal” than “junkies,” who have fallen the lowest levels of drug user category. In order to understand stigmatization, it is important to define what is considered to be “normal.” Society has set perceptions of how individuals should act and standards of normality. However, it is difficult to define normality as there are varying opinions of what “being normal” actually means. For the purposes of this study, drug users are seen as deviant from mainstream society standards for normal, but even within the drug user community, definitions of normal vary. As part of the survey, participants were asked the reasons why they did not seek any treatment. NIDA’s research on the biomedical and environmental factors around substance use and addiction contributes to an evidence-based understanding of substance use disorders.

The ability to focus and to work on the smallest details also helped them to conceal their use of drugs from others who may stigmatize them once they find out. These women are able to carry on with their lives and portray that themselves as “normal” and even productive to others, while feeling normal themselves only when using drugs. The National Institute on Drug Abuse reports that every 15 minutes, a baby is born with opioid withdrawal.

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The two focus groups were held at the offices of the NCSL, and interviews were held at a time and place convenient to the participants. The focus groups and several interviews were conducted by the first author of this study and the rest of the interviews were conducted by the fourth author, who was at the time of this study an undergraduate student at San Francisco State University. The interview and focus group guides were semi-structured, with a prepared list of topics and questions related to pre- and post-release experiences, particularly related to drug use, access to housing and healthcare, employment, and family/relationship issues. However, interview and focus group participants were also encouraged to share their own stories and to engage in a meaningful conversation with the interviewer, or with other participants in the focus group and its facilitator.

Disclosure is an important process given that it can act as a gateway to social support, which may facilitate recovery, and/or stigma, which may undermine recovery. Yet, people in recovery from SUDs report struggling with decisions regarding whether, to whom, what, when, and how to disclose to others (Earnshaw et al., 2019). Moreover, evidence from a nationally representative sample suggests that many people in recovery from alcohol and other drug problems are uncomfortable with disclosure (Earnshaw, Bergman, et al., 2019).

1. Basic social and behavioral science research can continue to clarify the experiences and impacts of stigma manifestations among people with SUDs over time (Corrigan et al., 2017).
2. However, as a “former drug user,” society still stigmatized them and formally controlled their status of motherhood with strict rules and requirements they often could not meet.
3. As discussed, some of these women did not feel normal before using drugs, but felt more normal while using.
4. Much of our understanding of associations between stigma and health inequities rests on research with people with stigmatized statuses that are relatively stable over time.
5. Although the Americans with Disabilities Act provides protections for people who are in recovery from SUDs in the workplace, it does not protect people who are currently engaged in illicit drug use (Lopez & Reid, 2017).
6. Finally, incarceration and drug use added to the burden of stigma already elicited by the gender and race/ethnicity of the participants in this study, categories with lower levels of power in our society.

The findings of this in-depth study, with its focus on all stages of drug use progression, show that women need a link to mainstream society and social bonds that help motivate them to believe they can “fit in” and be normal without drugs. Simply trying to change who they are will not allow them to integrate into new social networks that provide this sense of belonging and acceptance. Continuous emphasis on their “former drug user” status, such as requiring them to go to meetings with other former users, can increase feelings of inadequacy, marginalization and stigmatization.

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These quotes reveal the difficult choices some women are forced to make in the face of the challenges they faced getting a job, housing, and recovering from drug use to achieve enough stability to become good mothers to their children. They also noted that there is little support to get clean and sober in their home communities. The purpose of this study was to better understand the experiences of women with drug problems returning home from San Francisco County Jail.

In addition, it is important to note that this study was designed to elicit women’s pre-release and post-release experiences and the challenges they experienced trying to find city programs and services. “It is not enough to address logistical concerns like providing childcare or financial support to incentivize women to seek treatment,” noted Apsley. “It is not enough to address logistical concerns like providing childcare or financial support to incentivize women to seek treatment,” noted Apsley.

Psychologists can leverage acceptance and mindfulness approaches to address internalized stigma among people with SUDs. As noted above, people with SUDs with greater internalized stigma and shame experience worse treatment and recovery-related outcomes. Luoma and colleagues have developed and tested a group-based intervention for people with SUDs targeting shame that is based on the principles of acceptance and commitment therapy (Luoma et al., 2012).

Individual factors situate stigma within individual characteristics, including identity processes, age, and stigma course (e.g., substance use stage). Understanding where, when, and among whom stigma is experienced can elucidate how stigma is manifested and impacts outcomes. Resilience resources are factors at the structural and individual levels that may attenuate the impact of stigma on outcomes.

For example, the Americans with Disabilities Act protects people in recovery from SUDs from discrimination in employment and other settings. An additional policy, 42 CFR Part 2, protects confidentiality of people with SUDs from disclosures that may place them at risk of experienced stigma (Lopez & Reid, 2017). The 20 participants used in the analysis for this paper were selected because they were mothers who had children in their care when they were using methamphetamine or they were of childbearing age.