Stigma Communication Surrounding Opioid Use Disorder Among Affected Family Members

Background & Purpose

A growing body of research examines the role of language in the stigmatization of opioid use disorder (OUD). Terms like “addict” and “substance abuser” elicit stigma and perpetuate negative stereotypes. When a family member uses this terminology, it may also affect treatment and recovery outcomes. Research among family members impacted by OUD suggests the attitudes and behaviors of affected family members (AFMs) can impact treatment and recovery. While prior research has identified terms AFMs consider stigmatizing, little is known about the language AFMs use when talking about their loved one’s OUD. Guided by stigma communication theory (Smith, 2007), this study examines how AFMs convey stigma when talking about their loved one’s OUD.

Methods

Thirty-four semi-structured phone interviews were conducted with adults in Michigan who had a close family member with a history of nonmedical opioid use. Participants were recruited from a prior study involving a survey of family members affected by OUD. AFMs were parents (n=13), children (n=11), siblings (n=11), and/or spouses (n=1) of people with OUD; three AFMs had multiple family members with OUD. Most participants were female (70.6%, n=24) and White (76.5%, n=26); smaller proportions identified as Black or African American (8.8%, n=3), or another race/ethnicity (14.6%, n=5). Participants ranged from 20 to 74 years old (M=47, SD=16.6). Qualitative analysis was guided by Tracy’s (2020) iterative approach which alternates between emerging findings from the data and existing research and theory.

Results

AFMs used marks to identify people with OUD; labels to distinguish people with OUD as part of a separate social group; attributed responsibility for the OUD; and linked people with OUD to physical and social peril. People with OUD were described as underweight, “dirty,” and/or “nodding off.” AFMs referred to people with OUD as “addicts” or opioid “abusers,” though usually without ill intent. Responsibility for the OUD was attributed to both internal (e.g., choice) and external (e.g., brain disease) factors. People with OUD were linked to physical danger, resource threats, threats to one’s reputation, and relational threats. While most stigma messages related to the person with OUD, stigmatizing messages directed toward AFMs emerged as well; people who were labeled “enablers” were blamed for the OUD and described as a threat to their loved one.

Conclusions & Implications

Although AFMs expressed care and tried to support their loved ones, they still utilized stigmatizing language. This language among AFMs is often a reflection of internalized stigma. Most AFMs did not blame their loved one for their OUD, but instead attributed the OUD to factors outside of the person’s control. Findings suggest the four characteristics of stigma messages (i.e. marks, labels, responsibility, and peril) are reinforcing and interrelated. Future studies should examine methods to help AFMs deal with the challenges of having a loved one with OUD and how they can support their loved one. Research should also examine if the portrayal of OUD as a brain disease effectively reduces stigma. Social workers can play a role educating AFMs about OUD and the power of our terminology.