“…The sense of stigma is most likely to diminish as a result of public education and broader acceptance of addiction as a treatable disease.”
—Institute of Medicine, USA

Drug users face pervasive stigma and it lies at the heart of many of the problems they experience.  Stigma can be defined as “an attribute that discredits the individual, denying full social acceptance where notions of social inclusion and exclusion are firmly brought to the fore” (HDN, 2006)

The roots of stigma towards drug users are multifaceted and often related to inadequate understanding of addiction; judgments and fear related to differing physical appearance, behavior, and medical conditions such as HIV, hepatitis, TB and or mental illness. Stigma affects the way peers, family members and medical and social service providers interact with drug users and also affects law and policy in ways that exacerbate and cause many of the problems linked with problem drug use.  It also affects the way drug users are portrayed in the mass media.

In medical or social service settings, stigma can inhibit access to needed care either through direct discrimination or as displays of disdain discourage desire for contact.  In some cases drug users are systematically denied access to treatment.  In some countries in the region drug users for example are explicitly denied access to hepatitis treatment, as a non-priority group that within general limited availability of this treatment and as a group in which allegedly the needed treatment adherence could not be reached.  In Russia and some other countries, prior to 2004, drug users were systematically denied access to HIV treatment deemed lacking in “social prospective.”  Drug users are often denied access to adequate pain management. Stigma can more subtly inhibit access as glace of disgust or harsh words from a doctor or nurse can make a patient feel so uncomfortable that they do not return and having the same deadly effect as direct discrimination. (EATG/EHRN 2008)  Stigma in the medical setting can be countered by educating medical professionals about stigma and addiction. Involvement of drug users in the planning, implementation and evaluation of services can reduce the impact of stigma and build trust between medics and drug users.  Discrimination can be countered by legal and human rights action.

Drug users are also stigmatized the general public, friends and family.  Abandonment by friends and family can deepen social isolation and depression, further exacerbating problem drug use and social isolation.  The scapegoating of drug users in the media can adds to stigma.  Even well-intentioned drug use prevention campaigns sometimes demonize drug users rather than focus on the harms of drug use.  The perception of stigma can lead to “self stigma” or “internal stigma” lowering self-esteem and self- efficacy.  Programs that empower users and their communities as well as efforts to educate the media, family and friends about the nature of drug dependency can help alleviate the stigma.

Drug user stigma also impacts policy.  While recognized as effective and cost-effective harm reduction services remain with funding levels disproportionately low given the burden of disease among drug users due to their “unpopularity.”  The ultimate form of stigmatization enshrined in policy is the criminalization of use and position of amounts of drugs for personal use leading to the incarceration of drug users and the many problems associated therewith.  Again, defense of human rights, targeted education and advocacy campaigns and community empowerment can lead to improvement.

[1] Global Network of People Living with HIV (GNP+) The people living with HIV Stigma Index, instrument for measuring and countering stigma of PLHIV
[in English]

[2] HBO, (2007) The Addiction Project, Home Box Office (HBO) and US National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism. This webpage on addiction and stigma includes text and a 14 part video series entitled “Why can’t they just stop?: Addiction, new knowledge, new treatments, new hope.”
[in English]

[3]  HDN( 2004) Stigma, HIV/AIDS and drug use, Health Developments Networks, July 2004
[in English]

[4] www.naturalism.org. The Addiction and Behavioral Health page
This site provides provides a wealth of philosophical arguments to counter stigma associated with drug use based on the explanation that physical conditions rather than free will lie at the heart of addiction.
[in English]

[5] UNAIDS (2007), Reducing HIV Stigma and Discrimination: a critical part of national AIDS programs, A resource for national stakeholders, UNAIDS 2007.
[in English]

[6] The US National Mental Health Awareness Campaign
[in English]