Addiction Stigma from an Intersectional Perspective

Stigma has the potential to negatively affect a person’s self-esteem, damage relationships with loved ones, and prevent those suffering from addiction from accessing treatment – Image adapted from Shutterstock

The stigma towards people who use or have used drugs doesn’t only affect the individuals emotionally, mentally and physically, but also affects their chances of finding and keeping employment or places to live and even affects their social relationships. Stigma makes it difficult for those who need help to ask for it and delays requests for treatment and access to harm reduction and other targeted services. Also, stigma may give rise to situations that increase the likelihood of becoming involved in risky behaviours and aggravate substance use-related socio-healthcare problems.

In the wake of the executive training that was organised by the Pompidou Group[1] and held over two modules in 2021 (Malta and Croatia) DIANOVA was keen to follow-up and learn more about the matter of stigma by organising the “Stigma and Addiction: where do we stand today?” online seminar. Around 70 participants who had access to an English and Spanish interpreting service attended this event. See the event recording below

The event was held as an online round table discussion on 13 January 2022 and five individuals who participated in the Pompidou Group’s executive training were also in attendance as participants and speakers:

• Gisela Hansen is a professional in the treatment and intervention sector at Dianova Spain. Specialist in gender, stigma and the child perspective in the addictions domain and has on-field as well as academic experience and knowledge.
• Maria Otero from UISCE works in services for people who use drugs in Ireland, which operates on a political advocacy level and focuses primarily on harm reduction and overdose prevention from a rights-based perspective.
• Ricardo Fuertes has focused his career on serving people living with HIV and the LGBTI+ community in harm reduction services and more recently as a political advisor in the Municipality of Lisbon, Portugal.
• René Stamm spent 25 years working in the Swiss Federal Office of Public Health focussing on empowering addiction services professionals and other such issues. She is an active team member of the Pompidou Group.
• Sabina Bredova is a social worker from Slovakia who has worked with the Roma community, with people who use injectable drugs and female sex workers.

Intersectional Perspective

The objective of this round table discussion was to learn more about stigma from an intersectional perspective to assess how the various core concepts of life come together with stigma and the ensuing discrimination, and to propose different ways for professionals in addiction services to address it. Training and raising awareness is required for individuals in this sector to ensure the ability to deal with all individuals and validate differences.

Also, when it comes to the concurrence of various problems in the same person (gender-based violence, problem substance use, mental health, poverty, etc.) joint and coordinated actions must be taken between support networks, ceasing to see people in a sectorial and biased manner in order to develop comprehensive, effective and universal ways of working.

Drug use stigma and the relationship with other forms of discrimination

Stigma is reflected in everyday attitudes and stereotypes that can generate prejudices that are reflected in laws and regulations and that contribute to the exclusion of people. This exclusion is manifested in difficulties accessing health services (medical, psychological, and social), which would not be found if it were any other illness. A clear example of this are the prejudices that surround the use of substitution therapies (Ex.: Methadone, Suboxone).

The impact of stigma in the design of drug policies and services is obvious. It is thereby important to work with policy makers to ensure that stigma does not come from above and does not affect the decision-making process, and the design and implementation of policies and programmes.

In 2018, Dianova launched a campaign to raise awareness of the physical and psychological consequences of stigmatizing people facing substance use disorders or behavioural addictions

Progress over the last decade

Clear progress in Western European countries, owing to the HIV epidemic that forced society to rethink its priorities and the progress made in the neurosciences field, which partly explains the scientific process concerning the reward system and addiction by addressing the judgmental conceptions of problematic substance use. A paradigm shift is currently taking place (not in all countries equally) in the criminal field towards the implementation of a public health perspective.

Although a long road still lies ahead, the activism of people who use or have used drugs has been encouraged. Stigma makes it difficult for those who use or have used drugs to get organised and assert their rights as full-fledged citizens. In any case, this call for the activism of people who use or have used drugs to get involved in the decision-making process must continue and public funding for their involvement must also be requested.

The role of families

Another important factor to consider is the stigma experienced by family members of those affected as they are neither supported by society nor institutions. It is important that they be seen as interested parties in the drug policies (as is the case in the Drug Strategy of Ireland). The stigma of family members of individuals who have died from an overdose is a clear example of the lack of empathy towards them and the poor understanding of problem drug use.

This distinction should also be considered by support services that deal with issues of violence, given that violence can sometimes come from brothers/sisters in the case of trans individuals for example.

People who turn to addiction services may also reveal that it is a family member themselves who has an addiction problem, amongst others. It is therefore necessary to consider working with family members.

How to address stigma in addiction services

Even within addiction services themselves, patterns are followed that assume that the people who use these services will be of a particular profile (mostly male, heterosexual, in a particular age bracket, from the same home country) and do not consider any other profiles or sexual identities when designing and implementing the services. We must therefore take people’s various situations of vulnerability into consideration to create safe professional spaces.

The recommendations of the Pompidou Group on regulating substitution therapies (opioid agonist treatment) are an example of how to address stigma in addiction services. This report provides a series of recommendations for governments on substitution therapy regulations, which will work in sync with human rights principles and scientific knowledge to provide non-discriminatory services.

However, change can also be achieved through small deeds. For example, when it comes to work with the LGTBI+ community drug services can be formed, collaborating with organisations that represent this community (for example, by joining the Gay Pride or participating in film festivals) is a matter of breaking barriers. And send small clear signals like treatment or harm reduction centres having banners and posters that represent the LGTBI+ community as a sign of it being a safe space.

It may be the case that a team of professionals occasionally experiences stigma-related situations where it is colleagues themselves who display it. It is therefore important to try and understand the problem in order to address it efficiently.

Finally, it is vital to be aware that what applies today may be outdated tomorrow. The centrality of training and contact with professionals from various parts of the world who may follow different approaches thereby continues.

Structural and cultural changes are needed

Beyond that, the changes that are required are structural. For example, ending the war on drugs, which when all is said and done is a war against the people who use drugs, is key. It is a matter of changing broader assertions.

Don’t focus so much on changing culture, but rather work on accepting diversity and designing interventions whilst acknowledging that the population is not a homogenous whole. Primary prevention work in schools plays a significant role here.

It is also important to give greater flexibility to the concept of family in the individuals’ support networks and work with them at a field and impact level.

At Dianova we wish to thank the speakers for sharing their time, experience and knowledge in such an honest and interactive manner. It has been an enriching discussion and we are coming away from it with an optimistic and proactive perspective.

Event video

[1] The Pompidou Group is the Council of Europe’s intergovernmental cooperation platform on drug policies.