Editors note: “A Better Life” is a new weekly column by the USU Extension – Tooele Office that focuses on a variety of topics intended to enhance quality of life.
Experts say that stigma is an attitude, discrimination, or prejudice directed toward an individual or a group. Looking back, stigma has been the source of much needless suffering.
In one case decades ago, an older woman let a lump in her stomach grow for years, fearing to go to the doctor. In her day, cancer was considered contagious. Only when the lump had grown so large that she had trouble walking, did she seek medical attention. At that point the tumor was stage 4 and nothing could be done. Stigma had prevented her from seeking needed medical treatment.
This example may seem extreme. We may think, surely, this couldn’t happen today. But with 72,000 people in the U.S. dying from opioid overdose each year, the power of stigma should not be ignored. Stigma about opioid addiction has been shown to prevent individuals from seeking the care, support, and treatment they need.
As a society, we understand the neurobiological basis of addiction. We understand how a person can find themselves addicted to a prescription medication — and how subsequently their lives may spiral out of control with no wrong intent. Yet this isn’t always enough to break through the judgments and shame surrounding harmful addiction-influenced choices. This is because stigma focuses on the morality of a behavior.
There are generally three types of stigma: social, self and structural. Each of these forms of stigma serves to increase discrimination. Each can be a barrier to treatment seeking. And each can result in prolonged substance use and devastating impacts of opioid addiction.
We usually think first of social stigma, where group attitudes lead to prejudice and stereotypes. Thinking of the heroin addict, shooting up in a back ally, conjures images full of social stigma. But knowing that 80% of those addicted to heroin began their addiction cycle using legally prescribed pain medication alters the image. Thinking about this origin of addiction reminds us that it is someone’s daughter, an uncle, or likely someone you know — such as a former teacher at the local school. By humanizing our understanding of a problem, we can shift out of stereotyped thinking.
Self-stigma, however, can be just as damaging. Self-stigma is when societal attitudes get internalized and the judgment happens from within. In this case, struggling individuals label themselves as damaged, and give up hope that they can ever change or make things right.
Structural stigma is another type that occurs as stereotypes filter into organizations, limiting the options that may be available for stigmatized groups. For example, Medication Assisted Therapy (MAT), where low doses of maintenance opioids are administered on a long-term basis, has been shown to be effective for opioid addiction. Structural stigma may result in stereo-typed groups being denied these services if they are deemed untrustworthy.
There are several things we can do to reduce stigma. Increasing education and understanding is a first step. Knowing that 80% of heroin addiction cases start with prescriptions reduces blaming and distancing — it could happen to anyone. Knowing that MAT helps create longer-term recovery changes the conversation from calling it a cop-out to understanding it as a viable treatment.
Next, you can learn about prevention strategies. Tooele has a Communities that Care (CTC) coalition and a Tooele Interagency Prevention Professionals (TIPP) coalition that offer regular trainings on prevention. Getting involved with Parent’s Empowered campaigns, Question, Persuade, Refer trainings, or Family Meal Nights are all ways to get involved with prevention.
Stigma can be reduced as the community learns about harm reduction strategies. MAT is one type of harm reduction, as well as the opioid-overdose reversal drug, NARCAN. Start a conversation about opioids and find out where to get NARCAN (like the Grantsville Library or your local USU Extension Office). Talk to the health department and find out more about how needle exchange could be safely brought into the community to reduce disease.
In hopes of never repeating the mistakes of the past, when cancer was a bad word, the community can come together to reduce stigma. Talk, share, learn and understand. Maybe then stigma might become as ridiculous as the thought that cancer is contagious.
Maren Wright Voss, ScD, is a professional practice extension assistant professor of health and wellness at the USU Extension – Tooele County office, which is located inside the Tooele County Health Department Building, 151 N. Main, Tooele. She can be reached at 435-277-2409 and at firstname.lastname@example.org.