Transcript Stigma
Dr. Oliver Aldridge Edinburgh, Midlothian & East Lothian DTTO I and DTTO II Theory Client Communication Agency Conclusions Ancient Greeks physically scarred people to permanently “mark” them Today: amputation of a finger to denote someone who is deemed to be a “grass” May be part of the survival mechanism of group living Some of the original driving force behind drugs legislation – San Francisco 1865 Reciprocity Threat: housing, benefits, treatment/support, theft, “infecting others” by introducing to drugs. Downward comparison Belief in a “Just” world/ “Protestant Work Ethic” – you get what you deserve and you deserve what you get Drug users are bad parents Drug users are dishonest Drug users are manipulative Drug users are self-indulgent Drug users are wasters Drug users destroy communities Drug users choose to be drug users Stereotyping facilitates stigmatisation Stigmatisation encourages stereotyping May be linked to depersonalisation Needs to be openly discussed so that it can be managed on an individual level. Differing levels of stigma sensitivity between clients Cannot make automatic assumptions about the effect on a client Cannot make automatic assumptions about the main sources of stigma Usually drug use is only one factor: Poverty Poor education Unemployment Criminal record Drug taking Injecting Parenting Difficult childhood Learning difficulties May contribute to feeling excluded Social acceptance may be sought in a marginalised peer group As part of that group, drug taking/experimenting may be the norm Effect of criminalising groups? Physical Signs Treatment Stigmata Social Stigmata Visible signs of drug use include: Injection sites Poor dentition Poor nutrition Appearing intoxicated/withdrawn Managing these appropriately may increase the range of options in managing stigma You’ve got to know when to hold ‘em….. Know when to fold ‘em….. Managing disclosure is a highly individual, situation specific problem If stigma is not overtly discussed, it is not possible to devise an effective, individualised strategy to deal with it Exposure of a previously, largely hidden level of drug use Loss of employment Peer group rejection Relationship breakdown Increased intervention e.g. Children & Families Labelling Disempowerment Social Isolation Local vs. Centralised treatment services – pros and cons Failing to treat people holistically Perpetuating or increasing stigma in the treatment environment Recovery = Abstinence Information sharing vs. “raw data” being communicated to people without specialist knowledge Some treatment options may feel less stigmatising to the client e.g. DHC vs. Methadone Treatment needs to have a solid evidence base and be effective and appropriate for the client at that time May be stigmatising Alterations to pharmacy may impact positively May reduce stigma Effect is individual and, therefore, policy should allow individual assessment/decision making Method – supervised urine collection processes Rationale – is it being done to “catch” people? What is the context of a result? May help to combat negative attitudes Wraparound care essential Helping people integrate into new social groups The role of “ex-user” does not work for everyone As specialist agencies we have a responsibility to provide good quality, objective information to: Communities Media Government Professionals Students Views/hypotheses may impact on stigmatisation Is it better to be viewed as someone with a genetically determined problem or as someone with a social problem? Facilitating appropriate contact with people who don’t conform to stereotypical views may catalyse change Caveat: Stigmatisation may paradoxically be increased by contact with someone who is massively different to the stereotypical view Does the “exception” prove the “rule”? May be stigmatised by the communities in which it works – “NIMBYism” Workers may need support – e.g. outreach, needle exchange workers Related professionals/disciplines may stigmatise those who work in this field We may stigmatise each other by perpetuating false debates e.g. Harm Reduction vs. Abstinence Funding wars may increase stigmatisation by threatening survival Stigma is here to stay – we have to learn to manage it effectively Management of stigma has to be individualised Stigma cannot be dealt with if it’s not openly addressed Treatment can contribute to stigmatisation: agencies need to consider this in service planning/delivery Commissioning needs to look at the range of treatment services available to increase choice Agencies have to play a positive role in educating/communicating