Overcoming the Stigma of Addiction: 4 Facts You Need to Know

Person in skirt with long ponytail walks up stairs, rear view September is National Recovery Month. Sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), its observance is intended to increase public awareness of mental and substance use issues, as well as to celebrate people in recovery.

I was reminded of the ongoing need for increased public awareness of substance use issues while following the media coverage of and social commentary about Prince’s death due to an accidental overdose of the opioid drug fentanyl. “How could he have professed to be a Jehovah’s Witness and have a drug addiction?” “What about all that talk about his healthy diet?” “Was he taking the drugs out of medical necessity or was he just a junkie?” “He had everything. Why didn’t his people make him go for help?” These questions reveal many of the misconceptions and lack of general knowledge about addiction that many people have.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the guide used by mental health professionals to categorize mental health conditions, refers to addiction as a “substance use disorder.” While the specific substance—alcohol, opioids, cannabis, or others—may vary, substance use disorders are generally characterized by continued use of a substance and unsuccessful attempts to stop using despite negative social, occupational, legal, and/or physical consequences. Symptoms of substance use conditions can also include:

  • The need for larger amounts of the substance to obtain the same effect (tolerance)
  • Cravings for the substance
  • Symptoms such as anxiety, nausea, and seizures in its absence (withdrawal)

There is an interesting human tendency: when something undesired happens to us, we tend to attribute the cause of it to something situational or outside our control. However, when the same undesired event happens to someone else, we tend to attribute the cause of it to some internal characteristic. This is referred to as the fundamental attribution error, and it helps explain why so many people have the misconception that the inability to stop using a substance is evidence of a character or moral defect or lack of willpower.

Holding on to this, as well as other misconceptions about addiction, allows many of us struggling with our own sense of inadequacy, for whatever reason, to feel better about ourselves. Instead of feeling compassion for their struggle, we may feel disdain or disgust. This stigma has far-reaching negative implications, including increased shame and guilt that make it more difficult to reach out for help. Family members of people who use also may struggle with their own guilt and shame as well as anger, believing their loved one “just won’t quit.”

Substance use issues are so prevalent that it is likely you know someone who is struggling with or in recovery from one. If you are a close friend or family member, you have probably experienced the negative impact problematic substance use can have on relationships. Here are some facts about substance use issues that may help you understand the challenges of asking for help, getting sober, and beginning the journey of recovery:

1. While there are factors such as age, gender, and socioeconomic status which influence the type of substance an individual is likely to use, addiction can happen to almost anyone—for many reasons and at any point during the lifespan.

Instead of feeling compassion for their struggle, we may feel disdain or disgust. This stigma has far-reaching negative implications, including increased shame and guilt that make it more difficult to reach out for help.

Research has found that the type and number of adverse childhood experiences can have a profoundly negative impact on later development. Individuals whose parents separated or divorced or who experienced physical, sexual, and/or emotional abuse are more likely to develop many physical illnesses, mental health conditions, and substance use issues. Other research has consistently shown that individuals who struggle with depression and/or anxiety are at greater risk for substance use issues. Individuals with high levels of stress and inadequate coping skills are also more likely to begin using drugs and alcohol as a coping mechanism.

Individuals diagnosed with attention-deficit hyperactivity (ADHD) or learning disorders such as dyslexia are also at greater risk for developing a substance use issue. LGBTQ teens also have an increased risk for challenges with substance use, as do individuals who feel lonely due to recent social changes. This is one of the reasons cited by SAMHSA in a January 2010 press release as a reason for the increase in nonmedical prescription drug use among older adults.

2. The inability to stop using a substance that leads to negative consequences is better explained by immediate and long-term changes in the brain caused by the substance used rather than a character defect or lack of willpower.

Substances such as alcohol, marijuana, cocaine, opioid medications, and LSD are all mood-altering. They affect levels of the chemical dopamine, so that reward pathways of the brain are stimulated more intensely and for longer periods than with other pleasurable activities, such as sex. At the same time, the substances decrease one’s awareness of internal feelings as well as events happening around them. These effects are what make the person want to use again despite possible consequences.

