Stigma and substance misuse are closely linked. This article looks at what can be done to understand how we can destigmatise substance misuse and comes to an intriguing conclusion: substance misuse behaviour is stigmatised correctly, whilst the substance misusing individual should have his/her stigma removed to reduce barriers to coming forward for increasingly effective treatment.

 

Primary health care is ideally placed to offer screening for substance misuse and early intervention. Substance misuse in the workplace is costly in both human and financial terms. Work place testing offers an opportunity to detect such problems and provide appropriate help. However, it is not a panacea and results should be interpreted as part of a wider picture.

 

The link between communicable diseases and substance misuse can result in an increase in stigma, even affecting national guidance on some treatments. Treatments for drug and alcohol problems are more available than ever and increasingly mainstreamed (eg in Primary Care). Self-help approaches are an established cornerstone and helplines offer accessible advice to the community at large.

 

Health care education has a particular role in destigmatising substance misusers. The costs of substance misuse to the NHS are enormous, so it makes economic as well as clinical sense to invest in greater emphasis on addressing the issue, during both undergraduate and postgraduate training. Until this happens, health services will help to perpetuate stigma rather than take the lead in reducing it.

 

Download the entire article - Drugs and Alcohol – Whose problem is it anyway? Who cares?

 

It is hard not to blame a man who is drinking himself to death. Or a woman whose baby is born addicted to heroin. But what are we blaming them for? For being weak, or selfish or stupid? Just like the rest of us?

Do we blame the man with no legs for using a wheelchair? The ostrich for sticking its head in the sand? The child for asking for the light to be left on? People give all sorts of reasons for using drugs. Some just want to have fun. That’s fine until it stops being funny. When that happens there is something else going on. It may be physical or psychological dependence.

Physical dependence is straightforward. Your body adjusts to the drug and then it doesn’t function properly when you don’t have it. After a while without it things go back to normal. Usually.

Psychological dependence is different. It is when a person believes he needs a drug. What does it mean to need a shot – of whisky or amphetamine? It means that life isn’t quite right without it. That things don’t work as they should. The need is an absence that no-one else may notice.

The absence may be a parent who was never there. Or who was, but not as a parent – as an abuser perhaps, or even as a child. Someone who couldn’t look after herself, let alone you. Or maybe something else happened and you grew up lopsided, full of loathing and hate and thoughts of destruction. Or maybe it was all just too hard, too miserable, putting one foot in front of another, day after day.

The drug doesn’t solve the absence. In the end it just fills the hole with new problems. Being late for work, getting in trouble with the law, arguing with lovers and relations, late nights, forgotten places, bad mornings after the night before. Then there’s the denial and deception – ‘I’m all right, I can handle it’. The secret sessions. Others’ rage.

Anger and evasion may distract from the real problem. They can occupy a night, a day, a week, a lifetime, so in the end you don’t have to think about what’s really wrong. That’s the real joy of blame, it’s thoughtless.

1. Alcohol and other drug misuse

Whose fault is it that this woman lives on the street? The government's for not providing housing? The hostel's for throwing her out for shouting? Her husband's for leaving her for being drunk all the time? Her employer's for sacking her for always being late? her school's for not noticing that she was never there? Her friends' for offering her cider? Her step-father's for abusing her? Her own for not saying no?   People drink for all sorts of reasons. Many say its their only option. It is hard to choose when you believe you have no choice.

2. Alcohol and other drug misuse

3. Alcohol and other drug misuse

4. Alcohol and other drug misuse

5. Alcohol and other drug misuse

 

Substance misuse (usually the abuse of alcohol or illicit drugs) is the excessive use of that substance. It can lead to dependency. It results in physical or emotional harm and may be the cause of difficulties in relationships, at home and at work. With repeated use, ‘tolerance’ develops so that a person has to take more of the substance to achieve the desired effect. Stopping using the substance may lead to a state of withdrawal with physical and psychological symptoms.

 

Substance misuse is a growing problem around the world. In the West, alcohol remains the most commonly misused drug because it is a key part of our social lives. In small quantities it may even have a beneficial effect on health. But alcohol dependence leads to potentially fatal physical illnesses, and to psychological and social difficulties such as increased rates of divorce, poor performance at work, increased traffic accidents, acts of violence or death from suicide.

