7 Reasons for Alcohol and Drug Addiction Stigma: By Ryan Jackson

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(image: Pinterest)

Stigma is a set of pre-conceived false beliefs that people have against a particular group of people. According to the World Health Organization’s website, stigma is a major cause leading to discrimination and exclusion. Not only does it disturb the personal life of a person, stigma can also limit their chances of obtaining proper jobs and housing. The unfortunate thing about stigma is that it’s not based on facts, but rather on assumptions and generalizations that have been embedded into society.

7 reasons addiction carries a stigma

The American Society of Addiction Medicine characterises addiction as a “primary, chronic disease of brain reward, motivation, memory and related circuitry.” The National Institute on Drug Abuse defines addiction as a ‘chronic, relapsing brain disease” that changes the structure and functionality of the brain.

So, why do so many people still think of addiction as a moral failing? Why do they still refer to victims of substance misuse disorders as meth freaks, alcoholics, junkies, crackheads and garden-variety drunks?

The answer is simple as it is depressing: because that’s the way it’s always been.

Addicts are scorned by communities, and celebrities with addictions are exploited or hounded by paparazzi. And, while the government purports to view addiction as a disease, it often works in opposition to that position through the “War on Drugs,” which counts most drug users as criminals. Even those of us in the treatment community still—consciously or unconsciously—employ stigmatising programming and language—such as when we focus on “dirty” urine.

So despite widespread agreement that addiction is best understood as a complicated behavioural-biological scenario that requires treatment, the system is hard-wired to prolong stigmatisation, and stigma contributes to addiction’s lethality.

Of course, there is a long history of mental illness being misunderstood and stigmatised,  in state hospitals or prisons, which was beautifully captured by the director Lucy Winer in her recent highly-acclaimed documentary, Kings Park. Addiction and mental health problems are still spoken of in hushed tones, and patients and their families are still blamed. This is changing, but there is still stigma. 

The idea that those with addictive disorders are weak, deserving of their fate and less worthy of care is so inextricably tied to our zeitgeist that it’s impossible to separate addiction from shame and guilt. Addiction comes with a second punch in the gut: the burden of being treated like a second-class citizen and expected to act accordingly. Stigma impacts us all, both consciously and unconsciously, and is perhaps the single largest contributor to the mortality rate. Consider these eight points:

  1. People fail to seek treatment.

Most people who struggle with an addictive disorder fail to seek treatment, in part because of their concern that they will be labeled an “addict” and that the stigma will stick. 

Often, a crisis precipitates treatment, so the problem is already well-advanced. If we removed the stigma, guilt and shame from the equation, people would find it easier to make a realistic, objective assessment of their substance misuse and discuss it openly with a health care provider.

  1. The medical profession fails to treat addicts properly.

Can you think of other situations in which the health care system abdicated responsibility for dealing with a health care issue that afflicts such a huge segment of the population? For far too long, those people who did seek treatment, often following a crisis, found no appropriate reception from the medical community. Doctors were slow to recognize addiction as treatable, and so patients were encouraged to find help outside of the medical community, in 12-step programs that based on non-scientific practices, normally anathema to physicians.

12-step programs helped many, but those that did not succeed there found themselves in the unenviable position of having been directed to a place by their doctor, having the recommended solution ineffective and being reluctant to return to their physician for further help. A better paradigm? The medical community should recognize addictive behavior as part of its purview and would apply evidence-based approaches in their practices.

 

  1. The mental health profession ostracizes people with addictive disorders.

It is routine in some mental health settings for persons with substance misuse problems to be discharged from treatment when substance misuse is revealed. They’re told that the drinking or drug use renders them “unavailable” for the work of psychotherapy and that they need to “get clean” first by going to a chemical dependency or substance abuse treatment program. They are told that whatever issues seem pressing and paramount to them are “just the drugs talking’

It’s common for clinicians to believe that before they can help a patient with the various traumas, interpersonal conflicts, intrapsychic issues and other problems that other people are  helped with in psychotherapy (and which are, of course, related to their use of substances) the patient needs to first become abstinent from substances. Many patients who are sent to traditional drug treatment programs that are abstinence-focused end up neither “clean and sober” nor receiving good psychotherapy.

