Stigma from within: Exploring Peer Relationships for Women in Recovery for Substance Use Addictions

Background: Previous research suggests that women managing illness experiences face stigma. Women with histories of addiction are one such group facing not just one but multiple stigmas.  In light of these intersecting stigmas, it is no surprise that social support, particularly emotional (i.e., esteem, trust, concern, listening) and appraisal support (i.e., feedback, affirmation), are crucial for recovery.  With that said, women with addiction experiences often seek support from their familial networks.  However, research suggests that familial support can have negative effects on treatment outcomes due to emotional strain and family dysfunction. Alternatively, social support from peers has been found to be more effective forms of social support for overcoming illness as well as managing stigma.  Peer networks share common illness experiences allowing for a more empathetic and positive social support exchange.  However, these internal peer networks may pose challenges as well.  Peer groups may promote intra-group stigma impeding the quality of the social support exchange process during recovery. 

Purpose: This paper aims to examine women’s perceptions of negative supports in the form of stigma from treatment peers and explore possible explanations for stigma. Although much is known about the stigma experiences of various populations, little is known about how women navigate recovery in the context of not just one but multiple stigmas.

 Methods: This grounded theory study used semi-structured interviewing with 30 women in substance use treatment.  Purposive and theoretical sampling methods were used to recruit a diverse sample and reveal possible variation in the data.  Grounded theory analysis involved constant comparison of data from the beginning of collection through analysis.  Open, focused and theoretical coding methods were used to refine categories and uncover themes to understand the causes, conditions and contexts under which stigma occurred.

Findings: Study results reveal that women perceive stigmas due to peers’ judgment of what different types of drug use indicate about a woman’s ability to embody important social roles.  Specifically, the “heavy-weights” (those using drugs of heroin or crack cocaine) perceive stigmas regarding how their drug use violates beliefs about proper womanhood and motherhood.  In addition, heavy-weights perceived stigmas based on how their drug use communicated moral and character deficits.  Alternatively, the “light-weights” (those using drugs of alcohol or marijuana) perceive stigmas that their drug use experiences are less valid and undeserving of support.  Possible explanations for intra-group stigma point to self-esteem enhancement through downward comparisons and coping strategies for navigating larger societal stigmas.

Conclusions and Implications: While research suggests that peer networks can be effective for social support exchange, findings of this study reveal they can impose psychological threats of stigma. Considering research substantiating that peer groups are essential for recovery and stigma management, this study increases understanding into the complexities of these micro-relationships. Moreover, it extends existing literature by exploring the stigma experiences of women navigating not just one discredited identity but several. The study has significant implications that can inform group treatment models and strategies for combating the stigmas that hinder recovery and healing.