Drug-Related Stigma

There are several different types of stigma. These include:

• Stigma from Individuals: Stigma from individuals develops and sustains negative stereotypes and assumptions about individuals (can be verbal or physical). Examples include locking up valuables when a person who uses drugs visits or calling people junkies.
• Institutional Stigma: Occurs when assumptions and stereotypes are translated into public policies, practice and funding decisions. For example, treatment guidelines or hiring practices that exclude people who use drugs.
• Self-Stigma: Self-stigma or internalized stigma occurs when people who use drugs adopt negative stereotypes and assumptions about themselves. Deep-rooted feelings of shame are felt, which results in the individual feeling they are “bad” or don’t “deserve” services or respect from others. It often results in a “why bother” attitude because people will just think they are liars.
• Stigma by Association: Stigma by association occurs when assumptions or stereotypes are made based on association with stigmatized individuals or groups. This could include service or harm reduction workers who work with people who use drugs or having a family member who uses substances.

There are five key elements that contribute to drug-related stigma. These include:

1. Blame and Moral Judgement: Blame and moral judgement is the belief that drug use is a choice. People who use drugs are often told “just say no,” and are blamed for bringing on drug use and any associated infectious diseases acquired through drug use.
2. Criminalization of Drug Use: People who use drugs receive poor treatment, and are judged and labelled as a result of the criminalization of drugs. Drug use is treated as a criminal matter in society rather than a public health issue. People who use drugs are often incarcerated for non-violent crimes rather than providing them with the resources and supports they need.
3. Pathologizing Drug Use: Pathologizing people who use drugs implies they are sick, diseased and cannot help themselves. This leads to people thinking they know what is best for people who use drugs. Pathologizing drug use also implies that generic treatments work (one size fits all model) and that there is something wrong with people who use drugs.
4. Patronizing People who Use Drugs: People who use drugs are often patronized, spoken down to or treated as a lower class citizen. This emerges though language as well as presumptions about needs and experiences of people who use drugs. People such as service providers, family and/or friends feel that they know what is best for individuals who use drugs and often tell the person what to do, instead of asking for input and involving individuals in the decision making process.
5. Fear and Isolation of Drugs: Fear and isolation of drug use works in two ways. This includes fear of drug use which stems from fear-based messaging and campaigns like “this is your brain on drugs” as well as fear of people who use drugs. People become afraid to talk about drug use and believe that people who use drugs are aggressive and/or dangerous.

Drug-related stigma impacts people who use drugs in a number of ways. These include (but are not limited to):

• Shame and internalized judgement
• Isolation
• Fear of being identified as a person who uses drugs
• Low self-esteem
• Decreased sense of autonomy
• Hiding use due to fear of being arrested
• Incarceration for non-violent crimes
• Increased participation in risky behaviours since they are already seen as criminals
• People who use drugs have fewer services available to them and/or are fearful of accessing services
• Frustration with self if unable to change behavior
• Discourages people from talking about drug use which further isolates people who uses substances
• People who use drugs find community with other people who use drugs, which can make behavior change more difficult
• Diminished job, education or health care opportunities

A lot of stigmatizing language exists around drug use. This language is negative and dehumanizing. Some language has become so commonly used that we often do not realize that we are using stigmatizing language. When interacting or working with individuals who use drugs it is important to be aware of the language you use and how you use it. Body language is also important to consider and often can send different messages. There are four key guidelines that can help guide our language use and reduce the use of stigmatizing language when talking about drug use. These include:

1. Use person-first language (e.g., “person who uses drugs” instead of “drug user”)
2. Use language that reflects the medical nature of substance use disorders (e.g., “substance use disorder” instead of “junkie”)
3. Use language that promotes recovery (e.g., “opted not to” instead of “non-compliant”)
4. Avoid slang and idioms (e.g., “positive” or “new” instead of “clean”)

For resources specific to non-stigmatizing language use please see the resource section below.

There are three functions/reasons why drug-related stigma exists. These include:

• Difference: This includes keeping people in a group and keeping others out because they are different in some way. Those that are in the group are seen as “normal” and those outside are seen as different (i.e., “us” vs. “them” mentality; seen as engaging in unacceptable behaviours)
• Danger: This function is rooted historically where stigma equals disease avoidance. Examples of this include incarcerating people who use drugs and isolating people with an illness.
• Discrimination: This function plays on the idea that some people are just inferior to others and do not deserve the same power, respect or opportunity. Examples include mass incarceration of individuals for non-violent drug-related offenses.

Addressing drug-related stigma can take place at multiple levels including the individual, staff or agency, and community level.

Individual level

• Use non-stigmatizing language
• Invite open and honest conversations with people who use drugs
• Treat all people with respect and as individuals
• Avoid using “cookie-cutter” approaches when working with people who use drugs
• Learn and start a conversation about the root causes (e.g., housing, support, income, abuse) of drug use
• Participation in education and personal development opportunities around drug use

Staff or agency level

• Offer and participate in staff education and training sessions around drug use
• Offer outlets for staff and clients to provide feedback on services, policies and experiences with staff
• Assess workplace policies and procedures to ensure they are non-stigmatizing and inclusive

Community level

• Develop a participant advisory board (PAB) in your community
• Support and develop education and awareness campaigns
• Advocate for policy changes that breakdown institutional stigma
• Participate and host community events around stigma
• Engage people with lived experience with drug use to support community work

Feel free to check out the following resources for more information on drug-related stigma:

• Intervention to Reduce Stigma among Health Care Providers working with Substance Users [document]-The Ontario HIV Treatment Network
• Language Matters [website]-Toward the Heart
• Language Matters [guidance document]-Mental Health Commission of Canada
• Language Matters: Using Respectful Language in Relation to Sexual Health, Substance Use, STBBIs and Intersecting Sources of Stigma [guidance document]-Canadian Public Health Association
• Stigma and Discrimination [website]-Canadian Mental Health Association
• Stigma around Substance Use [website]-Government of Canada
• Stigma, Discrimination & Substance Use: Experiences of People who Use Alcohol and Other Drugs in Toronto [document]-Toronto Drug Strategy Implementation Panel
• Understanding Drug-Related Stigma: Tools for Better Practice and Social Change [workshop guide]-Harm Reduction Coalition