  1. Funding for addiction treatment is discriminatory.

In spite of the huge impact and cost of addictive disorders on society, the way that addiction treatment is funded (in America) is disproportionately low. Despite passage of Federal Mental Health Parity legislation, mental health and substance use disorders continue to be treated differently—and often poorly—compared to “medical” illnesses.

What if there was no stigma in addiction? Given its huge cost to society, addiction should be funded and paid for on a level playing field with medical problems.

 

  1. Addicts get sent to jail.

Where substances are concerned, people go to jail for the possession of something that is part and parcel of their addiction. Most of the money that governments spend on “drug control” is spent on criminal justice interdiction rather than treatment and prevention.

Here again, clearly, is a system with stigmatisation at its roots: blaming, punishing and making moral judgements instead of providing treatment and other help that would change behavior. The more of a stigmatising stance one takes towards substance misuse the more likely one is to support criminalisation of drug offenses and the less likely is to support insurance coverage and treatment for drug addiction. Taking the stigma out of addiction argues for prevention and treatment as opposed to prosecution and incarceration.

 

  1. Even when people do get to treatment, stigmatization can continue and contribute to poor treatment outcomes.

It is critical to recovery that treatment programs not send messages to patients that are blaming (for relapse) and shaming (for being weak). People enter treatment at a vulnerable moment, psychologically and in terms of their brain chemistry. Addiction comes with a hard-to-escape sense of failure that recapitulates prior disappointments and works in opposition to growth.

Patients have spent a lifetime trying to silence the “inner critic” that repeats “I’m-not-good-enough” messages, so it’s critical that the culture and language of treatment provide a healthy soil in which patients can grow seeds of hope that are vital to recovery. In an optimal treatment setting, patients aren’t expected to play the role of one-who-should-be-ashamed. Instead, they are intrinsically involved in planning their own treatment, helping to choose the goals and techniques of treatment.

  1. They confront stigma-based roadblocks constantly.

Those in recovery from addiction face ongoing stigma and discrimination. People in recovery are faced with obstacles, especially those who have been in treatment or in the criminal justice system for chemical dependency. Employment, education, insurance and the ability to vote are all fraught with uncertainty and discrimination for those in recovery.

People in recovery have a harder time finding and keeping jobs, getting licenses, food stamps, benefits that help their children.  In other words, important aspects of living that are so critical to a stable recovery for persons who have been treated for addiction, such as employment, housing and providing for one’s family are that much harder to get. Things need to change. Having struggled with addiction in the past should not make life that much more difficult now. End the stigma.

 

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Raising our Voices: Stigma and Bipolar Disorder (For Equilibrium Magazine Issue 63)

I was asked by Equilibrium magazine, an online magazine dedicated to mental health and wellbeing by those with lived experience, to write an article for them. I chose to write it on stigma and bipolar disorder and here it is. You can also read it online at :   https://issuu.com/antz333/docs/equilibrium_2063

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I am very excited to be writing my first article for Equilibrium. In this article I
will discuss stigma and life with bipolar.

I have lived with bipolar disorder for thirteen years, having been diagnosed at just
sixteen years old. The illness runs in my family, but it was still a shock when I
found myself unwell in hospital as a teenager. Bipolar disorder is a mood disorder,
which means moods can oscillate between depressive lows and manic highs that
can be treated with medication and therapies. When depressed, one might find
oneself feeling extremely negative and unable to do activities previously enjoyed
or, in bad cases, suicidal and unable to cope with life. When in a manic state, one
may be in a heightened hyperactive state, talking fast/not making sense and
unable to sit still. A person may act in ways they would not usually behave when
in a typical state. This can then spill over into psychosis, with delusions and a loss
of touch with reality, which can eventually lead to hospitalisation in severe cases.
There is currently no cure for the disorder; however, mood stabilising medications
such as Lithium, prescribed by a psychiatrist, and courses of therapy can very
much help. It is believed that bipolar may be caused by a chemical imbalance in
the brain, but there is still so much we do not know. It is for this reason that
stigma about the disorder and other mental health conditions, pervades across
the world.

