The Social Construction of Stigma & Problem Drug Use

Copyright © Buchanan 2008

This PowerPoint presentation on Stigma was originally presented at a Scottish Drug Forum Conference on

Drug Use and Stigma


People who may suffer stigma• A person with disability• A person from Black Minority Ethnic Group• A Gay/Lesbian person• A person with a drug problem • A person with mental health difficulties• A person from a religious minority• A person who is HIV+• Any person who is defined as ‘different’


What is Stigma?The concept of stigma refers to negative

stereotypes assigned to a people when their attributes are considered both different from or inferior to societal norms.

For Goffman stigma was about the social

interactions between ‘stigmatized’ and ‘normal’ persons in society.

The process of stigma is deeply discrediting.(Goffman 1963)


Processof stigma

– involves severe social disapproval of a persons characteristics or their beliefs which at the time are considered to be unacceptable to dominant cultural norms

stereotypes&

labels

roles&

expectations

diminishedopportunities

STIGMA

Internalised& reinforced

tainted identity


Impact of StigmaIsolation – lack of social capitalRejection – reduced life opportunitiesHostility – even violence (e.g. Stephen Lawrence)Marginalised – face discrimination and exclusion

Restricts a person's ability to develop their potential and impact negatively upon:

– Relationships– Housing– Health– Employment– Insurance– Education– Travel


Stigma reflects cultural shifts in norms• What was acceptable in the past may be

unacceptable today.

• What was unacceptable in the past may be acceptable today.

• What is unacceptable today may be acceptable in the future.

• What is acceptable today may be unacceptable in the future.


Smoking was once an

approved and

promoted cultural norm



Smoking is no longer an approved cultural norm

Smoking now attracts stigma



Thestigmatization

oftobacco

users


In the UK opium was once a socially acceptable and widely used

drugfor recreational as well as medicinal

purposes.

The Lakeland poets were a distinguished group of opium users


Samuel Taylor ColeridgeLaudanum, a solution of

opium and alcohol


Opiate use today carries considerable stigma and is

presented as an evil in our society


Drugs & Drug Users - the Enemy?‘hardly a family is unaffected by the evil of drugsevil of drugs… Drug-related

crimecrime blights our communities. It destroys familiesdestroys families and young lives and fuelsfuels a wide range of criminal activity, including burglaryburglary and robberyrobbery….. We won’t tolerate the menacemenace of drugs in our communities – it causes miserymisery and costs livescosts lives…. This new money will enable agencies to step up their fight against drugsagainst drugs and the crime it breedsbreeds. It will get drug dealers off our kids’kids’ backs and into prison and help safeguard our communities’

HM Treasury Press Release, 49/01 09 April 2001


Drug use is portrayed in the media as the key causal factor in violent

and abhorrent crimes

- as if taking an illicit substance turns people into monsters



Demonizing drugs and drug users

Government Voices– ‘Drug misuse can ruin individual lives, tear open families and

blight whole communities with the menace of dealers and crime driven by drug abuse… more drug dealers – people who profit in the misery of others – behind bars… more addicts into treatment…further powers for police to drug test suspected addicts on arrest… vicious circle of drugs and crime …dealers will face harsher sentences where they prey on children …Drugs are a scourge on the world’ (2005)

Media Voices– ‘Cannabis caused a 14-year-old to kill’ …. ‘Woman murdered was

deliberately run down by suspected drug addicts’


Demonizing drugs and drug users (2)

Community Voices– ‘there’s always junkies … they fight people are

aggressive, do dealing in houses, break-ins and steal from cars …..get rid of all the junkies…nuke the junkie scum’

Drug User Voices– ‘They look down on me as scum of the earth and

as someone not to be associated with’ another said ‘They see me as a drug addict, a smackhead and they think I’d rob them’


The Drug Divide

Buchanan J (2009 forthcoming) Understanding and misunderstanding problem drug use, in R. Carnwell & J. Buchanan (eds) Effective Practice in Health, Social Care & Criminal Justice: A partnership approach, Second edition, Open University Press, Maidenhead.


The Barrier of Exclusion

‘it is evident that the anti-drug campaigns over the past 20 years have added to the isolation and marginalization of the discarded working-class youth …. In addition to having to overcome their addiction, one of the biggest hurdles they have to face is breaking through the barrier of social exclusion.

JULIAN BUCHANAN & LEE YOUNGThe War on Drugs -a war on drug users?Drugs: education, prevention and policy, Vol. 7, No. 4, 2000


House of Commons Science and Technology Committee: Evidence 2006: Ev 114


Problem drug users‘The motivations for using illegal drugs are largely the same as the motivation for using legal drugs – a pleasurable habit, to be social, to relax and generally enjoy the affect of the drug. However, a small proportion of people who use drugs (legal and illegal substances) develop serious drug problems (UNODC 2007). The vast majority of drug users are recreational users who use drugs in a controlled manner without incurring significant social, psychological and/or physical problems to themselves or others around them. In contrast the minority who develop problems sometimes referred to as ‘problem drug users’ become socially, psychologically and/or physically dependent and this lack of control tends to have a detrimental impact upon their social, psychological and/or physical well-being, and is likely to have a negative impact upon those around them.’

