DAY 3: Stigma
Stigma Kills.
Language Matters.
Substance use disorder is the most stigmatized health condition in the world. We can’t allow the stigma surrounding drug use and overdose to prevent people from reaching out for care and connection—or to influence how caregivers, first responders, and lawmakers think about or treat people who use drugs.
Change starts with the language we use when we talk about people who use drugs.
Language can promote stigma or decrease it. A more accepting society starts with bottom-up processes, like language choices in day-to-day conversations.
Person first language is de-stigmatizing because it places the focus the individual and not their issue. The Harm Reduction Action Center has put together these Person First Language Guides: Person first language guide and Person first language guide in Spanish
Study: How language influences attitudes towards people who use drugs.
A study by the Recovery Research Institute found stigmatizing language causes cognitive bias.
Participants were asked how they felt about two hypothetical people “actively using drugs and alcohol”.
Person #1 was described as a “substance abuser”
Person #2 was described as “having a substance use disorder”.
No further information was given about them.
Results: Participants felt the Person #1, the “Substance Abuser”, was:
Less likely to benefit from treatment
More likely to benefit from punishment
More likely to be socially threatening
More likely to be blamed for the difficulties in their life
More able to control their substance use without help
Subscales comparing the substance abuser & substance disorder descriptive labels
Stigma and how people who use drugs see themselves
Self-stigma (when a person internalizes negative stereotypes) can cause intense shame and/or guilt, and prevent people with substance use disorders from accessing care, or from believing they are worthy of trying to heal. Studies even show that higher rates of shame and guilt are linked to poor recovery outcomes.
Stigma and how others see people who use drugs
Stigma and mistreatment in medical settings is a barrier to accessing healthcare for people who use drugs, leading them to delay or forgo care. Negative attitudes are as common among healthcare providers towards people who use drugs as they are among the general public.
Percentage of primary care physicians that report high levels of stigma towards people with opioid use disorder.
Despite the fact that 50% of people aged 12 and over in the U.S. have illicitly used drugs in their lifetime, the tremendous stigma surrounding drug use has a negative effect on public opinion and public policy. Despite the clear evidence showing that interventions like overdose prevention sites and safe supply would significantly reduce deaths, it is difficult to convince policy makers to get behind those programs.
Instead, they prioritize criminalization and punishment, ignoring the mountain of evidence over decades that show these interventions are ineffective and profoundly harmful.
Policy makers need a better understanding of substance use disorders, but they also need to hold fewer negative perceptions towards people who use drugs. That’s why normalizing destigmatizing language in both the media and the public sphere in general is crucial to changing attitudes.
Stigma and public policy
Half of all people in the United States age 12 and over have illicitly used drugs in their lifetime.
Is it a drug overdose or a “poisoning”?
Because of the stigma associated with illicit substance use, grieving parents of youth who have died of overdose as a result of illicit fentanyl adulterated in the street drug supply have rejected the word “overdose”, preferring to say that their children were “poisoned”. But the word poisoned implies a poisoner, a bad guy (the drug seller) who is to blame, who has acted with intentionality and malice. Read more.
It divides people who overdose into “deserving” vs “undeserving” of criminalization & death. This hurts everyone -- even the so-called poisoned people -- because it perpetuates stigma and prevents evidence-based policies from being enacted.
Whether a person who routinely uses fentanyl or a person who bought 30mg pills of (what they thought was) oxycodone dies as a result of the amount of fentanyl in their drugs, there are many reasons people overdose such as an unpredictable drug supply, mixing, or using alone. When we frame one of them as an overdose and one of them as having been poisoned, we divide people who use drugs into guilty vs. innocent -- despite the fact that both people chose to take drugs, and neither one of them meant to die.
“Reframing the crisis as drug poisoning in hyper-individualistic America will only lead to more punitive responses. Punishment crowds out prevention and treatment, as we can see by looking at a nation that simultaneously holds the trophies for most citizens incarcerated and most likely to die of drug overdose. Upper, middle-class white people will be framed as poisoned, innocent, victims. The poor, the Black, and the brown will be framed as the guilty—those who overdosed of their own volition, those who used those drugs and got what they deserved.”
- Morgan Godvin | Founder, Beats Overdose, a nonprofit harm reduction service provider for the music industry
Tell the media: Stigmatizing language kills
The media plays an important role in whether stigma is perpetuated or discouraged. Media portrayals of people with substance use disorders are one of the key factors responsible for shaping public perceptions and beliefs about people who use drugs.
