The Roots of U.S. Stigma of Drug Use and Addiction

This article explores the internal and external factors of the stigma of drug use and how it relates to our social understanding of addition. In this article, we’ll look at social context and how it affects identity for drug users…plus, its implications in policy, treatment, and criminalization of drug users.

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What is Stigma?

Stigma is a term that is used often without much clarification on what it means. So, before we begin, let’s define the word “stigma” and agree on a meaning:

Stigma refers to an attribute that is discrediting to an individual within a social context. It could be something that is obvious or hidden, but once the attribute is made known, the owner of the trait is disgraced and their identity is spoiled.

Usually, a stigma is created by the contradiction between the expectation of an individual’s social identity and their actual social identity. Since stigma is only within a social context, an attribute can be stigmatizing in one context but an asset in another.

In this article, I will discuss the stigma of being a person who has, or who has had, a relationship with substances. The consequence of the stigma of addiction comes in different forms depending on the social context, such as in the greater society versus a 12 Step meeting. Stigma is perpetuated just as much by those who are in recovery as those who are not. The spoiled identity of the addict is an issue that is much deeper than just viewing addiction as a disease or a choice. It involves all areas of life that are too numerous to count but I will attempt to explore stigma by using history, language, identity, and addiction recovery ideology.

The Protestant Ethic and the American Dream

Since a spoiled identity is linked to the expectations that a society holds on its members, I think it’s important to look at the historical perspective of how those expectations were formed to begin with. Basically, the Protestant Ethic holds that for a person’s life actions to be aligned with a higher divine purpose, they must work hard for their own rewards. According to the Protestant Ethic, humans have only a few ways in which pleasure can be obtained without sin. Only “natural highs” are allowed through eating, hard work, exercise, and sex within heterosexual marriages. Any other type of pleasure is a sin and punished as such through the court of public opinion. Drugs fall in this category. Instead of receiving a good feeling through the joy of hard work and social obedience, the drug user avoids hard work and skips straight to the euphoric reward.

As the Protestant Ethic morphed into the American Dream, Americans (at least white American) are taught that anyone who works hard and plays by the rules will be rewarded accordingly; that the reward is directly proportional to the amount of hard honest work that is involved. Therefore any reward, either emotional or material, that is received without honest work is cheating. Those who cheat are labeled as such and stigmatized appropriately.

The bottom line?

Americans hate when folks don’t follow the arbitrarily constructed rules, rules that were made to sustain the system of power, privilege, and oppression. Those people, the ones who break the rules, are cast out, marginalized, and stigmatized.

Race, Ethnicity, and Stereotypes

Stigma is inseparable from stereotypes and, therefore, implicitly linked to race and systems of power in the United States. The best way to stigmatize a drug is to attach it to an already marginalized group of people. Every drug scare is fueled by an exacerbated fear, not only of the drug itself but also, of the ethnic group that supposedly uses it. Think of all the drug scares in this country and the group that is, or was, connected with it:

  • Crack Cocaine and African Americans
  • Marijuana and Mexicans
  • Opium and the Chinese
  • Heroin and African Americans
  • Marijuana and Hippies (stigmatized deviant group)

Historically, it is not the drug itself that is to be feared but, rather, the people who use those drugs bleeding into the suburban from the urban. The stereotypes of people of color in the United States are really all the same: lazy, criminal, dishonest, aggressive, animal like, hypersexual, impulsive, and so on. Look at that list and then make your own list of the stereotypes of the addict. Look familiar? It should. Just as there are no inherent traits of a Mexican, there are no inherent traits of a person who uses substances. Any attempt to lessen the stigma of the substance user without acknowledging the inherent racist roots will fail.

Whitewashed Stigma

Only when white people use drugs is the drug itself feared more than the people who use it. We can look back at the transformation of public opinion of Marijuana and the direct correlation of white people smoking pot. As white people, and more specifically their children, started to use and be arrested for marijuana, the drug started it’s decent into decriminalization.