 

Drug trafficking and dealing is a multi-million pound business. Illicit drug use is becoming more common, particularly among young people. Drugs of misuse include opiates such as heroin, stimulants such as cocaine and crack, hallucinogens such as LSD, and cannabis. Drugs available on prescription from a doctor or bought in a chemist can also sometimes be misused, and long term tranquilliser use can lead to dependence.

 

People may also misuse substances such as solvents and some glues. Drug use is linked with risks such as accidents while someone is intoxicated, overdose, or infection from sharing injecting equipment. Regular drug use is linked with a variety of bad effects, both physical illness, and psychological and social problems, and can lead to criminal behaviour to pay for the drug habit.

 

 

We do not know how common alcohol and drug misuse are in the general population. We can estimate numbers from data such as the numbers of people admitted to hospital with liver disease or the number of addicts who have come for treatment. One in four men and one in ten women may drink over the recommended upper limit for safe drinking. More men than women also misuse illicit opiates (e.g. heroin). Although many young people try drugs, a smaller number become dependent with a regular drug habit. Seven per cent of the adult population is alcohol dependent, and two per cent is drug dependent.

 

 

We do not know the cause of substance misuse, but it is likely that several factors may be important. People with easy access to alcohol or drugs are at higher risk of becoming substance dependent. Young people with behavioural problems or who have not learned to deal with the stresses of life are more liable to misuse drugs. Peer pressure can be another factor. Alcohol misuse tends to run in families and there is evidence that genetic factors contribute to this. Nicotine addiction is an example of how prevalent an addictive behaviour can be and how much social influence can be brought to bear on the development of addiction. Once somebody has become alcohol or drug dependent, other life difficulties such as unemployment, poverty or homelessness will impair their ability to regain control over their addiction.

 

 

Health professionals can help to identify problem alcohol and drug use as early as possible. A person may not be aware that he/she is becoming substance dependent, but may seek help for some of the consequences of his/her alcohol or drug use.

 

The health professional will need to understand the extent of the person’s alcohol or drug use and its effect on his/her life. Many people may not be ready to consider stopping their drug use and may deny the problem. The health professional may want to discuss the consequences of continued drug use, to allow the person to weigh up the pros and cons of continued use. If someone is determined to carry on their drug habit despite the dangers, health professionals may advise on, for example, safe injecting techniques and supply sterile needles to minimise risks of harm, such as HIV infection, whist encouraging them to rethink their commitment to drug use.

 

For people wanting to try and stop their substance use, a detoxification programme (drying out) may be helpful. For either alcohol or drugs, a doctor can prescribe a reducing course of another drug to relieve the unpleasant withdrawal symptoms. In some cases this treatment may be offered in specialist drug or alcohol units. Admission to hospital is sometimes necessary, especially if a person has previously found it too hard to stop at home. The relearning and regaining of trust and social responsibility during the recovery process, can be slow and painful.

 

Longer term, people need to learn about ways of living without using alcohol or drugs. Talking treatments can help. Health professionals may advise about joining one of the variety of support groups, many of which are run by ex-users. Examples of support groups are Alcoholics Anonymous and Narcotics Anonymous. There are also support groups for relatives to attend. People who have been alcohol and drug dependent for some time may want to join a rehabilitation programme. Many of these are run by non-statutory agencies, and may be staffed by ex-users.

 

Young children of alcohol and drug addicts may suffer the combined stigmatisation of family violence, neglect, poverty and a premature adult role in protecting the addict parent from the consequences of their own problems and society’s response to them. They should be offered their own counselling and support.

 

 

Political measures, such as the amount of taxation on alcohol, affect the amount of alcohol people drink and the number who become alcohol dependent. Education through schools to children, and through the media, can influence our knowledge and attitudes. These programmes can inform us about the origins, nature of and the risks of substance misuse. Improving communication and problem-solving skills during childhood, so that young people can cope better with the strains of adolescence, can also help. Education of parents, who may know less about drug misuse than their children, can also be beneficial by improving family communication and family understanding of the problems facing youngsters growing up in today’s society. Altering social conditions, such as unemployment and lack of leisure facilities, may also be helpful.

 

We would like to thank Dr V Y Allison-Bolger and Dr R L Ramsay for their tremendous help in writing these booklets and factsheets. Our thanks also go to the Campaign Management Committee and to the members of the College Faculties and Sections who have generously given their advice and help.

Professor Arthur Crisp
Chairman,
Changing Minds Campaign Management Committee