The Dark Side of Stigma

The Dark Side of Stigma

Today's Learning Moment 03-20-23 – The Dark Side of Stigma

Written by and for people with Lived Experience - Port Alberni Community Action Team - Families Helping Families.

Substance and mental health conditions are often intertwined, with people frequently experiencing both conditions at the same time. Unfortunately, the stigma surrounding concurrent disorders has a major impact on treatment outcomes, leading to hidden costs that affect people and society as a whole. We’ll take a look at the underbelly of stigma (its hidden cost) and how it impacts people with substance and mental health disorders.

Usually, when you mention a word like cost, people go directly to thinking of money. Certainly, stigma has direct money expense for all of us, (society as a whole) however, the cost of the dark side of stigma is measured in the destruction of people and their reluctance to reach out for help.

Stigma is defined as a mark of disgrace or shame associated with a particular condition, characteristic, or person. In the framework of substance and mental health disorders, stigma reveals itself in many ways, including negative attitudes and beliefs, discrimination, and social exclusion towards people with these conditions. Stigma often prevents people from seeking treatment, delays diagnosis, and reduces sticking with recommended treatment actions.

One of the most significant underbelly costs of stigma is that it prevents individuals from seeking treatment for substance and mental health conditions. The horrible negative undertones society has heaped on people with concurrent disorders have done their work with unsurpassed efficiency. People suffering from concurrent disorders often feel ashamed. That leads to people avoiding seeking treatment for fear of being labelled as "addicts" or "crazy" or facing discrimination from people in general, healthcare, employers or friends and family. Even if people do seek treatment, they are often reluctant to disclose their substance or mental health disorders to healthcare professionals. That hinders accurate diagnosis and treatment planning.

Stigma also leads to social exclusion, isolation, and discrimination against people with these health conditions. This leads to further negative consequences, including an increased risk of poverty, homelessness, and incarceration.

Let’s look at a couple of personal stories of how this all plays out in real life. Meet Jane (Jane is one of the thousands of stories like hers in British Columba). Jane, in her mid-teens, started suffering from mental health challenges. It took years to receive a definitive diagnosis. By that time, her mental health had morphed into full-blown schizophrenia, with depression and anxiety disorders. Her childhood was filled with physical and emotional trauma. Topping that off, she received a  serious brain injury when she was twelve. All of which contributed to Jane seeking peace from her inner pain by self-medication with street drugs. It wasn’t long in her journey when Jane found herself in full-blown addiction. Jane’s overall state of health deteriorated rapidly. Combined with behaviour challenges, her family disconnected from Jane. Soon, she found herself on the streets, homeless. Fast forward five years and Jane’s overall condition is horrible. Living on the street is hard, add drugs and mental health challenges and it becomes unbearable. Jane certainly looks the part. Often when people first encounter Jane, you can see the fear and disgust on their faces. Jane has become super sensitive to people’s reactions. Seeing the look in people’s eyes when they meet Jane causes her feeling of self-loath and shame. When she can, Jane prefers to be as far away from “the norms” as she can.

During those first years on the street, Jane tried several times to get help for her substance disorder through the nearest ER. Every single time she was referred to a community outreach program that had a wait time of three to four weeks. An impossible wait for anyone suffering from withdrawal. All of what you read of Jane’s story is bad enough, but here’s where the dark side of stigma impacts Jane.

You see, for Jane, every single touch point in the system resulted in her experiencing negative stereotyping. Admission clerks rolled their eyes when they saw her, and triage nurses accused her of wanting to admit herself to the hospital so she could have a bed to sleep in for the night. Doctors who just didn’t want to deal with another drug “addict” and the complexities of treating substance disorders mixed with mental health. To be clear, there are lots of excellent caring professionals in our hospitals, doing incredible trauma-informed care, however, it only takes one to sabotage the good work of all the others and it seems there is always at least one on every visit. Jane feels judged all the time …she told me in one of our talks, ”People tell me I’m no good.”

All those visits for help culminated in reinforcing in Jane’s mind that she was worthless, an untouchable in our society. Then came the day when she overdosed. First responders saved her life. She ended up in the ER at 1 AM, with just a t-shirt and pants – no coat, no socks, and no shoes. Staff were at the best rude, at the worst, uncaring and wanting her out as soon as possible. At 6:30 AM the ER discharged her. She walked barefoot a mile back to her cardboard shelter in a back ally of a downtown strip mall. There she found that most of her stuff had been stolen while she was in the hospital.

