Stereotyping SUD

Stereotyping Leads To BIAS

Today's Learning Moment 04-24-23 – Stereotyping SUD

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

Here is a short list of judgements that are commonly made against people who use substances. Particularly to those who use illegal substances and those who develop substance use disorder. These opinions often lead to stereotyping. That, of course, results in stigmatizing people who are already struggling with an illness many of us could never imagine.

    1.    They are weak-willed and lack self-control.

    2.    They are irresponsible and unreliable.

    3.    They are immoral or lack morals.

    4.    They come from broken or dysfunctional families

    5.    They are homeless or live in poverty.

    6.    They are criminals or engage in criminal behaviour.

    7.    They are violent or aggressive.

    8.    They are uneducated or have low intelligence.

    9.    They are lazy or unmotivated.

    10. They are hopeless and cannot be helped

    11. They are not worthy of help. 

A stereotype is when certain characteristics, usually physical and often psychological are applied to a group in broad strokes. The characteristics may or may not have any factual basis.

For instance, in my youth, “all hippies were drug addicts and lazy and any man with long hair was a hippie”. I did fancy myself a hippie. Remember that song, "Long-haired freaky people need not apply" – That was me. I experienced a great deal of difficulty obtaining meaningful employment because of the length of my hair at those times. I was also frequently followed by security in stores and was even chastised by my own family. Yet, here I am, decades later, successfully retired from a satisfying fulfilling career and my hair is still all the way down my back. So I suffered (and overcame) the social limits of a stereotype that was mostly based on judgement and fear.

What do you see when you think of the terms “alcoholic” or an “addict”?  Do you see a derelict, dirty, downtrodden, sneaky, uncaring, inhuman person? The fact is that many of us do see those who struggle with substance use disorder and/or use illegal substances in this way. The fact is that of all people who use substances, only between 10-20% (depending on the study you read), develop substance use disorder or what we refer to as addiction or alcoholism. A very small number of people who use substances spiral down into homelessness, poverty and living on the streets. Many of us base our perceptions of people with substance disorders on these desperate few. These visible few drive our stereotypes. Images based on what we have been shown and told over decades and centuries.

Personal biased assumptions come from a centuries-long history of little to no understanding of what addiction entails, why it develops and how to manage it. We focus on the surface behaviours that can often come with addiction. These behaviours include dishonesty, manipulation, unpredictability, aggression, passiveness, loss of memory, profound loss of self-esteem, isolation and more.

What we don’t see is what is underneath these behaviours. That prevents us from truly understanding them. Then when these behaviours happen, it hurts us. We fear them, lash back, banish, avoid them, and in the end, assign words and images that objectify what we don’t understand. When we objectify, it is easier to punish, banish, ignore and dehumanize. It is easier to make this criminal and thus deserving of punishment. We stereotype. We stigmatize.

Interestingly, our main thought or belief is that the substances we have criminalized were very bad for our health. Yet the one substance that is enjoyed and legal almost universally is the one that has accounted for more harm from a substance than all other substances combined; - That’s right, alcohol. We view those who can drink alcohol without problems as normal. Yet alcohol is extremely addictive under the right circumstances. As stated, up to 20% of people who use alcohol develop alcohol use disorder. That is one in five people! Basically, people who develop a disorder using alcohol are on par with people who develop a disorder using illicit substances. Something to think about no matter what substance you try or use. We see those who develop AUD through a false distorted fear-based moralistic stereotype, rather than a person experiencing a health problem. They’re not normal. This is stigma.

So what about the behaviours and personality traits that we do see from people who struggle with SUD? Those behaviours do hurt sometimes. They are inappropriate and seemingly even seem immoral at times. In the end, we live in a world that requires and expects us to be honest, have integrity, and loyalty; to have morals. Unfortunately, while there is accountability for these behaviours and traits, there is an explanation that provides a rational context to what occurs when inappropriate actions are happening: A brain that has been impacted by substance use disorder has been profoundly changed.

