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Contributed by Corey B. Rabin, Esq., Caron Treatment Centers
Stigma associated with mental and physical illnesses, such as substance use disorder or Covid-19, is a very troublesome reality today. As individuals, we care about how other people think and feel about us, and this can greatly impact how we feel about ourselves. When people return to their regular activities and to their jobs after treatment for a mental or physical illness, it is important for them to be mindful of the possible stigma they may encounter and be prepared with a strategy to deal with it.
A stigma is defined as a mark of disgrace or dishonor in connection with a particular circumstance, characteristic, or individual. People from all walks of life may be affected regardless of their education, wealth, age, or background.
People afflicted by substance use disorder or mental health issues, even people in recovery, have often suffered from the stigma attached to their addiction. The fact is that negative perceptions about people who have a substance use disorder or mental health condition are very common. Some may even go to great lengths to avoid a person they know with these conditions because they automatically assume the individual is either untrustworthy, dangerous, or unstable.
The American Medical Association has long recognized substance use disorder as a chronic brain disease. However, it is often considered to be a condition which can be individually resolved by inner strength and discipline. This is not the case with other chronic diseases such as arthritis, heart disease, or diabetes, where more objective symptoms present and diagnosis/treatment options may be more straightforward through testing, imaging, blood tests, biopsies, etc.
A substance use disorder manifests in behaviors that are typically negative and antisocial, complicating not only the diagnosis but also the perception of patients, their families, and their peers. This unique aspect of addiction explains why so many perceive it as a character flaw and attach stigma and shame to the individual who is unable to stop using or drinking and is engaging in such negative and untrustworthy behavior.
As with substance use disorder, those who have been diagnosed with Covid-19 or are in recovery from it may also experience a very real stigma attached to contracting this disease, including speculation about how the virus was contracted.
Stigma can make people feel isolated and even abandoned. They may feel depressed, hurt, and angry when friends and others in their community avoid them. Perhaps more concerning, stigma harms people's health and well-being in a variety of ways. Victims of stigma may often be deprived of the resources they need to care for themselves and their families in “normal” times and even more so during a pandemic.
Misunderstanding and confusion can be the breeding ground of stereotypes and discrimination. As psychological beings, we have a very real need to understand the “why” of events, especially unusual and threatening occurrences. Why is the coronavirus pandemic plaguing the globe? What is to blame? Stigma arises when the virus and the person with the virus are conflated —when we change the question from what is to blame to who is to blame. The same analysis can be applied to substance use disorder.
In many cases the stigma around mental and physical illnesses can be as harmful as the underlying syndromes themselves. People suffering from the disease are the most obvious victims. Some might view these people as having spoiled or tainted identities that therefore justify discriminatory responses against them. Families and friends of identified patients may also be stigmatized by extension.
The public health approach to the coronavirus pandemic may yield unintended consequences in terms of stigma. The primary tool to decrease the rate of coronavirus infection is social distancing as recommended by the Centers for Disease Control, the National Institutes of Health, and the Food and Drug Administration. Avoiding people altogether is preferred with physical separation by six feet apart as the minimum rule. As a result, those who are diagnosed with Covid-19 are often totally isolated from family and friends as they recover. The risk of stigma heightens when distance from the virus is confused with distance from the individual.
In fact, research consistently shows interactions between people with a stigmatized condition and the public is the best way to erase stigma's harmful effects and promote dignity and respect. Connection with others, which can be done safely through virtual technology, is the best way to diminish the harm experienced by the person stigmatized by substance use disorder or Covid-19.
Just like any form of racism, sexism, and ageism, it is both morally unacceptable and legally impermissible for an individual to be subject to discrimination because they are recovering from a mental or physical illness, to say nothing of the obvious individual affront.
For example, when people who have received treatment for Covid-19 return to their workplace, it is important for them to coordinate with human resources, but not feel they need to share their experience with everyone. If that staff member is doing their part to take care of themselves and protect others, no explanations are owed to other colleagues.
The same could be said for an individual in recovery from substance use disorder returning to the workplace after treatment. People do not need to tell everyone about their struggles – doing so is up to everyone as a personal choice. That said, in my experience, people in recovery from addiction often feel better when they live authentically and feel empowered to be themselves in all aspects of their lives. Many come to believe that their struggles were more of a blessing than a burden, and an important way to connect with and help others with similar difficulties.
Ultimately, education is one of the best ways to address stigma because it helps to dispel harmful stereotypes. While it should not be the responsibility of the person in recovery to educate their colleagues, when people succeed through intense self-improvement efforts and have built a robust support network (sometimes referred to as “working a strong program of recovery”), their actions and words speak volumes and can help to diminish stigma.
It is also important for workplaces to take steps necessary to create a supportive environment for all employees. Employers should provide facts about common diseases such as alcohol use disorder and Covid-19, show support for those in recovery, and make clear that discrimination will not be tolerated in any form.
While we cannot eliminate disease, we can and must do much more to alleviate the painful and avoidable harm of stigma in the workplace. No family is beyond the reach of the ravages of addiction or the devastating impacts of the coronavirus. Let us replace fears and rumors with facts, and proper action with support for one another.