We’ve created a “choose your own adventure” email template below! Copy and paste and customize as you wish. Thank you for sending this crucial message!
TO: [Your Email]
BCC:
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SUBJECT:
***Subject line ideas***
Please adopt person-first language for people with substance use disorder
Words matter! Stigmatizing language prevents evidence-based policy changes
Prevent overdose deaths by adopting person-first language
Destigmatizing language is harm reduction for people who use drugs
BODY:
***Choose an introduction , or craft one of your own along these lines***
August 31st is International Overdose Awareness Day, a day to raise awareness of overdose and reduce stigma associated with drug-related deaths. In that spirit, I’m writing to draw your attention to the role of the media in perpetuating negative stereotypes about people who use drugs.
If we’re going to prevent our friends, family, and neighbors from dying of drug overdose, public attitudes towards people who use drugs need to change. The media plays an incredibly important role in whether stigma is perpetuated or discouraged. Portrayals of people with substance use disorders are one of the key factors responsible for shaping public perceptions about people who use drugs.
It’s not a coincidence that overdose is a leading cause of death in the U.S. for people under 50 and substance use disorder is the most stigmatized health condition in the world. You have the opportunity, and the duty, to reduce that stigma by adopting de-stigmatizing language when referencing people who use drugs. In the context of the overdose crisis, the stakes could not be higher.
107,000 people in the U.S. died from overdose in 2021, and we have an overdose mortality rate that is 20 times the worldwide average. We can’t let stigma surrounding drug use prevent people from reaching out for care and connection—or continue to influence how caregivers, first responders, and lawmakers think about or treat people who use drugs. The media has a tremendous influence on the attitudes of people in our culture towards people who use drugs.
***Choose a supporting statement***
I have a personal stake in this issue. I have a (friend, sister, brother, etc.) who has a substance use disorder. They, and others like them, deserve care and not punishment. Judgemental, stigmatizing language contributes significantly to the negative attitudes that first responders and lawmakers have towards people who use drugs. Stigma can lead to overdose death. People who use drugs are most at risk of dying when they use alone, and stigma often causes people to hide their drug use or use drugs alone
Overdose deaths are preventable, but the stigma surrounding illicit drug use gets in the way of lawmakers enacting evidence-based public policy that could meaningfully prevent people from dying.
Like diabetes, cancer and heart disease, substance use disorder is caused by a combination of behavioral, psychological, environmental and biological factors. People do not choose how their brain and body respond to substances, which is why people with substance use disorder cannot control their use while others can.
Stigmatizing language evokes strong negative feelings against people who use drugs. It conjures images of people who have somehow chosen drug use over their families, their jobs, public safety, and their health. This impacts both public perception and policy decisions.
The American Medical Association and the American Society of Addiction Medicine classify substance use disorder as a disease, but people still commonly believe that substance use disorder is a choice, a moral failing, or even a sin. For the 1 in 10 Americans who have a substance use disorder at some point in their lives, these conceptions have profoundly damaging consequences to their mental health, physical health, employment, housing, and their willingness to seek help.
***Add a plug for person-first language***
Person-first language is non-judgemental, de-stigmatizing, and is the most respectful and accurate way to talk about substance use disorder.
Using person-first language conveys a sense of a whole person with dignity, and rights. They are not a disability or disease. They are a person with a disability or disease.
Person-first language maintains the integrity of individuals as whole human beings—by removing language that equates people to their condition or has negative connotations.
Adopting person-first language when talking or writing about substance use is more accurate and less biased. “Person with a substance use disorder” is morally neutral, and distinguishes the person from his or her diagnosis.
***Make an ask***
Please consider reviewing this guide changingthenarrative.news/style-guide to adopt person-first language when writing about people who use drugs, both in your own reporting and as part of your newsroom style guide.
Please protect our most vulnerable neighbors from overdose death by using accurate and unbiased language when reporting on people with substance use disorder. Here are some great examples of how you can incorporate the non-judgemental language of harm reduction into your writing: changingthenarrative.news/style-guide
***Be sure to add a note of thanks***
Thank you!
I appreciate your kind consideration.
Thanks for your reporting, and your attention to this important issue.
Sincerely,
[YOUR NAME]