Some months later, I had the good fortune to meet Jane at a community harm reduction event. By then it was early summer. Jane wore shorts which made it impossible not to see the huge abscessed sores on her legs. I asked her if I could take her to the hospital to get her legs looked at. She told me, she’d rather walk on broken glass, barefoot than go to the ER. She then explained her story and added that she’s afraid of accessing any programs including the ER. I don’t think Jane realised the irony of her story, especially her analogy of walking barefoot on broken glass considering she’d already been there and done that when she was discharged after her last overdose. Moreover, when she does break down and go for help, every time it just made her feel worst about herself. In that last sentence is THE underbelly of stigma for Jane and many more like her.

Meet Sam. If you ask Sam, he’ll tell you he is just an ordinary middle-class Canadian. Sam is a blue-collar worker. He’s in his mid-thirties and has a good job in heavy industry. Sam has a house, wife, family and a dog. Sam and most other people would say he’s living the Canadian dream.

Sam dabbles with drugs for recreational purposes. Lately, it’s been more frequent than he’s comfortable with, but he justifies his extra use with added stress currently in his life. Most Friday nights, you’ll probably find Sam kicking back in his recliner in his rec room. This will be the time he eases the stress of the week by taking a hit from the stash he gets from a person who deals drugs at work. Sam uses alone which puts him in the very highest risk category. He also doesn't have harm reduction equipment like a naloxone kit. No way could he explain that to his wife, so he chooses not to have one with him when he uses substances.

Anyway, Sam will tell you overdose won’t happen to him, so he does not need harm reduction. His wife and family have no idea Sam uses substances. Neither do any of his extended family or close friends. Sam doesn’t want anyone to know. He’s well aware that he has a lot to lose if people find out. Foremost would be his job. No job, - no house. His wife is anti-drug use and has often said she’d never stand for it in her house. Yeap, Sam has a LOT to lose. There in that last sentence is the dark side of stigma for Sam. What his employer will think, what his wife and family will think, and what his friends will think all contribute to Sam keeping his use of substances a secret. He has TOO much to lose.

Moreover, in Jane and Sam’s stories we can see the dark side of stigma also impacts the quality of care that people receive for substance disorders and mental health conditions. Healthcare providers may hold negative attitudes towards individuals with substance and mental health disorders, which can impact the quality of care they provide. For example, healthcare professionals who believe that substance disorders are a sign of weakness may be less likely to offer support and encouragement to people who are struggling. Stigma also leads to a lack of funding and resources for substance disorder and mental health services, which limits access to quality care.

Another hidden cost of the stigma that both Jane and Sam face is its impact on overall health outcomes. Substance and mental health disorders are often present with other physical health conditions. Stigma can affect the management and treatment of all of a patient's conditions. People with concurrent conditions are less likely to seek out or receive appropriate medical care for other ailments, leading to worse health outcomes. Additionally, stigma can worsen substance disorders and mental health conditions, leading to increased symptoms and decreased quality of life.

All of us have a part in ending stigma. Frankly, in simpler terms, stigma is a nice way of saying prejudice. No one wants to be “that” person. We can end stigma. It starts with each of us. Let’s take a look at how.

Strategies to address stigma include education and awareness campaigns, anti-discrimination policies, and increasing access to substance and mental health disorders services. By changing our attitude towards concurrent disorders we can reduce stigma. We can create a more supportive environment for people with these conditions, improving their quality of life and overall health outcomes.

To wrap up, stigma is a significant barrier to substance and mental health disorder treatment, with hidden costs that especially impact people on a personal level. By raising awareness of the impact of stigma and implementing strategies to address it, we can reduce the hidden costs to people and improve the substance and mental health disorder outcomes for all. Substance and mental health are essential aspects of overall well-being. Working together creates a more supportive and accepting environment for everyone

Author: Ron Merk  – Ron is a person with lived experience and advocates for people and families with concurrent disorders.

Note: We may use words or phrases in our articles that are not first person, or the latest best-in-practice language. Sometimes we will use older, non-informed jargon. to clarify and inform people who are learning the new non-stigmatizing language. (linking old language usage to new terms) You can tell when you run into these old or non-inclusive words or phrases. They will be in quotation marks - eg old word “addiction” – When we introduce new inclusive language, words or phrases, they will be in Parenthesis - eg (people with substance disorders).

Families Helping Families is an initiative of the Port Alberni Community Action Team. We regularly send out "Learning Moment" articles to help folks understand substance illness. Knowledge is vital in understanding the disorder of our family members. You may copy, distribute or share our articles as long as you retain the attribution. Add yourself to our distribution list by dropping us a note at - albernihelp@gmail.com