Coping With the Stigma of Addiction
Stigma is one of the meanest and most difficult aspects of addiction because it makes it harder for individuals and families to deal with their problems and get the help they need. Society imposes stigma - and its damage - on addicts and their families because many of us still believe that addiction is a character flaw or weakness that probably can't be cured. The stigma against people with addictions is so deeply rooted that it continues even in the face of the scientific evidence that addiction is a treatable disease and even when we know people in our families and communities living wonderful lives in long-term recovery.
Stigma is the reason there is so much social and legal discrimination against people with addictions. It explains why addicts and their families hide the disease. Discrimination always hurts stigmatized groups because they are excluded from the rules that apply to "normal" people. So insurance companies get away with refusing to pay for alcohol or drug treatment, or with charging higher deductibles and co-pays than for treating any other disease. People who need the help are often afraid to speak up. State and federal agencies feel safe in denying food stamps and baby formula to mothers who have past drug convictions because mothers who used drugs have few supporters in the political system and face lots of people who think they must be "bad mothers." Though studies have found that helping employees to recover is more cost-effective than termination, some employers believe that firing an employee with a drinking problem is a lot easier than providing rehabilitation. A firestorm of protest would erupt if employers treated workers with cancer or heart disease the same way.
People who are victims of stigma internalize the hate it carries, transforming it to shame and hiding from its effects. Too often, people with alcohol and drug problems and their families begin to accept the ideas that addiction is their own fault and that maybe they are too weak to do anything about it. In many ways, hiding an addiction problem is the rational thing to do because seeking help can mean losing a job and medical insurance, or even losing your child when a social service agency declares you an unfit parent because you have an alcohol or drug problem.
The stress of hiding often causes other medical and social problems for the individuals and their families. This is especially true when an adolescent has an alcohol or drug problem. Fear often prompts kids to conceal the problem from parents. Then, when parents find out, stigma makes them feel guilty and somehow negligent. Illness and family dysfunction explode. When that happens, parents find it even harder to fight for the care and resources their child urgently needs from a social and medical system that blames the family and the child.
FIVE THINGS YOU CAN DO TO FIGHT STIGMA
We may not be able to change overnight the way society feels about people with alcohol and drug problems, but we can end the legal discrimination caused by stigma
- 1. Demand equal medical insurance coverage for alcohol and drug treatment.
Almost all private or public health insurance and managed care policies still provide no or unequal coverage for alcohol and drug treatment. Repeated studies have shown that including alcohol and drug treatment coverage that matches the coverage available for "physical" illnesses will not raise premiums, in part because it will eliminate many of the other covered medical illnesses that are caused by untreated alcohol and drug problems. Many managed care plans say they cover alcohol and drug treatment, but their case managers almost never approve the amount of care a person needs to actually get and stay better. (Research shows that results really start to improve after a person receives three months of treatment.)
- 2. Tell your elected representatives to stop punishing babies for the past problems of their mothers.
Current federal law bans mothers with past drug convictions from participation in the food stamp program and WIC, the women and infant's nutrition program. In recent years, more than 150,000 babies have suffered because of this law.
- 3. Tell your state lawmakers to remove the legal barriers that prevent people recovering from addictions from getting jobs.
In the American criminal justice system, once you have served a sentence for a crime, you should be able to resume your full participation in society. That does not happen today for people with alcohol and drug convictions. State laws and regulations keep punishing them, often making it impossible for them to find employment. For example, many regulations ban the granting of new licenses to people with nonviolent drug or alcohol felony convictions who apply to become barbers, construction workers or even some types of restaurant workers. In some states, employers have access to criminal records that are supposed to be confidential, making it easy to avoid hiring anyone with a past problem. This continuous punishment virtually condemns many - mostly young African American, Asian American, Latino or Native American men - to wasted lives because research has shown that recovering individuals who don't have jobs are significantly more likely to relapse and commit new crimes than similar individuals who get jobs.
- 4. Give more than lip service to the reality that addiction is a disease, not a character weakness.
A recent poll showed that 80% of Americans think there is discrimination against recovering people in the workforce, but more than a quarter of the survey participants in that poll said they themselves would be reluctant to hire someone in long-term recovery. Large-scale social change often starts with small, sometimes uncomfortable, individual steps.
- 5. Be an advocate for an individual or family with an addiction problem.
Until you have actually been there, it is virtually impossible to describe how hard it is for a family or individual to get access to quality and medically appropriate alcohol or drug treatment. At this most vulnerable point, any setback is likely to send its victim right back to the bottle or pills. Recovering people need an advocate to ask the right questions, insist on the appropriate insurance coverage and make sure there is a treatment plan that makes sense. They need someone who will say no to a suggestion that the patient come back in three weeks for an assessment. A mother and father who are fighting with their insurance company need someone on their side who will not be made to feel ashamed and guilty by a managed care clerk. You can be that person.