substance use disorders and stigma · what is stigma? • negative stereotypes assigned to a group...
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Substance Use Disorders and Stigma SHAWNA ADKINS, LCSW; DEBRA MONTOYA; DAVID TIAN, MD; JESSICA WANG, MD; AND DENISE WILLIAMS-TAYLOR, RN
Roadmap • Definesubstanceusedisorderandstigma• Explorehowlanguageandattitudesaffectourperceptionofpeoplewithsubstanceusedisorders• Exploreusing“person-first”languagetoreducestigma• Recognizesubstanceusedisordersaschronicdiseases
Let’s Get Technical • ASubstanceUseDisorder(SUD)isaproblematicpatternofuseofacertaindrug/classofdrugthatleadstoclinicallysignificantimpairmentordistressthatcauses:
• Drugclassesincludeopioids,stimulants(methamphetamines,cocaine),alcohol,marijuana,tobacco,caffeine,etc.
CravingstoUse LossofControl
ContinuedUseDespite
Consequences
Let’s Get Technical • Opioids(alsocalled“opiates”and“narcotics”)areaclassofdrugsthatincludeheroin,fentanyl,morphine,oxycodone,tramadol,andcodeine.
• OpioidUseDisorder(OUD)isapatternofopioidusethatleadstoproblematicbehaviorinaperson’slife
CravingstoUse
LossofControl
ContinuedUseDespite
Consequences+ =OUD
Let’s Get Technical • MedicationAssistedTreatment(MAT)istheuseofmedicationsinadditiontocounselingandbehavioraltherapiestotreatopioidusedisorder.• MATisthestandardofcareinthetreatmentofopioidusedisorders!
Methadone Buprenorphine
What is Stigma? • Negativestereotypesassignedtoagroupofpeoplewhentheirattributesareconsidereddifferentfromorinferiortosocietalnorms(Goffman1963)
◦ Structural◦ Social◦ Individual◦ Self
Stigmatization in Local News
https://www.youtube.com/watch?v=5gT5NULvRSk
Think Pair Share Exercise
Mr.Jonesisasubstanceabuserwhoabusesheroinandisattendingatreatmentprogramincourt.Aspartoftheprogram,Mr.Jonesisrequiredtostaycleanfromalcoholandotherdrugs.However,lastmonthhetesteddirtyinhisurineforopioids.Hereportsthathewasunderfamilystressandrelapsed,buthewantstostopabusingdrugs.Hehasbeenasubstanceabuserforthepast5years.Henowawaitshisappointmentwiththejudgetodeterminehisstatus.
Think Pair Share Exercise • Asapair,answerthesequestions:◦ WhatisyourmentalimageofMr.Jones?◦ Didhedosomethingwrong?◦ Whatshouldthejudgedo?
Think Pair Share Exercise
Mr.Joneshasanopioidusedisorderwithheroinuseandisattendingatreatmentprogramincourt.Aspartoftheprogram,Mr.Jonesisrequiredtoremainabstinentfromalcoholandotherdrugs.However,lastmonthhetestedpositiveonhisurinetoxicologyforopioids.Hereportsthathewasunderfamilystressandresumedheroinuse,buthewantstostopmisusingdrugs.Hehashadasubstanceusedisorderforthepast5years.Henowawaitshisappointmentwiththejudgetodeterminehisstatus.
Think Pair Share Exercise • Asapair,answerthesequestions:◦ HowdoesyourmentalimageofMr.Joneschange?◦ Whatarethedifferencesbetweenthetwoparagraphs?
Group Share • Mr.Jonesisasubstanceabuserwhoabusesheroinandisattendingatreatmentprogramincourt.Aspartoftheprogram,Mr.Jonesisrequiredtostaycleanfromalcoholandotherdrugs.However,lastmonthhetesteddirtyinhisurineforopioids.Hereportsthathewasunderfamilystressandrelapsed,buthewantstostopabusingdrugs.Hehasbeenasubstanceabuserforthepast5years.Henowawaitshisappointmentwiththejudgetodeterminehisstatus.
• Mr.Joneshasanopioidusedisorderwithheroinuseandisattendingatreatmentprogramincourt.Aspartoftheprogram,Mr.Jonesisrequiredtoremainabstinentfromalcoholandotherdrugs.However,lastmonthhetestedpositiveonhisurinetoxicologyforopioids.Hereportsthathewasunderfamilystressandresumedheroinuse,buthewantstostopmisusingdrugs.Hehashadasubstanceusedisorderforthepast5years.Henowawaitshisappointmentwiththejudgetodeterminehisstatus.
ModifiedfromKelly,InternationalJournalofDrugPolicy,2009
Language Matters • Use“person-firstlanguage”◦ Putthepersonbeforeadiagnosis◦ Describewhataperson“has”ratherthanwhataperson“is”
• Ourmedicalconditionsdonotdefineus
Language Matters INSTEADOF…
• Addict,junkie,alcoholic,drugabuser,dopefiend,crackhead• Drugabuse• Clean/Dirty
• Formeraddict• Relapse
USE…
• PersonwithaSUD
• Addiction,SUD,misuse• Abstinent/activelyusing.Neg/Pos(utox)• Personinrecovery• Resumption,recurrence
Stigma is Harmful
• Peoplewhoexperiencestigmaare:
lesslikelytoseekorbeofferedtreatment
SUDs are Treatable Chronic Diseases
NoWrongDoor!AWindingPath
(Chronic,RelapsingCondition)
Opioid Use Disorder Treatment WORKS
Connery,HarvardReviewofPsychiatry,2015
• Whenaskedtostop“coldturkey,”asfewasoneintenpatientsareabletosucceed.
• Whenmedicationsareused,morethanhalfofpeopleareabletostopopioiduse.
Opioid Use Disorder Treatment WORKS
Sordo,BMJ,2017
MethadoneTreatmentEffect
BuprenorphineTreatmentEffect
Peopleare50%lesslikelytodiewhentheytakemedicationsforopioidusedisorder.
What Can We Do? • Practice“person-first”language• Encouragepositiveattitudesandlanguageinclinic• Encouragepatientstoaskquestionsandseektreatment• Sharethatsubstanceusedisordersaretreatable• Alertprovidersandbehavioralhealthteammemberswhenpatientsscreenpositiveonsubstanceusequestions(AUDIT/DAST)
Why Does Stigma Matter?
• SubstanceUseDisorder(SUD)isamongthemoststigmatizedconditionsintheU.S.andaroundtheworld
• Healthcareproviderstreatpatientswithsubstanceusedisordersdifferentlyduetostigma
• Peoplewithasubstanceusedisorderwhoexpectorexperiencestigmahavepoorerhealthcareoutcomes
(SAMHSA,2018)
Breastcancer
SUD
Language Changes Treatment • Arandomizedclinicaltrialofdoctoral-levelclinicianslookedattheimpactthatlanguagehadonjudgingapersonwithSUD.
(Kelly2010)
“Comparedtothoseinthe‘substanceusedisorder’condition,thoseinthe‘substanceabuser’conditionagreedmorewiththenotionthatthecharacterwaspersonallyculpableandthatpunitivemeasuresshouldbetaken.”
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