Abstract
Self-stigma in addiction occurs when individuals with substance use disorders (SUDs) experience shame based on mythological stereotypes in public stigma, as well as from their own sense of what they take to be shameful about addiction. This process leads to changes in identity in line with negative stigmatising stereotypes. The main source of the shaming process comes from public stigma where powerful others impose upon the individual with SUDs a social world (an ambience) containing false and distorting attitudes and beliefs that are internalised and lead to harmful effects, including further substance use and self-sabotage. A second source of self-stigma is the private shame that individuals feel based on accurate recognition of their situation. This may generate the motivation to heal but typically only when it occurs in a supportive context where public stigma is absent and acceptance by others is present. With the barrier of public stigma removed, or at least lowered, the individual with SUDs will stop self-stigmatising based on the damaging mythology around addiction and so may be given the support he or she needs for self-compassion, and in particular self-trust, in order to recover.
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Notes
- 1.
See www.memoirsofanaddictedbrain.com/connect/addiction-recovery-and-self-trust/. For his unique account combining narrative and neuroscience see Lewis [29].
- 2.
On social construction theory, see Berger and Luckman [4].
- 3.
- 4.
I thank Robyn Dwyer for originally drawing my attention to Ian Hackings’ work, and for connecting the idea of looping to the feedback mechanisms inherent in self-stigma.
- 5.
The strong reading of this claim is in terms of social construction theory which is the view about the metaphysical status of social phenomena, and some authors have argued that this would include addiction (Matthews et al.). The theory understands the phenomena as dynamically formed in stages: ideas and concepts are externalised, objectivised, and finally internalized by social actors [4]. So, in this case, the concept of addiction (and related cognates), the discourses, practices, policies, objects and so on associated with it that come into the social space are then made objective. Addiction is then seen as objective (carrying the normative weight of objectivity) when in fact it develops out of perspective-dependent phenomena. And because of this externalisation and normativity it will frame understandings of the actions and behaviour of those it describes whose experience of the world is in fact unique, and which may not neatly fit into the imposed externalising categories.
- 6.
See Matthews et al. [38]. The diagnostic tools occupy a liminal position between describing and prescribing; they contain morally loaded classifications that simultaneously seek to identify kinds of people in order to help them while at the same time positing social categories that describe norms and frameworks within which individuals with SUDs will grow.
- 7.
This is compatible with Kent Berridge’s distinction between liking and wanting in which individuals with SUDs stop liking the drug of choice they cannot help continuing to want [5].
- 8.
This is associated with the phenomenon of the resigned addict in which those affected retain an awareness of their fundamental values, but they estimate that a life according to such values is no longer open to them [25].
- 9.
- 10.
Nevertheless, the relation between illicit drug taking and the law is complex [36].
- 11.
On the choice model, see Heyman [23]; on the deep learning account, see Lewis [30]; the disease model has been championed by medicine in general, but particularly in North America by the National Institute on Drug Abuse (NIDA), and its members. See, e.g., Volkow [52]. To get an overall sense of the landscape in theory of addiction, see Snoek and Matthews [48], and Part 1 of Pickard and Ahmed [43].
- 12.
See Denver et al. [13] who discuss recent interest in the way linguistic choices (labelling theory) feed into conceptualisations of stigmatising categories in the context of criminal stigma.
- 13.
- 14.
Kathleen Gallo [15] writes movingly about these different aspects in a first-person account of her mental illness. When in private quarters she could ‘hide from the cruelty of social stigmatization’. But outside her house she said ‘I tortured myself with the persistent and repetitive thought that people I would encounter, even total strangers, did not like me and wished that mentally ill people like me did not exist … I would do things such as standing away from others at bus stops and hiding and cringing in the far corners of subway cars. Thinking of myself as garbage, I would even leave the sidewalk in what I thought of as exhibiting the proper deference to those above me in social class. The latter group, of course, included all other human beings.’
- 15.
For a detailed account of the way the physical marks of addiction compound self-stigmatization see (Matthews et al. [36]: p. 281)
- 16.
Luoma and Platt [35] discuss this in the context of Acceptance and Commitment Therapy (ACT). See also Luoma et al. [34]. Gallo [15] also identifies acceptance as important to counter stigma. More broadly, Livingston et al. (2012) reviewed thirteen studies concerning interventions reducing stigma in substance use disorders. They concluded that not all are effective but that ‘…therapeutic interventions, such as group-based ACT and vocational counseling, are likely to produce positive effects [and this] is consistent with the broader research literature regarding self-stigma interventions.’ (p. 47)
- 17.
Some writers on addiction – e.g., George Ainslie ([1], and elsewhere) – make the idea of preference oscillation definitive, so self-trust has to be central to recovery in order to stabilize a preference for abstinence.
- 18.
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Matthews, S. (2019). Self-Stigma and Addiction. In: Avery, J., Avery, J. (eds) The Stigma of Addiction. Springer, Cham. https://doi.org/10.1007/978-3-030-02580-9_2
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