Substance Use Disorders (SUDs) cost about $4 billion a year in the United States. SUDs include alcohol, prescription medications, illicit drug use, tobacco, and substances such as heroin, methamphetamine, and other synthetic substances. Fentanyl is the most lethal drug epidemic in human history, and since the 1990’s the opioid crisis has taken over 100,000 lives a year in the U.S. SUDs are associated with healthcare expenditures, accidents from motor vehicles, falls, drownings, lost productivity in the workplace, and criminal justice actions among a number of other costs to society.
With the morbidity and mortality associated with addictions, the need to expand the knowledge base of the nursing workforce is needed more than ever. Addiction is a health care disorder established as a chronic brain disorder since the 1990’s. Yet today, those who have an addiction continue to be misunderstood and stigmatized. The nursing workforce can play a key role and significantly contribute to decreasing stigma associated with SUDs.
Stigma is more than a negative attitude. It is a social process in which people are labeled as different, associated with negative stereotypes, separated into “us” and “them,” and experience status loss or discrimination within a context of unequal power. Substance use disorders continue to be associated with beliefs about personal responsibility, morality, dangerousness, and trustworthiness. People with SUDs may be viewed through a moral lens, labeled as “drug seeking,” blamed for their illness because of their weakness, or perceived as more difficult or less deserving of care. These attitudes can influence communication, therapeutic relationships, clinical decision-making, and whether evidence-based treatment is offered. Experiences of judgment, discrimination, and mistreatment can undermine trust, discourage disclosure of substance use, and contribute to delaying or avoiding healthcare and addiction treatment.
In a systematic review, Livingston et al (2011), evaluated interventions designed to reduce stigma related to SUDs. This review identifies three types of stigmas associated with SUD: Social-stigma, Structured-stigma, and Self-stigma.
Social-stigma relates to the general public. This is stigma that an individual has because of their own experiences of knowing someone; a relative, family friend, or any relationship they may have experienced with someone who has an addiction. Social-stigma can be decreased by communicating positive stories about those who have a SUDs.
Structured-stigma is related to health care professionals, and health care students. Structured-stigma can be decreased by providing didactic education, clinical experiences and contact with those who have SUDs.
Self-stigma is stigma that the person with the SUD has about themselves. They may feel that something is terribly wrong with them, that they themselves are weak and without willpower; or they may seek help only to feel poorly judged by the person to whom they have gone for help. Self-stigma can be decreased by a person experiencing therapeutic interventions and evidenced-based education about addictions.
Nurses have regular contact with people who have addictions. We strive to deliver evidence-based care, to have empathy, and to offer hope to people who have illness that can be treated. This is certainly a framework and a practice that all nurses can deliver when working with those with addictions.
Self Reflection:
What are your attitudes toward people with SUD?
What can nurses do to identify and decrease stigma in the healthcare setting?
Livingston, J.D, Milne, T., Fang, M.L. & Amari, E. (2011). The effectiveness of intervention for reducing stigma related to substance use disorders: A systematic review. Addiction, (107),39-50.
The CO Advanced Practice Psychiatric Nurses (CAPPN) meet virtually the first Wednesday of each month, at 6:30 PM. See the CNA website to receive the link.