So, what is stigma? Stigma can be defined by the Oxford dictionary as a ‘mark of
disgrace associated with a circumstance, quality or person’. In terms of mental
illness, people fear what they have not experienced, do not know and do not
understand. It is the fear and ignorance that then perpetuates myths about those
who struggle with their mental health.

Due to the sometimes unpredictable nature of mental illness, in our case, bipolar
disorder, fear and stigma are most definitely generated. When people haven’t
been through the suicidal, heart-wrenching lows, and the sometimes equally
terrible highs, they will comment that the person is ‘attention-seeking’ and just
doing it to get a reaction from other people. We have seen this recently when
depressed celebrities, for example singer Sinéad O’Connor (who has bipolar), open
up to the world about their demons. They get criticised, shot down, told they are
being drama queens, silenced, as if their problems are trivial. There is nothing
trivial about serious mental illness or how the brain can trick you into feeling.
There is nothing trivial about feeling so unwell you can’t get out of bed, wash,
live. There is nothing trivial about experiencing suicidal tendencies and not having
support, because support networks are the one thing that keep bipolar sufferers,
and those with other conditions, going. Without my support network, I know I
would find things so much harder.

So, how do we tackle this stigma? In one word: talking. Telling people about our
experiences. Sharing the world of people who have mental health issues and
reflecting it back to wider society, through explaining to non sufferers what its
like to live with a mental health condition. It Is so important to show wider
society the world inhabited by people with mental health conditions. Everyone
is different. Its vital to explain the unexplainable. Talking about our symptoms
but showing how we can reach recovery or what recovery means to us.

I began speaking about my experiences online via my WordPress blog ‘Be Ur Own
Light’ (www.beurownlight.com) about a year and a half ago. The blog began as a
diary, as I was navigating life with a difficult anxiety disorder which made it
difficult for me to hold down a job long term. I still live with this anxiety and am
learning how to manage it. When I first began writing, I did it secretly and only
showed it to close family members and wrote under pseudonyms. I was effectively
testing the waters to see the reaction. I was frightened I would get negative
feedback.

I began writing for charities such as Rethink Mental Illness, Time to Change and
Bipolar UK, under pseudonyms, because I didn’t yet feel able to associate my name
with the illness. I was scared, and I suppose was experiencing some self-stigma. In
thirteen years I had never written about my illness or mental health online,
though I had explained it to close friends. I remember the day when my first
article for Rethink was published –‘Being Jewish and Bipolar’- and getting hundreds
of likes, shares and positive comments. This built my confidence, and, over the
course of a year, I wrote for more charities and even started writing for the
Huffington Post Lifestyle blog and other websites/magazines under my real name.

A month or two ago, I decided to write all my mental health blogs under my real
name. There is still so much work for us all to do to bring down the stigma, but it
starts from raising our voices. We deserve to be heard and we need to talk in order
to make mental health issues ‘normal’ in society and to fight for better treatment.
One in four people suffer, although I would argue the figure is more like one in
two. Together we can battle, speak out and one day beat the stigma.

