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Understanding and Intervening on Addiction Stigma

This article explores the origins and impact of addiction stigma and provides insights on intervention strategies. It covers various manifestations of stigma, discrimination, and the importance of addressing intersecting stigmas affecting affected individuals. The article also emphasizes the need for public education, advocacy, provider training, peer support, and personal empowerment to combat stigma.

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Understanding and Intervening on Addiction Stigma

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  1. Understanding and intervening on addiction stigmaLisbon Addictions 2017 Karsten Lunze 24 Oct 2017

  2. Goals 2 1/1/2020 • What is stigma and where does it originate? • What is stigma’s impact on prevention? • How can we intervene on stigma?

  3. Goals 3 1/1/2020 • What is stigma and where does it originate? • What is stigma’s impact on prevention? • How can we intervene on stigma?

  4. What is stigma? 4 1/1/2020 • Dehumanization of individual in undesirable social category • External, public stigma • Attitudes and reactions towards socially excluded groups • From providers, law enforcement officers, families, communities • Laws, regulations, cultural context represents structural stigma • Internal, “felt”, self-stigma • Experience of discrediting attributes result in devaluation, shame, stigma avoidance, fear of enacted stigma • Rejection further increases marginalization Goffman E. Stigma: Notes on the Management of a Spoiled Identity. Simon & Schuster, New York 1963. Kulesza Met al. Substance Use Related Stigma. J Addict Behav Ther Rehabil 2013 Luoma JB. Substance Use Stigma as a Barrier to Treatment and Recovery. Addiction Medicine, Springer 2010. Corrigan PW, Rao D. On the self-stigma of mental illness. Can J Psychiatry 2012 Ahern J et al. Stigma, discrimination and the health of illicit drug users. Drug Alcohol Depend 2007

  5. What is discrimination? 5 1/1/2020 Discrimination consists of actions or omissions that are derived from stigma and directed towards those individuals who are stigmatized. • Result of the process of stigmatization, when stigma is acted upon (“enacted stigma”) • Different and unfair, prejudicial treatment (to their disadvantage) Goffman E. Stigma: Notes on the Management of a Spoiled Identity. Simon & Schuster, New York 1963.

  6. Stigma manifestations 6 1/1/2020 • Overt or external deformations • Scars, physical manifestations, manifestations of physical disability or social disability • Deviations in personal traits • Mental illness, substance use disorder, unhealthy alcohol use, criminal background • "Tribal stigmas“ • Traits (imagined or real) of ethnic group, nationality, or of religion deemed to be a deviation from the prevailing Goffman, E. (1963). "Stigma: Notes on the Management of a Spoiled Identity." Simon & Schuster, New York.

  7. Stigma manifestations 7 1/1/2020 • Anticipated stigma • anticipation of being devalued by others if the identity became known • Centrality • level of defining oneself by the stigmatized identity • Salience • frequency of thinking about the identity • Internalized stigma • the extent of agreement with negative stereotypes about the identity • Outness • extent to which other people currently know about the identity Quinn, D. M., M. K. Williams, et al. (2014). PLoS One

  8. 8 Operationalizing stigma 1/1/2020 General population, healthcare workers, affected people • Fear: of contact, infection, etc. • Social judgment: shame, endorsement thereof • Legal and policy environment: existence, compliance, awareness • Anticipated stigma: hesitance to test, avoidance of services • Internalized stigma: shame, blame, guilt • Perceived stigma: talk, hear talk • Stigma experiences: contact, avoidance, exclusion • Discrimination: opinion about discrimination, preferences, denial • Resilience: confronting, challenging, educating

  9. Stigma identities of people with substance use 9 1/1/2020 • Mental illness • Infections (HIV and others) • Race • Gender • Experience of domestic violence, sexual assault, childhood abuse • Identity as sexual minority • History of criminal justice involvement • … Goffman, E. (1963). "Stigma: Notes on the Management of a Spoiled Identity." Simon & Schuster, New York.

  10. Stigma determinants Conceptualizing stigma Barrier to Adverse effects on Internalized stigma Stigma education Stigma therapy Interventions Health Care Health and Wellbeing Access to health care Social exclusion PWUD Quality of life Vulnerability, shame, guilt, trauma, criminaliza- tion Mental health and wellbeing Health care utilization ProtectiveFactors Resilience, agency, coping strategies, other mitigating factors ReinforcingFactors Marginalization in society, discrimination, legal status, political factors with other stigmatized challenges Social Integration Other Stigma Identities HIV, HCV, homeless, sexual orientation, criminal justice involvem. Intersectional stigma

  11. Interventions 11 1/1/2020 • Public education • Advocacy • Provider training • Peer support • Personal empowerment

  12. Conclusions 12 1/1/2020 • Solid body of evidence on various forms of stigma and health • Knowledge gaps regarding substance use stigma • Budding research field on intersectional stigma affecting PWID • Interventions to address public and structural stigma urgently needed • Interventions to empower affected people cope with stigma urgently needed

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