Currently, we have an “opiate epidemic,” which basically means that white people are dying. The disease of addiction, and the drug itself, is to blame when whites feel the consequences of the substance. The disparity in how we treat crack and powder cocaine is another in the long list of racially motivated stances on drugs. These examples of race and stigma should be blatantly obvious to anyone who honestly looks at how we deal with drugs and those who use them.

Liars, Cheats, and Thieves

When I first came into recovery, I would hear things in meetings like “we are all liars, cheats, and thieves.” Although I certainly occasionally did (and still do) all of those things, I didn’t identify with the identity of being a villain or any type of bad person. Lying, cheating, and stealing seemed to me to be a condition of being human, not necessarily an addict, and I felt that I did those things less than even most non-addicts. But I was desperate to belong and believed, rightly so, that if I wasn’t accepted by these people then I would die. If that meant pretending to be a liar, cheat, and a thief then so be it.

This ownership of the criminal identity of the addict plays as much of a role in the perpetuation of stigma as anything a non-addict could ever do. Just the wholly embraced identity of the label “addict” does enough to inflate stigma without the further attachment to the criminal identity. Let’s not forget that criminology, and its consequences, are social constructs that are completely arbitrary. People who use substances are criminals only because laws were formed to make us so. There is nothing inherently criminal about a person who uses substances. By embracing this construct we are buying into the lie that we are less than human, which is the basis for stigma.

It’s fun for recovered people to sit around in meetings and social media and talk about how screwed up they were. The human inclination to always “one-up” our fellow users further exacerbates the solidification of the inflated criminal identity. This identity comes with benefits within the internal stigmatized group by being considered a “real” addict. There are even benefits from the greater society when viewed as a recovered criminal, as everyone loves a rags-to-riches story.

But what does this criminal identity do for the person who is still currently using substances?

It justifies the stigma and all the socially constructed negative consequences that go along with it. Viewing former users as reformed criminals deepens the isolation of current drug users and lessens their ability to seek help. When drug users claim to not be criminals, but merely someone who has a relationship with a drug, they are deemed “in denial” and not ready to change.

Are We Diseased Or Criminal?

Although it is clear the criminality is socially constructed, the disease concept of addiction is much more nuanced. In the United States, we systematically treat addiction in a way can only be described as bipolar, hypocritical, and counterproductive. Most people are pretty much on board with the disease concept of addiction, at least at a systematic level, but we treat said disease with law and order.

Personally, I don’t believe in either zero tolerance or the disease concept, but that society as a whole needs to come to a unified stance on what addiction is and create a treatment that aligns with that viewpoint.

The current system does nothing but completely confuse those who attempt to think about addiction with any type of linear logic. If we want addiction to be a disease, it should be treated as one. If we want it to be an inherent trait of a criminal, then we need to acknowledge it and continue with the current system. Making people who use substances into criminals rapidly perpetuates stigma, which is fine if that is what we as a whole feel is right, but to say that it is a disease that is worthy of treatment, and then completely ignoring that ideology in its treatment, is both hypocritical and unethical.

But What About the Real Alcoholic?

With so many different definitions and perspectives on addiction, it is hard to say exactly what – or who – an “addict” is. The Big Book of Alcoholics Anonymous innocently addresses this question in a way that has greatly contributed to the internal perpetuation of stigma within the recovery community. The AA book, which lays at the foundation of the recovery ideology, attempts to separate the alcoholic from the non-alcoholic by giving examples. Presumably, to understand what, or who, an alcoholic is, one must first know what an alcoholic isn’t.

First, the Big Book outlines the definition of the teetotaler and the heavy drinker before they ask the all-important question: “But what about the real alcoholic?”

Members of the recovery community have taken this phrase to heart and verbally identify themselves as real alcoholics in meetings and other recovery settings. To say publically that you are a “real” alcoholic is to imply that there are “fake” alcoholics among the crowd. The word “real” is the true language of stigma and the Stigmatizer. To imply that someone or something is not real is to rob that person, or thing, of their very identity––to spoil their identity. Not only is it an accusation of authenticity, it is also an accusation of being a fake or a fraud.

