![Page 1: Substance Use Disorders and Stigma · What is Stigma? • Negative stereotypes assigned to a group of people when their attributes are considered different from or inferior to societal](https://reader034.vdocument.in/reader034/viewer/2022050113/5f4a275862ffaf063c3e8359/html5/thumbnails/1.jpg)
Substance Use Disorders and Stigma SHAWNA ADKINS, LCSW; DEBRA MONTOYA; DAVID TIAN, MD; JESSICA WANG, MD; AND DENISE WILLIAMS-TAYLOR, RN
![Page 2: Substance Use Disorders and Stigma · What is Stigma? • Negative stereotypes assigned to a group of people when their attributes are considered different from or inferior to societal](https://reader034.vdocument.in/reader034/viewer/2022050113/5f4a275862ffaf063c3e8359/html5/thumbnails/2.jpg)
Roadmap • Definesubstanceusedisorderandstigma• Explorehowlanguageandattitudesaffectourperceptionofpeoplewithsubstanceusedisorders• Exploreusing“person-first”languagetoreducestigma• Recognizesubstanceusedisordersaschronicdiseases
![Page 3: Substance Use Disorders and Stigma · What is Stigma? • Negative stereotypes assigned to a group of people when their attributes are considered different from or inferior to societal](https://reader034.vdocument.in/reader034/viewer/2022050113/5f4a275862ffaf063c3e8359/html5/thumbnails/3.jpg)
Let’s Get Technical • ASubstanceUseDisorder(SUD)isaproblematicpatternofuseofacertaindrug/classofdrugthatleadstoclinicallysignificantimpairmentordistressthatcauses:
• Drugclassesincludeopioids,stimulants(methamphetamines,cocaine),alcohol,marijuana,tobacco,caffeine,etc.
CravingstoUse LossofControl
ContinuedUseDespite
Consequences
![Page 4: Substance Use Disorders and Stigma · What is Stigma? • Negative stereotypes assigned to a group of people when their attributes are considered different from or inferior to societal](https://reader034.vdocument.in/reader034/viewer/2022050113/5f4a275862ffaf063c3e8359/html5/thumbnails/4.jpg)
Let’s Get Technical • Opioids(alsocalled“opiates”and“narcotics”)areaclassofdrugsthatincludeheroin,fentanyl,morphine,oxycodone,tramadol,andcodeine.
• OpioidUseDisorder(OUD)isapatternofopioidusethatleadstoproblematicbehaviorinaperson’slife
CravingstoUse
LossofControl
ContinuedUseDespite
Consequences+ =OUD
![Page 5: Substance Use Disorders and Stigma · What is Stigma? • Negative stereotypes assigned to a group of people when their attributes are considered different from or inferior to societal](https://reader034.vdocument.in/reader034/viewer/2022050113/5f4a275862ffaf063c3e8359/html5/thumbnails/5.jpg)
Let’s Get Technical • MedicationAssistedTreatment(MAT)istheuseofmedicationsinadditiontocounselingandbehavioraltherapiestotreatopioidusedisorder.• MATisthestandardofcareinthetreatmentofopioidusedisorders!
Methadone Buprenorphine
![Page 6: Substance Use Disorders and Stigma · What is Stigma? • Negative stereotypes assigned to a group of people when their attributes are considered different from or inferior to societal](https://reader034.vdocument.in/reader034/viewer/2022050113/5f4a275862ffaf063c3e8359/html5/thumbnails/6.jpg)
What is Stigma? • Negativestereotypesassignedtoagroupofpeoplewhentheirattributesareconsidereddifferentfromorinferiortosocietalnorms(Goffman1963)
◦ Structural◦ Social◦ Individual◦ Self
![Page 7: Substance Use Disorders and Stigma · What is Stigma? • Negative stereotypes assigned to a group of people when their attributes are considered different from or inferior to societal](https://reader034.vdocument.in/reader034/viewer/2022050113/5f4a275862ffaf063c3e8359/html5/thumbnails/7.jpg)
Stigmatization in Local News
https://www.youtube.com/watch?v=5gT5NULvRSk
![Page 8: Substance Use Disorders and Stigma · What is Stigma? • Negative stereotypes assigned to a group of people when their attributes are considered different from or inferior to societal](https://reader034.vdocument.in/reader034/viewer/2022050113/5f4a275862ffaf063c3e8359/html5/thumbnails/8.jpg)
Think Pair Share Exercise
Mr.Jonesisasubstanceabuserwhoabusesheroinandisattendingatreatmentprogramincourt.Aspartoftheprogram,Mr.Jonesisrequiredtostaycleanfromalcoholandotherdrugs.However,lastmonthhetesteddirtyinhisurineforopioids.Hereportsthathewasunderfamilystressandrelapsed,buthewantstostopabusingdrugs.Hehasbeenasubstanceabuserforthepast5years.Henowawaitshisappointmentwiththejudgetodeterminehisstatus.
