Substance use, shame & stigma
Updated: Sep 22
I worked at a methadone clinic for almost 5 years. During that time, when I told people where I worked, I was usually met with one of two questions. The first was why. Rarely was it a why of genuine curiosity. No, it tended to be more of a “why on earth would you want to do that?” The other question I frequently received was, “is it scary?” At this, I would try to hide my annoyance and politely let them know that it was not in fact scary.
The reason these questions bothered me so much was they highlighted the stigma surrounding people with substance use issues. I believe one of the greatest barriers to getting treatment and support is the stigma. And for many, that stigma causes false beliefs about who uses drugs and alcohol. Stigma causes shame. Shame impedes willingness to ask for support.
Substance use and stigma
Our society has some deeply held beliefs about what kinds of people use drugs and alcohol. This is largely due to the criminalization of addiction, alcohol not withstanding. Usually when people with substance use disorders are portrayed in movies and television, they are shown as devious and dangerous. They are portrayed as volatile and somehow morally compromised.
This leads to us an uncomfortable cognitive dissonance that we then must reconcile. We think that person we know could not have had addiction issues—they were so nice, they were so talented, they were so kind. To make it make sense we use but instead of and. “They seemed so great, but I guess I didn’t know who they really were” instead of, “they were so great, and I didn’t know they had this struggle.” Our need to put drugs in either/or categories has had the effect of putting people into the same either/or category. All good or all bad. Sober or not. Clean or dirty.
These portrayals and these dated and harmful beliefs obscures the truer reality that people people with substance use disorders are related to us, they work in our office, they are our neighbors and friends. They are us.
Substance use and shame
It is natural to keep hidden what we feel ashamed of. It is not terribly helpful, but it is natural. In my work with clients struggling with substance use and in readings about drug and alcohol addiction, the theme I see over and over is isolation. People feeling alone in their struggle. They are not alone though. According to SAMSHA, in 2018, approximately 20.3 million people had a substance use disorder. This does not include people who perhaps used substances or had an unhealthy relationship with drugs and alcohol but did not meet criteria for a substance use disorder.
People who feel that they have no social support are less likely to obtain treatment. Isolation frequently leads people to use more substances. This worsens the substance use, and frequently increases the isolation, creating a painful cycle.
When even your treatment is stigmatized
The stigma surrounding substance use is unhelpful and demoralizing. The stigma surrounding certain treatments is reprehensible. Society judges people for using and then judges them further for trying to make positive changes, for trying to get help. Harm reduction approaches such as moderate drinking, needle exchanges and medication assisted therapies save lives and improve individuals’ wellbeing. When we do not embrace these methods and insist on abstinence only methods, we often create cycles of failure, again worsening the shame and thus worsening the substance use.
Fight the Stigma
Each of us can do our part to support people struggling with substance use problems and reduce the stigma. Learn about drugs and alcohol and why people use them. Be compassionate. Listen to them without judgment. Offer your support. See the person, not just the problem.
About the Author: Kimberly May, LPC-S, LMFT is a therapist at Substance Use Therapy in Austin, TX. Kimberly works with individuals, couples and families whose lives have been affected by drug and alcohol use. By utilizing a harm reduction framework, Kimberly works effectively with people in any stage of use. In addition to substance use, she works with other issues such as anger, gambling, anxiety and grief. Contact today to schedule a no-charge, 30 minute, in-person consultation. *Note: telephone and telehealth sessions are currently available.