The recent death of beloved pop star Prince has undoubtedly put one of the world’s most famous faces on the deadly opioid overdose epidemic facing the United States, and perhaps prompted the public to take a closer look at addiction stigma.
The musical icon, whose full name is Prince Rogers Nelson, died at age 57 on April 21, 2016, from what authorities say was an accidental overdose of the prescription drug fentanyl, a potent synthetic opioid that is 50 to 100 times stronger than morphine and 25 to 50 times stronger than heroin, according to the Drug Enforcement Agency (DEA). It is used to treat patients who have chronic pain. Even at low levels, the drug is potentially deadly and overdoses are “occurring at an alarming rate,” the DEA said in an April 2016 press release.
While opioid overdose can affect anyone, known or unknown, as proven by Prince’s untimely death, some observers say his celebrity has elevated the visibility of prescription drug use and the complex issues that surround substance use disorders (SUDs) and addiction stigma.
His use of painkillers and what may have been a delayed decision to seek professional help, which some attribute to how addiction is viewed in the public eye, is a reminder of why addiction stigma must be a part of the national conversation about addiction—one that defines what addiction is, what it means to have one, who is affected, and how to treat it.
How addiction stigma forms
How the general public views addiction can influence how others see the condition, how the disease is treated and if those who are struggling with addictive disorders get the help they need, some say.
Research conducted by the Johns Hopkins Bloomberg School of Public Health in 2014 gave insight into how addiction stigma influences how substance abuse is viewed by the public in the US. The study showed that people with drug addiction are more likely to be viewed unfavorably than those who have a mental-health disorder. Their condition is considered a “moral failing,” the researchers found.
“While drug addiction and mental illness are both chronic, treatable health conditions, the American public is more likely to think of addiction as a moral failing than a medical condition,” study leader Colleen L. Barry, Ph.D., MPP, an associate professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, said in a press release about the study.
“In recent years, it has become more socially acceptable to talk publicly about one’s struggles with mental illness. But with addiction, the feeling is that the addict is a bad or weak person, especially because much drug use is illegal,” Barry said.
Researchers surveyed more than 700 participants in the US about their attitudes toward either mental illness or drug addiction, and stigma, discrimination, treatment, and public policy.
According to the study’s press release, respondents had significantly more negative opinions about those with drug addiction than those with mental illness, and researchers found respondents had higher levels of public opposition to policies that might help drug addicts in their recovery.
Addiction doesn’t discriminate
Prince’s alleged dependence on painkillers put him in a large population of opioid users in the US. According to data from the Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health, almost 2 million Americans abused or were dependent on prescription opioids in 2014.
Methadone, oxycodone (such as OxyContin), and hydrocodone (such as Vicodin) are the most common drugs involved in prescription opioid overdose deaths, according to the Centers for Disease Control and Prevention (CDC), and more than half of all US opioid overdose deaths involve a prescription opioid.
Prince, also like many people, did not fit the “junkie” or “druggie” stereotype that is attached to people with addiction, but some say his celebrity may have helped others realize that opioid addiction affects people from all walks of life and does not discriminate.
“Prince’s death will help to remove the stigma attached to overdose primarily because his death received so much attention from the media,” said Judy Rummler, founder and CFO of the Steve Rummler Hope Foundation, in a recent Forbes interview.
She also said: “His death is evidence of the fact that unintentional overdose deaths are not limited to unsuccessful, down-and-out people.”
Dr. Andrew Kolodny, director of Physicians for Responsible Opioid Prescribing and chief medical officer at Phoenix House, a drug treatment facility, also spoke with Forbes, saying, “Like many opioid overdose victims, he lost his life to the disease of opioid addiction—he was not a so-called ‘drug abuser’ looking to get high.”
Kolodny also said, “The vast majority of overdoses are occurring in people suffering from the disease of opioid addiction—these are people who need to use opioids just to avoid feeling awful.
“It’s true that some people developed opioid addiction from recreational use, but many people also develop the disease taking opioids as prescribed by a doctor.”
According to the CDC, overdose deaths involving prescription opioids have quadrupled since 1999, as well as, the sales of these drugs.
From 1999 to 2014, more than 165,000 people have died in the US from opioid-related overdoses, the CDC said.
And, according to the National Center for Health Statistics (NCHS), there were 18,893 deaths involving prescription opioids in the US in 2014, a 16 percent increase from 2013.
What is addiction?
