Internalized stigma refers to the process in which a person using substances or with a SUD cognitively or emotionally absorbs negative messages or stereotypes about substance use and comes to believe them and apply them to themselves. This process can lead to anxiety, isolation, loss of self-love and facilitate people accepting injustice as deserved suffering.3,4 For people using drugs or with SUD, this may manifest in decreased engagement with support systems and avoiding medical care at the detriment to their overall health and wellness. Instead of addressing addiction as the public health problem that it is, we tend to treat substance use disorders as moral and criminal issues. This is especially true for addiction to illicit drugs, which we perceive more negatively than addiction to legal substances such as alcohol or cigarettes. The ridicule and judgement doesn’t just come from society but from healthcare professionals and individuals within the justice system, too.
2. Overview of key barriers to specialty treatment among women with SUD
It is likely that other factors or barriers to treatment (e.g., stigma, logistical barriers) may be more pronounced among Latinas relative to White women, but were not examined by this study. NIDA’s research on the biomedical and environmental factors around substance use and addiction contributes to an evidence-based understanding of substance use disorders. This helps bust myths and upend stereotypes and promotes appropriate treatment and services. NIDA also conducts and supports research into stigma’s causes and effects, and interventions that work to confront it.
How do language and criminalization perpetuate stigma against people who use drugs or have substance use disorders?
- Knowing and incorporating these words into discussions about substance and alcohol use helps, as does treating individuals with substance use disorders compassionately.
- Focus groups were used to supplement interviews, because many women perceive focus groups as less threatening because they reduce the power differential of researcher versus research participant.
- Individuals with hidden stigma “may expend much energy to ensure that stigma-related ‘leakages’ do not occur” (Pachankis, 2007, 335).
- For most age groups, men have higher rates of use or dependence on illicit drugs and alcohol than do women.14 However, women are just as likely as men to develop a substance use disorder.15 In addition, women may be more susceptible to craving16–19 and relapse,20,21 which are key phases of the addiction cycle.
- From a stress and coping perspective (Miller & Kaiser, 2001), stigma manifestations are characterized as significant stressors that may elicit both internalizing (e.g., depression, anxiety) and externalizing (e.g., anger, hostility) symptoms among targets.
- In 1971, President Nixon declared the “war on drugs” by naming drugs as America’s “public enemy number one.” The war on drugs rested on the theory that drug use is voluntary and controllable, and thus can be prevented and stopped through harsh punishment (Gostin, 1990).
In a South African study, non-drug using individualsreported that WWUD are not viewed as a “policy or funding priority,”and that this omission from the policy and funding discussion within thehealthcare arena further results in women being an underserved population of PWUD(Myers et al., 2016 [49]). Thesestructural level oversights result in a lack of gender-specific drug treatment andother health-related services, which creates important barriers to care and servesto further perpetuate vulnerability for WWUD. Another problem is low self-esteem, which can stimulate the mechanism of initiation and substance abuse and cause addiction and relapse.
Trauma-Informed Care for Substance Use in Pregnancy
Yet, while they try to fit into “normal” or conventional society, they also struggle with feelings of insecurity, isolation and anxiety (Hetrick & Martin, 1987). They’re very strict and they’re very judgmental […] there are certain things [people] don’t https://rehabliving.net/the-general-formula-for-alcohol-is/ tell their family, they don’t want them to know. I can’t even stand being around [them], that’s why I feel some people keep things to themselves in a big family […] They are religious, not only that, just how they are, they’re just judgmental.
For example, referring to “overdose prevention sites” rather than “safe consumption sites” leads to increased public support for an evidence-based harm reduction strategy wherein individuals can legally use pre-obtained drugs under medical supervision to reduce risk of overdose (Barry et al., 2018). The United States is currently experiencing an opioid epidemic, with deaths due to opioid overdoses persisting in many communities. This epidemic is the latest wave in a series of global substance use-related public health crises. As a fundamental cause of health inequities, stigma leads to the development of substance use disorders (SUDs), undermines SUD treatment efforts, and drives persistent disparities within these crises.
Prescription Drugs
This punitive approach fails to optimize chances for treatment and recovery, is based on stigma (eg, the belief that treatment does not work, or the person is not worthy of treatment), and reinforces stigma (eg, the belief that if the person has continued to use substances during pregnancy, they are not worthy of being a parent). Since there are many barriers happening in tandem for women seeking treatment for SUDs, the researchers recommended that clinicians and practitioners https://sober-home.org/how-long-does-ecstasy-mdma-stay-in-your-system/ understand that there is often not just one reason why a woman might not seek treatment. Stigma, logistics like transportation and childcare, the lack of the perceived need for treatment, and a lack of readiness for even starting treatment, could all be legitimate factors for women across economic, educational and cultural lines. “It is not enough to address logistical concerns like providing childcare or financial support to incentivize women to seek treatment,” noted Apsley.
And if the other people around her are telling her, ‘You have to do this or you don’t love your kid,’ that’s going to make it even worse…as long as she’s in a forced situation… And you don’t know which way to turn, and you don’t know what to do, and if you fuck up this way, you’re going to lose your kid permanently. So until I can learn how to deal my emotions, they feel it’s better for me not to be in a shelter. So I was diagnosed [with borderline personality disorder] and I’m waiting – I’m on SSI and pending right now. You know, after you go back out there, you aren’t even worried about the services.
They are able to possess the abilities that they see in others that make them normal. They find value in themselves as they accomplish tasks and achieve goals that they believe society has set for them. Ironically, using drugs was a way for them to deal with feelings of being stigmatized, abused, or not valued, superficially raising their self-esteem for a time—until they are exposed as a drug user. As discussed, some of these women did not feel normal before using drugs, but felt more normal while using.
Table 1 provides examples on how stigma can impact care of pregnant PWUD at each level, as per this framework. Structural is imposed on people with addiction by healthcare providers, people who offer social services, workplaces, and government organizations. Because of the societal stigma attached to mental health disorders, many people with psychiatric disorders often self-stigmatize. Having self-stigmatizing attitudes have been shown to decrease a person’s https://sober-house.org/58-best-rehab-centers-in-california-2023-free-and/ likelihood of recovering from their mental illness. Women in one study all reported that social stigma strongly influenced their decision whether to breastfeed while they were prescribed methadone.19 They also reported that information from HCPs was based on methadone-related stigma, rather than on evidence. Further, skipped prenatal and other medical visits limit opportunities for mothers to learn about the safety and benefits of breastfeeding.
‘Many drug-using women reported negative experienceswith medical providers and only sought health care when they were so illthey had no choice. The women generally felt that medical personnel werehostile and did not take their problems seriously … Many womenreported feeling pain and discomfort during vaginal exams because doctorsused the wrong size speculum or conducted the exam in a rough or rushedfashion. Others reported that providers refused to provide care once theylearned of their drug use.’ (Oliva, 1999, California, US, pg. 9, [72]).
A standard dictionary definition of stigma is a mark of disgrace connected to a situation or quality of a person. Stigma affects individuals with a substance use disorder, health care providers, treatments, research, policies, and society as a whole. Some of the women were determined to be reunited their family, but they do not have the resources needed to be drug-free. Most of the mothers interviewed showed great compassion for their children and willingness to go to treatment to be with their family. Yet in society’s view, drug users are not “good mothers” and first they had to prove themselves.