![Page 9: Substance Use Disorders and Stigma · What is Stigma? • Negative stereotypes assigned to a group of people when their attributes are considered different from or inferior to societal](https://reader034.vdocument.in/reader034/viewer/2022050113/5f4a275862ffaf063c3e8359/html5/thumbnails/9.jpg)
Think Pair Share Exercise • Asapair,answerthesequestions:◦ WhatisyourmentalimageofMr.Jones?◦ Didhedosomethingwrong?◦ Whatshouldthejudgedo?
![Page 10: Substance Use Disorders and Stigma · What is Stigma? • Negative stereotypes assigned to a group of people when their attributes are considered different from or inferior to societal](https://reader034.vdocument.in/reader034/viewer/2022050113/5f4a275862ffaf063c3e8359/html5/thumbnails/10.jpg)
Think Pair Share Exercise
Mr.Joneshasanopioidusedisorderwithheroinuseandisattendingatreatmentprogramincourt.Aspartoftheprogram,Mr.Jonesisrequiredtoremainabstinentfromalcoholandotherdrugs.However,lastmonthhetestedpositiveonhisurinetoxicologyforopioids.Hereportsthathewasunderfamilystressandresumedheroinuse,buthewantstostopmisusingdrugs.Hehashadasubstanceusedisorderforthepast5years.Henowawaitshisappointmentwiththejudgetodeterminehisstatus.
![Page 11: Substance Use Disorders and Stigma · What is Stigma? • Negative stereotypes assigned to a group of people when their attributes are considered different from or inferior to societal](https://reader034.vdocument.in/reader034/viewer/2022050113/5f4a275862ffaf063c3e8359/html5/thumbnails/11.jpg)
Think Pair Share Exercise • Asapair,answerthesequestions:◦ HowdoesyourmentalimageofMr.Joneschange?◦ Whatarethedifferencesbetweenthetwoparagraphs?
![Page 12: Substance Use Disorders and Stigma · What is Stigma? • Negative stereotypes assigned to a group of people when their attributes are considered different from or inferior to societal](https://reader034.vdocument.in/reader034/viewer/2022050113/5f4a275862ffaf063c3e8359/html5/thumbnails/12.jpg)
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
![Page 13: Substance Use Disorders and Stigma · What is Stigma? • Negative stereotypes assigned to a group of people when their attributes are considered different from or inferior to societal](https://reader034.vdocument.in/reader034/viewer/2022050113/5f4a275862ffaf063c3e8359/html5/thumbnails/13.jpg)
Language Matters • Use“person-firstlanguage”◦ Putthepersonbeforeadiagnosis◦ Describewhataperson“has”ratherthanwhataperson“is”
• Ourmedicalconditionsdonotdefineus
![Page 14: Substance Use Disorders and Stigma · What is Stigma? • Negative stereotypes assigned to a group of people when their attributes are considered different from or inferior to societal](https://reader034.vdocument.in/reader034/viewer/2022050113/5f4a275862ffaf063c3e8359/html5/thumbnails/14.jpg)
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
![Page 15: Substance Use Disorders and Stigma · What is Stigma? • Negative stereotypes assigned to a group of people when their attributes are considered different from or inferior to societal](https://reader034.vdocument.in/reader034/viewer/2022050113/5f4a275862ffaf063c3e8359/html5/thumbnails/15.jpg)
Stigma is Harmful
• Peoplewhoexperiencestigmaare:
lesslikelytoseekorbeofferedtreatment