The use of mood-altering substances also affects other chemicals in the brain, such as serotonin and GABA. Chronic substance use can physically alter the brain capacity for memory, learning, and making sound decisions—even after the individual stops using. This makes it more difficult for the individual to recognize the severity of their substance use and the need for treatment. It also makes it difficult to make decisions that decrease the likelihood of relapse. All of these chemical changes in the brain also help explain the intense cravings that users often experience and make relapse even more likely.

Also, some drugs, such as the opioid medications hydrocodone and oxycodone, commonly prescribed for pain, work in such a way that a person may need a higher dosage of the medication to obtain the same level of pain relief after a short period of time. While not everyone who takes opioid medications as prescribed has problems, a review of the literature on opioid abuse in people with chronic pain, published in the July 2010 journal Pain Physician, found that individuals with a low pain threshold and risk factors mentioned above, depression, and/or a high level of psychosocial stressors were more likely to abuse the prescribed opioid medications.

3. Overcoming addiction isn’t as simple as stopping the substance use.

Many individuals believe that all the problems created by the substance use issue will disappear once the use stops. But this is likely the time when cravings will be more intense and the individual experiences withdrawal symptoms. People who use should never be encouraged to “go cold turkey” without appropriate medical supervision. In fact, while withdrawal from opioid drugs, including heroin, can be especially uncomfortable, withdrawal symptoms associated with alcohol are often more life-threatening.

In addition, once the individual stops using, the feelings that had been numbed—such as shame and guilt, depression, or anxiety—while using may begin to resurface. It is also the time family members who have been negatively impacted by the user’s behavior may confront the individual. For this reason, a recovery treatment program is needed to help the individual deal with these challenges, as well as learn more adaptive ways to deal with life’s stressors and how to avoid situations that increase the likelihood of relapse.

4. Recovery is an ongoing process.

There are many different types of recovery programs—short-term and long-term residential rehab, intensive outpatient, 12-step meetings, and more. The programs offer the degree of immersion in counseling and structure needed at different times during the recovery process. An individual in recovery should periodically reevaluate their needs and modify their recovery program accordingly.

It is important to know that while not inevitable, relapse may be a part of the long-term recovery process.

References:

  1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders(5th ed.). Washington, DC: Author.
  2. Centers for Disease Control and Prevention. (2016, April 1). Adverse Childhood Experiences. Retrieved from https://www.cdc.gov/violenceprevention/acestudy/
  3. Genetic Science Learning Center. (n.d.). The Science of Addiction: Genetics and the Brain. Retrieved from http://learn.genetics.utah.edu/content/addiction/.
  4. Sehgal, N., Laxmaiah, M., & Smith, H. S. (2012). Prescription Opioid Abuse in Chronic Pain: A Review of Opioid Abuse Predictors and Strategies to Curb Opioid Abuse. 15:ES67-ES92. Retrieved from http://www.thblack.com/links/RSD/PainPhys2012_15_ES67_RxOpioidAbuseInChronPain-26p.pdf
  5. Substance Abuse and Mental Health Services Administration. (2010, January 8). Increasing Substance Abuse Levels among Older Adults Likely to Create Sharp Rise in Need for Treatment Services in Next Decade [Press Release]. Retrieved from http://www.samhsa.gov/newsroom/press-announcements/201001080530

© Copyright 2016 GoodTherapy.org. All rights reserved. Permission to publish granted by Sonya Lott, PhD, therapist in Philadelphia, Pennsylvania

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • 25 comments
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  • Mark M

    Mark M

    September 22nd, 2016 at 7:54 AM

    I kind of feel like there is not so much of that stigma anymore because there is a greater understanding that addiction is something that can happen to all types of people from all walks of life. The thinking has progressed a lot since the early days of treatment. At least I hope that’s the case!

  • Sonya Lott Ph.D.

    Sonya Lott Ph.D.

    September 22nd, 2016 at 11:26 AM

    Hi Mark. I appreciate your comment. I too would like to think that stigma associated with alcohol and other substances has decreased to some degree, but it is still a huge problem in our society. The idea that people who struggle with addiction lack willpower or are “less than” those who do not is still prevalant.

  • Trevor

    Trevor

    September 22nd, 2016 at 10:47 AM

    The very first time that I admitted to my parents that I did have a drug problem after about the 63rd time that they had confronted me, they did exactly what I knew they would do, which was break down and the very reason that I had not been honest with them since the very beginning. I knew that this would be how they would react and I could barely hold myself up at that point in my life, so what made them think that I would have any strength left for them? I know that they finally came around and helped me when I needed them but I could not be their crutch because I couldn’t even be my own crutch at that time.