Buchanan J (2009 forthcoming) Understanding and misunderstanding problem drug use: working together, in R Carnwell & J Buchanan (eds) Effective Practice in Health, Social Care & Criminal Justice: A partnership approach, Open University Press, Maidenhead.


The USA & UK War on Drugs - locking up drug users?

In 1996 the US prison population was 1.6m Today it exceeds 2.3m

In 1985 the UK prison population figure was 47,500 Today it exceeds 83,000

Many prisoner have severe social and psychological problems: reading, writing, numeracy, mental health, dyslexia, drugs, no

qualifications, poor family support


Institutionalised stigma has invited widespread

discrimination

Discrimination involves those in positions of power exercising prejudicial beliefs, actions, or judgments and

using their power against the less powerful. The discrimination is based on difference and serves to maintain division and power by drawing upon and reinforcing stigma

and stereotypes.


Discrimination – more than just being rude

DISCRIMINATION =

POWER + DIFFERENCE + PREJUDICE


PCS ModelThompson, N. (2006) Anti-Discriminatory Practice, Palgrave

• Personal• Cultural• Structural CP C S

Discrimination occurs at three distinct levels


Damaged identities

‘The constant experience of this marginalization has led many problem drug users to internalize their problems and blame themselves for their plight. This loss of self-esteem then becomes a serious debilitating factor as they feel isolated and excluded from society.’ (p.394)

Buchanan J (2004) Missing Links: Problem Drug Use and Social Exclusion, Probation Journal Special Edition on Problem Drug Use Vol 51 No.4 pp.387-397


Mixing with ‘Non’ Drug Users‘I feel a bit beneath them, they make you feel like that’

‘I used to avoid them like the plague’

‘I’ve got to watch what I say so I don’t land myself in it. They blame smack heads for everything.’

‘I feel labelled … like they thought I was dirt’

‘Most people look down their noses if drugs are mentioned’


Stigma & discrimination worse than the drugs?

‘In an environment frightened with powerful moral and legal reactions to the use of drugs, the stigma attached to drugs may come to be a more important factor than the biology of addiction. The demonization of drugs and the criminalization of the drug user (i.e. the war on drugs) could be more damaging to the individual and society than drug use or addiction’ (p.31)

Drucker, E. (2000) ‘From Morphine to Methadone: Maintenance Drugs in the Treatment of Opiate Addiction’, in J.A. Incardia and L.D. Harrison (eds) Harm Reduction National and International Perspectives, pp. 27–45. London: Sage.


Impact of drug users‘I’m sick of it. I see people with their own houses, family and friends. I’d like friends who don’t

use’

‘I’ve been wanting to change for five years’

‘I want to be drug free, get a job and lead a normal life’

‘It is difficult you feel divorced from the mainstream. I want to get back into it’


Arguably the biggest hurdle a recovering long term problem drug user has to

overcome is not physical addiction, nor psychological cravings - but trying to break through the ‘wall of exclusion’ that keeps

them in a drug ghetto. This makes it extremely difficult for them to acquire new routines, friendships, skills, hobbies and

lifestyle. They are often ostracised, criticised

and distrusted.


The struggle for re-integration

Adapted from Buchanan J (2004) Tackling Problem Drug Use: A New Conceptual Framework, pp117-138, in Social Work in Mental in Health, Vol. 2 No 2/3, Haworth press Free article download from http://epubs.newi.ac.uk/siru/1/


Re-integration or integration‘When considering treatment and rehabilitation it must be recognised that

many problem drug users have had such limited options in life, that they lack personal resources (confidence, social skills and life skills) and have limited positive life experiences to lean upon or return to.

This client group need social integration not social reintegration, they need habilitation not re-habilitation – it seems that many have never really been able to get started in life in the first place. This makes living without drugs a very tough option indeed.’ (p.397)

Buchanan J (2004) Missing Links: Problem Drug Use and Social Exclusion, Probation Journal Special Edition on Problem Drug Use Vol 51 No.4 pp.387-397


Challenging Stigma & Discrimination

• Must happen at all three levels: personal, cultural and structural.

• Requires an ongoing public campaign to challenge existing stereotypes and promote positive images.

• Requires a challenge to existing language, notions and images used to make sense of drugs.

• Require education and training to inform people.


Challenging Discrimination

Personal Cultural Structural

Degree of Influence

It is easier to have impact at tackling personal

attitudes and behaviours but tackling cultural and

structural discrimination (institutional) is much more

difficult.

high

low

Thompson, N. (2006) Anti-Discriminatory Practice, Palgrave(Thompson N 2006)


A different way of seeing?

We are all drug users

Low risk High risk

‘All drug taking presents a degree of risk and some legal drugs will pose greater risk than some illegal drugs. It is argued then that rather than consider legal drugs as safer and illegal drugs more harmful, and rather than assess drugs according to a hierarchical table of risk posed by different drugs, there is a need for a comprehensive individual assessments to be made for each person according to the nature and context of the drug taking and this is best placed upon a broad continuum of risk which is applicable for all {legal user and illegal users alike] … it should be remembered then that virtually everyone uses drugs, and all drug taking presents some risk’ .

Buchanan J (2009 forthcoming) Understanding and misunderstanding problem drug use: working together, in R Carnwell & J Buchanan (eds) Effective Practice in Health, Social Care & Criminal Justice: A partnership approach, Open University Press, Maidenhead.


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