Eleanor Segall is a mental health writer and advocate, who has written for many
charities and magazines. She currently works for mental health and learning
disability charity The Judith Trust. Her blog ‘Be Ur Own Light’
(www.beurownlight.com) is read globally and tackles her life with mental health
issues and those of guest bloggers. Eleanor can be found on Twitter and Instagram

Guest post: Bipolar 2- Wading through depression and loss of motivation by Jessica Flores

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This article is about Bipolar 2 disorder, a mood disorder where sufferers can cycle between high and low moods. Jessica writes about her experiences: 

If you have been diagnosed with Bipolar II, you know that it differs from Bipolar I disorder in that you still cycle between high and low, but you never experience complete mania (high mood), which is good. Instead, you get hypomania (a lesser form). Yet, more often than not, you are trying to cope with long periods of substantial depression; which can be more severe and long lasting . Roughly six million people in the United States  and millions around the world, suffer from some form of bipolar disorder, so you aren’t alone.

When I am hypomanic, I find myself excited to go out and have conversations and stay up all night. I want to make friends and craft furniture and redecorate. I end up buying things online for some new life I plan to begin living. It’s why half of my living room has been filled with boxes of mid-century housewares for the last two years. However, I spend most of my time being depressed.

My life often feels like it is happening underwater. Every action I attempt to take exhausts me. Showering daily is impossible. I sleep for half the day and sit in front of the computer to do my job without the energy to move forward or the cognitive wherewithal to make sentences. I don’t have urges to harm myself, but I wonder why I need to keep feeling this way every day. I lose hope for the future- it can be very difficult.

Lately, I have begun to wonder if I am depressed or if I am simply losing motivation.  I feel sluggish. I don’t feel motivated. My house is a wreck. I can’t remember the last time I cleaned the kitchen floor. I thought about getting a maid service last week, but I didn’t want anyone to see my apartment.  Sometimes I have negative self talk and think I am lazy, not depressed.

As it turns out, I am not alone in my thoughts about this. Many people with clinical depression reach a point where they attach negative descriptors to themselves. If people hear they are lazy often enough during depressive episodes, it’s not unusual for them to question whether or not it’s true.

Mute Everyone Out

A depressed person isn’t simply dealing with a lack of motivation, they deal with changes in their sleep patterns, hopelessness, loss of pleasure in things they used to enjoy, changes in weight and/or appetite, and so much more. All of these are potential symptoms of bipolar depression and they can be treated. There are a number of medications that have proven effective in treating Bipolar II and many forms of therapy that are a critical element of a complete treatment plan.

Regardless, that’s a lot to handle all on your own. And what makes it especially difficult is the fact that it’s all being caused in your own mind.

Which is why it’s time to stop thinking of yourself as unmotivated or lazy, and it’s time to stop listening to anyone around you who does. You have a diagnosed medical condition. You are managing as well as you can in the given circumstances. I know it’s hard, but you’re going to need to learn to tell yourself that that’s all there is and you shouldn’t put yourself down for the resulting actions that you choose to take because of your condition. Instead of feeling ashamed, you need to make sure you are getting all of the treatment that you can and learning skills to help you control what you are able to.

Eleanor Roosevelt once said that nobody can make you feel inferior without your consent. This is your battle. To make sure that you yourself don’t make yourself feel bad for how you spend most of your days. By being proud of who you are and accepting your condition, you close yourself off from any hurtful comments any uninformed person could ever tell you. And it’s important for you to be able to do that. Because you’re not any of the negative things you just said. You’re amazing, capable, and strong. Remember that.

 

Jessica Flores is a wife, mother, writer, and woman diagnosed with bipolar II. She knows that her disorder affects her entire family and she works to lessen the impact as best she can. However, she also gives herself permission to experience changes in mood. Her drastic experience motivates her to blog about it and help others who are experiencing trying times.

Mental Health, Social Media and Relationships: Reality vs the Edit

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This post has been inspired by a few experiences that have happened to me in my life- regarding relationships with others- be they a friend or otherwise and social media.