  • Sonya Lott Ph.D.

    Sonya Lott Ph.D.

    September 22nd, 2016 at 4:21 PM

    Hi Trevor. Thank you for sharing your story. Addiction is often thought of as a family disease and your story is an example of this. All family members are affected and need support in their own healing processes as well as that of the family.

  • Cal

    Cal

    September 23rd, 2016 at 10:17 AM

    Most people seem to forget that this is not something that a person gets into overnight so why should we expect that they will get out of it that quickly?

  • Sonya Lott Ph.D.

    Sonya Lott Ph.D.

    September 23rd, 2016 at 10:53 AM

    Hi Cal. Thank you for sharing your thoughts. Addiction is an insidious process. By the time loved ones notice there is a problem-typically long before the user-the substance use has already had a significant negative impact. Individuals with addictions as well as their loved ones often wish treatment and recovery could happen faster because it’s emotionally painful for all involved.

  • Lisette

    Lisette

    September 23rd, 2016 at 3:12 PM

    But addicts don’t have to be so self defeating either! Most of us want to help any way we can, but they can become like the wet blanket, so negative and you just sort of lose hope that you alone will ever be able to help them!

  • Sonya Lott Ph.D.

    Sonya Lott Ph.D.

    September 24th, 2016 at 9:31 AM

    Hi Lisette.
    Thank you for sharing your feelings. It can be really difficult when we try to help our loved ones who are struggling with addiction. That’s why we too need emotional support when trying to help our loved ones who are active in an addiction.
    We also need to be educated about what addiction is and the impact it has on the individual user and their loved ones. That’s the primary purpose of this article.
    While every individual with a substance use disorder is ultimately responsible for seeking treatment to get sober and manage a recovery program it is very difficult to do. What looks like self-defeating behavior-willingly or intentionally engaging in behavior with the knowledge that it will have a negative impact-is actually a hallmark of addiction. If the user is experiencing withdrawal symptoms or intense cravings, they are likely to use again despite any negative consequences. When individuals with addiction have moments of clarity and realize the wreckage that their addiction has caused to themselves and others, they feel immense guilt and shame. This increases the need to numb the feelings again by using. And the cycle continues.
    As we begin to understand addiction more, we are able to let go of the perception that addiction reflects a lack of willpower or a choice to behave in self-defeating ways.

  • Chet

    Chet

    September 24th, 2016 at 8:15 AM

    I love the reminder that it is not only about the substances, there are lots of times that you actually have to remove toxic people from your life too. And these could be people whom you love but you also know are never going to be good for your recovery efforts. It can be hard, especially when this is the time when you most need friends you can lean on, and feeling like you are getting them all out at a time that is the most critical for you to have someone.

  • Sonya Lott Ph.D.

    Sonya Lott Ph.D.

    September 25th, 2016 at 11:06 AM

    Hi Chet. Is this something you learned in your recovery process? Most people in recovery has a better chance of remaining sober if they can limit contact with the people, places, and things associated with their using. This is a real challenge with loved ones, if you used together or if they have a negative impact on your well-being-even if it’s through loving but enabling behaviors.

  • Marie

    Marie

    September 25th, 2016 at 7:59 AM

    Being addicted to alcohol caused me to lose a lot in my life. I am only slowly starting to regain some of that.

  • Sonya Lott Ph.D.

    Sonya Lott Ph.D.

    September 25th, 2016 at 11:10 AM

    Hi Marie. Thank you for sharing your experience. Many people don’t realize how devastating alcohol addiction can be because it’s legal and “everybody does it.” It really is a journey to rebuild your life once you get sober. That’s why an ongoing recovery process is so important. All the best to your in your recovery process.

  • Marie

    Marie

    September 26th, 2016 at 7:27 AM

    Thank you for your kind words

  • Sonya Lott Ph.D.

    Sonya Lott Ph.D.

    September 28th, 2016 at 12:13 PM

    You are very welcome Marie.

