‘Living the stigma: understanding addiction and overcoming prejudice’ was the theme of this year’s NHS Addictions Provider Alliance (APA) conference. DDN reports.
‘We’re making progress – people are talking about this more,’ NHS APA chair Danny Hames told delegates at the organisation’s Living the stigma conference. Stigma was now being considered in terms of how policy was written and services developed, but ‘there’s still a job to be done’, he said.
Chair of the Drugs, Alcohol and Justice APPG, Dan Carden MP – who shared his personal story of recovery in the House of Commons (DDN, June 2022, p10) – said he’d chosen to talk about his experience partly to challenge the stigma. ‘Having overcome the grip of alcoholism, keeping my recovery hidden was never going to be an option for me. I wish I could tell you that the political will to prioritise addiction has been found, and attitudes towards those living with substance use disorders is changing – but that wouldn’t be true.’
This meant it was now vital to reach parity between addiction and other chronic mental health conditions, he said. ‘Addiction thrives on isolation, and the remedy is human connection. Reconnecting with my family and friends and community is what keeps addiction at bay’, with stigma undoubtedly the biggest barrier to recovery. ‘Intolerance towards addiction is well-known, well-researched and often denied by those setting policies’, with many still seeing substance issues as a moral affliction. ‘We’re fed an unhealthy diet of stereotypes. It’s not all – or even mostly – about the substance. It’s about reconnecting people to the world around them, treating trauma, and providing hope.’
On the question of how to go about influencing organisations, a significant misconception was that addiction was a choice, said clinical director at South London and Maudsley NHS Foundation Trust, Dr Emily Finch. ‘One of the best ways we can answer that is to educate people on what we know works.’ For people who had already developed a problem this was about making sure they had truly effective treatment, she said – ‘in the same way as someone with diabetes getting treatment that works. I think that’s the route to genuine understanding, rather than the moral weakness argument.’
‘Challenging at every point,’ was vital, said programme manager at North East Lincolnshire Public Health, Mike Hardy. ‘I’ll be in meetings and the language that’s used is not just old and antiquated, it’s offensive – but there’s no awareness of that. It’s also about making sure that everything we put out uses language that people with lived experience – or who are currently using – are comfortable with.’
It was also important to challenge definitions of recovery that had been externally imposed, said Jon Findlay, harm reduction lead at Humankind. ‘If I don’t stop using drugs, I’m not a successful treatment outcome – I’m not a success until I can tick a box on the NDTMS form. I’m measured on that, and I can’t volunteer or work for an organisation because of somebody else’s version of recovery. From a stigma point of view, we set the bar really high.’
It was also important for people in the sector to challenge themselves, however. ‘To a certain degree we’ve created this closed community,’ he continued. ‘Drug and alcohol treatment services are very confidential spaces. They’re a bit mystical – unless you’ve got a reason to, you’d never go in. It creates a kind of “it’s just for those people” attitude, whereas a GP’s surgery is for everyone.’ While it was clearly crucial to maintain confidentiality and dignity, it was also important to be more open and honest, he said.
Language was undoubtedly important, but it was also vital not to let it get in the way of other things, said Hames. ‘I think sometimes we can get so consumed with this, we miss the point of moving forward and doing something positive.’
‘I would always use “alcohol use disorder” or “substance use disorder”, but I recognise that for some individuals the words “alcoholic” or “alcoholism” can be useful and have a meaning for them,’ Finch stated. ‘For some people understanding that they are an “alcoholic” can be a pivotal moment of change, so I would listen to the individual. We don’t have one person with one problem – individuals are individuals, and they have different needs. And once you recognise that you get rid of some of the stigma, because it becomes more about the person.’ DDN
NHS APA is a founding member of the Anti Stigma Network (ASN) – find out more at www.antistigmanetwork.org.uk