“Society is measured by how we treat those most in need.”
Defining The Problem
When considering the widespread opioid overdose crisis occurring throughout North America, it is clear we are not doing enough to manage the devastating consequences. On both sides of the Canadian – American border, overdose leading to death is on the rise. British Columbia saw more than 1400 people die in 2017 alone. In 2020, the crisis has not abated.
While the US Government successfully declared the opioid epidemic a national health emergency, Canadian feds have yet to acknowledge the depth of the crisis. Those with lived experience, along with close family and friends who have directly experienced loss, wonder how bad the problem has to get before the Prime Minister takes action.
Stigma is a driving force behind inaction. Many individuals continue to under-identify the severity of their own substance problem, even when faced with the death of a substance misusing peer, or subsequent medical complications associated with chronic consumption.
In order to shift stigma, we must tackle widely accepted (yet ineffective) treatment regimes, cultural dynamics, language, and the roll healthcare and governments should play in order to decrease the impact of the problem.
Battling Shame and Stigma Culture
Substance dependence is a shame-based syndrome. There are two important parts to shame as it relates to substance misuse. First, everyone who sees themselves as dependent, feels a deep sense of failure. The dreams that propelled them into adulthood are never realized. They see others around them experience success. Growth becomes stagnant the farther down the path they find themselves.
Second, the traditional treatments for substance misuse reinforce shame-based culture through the promotion of powerlessness. In the 12-Step tradition, you are asked to acknowledge your inability to master your addiction on your own, and accept that you are, at core, defective. Once that is incorporated into your belief system, you are encouraged to address the harms that your behaviour has had on others.
The social comparative aspects of failure, along with a treatment system dominated by shame-based teachings, leaves the individual incapable of moving forward. In turn, both shame-based self identity, and our treatment system, promote a pervasive stigma culture. Shame and stigma are largely ineffective tools for promoting change. It should go without saying, that people change when they are ready.
The Challenge of Language
Language plays a critical role in shifting stigma culture. Historically, words like, “addict,” or, “junkie,” were widely used in recovery circles. People also often describe themselves as being, “clean,” or, “dirty.” For example, when a drug screen comes back as positive for illicit metabolite, the urine is noted as a “dirty” result.
We are slowly moving away from such language in an effort to decrease stigma and shame. Instead of, “substance abuse,” we now say, “substance misuse.” Urine is now described as only, “positive,” or, “negative,” for metabolite. Those struggling with addiction are also encouraged to drop terms like, “junkie,” in an effort to decrease negative self-identity.
There are those who find changes in language both a waste of time and abhorrent. Should we dictate the language of others? No! Should we model language that shows caring and non-judgement? Yes! Whether a healthcare professional decides to do that, is entirely on their own.
Role of Healthcare and Government
Both healthcare and governments have a responsibility in reducing the stigma and harms associated with substance misuse. This is best done through an open and accepting approach by health care professionals and government officials. The following considerations should be considered compulsory:
Harm Reduction: The top priority must always be to reduce the harms associated with substance misuse. It is important to note that Harm Reduction is a public health policy approach designed to save lives and decrease the spread of disease resulting from chaotic choices associated with substances. Harm reduction is not a treatment approach, such as AA or NA.
Readiness Training: Front-line staff must have a firm understanding of the techniques outlined in, “Motivational Interviewing: Helping People Change,” by Miller and Rollnick. The techniques promote acceptance regardless of the individuals’ level of motivation. People change when they are ready. It is the role of healthcare to be available as readiness develops.
Service Continuum: If you watch reality TV, you know that everyone sees addiction treatment centers as the, “go-to” approach for “fixing” the addicted person’s life. This is myopic at best. A wide variety of care options must be available to clients as they decide at what level they want to engage in care. This can range from accessibility of harm reduction supplies (e.g.; needle kits, etc.), to availability of long-rage treatment programs and second-stage housing.
A Better Future
A society is measured by how she treats those most in need. By addressing stigma, we provide the space for individuals to engage in life-saving care. Culture must shift away from shame focused approaches and language. Waiting for someone to, “hit their bottom,” has become a rejection by society, ending in death. If governments and healthcare work together, culture will shift over time. However, this requires persistence, especially in the face of government inaction.
Suggested Reading
The most powerful tool you will have on your bookshelf is, “Motivational Interviewing: Helping People Change,” by Miller and Rollnick. It is a must ready for anyone wanting to discover optimal methods for engaging with individuals struggling with substance misuse. Click on the book cover below to read more.