  • Tyler

    Tyler

    September 26th, 2016 at 10:14 AM

    When I was a teenager my parents staged this intervention because I think that they thought that I was drinking and I wasn’t, I was just moody and withdrawn like most normal teens that I knew. Of course I would have a drink every now and then but not like they were suggesting and it really turned me off to the whole idea of going to them if I did have a problem because I felt like at the bottom of it all they had no trust in me.

  • Sonya Lott Ph.D.

    Sonya Lott Ph.D.

    September 28th, 2016 at 12:20 PM

    Hi Tyler. The teen years are tough for everyone. Parents don’t always understand what their teens are going through and teens don’t always understand why parents act the way that they do sometimes. I think that you and your parents could agree there was a reason to be concerned based on the behavior they described, but the cause of it may not have been what they suspected. I have vivid memories of my teen years and my perception of my parents’ attempts at dealing with all that I offered to them during my adolescence. I also know how scary it can be as a parent when trying to address concerns about a teen-aged son who seems to be troubled for reasons that are not understood. I hope you and your parents are able to rebuild your trust in one another.

  • randall

    randall

    September 27th, 2016 at 10:53 AM

    Once I stopped all the secrets and lies about my issues then I felt a little more free to be open and be myself. It was hard when I was trying to hide it from everyone, not sure why I did, guess I thought that they would think of less of me or something. I realized that this journey is not about other people, it has to be about me and my efforts to get well, and once I started thinking like that and stopped worrying about everyone else, that is when I started implementing real change in my life, in a good way.

  • Sonya Lott Ph.D.

    Sonya Lott Ph.D.

    September 28th, 2016 at 12:25 PM

    Hi Randall. Thank you for sharing your experience with us. You are so right, your journey has to be about you first and focused on getting well. Secrets and shame hold so much power over us. It is amazing how freeing it is to move toward shedding the mask and living more authentically. All the best to you on your path of wellness.

  • Wanda D

    Wanda D

    September 28th, 2016 at 10:31 AM

    There is never any shame over trying to seek out help for a problem.

  • Sonya Lott Ph.D.

    Sonya Lott Ph.D.

    September 28th, 2016 at 12:29 PM

    Hi Wanda. Thank you for sharing your opinion. I certainly wish more people felt the same way that you do about seeking help. It is hard for many of us to ask for help. Also, the stigma of mental illness and substance use disorders really does prevent obstacles to individuals seeking the help that they need.

  • randy

    randy

    September 28th, 2016 at 2:49 PM

    Thank you for making the point that may times stopping the abusive behavior is not about willpower, it is that your brain has actually changed and when that happens it is not easy just to say that you are going to stop. A whole lot goes into changing that kind of behavior for good and really has nothing at all to do with so called willpower.

  • Sonya Lott Ph.D.

    Sonya Lott Ph.D.

    October 3rd, 2016 at 8:55 AM

    Hi Randy. You are very welcome. It is so important for us to understand the influence of the brain in the addiction process. The brain is changed in many ways even after you stop using and this makes it challenging to stay sober. Fortunately the ways in which individuals think and feel, along with practices such as mindfulness meditation can change the brain in ways that allow help them to not only maintain sobriety, but transform their lives, even after a long period of addiction.

  • Miller

    Miller

    September 29th, 2016 at 2:05 PM

    I quit drinking almost 20 years ago but there are still certain settings and certain groups of people that make me really long to have a drink. I have to try to limit those situations as much as possible because even after all this time the temptation is still very much there for me.

  • Sonya Lott Ph.D.

    Sonya Lott Ph.D.

    October 2nd, 2016 at 11:20 PM

    Hi Miiler. Thank you for your sharing this. For many people, the temptation always remains. This is why it is so important to maintain some type of support/recovery program. This is also a good example of the point that stopping the use of the substance is only the beginning. I wish you the best in your ongoing recovery process.

  • Hardin

    Hardin

    March 22nd, 2017 at 6:17 PM

    I have been clean from heroin six months. I was an addict two and a half years. I hid it from my fiancé for the first sixth months. when I came clean she just up and left. I was trying to get help then. I loved her so much. She has issues with alcohol. we had sort of a yo-yo relationship after she split. I finally went to inpatient rehab after the last go round with her. Now she does not speak to me and lives in a different city. I am still devastated by this loss. I blame the stigma of my addiction. There are probably many other factors

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