![Page 16: Substance Use Disorders and Stigma · What is Stigma? • Negative stereotypes assigned to a group of people when their attributes are considered different from or inferior to societal](https://reader034.vdocument.in/reader034/viewer/2022050113/5f4a275862ffaf063c3e8359/html5/thumbnails/16.jpg)
SUDs are Treatable Chronic Diseases
NoWrongDoor!AWindingPath
(Chronic,RelapsingCondition)
![Page 17: Substance Use Disorders and Stigma · What is Stigma? • Negative stereotypes assigned to a group of people when their attributes are considered different from or inferior to societal](https://reader034.vdocument.in/reader034/viewer/2022050113/5f4a275862ffaf063c3e8359/html5/thumbnails/17.jpg)
Opioid Use Disorder Treatment WORKS
Connery,HarvardReviewofPsychiatry,2015
• Whenaskedtostop“coldturkey,”asfewasoneintenpatientsareabletosucceed.
• Whenmedicationsareused,morethanhalfofpeopleareabletostopopioiduse.
![Page 18: Substance Use Disorders and Stigma · What is Stigma? • Negative stereotypes assigned to a group of people when their attributes are considered different from or inferior to societal](https://reader034.vdocument.in/reader034/viewer/2022050113/5f4a275862ffaf063c3e8359/html5/thumbnails/18.jpg)
Opioid Use Disorder Treatment WORKS
Sordo,BMJ,2017
MethadoneTreatmentEffect
BuprenorphineTreatmentEffect
Peopleare50%lesslikelytodiewhentheytakemedicationsforopioidusedisorder.
![Page 19: Substance Use Disorders and Stigma · What is Stigma? • Negative stereotypes assigned to a group of people when their attributes are considered different from or inferior to societal](https://reader034.vdocument.in/reader034/viewer/2022050113/5f4a275862ffaf063c3e8359/html5/thumbnails/19.jpg)
What Can We Do? • Practice“person-first”language• Encouragepositiveattitudesandlanguageinclinic• Encouragepatientstoaskquestionsandseektreatment• Sharethatsubstanceusedisordersaretreatable• Alertprovidersandbehavioralhealthteammemberswhenpatientsscreenpositiveonsubstanceusequestions(AUDIT/DAST)
![Page 20: Substance Use Disorders and Stigma · What is Stigma? • Negative stereotypes assigned to a group of people when their attributes are considered different from or inferior to societal](https://reader034.vdocument.in/reader034/viewer/2022050113/5f4a275862ffaf063c3e8359/html5/thumbnails/20.jpg)
Why Does Stigma Matter?
• SubstanceUseDisorder(SUD)isamongthemoststigmatizedconditionsintheU.S.andaroundtheworld
• Healthcareproviderstreatpatientswithsubstanceusedisordersdifferentlyduetostigma
• Peoplewithasubstanceusedisorderwhoexpectorexperiencestigmahavepoorerhealthcareoutcomes
(SAMHSA,2018)
Breastcancer
SUD
![Page 21: Substance Use Disorders and Stigma · What is Stigma? • Negative stereotypes assigned to a group of people when their attributes are considered different from or inferior to societal](https://reader034.vdocument.in/reader034/viewer/2022050113/5f4a275862ffaf063c3e8359/html5/thumbnails/21.jpg)
Language Changes Treatment • Arandomizedclinicaltrialofdoctoral-levelclinicianslookedattheimpactthatlanguagehadonjudgingapersonwithSUD.
(Kelly2010)
“Comparedtothoseinthe‘substanceusedisorder’condition,thoseinthe‘substanceabuser’conditionagreedmorewiththenotionthatthecharacterwaspersonallyculpableandthatpunitivemeasuresshouldbetaken.”