The Impact of Internalized Stigma on Recovery from Addiction


“Our understanding of substance use disorders as chronic but treatable health conditions has come a long way since the dark days when they were thought of as character flaws—or worse,” wrote Nora Volkow, MD, the director of the National Institute on Drug Abuse (NIDA) at the National Institutes of Health in 2021. “Yet societal norms surrounding drug use and addiction continue to be informed by myths and misconceptions. Among the most harmful of these is the scientifically unfounded belief that compulsive drug-taking by individuals with addiction reflects ongoing deliberate antisocial or deviant choices.” This belief continues to contribute to the stigmatization of people with addiction. The stigma is most unhelpful because it actually “impedes access to treatment and care delivery” and also “contributes to the disorder on the individual level,” Dr. Volkow wrote in April 2020 in the New England Journal of Medicine. Blaming people with substance use disorder (SUD) for their disease has a long history in the United States. “Tacit beliefs or assumptions about personal responsibility—and the false belief that willpower should be sufficient to stop drug use—are never entirely absent from most people’s thoughts when they interact with someone with a drug problem,” Volkow wrote. Social stigma is a treatment barrier for addicted individuals who often feel guilty and unworthy of care. But, as Dr. Volkow pointed out, “stigma plays an even larger role in this crisis, one that has been less discussed: when internalized, stigma and the painful isolation it produces encourage further drug-taking, directly exacerbating the disease.”The National Alliance on Mental Illness (NAMI) lists four types of self-stigma:

  • Alienation: Feeling embarrassed, ashamed, inferior, or disappointed in yourself. Feeling that your illness is your fault.
  • Stereotype endorsement: Applying existing stereotypes to themselves
  • Discrimination: Feeling discriminated against; feeling incapable of achieving much.
  • Social withdrawal: Avoiding to socialize or talk about yourself because you feel like a burden, inadequate, a potential embarrassment to loved ones.

There are wide-ranging consequences of self-stigma, warns NAMI. “It can be a barrier to recovery, increase depression, reduce self-esteem, reduce recovery orientation, reduce empowerment and increase perceived devaluation and discrimination, among other consequences. A study also showed a strong correlation between loneliness and self-stigma.”Crapanzano, Hammarlund, et al. looked at the association between perceived stigma and substance use disorder treatment outcomes in 2018. Their review of studies of recovery outcomes in individuals seeking treatment for SUDs suggested a “negative, though perhaps indirect, role for self-stigma and perceived social stigma.” “The qualitative studies demonstrated the complexity of emotions and processing that needs to occur for people who are attempting to recover from addiction. For that reason, in spite of the much-needed advances in pharmacotherapy interventions for addiction that are occurring, continued attention to the psychological needs of the recovering person is important as well.” This confirms once more that effective addiction treatment needs to address all relevant underlying issues of the patient, not just the substance use. SUDs and behavioral addictions are frequently driven by trauma, depression, anxiety, and other co-occurring conditions. Additional alienation, social withdrawal, and loneliness as a result of internalized stigma are not conducive to successful therapy. “Although stigma against addiction may be a protective factor that deters non-users from experimenting with substance use, it paradoxically promotes continued use once an individual has entered the drug culture and may prevent access to treatment services,” wrote Crapanzano, Hammarlund, et al. in their review. “Furthermore, while societal stigma against mental illness is recognized as a problem, stigma against people with addiction is more complicated, and people with SUDs are more frequently blamed for their condition. When perceived societal stigma is internalized (ie, self-stigma), it can result in loss of self-respect, decreased self-esteem, and loss of self-efficacy. These feelings may harm the individual’s chances of recovery from addiction.”In Internal Family Systems Therapy (IFS), utilized at Valiant Living, stigma frequently corresponds to what IFS calls “cultural legacy burdens”—extreme beliefs, emotions, and energies that were absorbed from family, ethnic group, or culture. Other such burdens are “racism, patriarchy, individualism, and materialism,” wrote IFS founder Richard Schwartz in his book No Bad Parts. “Each of these legacy burdens combines with the others to create the pervasive sense that we are all disconnected and on our own in a dangerous, dog-eat-dog world.” Successful professionals who value the ability to take responsibility and often sacrifice their families and themselves to prioritize work may be particularly susceptible to self-stigmatization and feelings of extreme guilt over their substance misuse and other self-soothing behaviors. Valiant Living’s therapists frequently utilize IFS in their treatment approach in order to help professionals understand and harmonize their minds and, thus, help them heal. We know that such clients need to balance a deep search for recovery with a work-life that demands attention. Our Professionals Program is designed to do just that, with a number of therapeutic options for men with challenging careers and a busy lifestyle. If you or a loved one has turned to drugs or alcohol to keep up at work and manage a high degree of daily stress, don’t hesitate to reach out for help by calling us today at 303-816-3571.

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