Indeed, using the word “real” to stigmatize others is a daily tool used to strip people of their credibility and authenticity:

  • He’s not a real man.
  • She’s not a real American.
  • That’s not a real religion.
  • They’re not really sober.

By using the word “real” the speaker is solidifying the stigma, not only by spoiling the identity, but also invalidating the identity all together. When the recovery community differentiates the “real” from the “fake” among its members, they are making a statement that only the truly stigmatized are welcome. These fake alcoholics are not bad enough to join the ranks of the stigmatized, nor normal enough to blend in to society. They are in a no-mans-land of addict identity.

Methadone and the Double Stigma

There is no better example of double stigma than in the case of Medication Assisted Treatment. MATs have been a controversial subject since the beginning of the use of methadone.

Although these treatments have been shown to cut the fatality rate of opiate use in half, those who use these types of treatments are double stigmatized by both society and the recovery community.

Folks who use MATs are not usually openly welcomed in most recovery circles, especially 12 Step fellowships. Drugs such as Methadone are viewed as cheating and that the user is not “really” clean. The person who has a relationship with heroin, for example, is stigmatized by society for being an addict, and they are doubly stigmatized from the recovery community for being a cheater.

These are the folks who have the least support in attempting to create positive change in their lives.

The research is clear that social support increases a person’s chance to change their relationship with substances and it is also clear that MATs save lives. By denying someone full acceptance because they choose a valid lifeline, is to force them into the darkest place of isolation; where they must choose between social acceptance and life itself.

Hard and Soft Drugs: A Drug is a Drug is a Drug

Another type of recovery invalidation that is common is when people choose to stop using one drug but continue to use another. Marijuana is a hot button topic in the recovery community and is becoming more and more prevalent as Marijuana’s legalization is spreading across the United States.

The bottom line is that anyone who chooses any recovery path that doesn’t involve total abstinence from all mind altering drugs, except nicotine and caffeine, are not deemed “clean.”

If a heroin user, with a daily injection habit, stops using heroin but continues to smoke marijuana they have the same “dirty” recovery status as if they never stopped shooting heroin. Recovery is a dichotomous institution that has no tolerance for middle of the road solutions. You are either clean or dirty, sober or drunk, sinner or saint.

Drug Mythology and Personal Experience

Stigma runs so deep with drugs that the mythology of drugs is almost impossible to separate fact from fiction. If a lie is said enough times, it becomes truth. This is where we are with drugs in our society. One of the drivers of mythology is the over emphasis on personal experience, specifically in dealing with substances. Because the majority of people don’t use drugs, drugs and drug users become a mythical world that’s clarification is left up to the imagination, and the biased testimony of those who survive addiction.

It’s time to look at facts and to wipe away everything that anyone thinks is true about drugs.

The truth is that the majority of people who use drugs do not become addicted and the majority of people who do become addicted stop using on their own without any type of formal treatment. Most information that we have about drug users comes from this small portion of drug users who actually present for treatment. Therefore, any truth that originates from the stereotypical user (someone who is addicted and can’t stop on their own), is based on an extreme minority of the population. Those assumptions have little to do with the drugs themselves or drug users in general.

Harm Reduction = Increased Functionality

Due to the Protestant Ethic, Americans can’t stand cheaters or anyone who takes short cuts. But this ideology is false and its reminiscence is as harmful now as ever.

Drug use should be viewed as what it is: a natural human experience.

Harm Reduction is the solution for moving away from old ideas. Just as using substances is a personal relationship between drug and person, changing that relationship is just as intimate of a process. Recovery is about functionality, and any gain in functionality is recovery. If that means smoking pot to avoid dying with a needle stuck your arm, then I applaud you, and count you as much of a success as any other type of person in recovery.

About the author
Scott Novotny is an associate clinical social worker and a certified addictions treatment counselor in San Francisco California. He is currently working as a clinical case manager at an outpatient mental health clinic. Scott is a harm reduction advocate and in involved in harm reduction and syringe access services in San Francisco. He obtained his master’s in social work at California State University East Bay in Hayward California.
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