Medical disease or moral failing? The people who work in addiction treatment, and work to help people who are entering drug and alcohol rehab, usually understand that addiction is a disease. Most doctors and health care professionals have the same understanding. However, as a society, there remains a wide spectrum of beliefs and misunderstandings about substance use disorder. An impressive 2017 study from the University of Alabama looked at this issue of stigma. The authors studied what factors people think about when judging another person who is suffering from addiction. They also focused on how people determine “causality”, or how a person becomes addicted to a drug. As always, this blog is brought to you by Florida Springs Wellness and Recovery Center, one of the best drug and alcohol rehabs in Florida. Florida Springs is located in Panama City, and it is a short driving distance from Alabama, where this study was conducted. If you or a loved one needs the best drug and alcohol addiction treatment, call the phone number at the top of the page to reach an intake counselor.
Where Does Stigma Come From
The classic view, which is still prevalent to some extent today, is that substance use is a behavior that is socially unacceptable, and those that engage in it must have some moral failing or character flaw. According to (Barry et al.), research has shown that people are significantly more likely to have negative attitudes toward individuals with substance use disorders than toward individuals with other behavioral and emotional disorders. Much research has focused on the impact of that stigma on the sense of identity and health of persons with substance use disorders, and indeed we have discussed that topic repeatedly on this website. According to this study at Alabama, there has been much less work examining the social origins of the stigma itself. Most people have put it down to religion (The body is a temple) or not endeavored to explain the cause of stigma at all.
The Alabama study asks:
“What kinds of shared understandings of substance use disorder, distributed in the wider society, underlie the tendency to socially discredit the individual with this disorder? This is the question of stigma attribution”
The study suggests that there are shared cultural models of substance use disorder that lead individuals, depending on their orientation within that model, to attribute greater or lesser stigma to the individual with substance use disorder. The authors refer to an interesting 1999 study that found that individuals who state that mental health disorders are caused by either stress or genetics were most likely to feel comfortable being friends with a person who has a mental health diagnosis. The respondents who believed that mental health disorders were a character flaw or were caused by a bad upbringing were less likely to associate with people with a mental health condition. That 1999 study, by Link et al, included substance use disorder in its surveys, but they did not focus on addiction the way that this newer University of Alabama study does.
Cultural Consensus and Ending Stigma
While these studies were able to easily establish a tendency for people to stigmatize addiction, or substance use disorders, what can these studies possibly tell us about ending that stigmatization of mental health conditions? The Alabama study says some incredibly interesting things on how stigmatization can come to an end. This is the idea of a cultural consensus, and I will try to explain it as simply as I can.
The idea is this: Not all people have the ability or time to become experts on a given topic, but even those who are not educated on a topic can eventually be swayed by a cultural consensus of opinion that is reached among people who do educate themselves. The first people to become knowledgeable about addiction will always be the experts in the field of addiction who go to school to gain that knowledge. They are followed by the wider health care establishment, who find value in gaining knowledge to best serve patients. The next few groups are also key to creating less stigma. Friends and family of people with substance use disorder, and people with substance use disorder, will often find value in educating themselves about the disease. In a society that is battling a crisis of addiction, with many deaths from overdoses, there will eventually be many ordinary citizens who choose to educate themselves on topics of substance abuse as well.
While it is a disaster and a scandal how bad the addiction epidemic has gotten in the United States and Florida, the increase of people who know someone with substance use disorder will increase the number of people who choose to be educated on the topic, which can ultimately lead to ending stigmatization of addiction and other mental health conditions. The cultural consensus moves faster when more people seek to educate themselves for any reason.
The University of Alabama study mentions the idea of “residual agreement”. Simply put, while the overall cultural consensus is building towards less stigma around addiction, strong agreement about the causes of addiction within smaller niches can move that overall cultural consensus even more. In the case of addiction, while the public becomes more understanding of addiction as a disease, strong agreement amongst people with substance abuse in their families can help push stigma out of the picture even quicker.
By T.A. Cannon
- “Medical Disease or Moral Defect? Stigma Attribution and Cultural Models of Addiction Causality in a University Population.” Henderson and Dressler. The University of Alabama
- Link, Bruce G., Francis T. Cullen, James Frank, and John F. Wozniak. 1987 The Social Rejection of Former Mental Patients: Why Labels Matter. American Journal of Sociology 92(6):1461–1500.