I am a self confessed social media lover and addict. I love its ease, I use it as a way to store memories to look back on- photos, places I have been. A kind of virtual diary. I use it to keep in touch with friends, acquaintances who I would never normally see as they are in different countries or regions- and to keep in touch with friends I see regularly. I am always on Facebook, Instagram and Twitter (though not Snapchat- showing my age) and I truly love being online. Most of the time.

The difficult part about having bipolar disorder and anxiety disorder/ social anxiety is that it is not easily visible. Equally, on social media we always tend to present an edited version of ourselves- the good side. The positive side. The places we’ve been and the friends we’ve seen, those close to us. My Facebook profile, when I can achieve things, shows me smiling and being out and about. However, this has the potential to upset people if I have had to cancel arrangements due to anxiety.

The main refrain is often ‘But you were able to do it then- so why can’t you do it now?’.   How come the next day you could go out for dinner (I saw it on your Facebook)?

I understand this reaction. I do post a lot to celebrate achievements to myself and keep memories- happy memories for when I do become unwell again (which I hope won’t be for a long time). Social anxiety means that I want to look back on and remember the good times, the happy times.

The tough part is that relationships can become strained if one overly posts on social media. So its a complete dichotomy.

Do I post my life and enjoy the times I am able to socialise and go out without anxiety? Or do I edit what I upload so as not to hurt feelings of people I have had to cancel due to anxiety attacks? Ultimately- do I take my memories offline and into a private journal or on Instagram rather than Facebook?

All of this has been going through my head. Mental illness is not as straight forward to others as a broken leg. I don’t wear a sign saying I am bipolar or a bandage round my head.

I may look like I am having the time of my life…. but one may not see that:

Yesterday I could have had a panic attack which meant I couldn’t leave the house as I felt overwhelmed and embarrassed, and totally drained from the adrenaline. I got out to socialise now because a family member drove me somewhere as a form of exposure therapy to lessen my anxiety.

OR this scenario…..

My anxiety took over and I felt so frightened I was hyperventilating, crying and beating myself up emotionally, for not being able to see a friend. Because yes, we don’t want to have this and we care deeply about our friends feelings.

OR this scenario….

I have heard you talking negatively about me to someone else because I had to cancel an arrangement. Yet, I have anxiety about travel and socialising and sometimes feel overwhelmed. You know this, yet will still be upset- which I have to take into account.

So no, I am not really having the time of my life all the time. Friends are my priority but equally optimum health and managing day by day is to me hugely important.

I will try my very best not to let you down. If I hurt you through my social anxiety, it is never intentional.

I have learnt the hard way the pitfalls of social media with mental health issues. The large part is that we don’t want to talk about how depressed or anxious or panicked we are on Facebook. So it gets hidden and misunderstandings happen.

I hope one day it comes into the light, through my blog and when I can be more open.

My article for Self Harm UK- ‘I don’t want to hide anymore (about stigma)’

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I am delighted to announce a blog collaboration with the amazing charity Self Harm UK (a part of Youthscape).

I have written a blog for them on my experience of mental health stigma as an ill teenager and what made me speak out further. In the past, I have had self harming thoughts and I myself like reaching out to teens and young people who are suffering out there- so they know they are not alone. I am so pleased to collaborate with Self Harm UK on this and my article can be found here:

Click here to read my article:

https://www.selfharm.co.uk/articles/i-dont-want-to-hide-anymore

Who are Self Harm UK?

From their website selfharm.co.uk:

‘ SelfharmUK (formally selfharm.co.uk) started out of the work of Youthscape, a local charity based in Luton, Bedfordshire, UK. Since it’s beginnings in 1993, the charity has developed a strong and professional reputation for delivering caring, child-centred work, which focuses on the emotional and social needs of all young people. Youthscape works alongside all young people, regardless of race, background, or faith.

By 2004, Youthscapes’s work increasingly involved young people engaging in self-harm. It wasn’t long before a plan began to form to try and reach them them, starting with the provision of informal support groups in local schools. With the help of funding from BBC Children in Need and other grant-making Trusts, the project was able to appoint a specialist staff team in 2005 and develop a more coherent provision that included art projects and therapeutic group programmes. Training and advice for parents and professionals soon followed, in conjunction with the Local Authority and local schools.

