Stakeholder Views on Substance Use Stigma

Background and Purpose: Although quantitative research has shed light on the extent of substance use stigma and its negative consequences for individuals and families, further research is needed to understand their lived experiences and the contexts in which the stigmatization occurs. This paper will attempt to fill this gap by examining accounts of stigma related challenges that were reported by community residents, people in recovery, and substance use providers.

Methods: The data for this research is drawn from a larger mixed methods study that examined substance use services, strengths, and gaps in a rural county. Participants completed a survey with open-ended questions on perceived challenges. Some of the participants that had completed the survey participated in four focus groups. Participants were recruited by word of mouth and an email sent to partner-agencies. Three stakeholder groups participated in the research, and these included women in recovery (n=26), community residents (n=63), and service providers (n=38). Qualitative content analysis was used to make sense of participants responses on perceived challenges using a coding frame developed according to the scheme proposed by Pearson (2015) and the National Academies of Sciences, Engineering, and Medicine (2016) on the three levels of stigma: (1) Social or Public Stigma such as negative attitudes or behaviors perpetrated by societal members, (2) Structural Stigma – policies or procedures at the state or agency level that limit opportunities or create disparities, (3) Self-stigma – shame or internalized stigma.

Findings:

Content analysis of the challenges reported by study participants identified 130 statements of which 49 (37.7%) related to stigma. The most frequent type of stigma was social stigma reflected in 67% of the statements, followed by structural stigma in 24% of the statements, and then self-stigma in only 8% of the stigma statements. The types of stigma reported by participants included a) stigma from service providers where participants felt ‘judged’ or that they were being ‘treated differently’ once the provider knew of their current substance use, b) lack of support from community structures and the public where there was “lack of compassion”, c) limited access to needed services such as Medicaid for substance use treatment, and c) fear of being known as someone using substances and shame that caused people to misreport cases of overdose. All the stakeholder groups that participated in the study acknowledged the barriers imposed by stigma experiences on access to services and integration into the broader community.

Conclusion and Implications: Findings highlighted the pervasive nature of stigma which has expanded social distance between individuals experiencing substance use issues and the broader community. Social workers can be instrumental in creating opportunities for individuals with lived experiences to interact and share their stories of recovery with the public. In addition, social workers can address structural stigma through strategies that seek to expand resources, enhance strengths, and defend the rights of people impacted by substance use. Following this research, grant funding was secured to expand resources in the community.