Stigma Unraveled – A Personal Reflection

Examining beliefs about addiction and substance use disorder

I’ve recently been asked to lead a major educational initiative to address stigma toward people with substance use disorder (SUD) and, more broadly, addictions. Unfortunately, stigma toward people with SUD and addiction is omnipresent, permeating nearly every facet of our society, including health professionals — the very people who have taken an oath to relieve human suffering. The prevailing view on addiction is so ingrained in our society, a belief that it’s a moral failing and results from a lack of willpower, that people with SUD often feel deep shame and are thus reluctant to seek help for fear they will be judged. And frankly, they are judged and chastized often. So, stigma is perhaps at the heart of the problem. It leads to self-blame and self-bullying, which then fuels and perpetuates the addiction because engaging in the addiction provides temporary relief from negative feelings. Stigma makes health professionals reluctant to talk about, screen for, or offer treatment for addiction. And stigma hampers funding for research, leads to disinterest in training programs, and diminishes public support for progressive laws and policies.

I’m not an addictions specialist. Yes, I’ve had patients in my clinical practice and students in my classes who have SUD and addictions. But it’s not something I’ve actively treated or have the expertise to manage. While I’m not an expert, I would say I’m enlightened. I know that SUD is a chronic disease, similar in many ways to hypertension, diabetes, and osteoarthritis. It’s a disease that affects millions in the United States and hundreds of millions worldwide.1 Like many families, my family has been impacted by addiction, and I’ve witnessed loved ones struggle.

I suspect all of us engage in undesirable behaviors that are difficult to stop. Addiction (in some form) might be a universal human experience. Luckily, my addictions are socially acceptable and haven’t negatively impacted my life. I need my morning cups (yes, plural) of coffee. I’m certain I’d suffer from withdrawal symptoms without them — but I don’t wish to test my theory. And I play with my front teeth with my tongue … all of the time. It’s embarrassing. No matter what I do, I can’t control it unless I direct all of my energy and attention toward NOT doing it, which is exhausting. Wish I could stop, but I can’t. If you don’t have some odd mannerism that you can’t control or engage in some repetitive behavior that you’d probably be better off not doing, you’re fortunate.

This blog is dedicated to exploring addictions, understanding why they develop, and why we view them so differently than other chronic diseases. I’m hopeful we can unmask addiction and unravel stigma.