In 2008, Youthscape responded to the growing number of enquiries for support and advice coming from outside Luton by beginning to plan for a national project that could support young people from all over the UK. Further planning and fund raising led to the establishment of SelfharmUK later that year and the appointment of a Project Manager

The development of a website was a key part of our initial vision… to have a safe online space available to inform and support young people who self-harm, as well as cater for the needs of their siblings, parents and friends. We also wanted to provide information and training for professionals like youth workers, teachers and social workers.

We wanted to create a safe, pro-recovery site for people to use to communicate with others and express their experiences through the use of blogs, stories, poetry and art. Our next goal was to develop an online group programme – Alumina – which has enabled young people from all over the UK to engage with our staff in real time in order to explore the deeper issues surrounding self-harm. For some it had been the catalyst needed to reduce or stop their harming behaviour, while for others it has proven empowering, enabling them to seek further support in their local area.

We already have a multimedia training programme available to professionals in the UK. Our ongoing vision is to see this rolled out more comprehensively; to serve every part of the UK in supporting and nurturing young people who may be experiencing difficulties with self-harm.

There remains much to be done but we remain committed to improving the lives of anyone impacted by self-harm. Providing effective support for parents and siblings will be a major goal in the near future.

For now, the project remains part of Youthscape as a separate element of this registered charity.’

 

Fighting mental health stigma: a personal journey

I have had bipolar disorder for almost 13 years, along side depression, anxiety, psychosis, hypomania and manic symptoms- which ebb and flow and fluctuate. Now that I am on the right medication these bipolar symptoms are kept under control. For most of these 13 years, I didn’t feel I could speak out about my conditions.

My family and close friends have always been very supportive but I felt ashamed. Ashamed of where my brain could go to when unleashed and its chemistry got confused. Ashamed of why I was either suicidally depressed or hyper and manic to a point of having to be sectioned to a psychiatric ward. Ashamed of my illness, confusing my identity with the illness, which made me worried about others judgement of me.

I was diagnosed at a very vulnerable age- 16 years old and as we know teenagers can be cruel. Although I experienced a lot of kindness and empathy, after a hypomanic episode abroad where I was disinhibited, I experienced a lot of cruel rumours from other teens I knew. Rumours that were stupid but that called me many names and compared me to evil things that I do not want to repeat. What was at the most basic of these insults? In my opinion, fear.

People fear what they cannot see and cannot understand.

People in their teen years do not want to be different- and I was the embodiment of difference.

If people can’t comprehend something and it is threatening- they judge or use name calling to feel better.

At 16, I represented a world of chaos at which many could not understand. Perhaps now they will.

I have spent a long time coming to terms with my illness and what it means, finding the right treatment and medication and the right support networks around me. I have incredibly supportive friends and family.

So what does the above treatment boil down to?

Stigma.

Stigma is according to an online dictionary- ‘ A mark of disgrace associated with a particular circumstance , quality or person’

For so long, I felt this ‘mark of disgrace’ and until I was 25, although close friends and family knew about my illness, I didn’t write blogs the way I do now. This was because I wanted to hide this illness that lodged in my brain chemistry.

I don’t want to hide any more and neither should I.

In 2014, I was hospitalised and sectioned for a severe manic episode encompassing psychosis, delusions and hyperness/ disinhibition.

It was shortly after going through the most traumatic experience of my life that I realised. Life is short. I need to help others. If I can break down the stigma and help others through my writing and other work then I will.

Mental Illness must no longer be a ‘mark of disgrace’ but must be seen as a partly physical illness in the brain, deserving and worthy of good treatment and empathy from others.

This post is dedicated to those friends who asked me to write on this and all my friends for their love and support