Stigmata that are desired: contradictions in addiction

Abstract

Many experts in the etiology, assessment, and treatment of substance use/addiction view stigma and stigmatization – negatively branding addiction and substance users – as obstacles to the solution of the substance misuse problem. Discussions on this topic impact research and policy, and result in oft-repeated calls to remove the stigma from substance use and users. The goal of the article is to analyze the stigmatization concept as applied to substance use/addiction. It is widely accepted in the literature that stigmatization negatively affects substance users because addiction stigma interferes in both seeking and receiving professional care. It is argued that the societal disapproval of substance use/addiction is inappropriate because it is a mental disorder, involving biological processes. Nonetheless, neither those processes nor negative attitudes towards substance use affirm the concept of stigmatization as currently applied. This concept conflates potential mistreatment and malpractice with the prosocial justified societal disapproval of a lethally dangerous behavior. Consequently, the stigmatization concept suffers from internal contradictions, is either misleading or redundant, and may do more harm than the supposed mistreatment of substance users that stigmatization connotes. On the contrary, the justified disapproval of harmful behavior may be a factor raising individual resistance to substance use. Instead of mitigating the effects of that disapproval, it may need to be capitalized on. If it is employed explicitly, conscientiously, and professionally, its internalization may be one of the resistance mechanisms needed to achieve any progress in the still elusive prevention of substance use and addiction.

Keywords:

• Substance use disorder
• liability to addiction
• disease model
• drug abuse
• biologization
• legalization

Ethical approval

The research in this paper does not require ethics board approval.

Disclosure statement

No potential conflict of interest was reported by the author.

Additional information

Funding

This work was supported in part by the National Institutes of Health grant R01DA054313. The content is solely the responsibility of the author and does not represent the official views of the National Institute on Drug Abuse.