# Presentation: 055530

## The Many Faces of Stigma:Impact on Substance Abuse Prevention

- Deborah M. Galvin, Ph.D.
- APHA
- Boston, Massachusetts
- November, 15 2000

## Impact of Stigma in Substance Abuse Prevention   

- The Stigma of Substance Abuse Can:
- Reduce Participation in Prevention
- Lessen Positive Effects of Prevention
- Widen Gap between Research & Application

## Impact of Stigma in Substance Abuse

- Stigma Can:
- Lead to Increased Substance Abuse  		Increase Individual, Peer Group and 		Community Risk
- 		Decrease Resiliency

## Webster’s Definition of Stigma

- “Something that detracts from the character or reputation of a person, group, etc.; a mark of disgrace or reproach; a mark, sigh, etc. indicating that something is not considered normal or standard”

## Stigma is possessing undesirable, “deeply discrediting” attributes that “disqualify one from full social acceptance” and motivate efforts by the stigmatized individual to hide the mark when possible.   					Erving Goffman, Stigma, 1963, p.1

*Definition of Stigma*

## 
For stigma to persist, a language of relationships is required -- beyond individual attributes...

					Erving Goffman, Stigma, 1963, p.1

*For stigma to persist, a language of relationships is required -- beyond individual attributes...*
*	**	**	**	**	**Erving Goffman, Stigma, 1963, p.1*

*Definition of Stigma*

## Abominations of the body - physical defects
Blemishes of individual character perceived as weak will, domineering/unnatural passions, treacherous & rigid beliefs and dishonesty (e.g., record of mental disorder, addiction, unemployment, sexual orientation, imprisonment, radical political behavior, etc.)
Tribal - race, nation and religion transmitted through lineages and contaminate all members of the family
					Erving Goffman, Stigma.  1963, p. 4

- Blemishes of individual character perceived as weak will, domineering/unnatural passions, treacherous & rigid beliefs and dishonesty (e.g., record of mental disorder, addiction, unemployment, sexual orientation, imprisonment, radical political behavior, etc.)
- Tribal - race, nation and religion transmitted through lineages and contaminate all members of the family
*	**	**	**	**	**Erving Goffman, Stigma.  1963, p. 4*

- Types of Stigma

## 70% respondents favored denying employment to job applicants testing positive for drug use. 
56% of respondents stated:  if an existing employee tested positive for drugs, the employer should terminate that person.  
61% of respondents stated there are jobs which exist that are so safety-sensitive that substance abusers should never be allowed to be employed in such occupations. 
	www.drugfreeworkplace.com (Institute for Drug Free Workplace) 1997

**56% of respondents stated:  if an existing employee tested positive for drugs, the employer should terminate that person.  **
**61% of respondents stated there are jobs which exist that are so safety-sensitive that substance abusers should never be allowed to be employed in such occupations. **
**	****www.drugfreeworkplace.com (Institute for Drug Free Workplace) 1997**

- Images of Stigma

## Primary and Secondary Deviance

- Primary Deviance - Initial stigma is applied - person begins to employ his/her behavior or role based upon the stigma or label as a means of defense, attack or adjustment in response to societal reaction to him/her
- Secondary Deviance - ultimate acceptance of the stigma or label.
- 				Lemert, 1951                                    Social Pathology.  New York:  McGraw-Hill.pp 76-77

## Societal Response to Label

**Indifferent** - do nothing; avoid it
**Welcome **- herald it -- a way for society to advance
**Punitive** - deterrent & retributive measures
**Progressive** - advocate intervention, treatment and therapeutic measures
- Stanley Cohen, Images of Deviance(Middlesex, England: Penguin Books), 1971 p. 11

## Web of Influence

- Alcohol and Other Drug Use

- Dropping out of School

- Teen-age Pregnancy

- Teenage Suicide

- Violent Crime

- Individual Based Risk Factors

- Family Based Risk Factors

- School Based Risk Factors

- Peer Group Based Risk Factors

- Community Based Risk Factors

## Address general audiences without stigmatizing potential users
Design prevention messages not to stigmatize substance abusers.
 To do prevention, eliminate stigma of substance abuse.

- Design prevention messages not to stigmatize substance abusers.
-  To do prevention, eliminate stigma of substance abuse.

- Universal Prevention

## Slide 13

## Slide 14

## Groups, geographic areas and individuals at risk for substance abuse should not be addressed in a way which stigmatizes.
By categorizing certain people in certain situations as high risk, be careful of creating the reality of a stigma and how our perceptions of others and the world are assumed.

- By categorizing certain people in certain situations as high risk, be careful of creating the reality of a stigma and how our perceptions of others and the world are assumed.

- Selected Prevention

## Caution in intervening not to stigmitize:
Self-fulfilling Prophecy of entering a program or service.
Social perception and definition of the situation of what surrounds and follows the act or actor
Focus on situational dynamics out of which meaning emerges

- Self-fulfilling Prophecy of entering a program or service.
- Social perception and definition of the situation of what surrounds and follows the act or actor
- Focus on situational dynamics out of which meaning emerges

- Indicated Prevention

## Tailor materials & dissemination plans to enhance effectiveness with diverse populations.
Eliminate stigma in meeting research or evaluation requirements.
Enhance capacity building for providers to include training on stigma.

- Eliminate stigma in meeting research or evaluation requirements.
- Enhance capacity building for providers to include training on stigma.

- Attention to Stigma Increases
-  Prevention Success