Substance Use Disorders and Stigma SHAWNA ADKINS, LCSW; DEBRA MONTOYA; DAVID TIAN, MD; JESSICA WANG, MD; AND DENISE WILLIAMS-TAYLOR, RN

Roadmap • Definesubstanceusedisorderandstigma•  Explorehowlanguageandattitudesaffectourperceptionofpeoplewithsubstanceusedisorders•  Exploreusing“person-first”languagetoreducestigma• Recognizesubstanceusedisordersaschronicdiseases

Let’s Get Technical • ASubstanceUseDisorder(SUD)isaproblematicpatternofuseofacertaindrug/classofdrugthatleadstoclinicallysignificantimpairmentordistressthatcauses:

• Drugclassesincludeopioids,stimulants(methamphetamines,cocaine),alcohol,marijuana,tobacco,caffeine,etc.

CravingstoUse LossofControl

ContinuedUseDespite

Consequences

Let’s Get Technical • Opioids(alsocalled“opiates”and“narcotics”)areaclassofdrugsthatincludeheroin,fentanyl,morphine,oxycodone,tramadol,andcodeine.

• OpioidUseDisorder(OUD)isapatternofopioidusethatleadstoproblematicbehaviorinaperson’slife

CravingstoUse

LossofControl

ContinuedUseDespite

Consequences+ =OUD

Let’s Get Technical • MedicationAssistedTreatment(MAT)istheuseofmedicationsinadditiontocounselingandbehavioraltherapiestotreatopioidusedisorder.• MATisthestandardofcareinthetreatmentofopioidusedisorders!

Methadone Buprenorphine

What is Stigma? • Negativestereotypesassignedtoagroupofpeoplewhentheirattributesareconsidereddifferentfromorinferiortosocietalnorms(Goffman1963)

◦ Structural◦ Social◦ Individual◦ Self

Stigmatization in Local News

https://www.youtube.com/watch?v=5gT5NULvRSk

Think Pair Share Exercise

Mr.Jonesisasubstanceabuserwhoabusesheroinandisattendingatreatmentprogramincourt.Aspartoftheprogram,Mr.Jonesisrequiredtostaycleanfromalcoholandotherdrugs.However,lastmonthhetesteddirtyinhisurineforopioids.Hereportsthathewasunderfamilystressandrelapsed,buthewantstostopabusingdrugs.Hehasbeenasubstanceabuserforthepast5years.Henowawaitshisappointmentwiththejudgetodeterminehisstatus.

Think Pair Share Exercise • Asapair,answerthesequestions:◦ WhatisyourmentalimageofMr.Jones?◦ Didhedosomethingwrong?◦ Whatshouldthejudgedo?

Think Pair Share Exercise

Mr.Joneshasanopioidusedisorderwithheroinuseandisattendingatreatmentprogramincourt.Aspartoftheprogram,Mr.Jonesisrequiredtoremainabstinentfromalcoholandotherdrugs.However,lastmonthhetestedpositiveonhisurinetoxicologyforopioids.Hereportsthathewasunderfamilystressandresumedheroinuse,buthewantstostopmisusingdrugs.Hehashadasubstanceusedisorderforthepast5years.Henowawaitshisappointmentwiththejudgetodeterminehisstatus.

Think Pair Share Exercise • Asapair,answerthesequestions:◦ HowdoesyourmentalimageofMr.Joneschange?◦ Whatarethedifferencesbetweenthetwoparagraphs?

Group Share • Mr.Jonesisasubstanceabuserwhoabusesheroinandisattendingatreatmentprogramincourt.Aspartoftheprogram,Mr.Jonesisrequiredtostaycleanfromalcoholandotherdrugs.However,lastmonthhetesteddirtyinhisurineforopioids.Hereportsthathewasunderfamilystressandrelapsed,buthewantstostopabusingdrugs.Hehasbeenasubstanceabuserforthepast5years.Henowawaitshisappointmentwiththejudgetodeterminehisstatus.

• Mr.Joneshasanopioidusedisorderwithheroinuseandisattendingatreatmentprogramincourt.Aspartoftheprogram,Mr.Jonesisrequiredtoremainabstinentfromalcoholandotherdrugs.However,lastmonthhetestedpositiveonhisurinetoxicologyforopioids.Hereportsthathewasunderfamilystressandresumedheroinuse,buthewantstostopmisusingdrugs.Hehashadasubstanceusedisorderforthepast5years.Henowawaitshisappointmentwiththejudgetodeterminehisstatus.

ModifiedfromKelly,InternationalJournalofDrugPolicy,2009

Language Matters • Use“person-firstlanguage”◦ Putthepersonbeforeadiagnosis◦ Describewhataperson“has”ratherthanwhataperson“is”

• Ourmedicalconditionsdonotdefineus

Language Matters INSTEADOF…

• Addict,junkie,alcoholic,drugabuser,dopefiend,crackhead• Drugabuse• Clean/Dirty

• Formeraddict• Relapse

USE…

• PersonwithaSUD

• Addiction,SUD,misuse• Abstinent/activelyusing.Neg/Pos(utox)• Personinrecovery• Resumption,recurrence

Stigma is Harmful

•  Peoplewhoexperiencestigmaare:

lesslikelytoseekorbeofferedtreatment

SUDs are Treatable Chronic Diseases

NoWrongDoor!AWindingPath

(Chronic,RelapsingCondition)

Opioid Use Disorder Treatment WORKS

Connery,HarvardReviewofPsychiatry,2015

•  Whenaskedtostop“coldturkey,”asfewasoneintenpatientsareabletosucceed.

•  Whenmedicationsareused,morethanhalfofpeopleareabletostopopioiduse.

Opioid Use Disorder Treatment WORKS

Sordo,BMJ,2017

MethadoneTreatmentEffect

BuprenorphineTreatmentEffect

Peopleare50%lesslikelytodiewhentheytakemedicationsforopioidusedisorder.

What Can We Do? •  Practice“person-first”language•  Encouragepositiveattitudesandlanguageinclinic•  Encouragepatientstoaskquestionsandseektreatment•  Sharethatsubstanceusedisordersaretreatable• Alertprovidersandbehavioralhealthteammemberswhenpatientsscreenpositiveonsubstanceusequestions(AUDIT/DAST)

Why Does Stigma Matter?

•  SubstanceUseDisorder(SUD)isamongthemoststigmatizedconditionsintheU.S.andaroundtheworld

•  Healthcareproviderstreatpatientswithsubstanceusedisordersdifferentlyduetostigma

•  Peoplewithasubstanceusedisorderwhoexpectorexperiencestigmahavepoorerhealthcareoutcomes

(SAMHSA,2018)

Breastcancer

SUD

Language Changes Treatment • Arandomizedclinicaltrialofdoctoral-levelclinicianslookedattheimpactthatlanguagehadonjudgingapersonwithSUD.

(Kelly2010)

“Comparedtothoseinthe‘substanceusedisorder’condition,thoseinthe‘substanceabuser’conditionagreedmorewiththenotionthatthecharacterwaspersonallyculpableandthatpunitivemeasuresshouldbetaken.”