First, to address the issue of addiction stigma, it is important to understand what addiction is—and what it isn’t.
The American Society of Addiction Medicine defines addiction (in its short definition) as “the primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestation.
“This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.”
The National Institute on Drug Abuse (NIDA) defines addiction as “a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain; they change its structure and how it works. These brain changes can be long-lasting and can lead to many harmful, often self-destructive, behaviors.”
NIDA also says, “Addiction occurs when a person cannot control the impulse to use drugs even when there are negative consequences—the defining characteristic of addiction.”
Despite these definitions, which explain that addiction is a brain disease, there are opposing views, among them the theory that addiction is not a brain disease, but a series of repeated habits that change the brain.
However, regardless of the debate about whether addiction is or is not a brain disease, there is general agreement that perspectives that do not promote education and understanding about addictive disorders, and only promote addiction stigma, are barriers to treatment for people with addiction who are seeking recovery or are thinking about seeking recovery.
There also is general agreement that addiction is not a moral judgment or character flaw or personal weakness, nor is it a permanent condition, particularly if a person pursues and completes the proper medical treatment for it. Terminology and stereotypes that promote this line of thinking are seen as counterproductive to efforts to get people with SUDs help.
What is a stigma?
Social stigma is defined as a set of negative attitudes and beliefs that encourage others to avoid, label, reject, stereotype or discriminate against others, among other behaviors. They are imposed by friends, family, and community members, and can happen just about anywhere—in educational settings, on the job, or in the criminal justice and healthcare systems. Some substance abusers may internalize these negative views and become unmotivated to reach out for help.
To get an idea of how addiction stigma can undermine recovery efforts, here are five common reasons people with substance use disorders and addiction do not seek treatment.
- Fear of being labeled or judged. People with SUDs or addictions often fail to seek treatment out of fear of being labeled an “addict,” “abuser,” “crackhead,” “junkie,” or other derogatory terms. Using negative language and terminology to describe substance use disorders and the populations they affect can have a damaging influence on whether people seek medical treatment for their disorder or not. Such labels accompany and promote stereotypes that make it hard to separate the person from the behavior and the disease. Labels also imply there is no room for change or growth, which is not true, and undermines recovery efforts or attempts to seek and complete recovery.
- Fear of being rejected. Individuals may shun the idea of seeking and completing addiction treatment because they fear people in their families, social circles, and even strangers in and outside of their community may not accept them or their substance use.
- Discrimination. Addiction struggles, even for those in recovery, can bring discrimination on the job, during a search for housing, and even the everyday things, such as getting a driver’s license, registering to vote, or finding health insurance or health care. People in recovery are urged to learn their legal rights concerning employment, housing, health insurance, and other areas.
- Incarceration. Substance users who want help may avoid seeking treatment out of fear they will end up being prosecuted and incarcerated in the criminal justice system. Criminalization of drug offenses is part of the stigmatization of addictive disorders.
- Negative view of drug treatment. Unfavorable perceptions about drug treatment and rehabilitation keep many people, who need help with starting the recovery process, away from treatment.
This by no means is a complete list of the social stigmas people with substance use problems face, but it highlights some of their challenges.
Addiction stigma keeps many people who are battling their substance use disorders from seeking recovery as they feel fear, guilt, shame and a host of other negative emotions that block or slow their chances of recovery. Waiting to get help could have consequences for the user because the earlier one gets help, the higher the chances are that they can catch their addiction while it is in the early stages.
Education key to changing addiction stigma
With the millions of people in the US who are struggling with substance use disorders, addictions, and other challenges—and with the cost of substance abuse in the US exceeding an estimated $600 billion annually, it is important to educate the general public about these issues.
Getting the facts about what addiction is and what it isn’t, and addressing addiction stigma, is the only way to improve understanding and find ways to make treatment appeal to those who require it. People in recovery can also open up and share their stories, which can increase knowledge about the issues and help separate facts from fiction.
“If you can educate the public that these are treatable conditions, we will see higher levels of support for policy changes that benefit people with mental illness and drug addiction,” said Beth McGinty, Ph.D., MS, also a study author and an assistant professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health.
If you, or someone you know, are struggling with addiction or if you suspect you have a substance use disorder, call Recovery Hub at 844-242-0890. We understand your journey and what taking that first step toward recovery truly means. Our addiction specialists are available anytime, day or night, and waiting for your call. Begin your journey to lasting health, happiness, and sobriety. Don’t wait; call us now.