What appears to be weak-willed and no self-control relates to the functioning of the brain after a disorder has developed. The long and short of it is that willpower has nothing to do with the functioning of the brain that is suffering from SUD.

Science has established that it is the altered functioning in the brain that is behind the inability to control thought processes and motivation during active addiction. Neural pathways are forged like train tracks or wires in the brain as the disorder progresses. Chemical compounds in substances interact with neural pathways and with neurotransmitters helping to reinforce those tracks. These tracks become major highways in the brain controlling everything a person does. The brain becomes dysfunctional from what we consider a normal ordered way for most people. This impacts how we think rationally.

Our behaviours become symptoms of this disorder. They manifest as what we see as immoral and hurtful. They don’t fit our values. They don’t fit the values of the person who is experiencing them. We don’t understand this from either side so we behave the only way we’ve been taught to; we shame, guilt, and punish, all because we hurt from the impact of these symptoms. This is partly why we define substance use issues as a disorder because it is a mental health challenge with symptoms consistent with various other mental health disorders. The person suffering from the disorder sees themselves as inferior, weak and wrong as do many of us in the general public or even those who are trying to support people suffering from SUD.

This is where our stereotypes have added fuel to the fire.

However, the brain has an incredible ability to respond to proper treatment of the disorder. Neuroplasticity is part of the answer. This is the brain’s ability to adapt and repair itself. The brain can reroute neural pathways and in so doing, can help change thought patterns and behaviours. Numerous interventions can assist in this “rewiring” and healing. Often it takes far more than one intervention. We see this as recovery, and the majority of people who struggle with SUD do recover under the right conditions.

Stereotyping and stigmatizing are the antitheses, the nemesis, of these conditions.

We would not stereotype, thus stigmatize someone who has broken their leg in the same way. We do not stigmatize someone with diabetes, heart problems, or even cancer in the same way. Even though all of these diseases can be prevented and treated to some degree based on our life choices. But our multi-generational beliefs and stereotypes about substance use just make SUD worse when we could be treating those with the disorder as people, not objects to be shamed.

So overall, there is no question as to the way stereotyping people with SUD contributes to the disorder and to the social problems that accompany the disorder. Science tells us that the disorder changes the functioning of the brain and that it has nothing to do with a moral compass or willpower. It develops and progresses much like a disease. We also know with certainty that the brain can rewire itself under the proper conditions and treatment.

I hope that this has at least demonstrated how important it is that we all critically think, and aggressively challenge the way we perceive substance use and substance use disorders. Substance Use Disorder is not a moral weakness of will. Many factors increase the risk of developing the disorder, none of which can fit into any moral box we try to place them in. Our own beliefs, thus stereotypes contribute to those factors and increase creating barriers to treatment, healing and recovery.

I implore everyone who reads this to really consider their beliefs and stereotypes. I have seen the damage they can do over my career in treating the disorders. I have studied from many informed colleagues, read the research and have learned from my own lived experience. The most difficult and stressful part of my job was not working with the person who was suffering, but rather working in systems that perpetuated the typical stereotypes, which increased the stigma towards people who use substances and develop Substance Use Disorder. It’s hard to help people who struggle when their world has abandoned them.

If we change the way we see things, we can change our part of the world. Maybe we could save some lives.

Author: Ben Goerner— Ben is a retired counsellor. He advocates for people with substance illness or mental illness.

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 disorders or concurrent disorders. Knowledge is vital in understanding these disorders 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

Resources:

Fisher, Carl Erik “The Urge: Our History of Addiction” Allen Lane – Penguin Random House 2022
Lewis, Marc: “The Biology of Desire: Why Addiction Is Not A Disease” Philadelphia, Public Affairs, 2015
Sandhu, Mandy: “History of Addiction Treatment and Rehab Facilities: A Timeline” Freedom From Addiction.ca/blog 2022

https://calgarydreamcentre.com/recovery-resources/   ***just one of many statistical resources many of which differ slightly***