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Brien Center's Medical Director Jennifer Michaels gives a presentation on the impacts the stigma has in address the opioid epidemic.

Work Group Discusses Stigma Associated With Heroin Use

By Andy McKeeveriBerkshires Staff
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Michaels said the cost to society in dealing with substance use issues is in the $400 billion range. But, most of that is dedicated to dealing with the consequences after and not prevention or treatment.
PITTSFIELD, Mass. — Terms like junky, addict, drug abuser, clean versus dirty, carry a negative connotation when it comes to the opioid epidemic. 
 
That stigma makes it even more challenging to address the nationwide problem, according to Dr. Jennifer Michaels, medical director of the Brien Center.
 
Michaels spent about two hours Wednesday morning with many who are combating the opioid epidemic in one way or the other to discuss the impact stigma has on the crisis. 
 
"If you are afraid of being outed for getting help for your illness, what are you going to do? You aren't going to get help," Michaels said.
 
Michaels said that of 25 million people dealing with some type of addiction, less than 10 percent sought treatment in 2012. There is a far greater number of people avoiding treatment programs than other diseases. She said the judgment of themselves and others is what keeps them from taking the step.
 
"The majority of people who could benefit from treatment are not in treatment or seeking treatment," she said.
 
There are multiple types of stigma, she said. There is the structural stigma when society creates unfair rules and regulations against certain groups of people. For example, when crack cocaine started to become a trend lawmakers, quickly implemented stricter rules on those using it. Those who were arrested with cocaine were ultimately given lesser punishment than those caught with crack despite it being essentially the same drug. That stems from the perception and stigma of the people who used crack versus those who used powder cocaine. 
 
Another stigma is social. For example, when someone has cancer there is an entire support network in place. There are people who will help out. Ways to get rides here and there. Ways to get treatment and supplies. But when it comes to addiction, many people look the other way. Someone fighting cancer is empowered while some suffering from addiction is ashamed.
 
That shame is a self-stigma, too. This is the people who want help but they don't want to be seen in waiting rooms by others. They are so ashamed because they believed they are a lesser person that they won't reach out to people for help.
 
And there is a stigma by proxy, Michaels said. This is the stigma on people like herself who work to help those addicted. Michaels said she is always asked questions like "how can you help those people," and others referring to her patients as scumbags, or having had their chance. Others in the audience Wednesday spoke up at this point telling stories of their interactions, whether it be people opposing their use of Narcan, or holding a rally to be greeted with negativity from the general public.
 
Michaels said the stigma first stems from a lack of knowledge. She said large groups of people in the general public lack knowledge of what certain people are going through and make generalizations. Those generalizations and prejudice create the general attitude about the issue, which then that leads to discriminatory behaviors.
 
When it comes to addiction issue, Michaels said this stigma is essentially a Scarlet Letter. Those who act and speak in such negative ways about those who are addicted to heroin, make a strong impact on others. Those with substance use problems feel they are being blamed and feel ashamed, they feel lesser.
 
In response, they isolate themselves and act in secrecy. And they certainly don't want to be seen entering a treatment program or admitting to being in one. More and more people struggling with addiction are discouraged from entering treatment programs, and thus the rate of recovery drops significantly.
 
Those who are successful in recovery don't want to share their stories of success and struggles, stories that can inspire and help another facing the same challenges, because of the possible judgment and comments they might hear.
 
It causes them to be restricted in housing and employment because of the way others think of addiction, adding more triggers for relapse. It stresses relationships and mental health. The stigma against it even prevents people from realizing they need help.
 
"People have trouble accepting they have a problem. There is denial and ambivalence," Michaels said.
 
Overdose deaths have now increased by 22 percent, Michaels said, and some $400 billion per year nationally is spent on substance abuse disorders. But most of that money is being spent on the "wreckage." Michaels said most of that money is related to vehicle accidents, incarcerations, people not paying taxes, and other consequences of the opioid problem. 
 
"We've got it exactly the wrong way. We are waiting for people to get sick, have consequences, and then we are dealing with it," Michaels said.
 
Meanwhile, only 1.9 cents on the dollar is spent on prevention and treatment, Michaels said. She wants to flip that script. She wants more people to enter treatment programs, and more money to fund those programs. And the change like that has been done before, she said.
 
Michaels said it was not socially OK to have breast cancer in the 1970s. It was hidden. Then in the 1980s, a movement came about breaking that barrier and led to people understanding breast cancer and that those with it didn't have to hide. And now, it is socially acceptable and has the support systems to prevent it. Michaels hopes for a similar path with opioid addiction. 
 
"It is a treatable disease and people can get better," Michaels said. "People do recover. They do get better."
 
That's the message Michael hopes to spread when it comes to the opioid problem in the Berkshires. She wants people to stop blaming those who are struggling with it, and accusing them of being lesser of a person, but instead encourage and support treatment. The first step is breaking down the stigma.
 
Michaels cited a 2010 study in the American Journal of Medicine in which two groups were formed. The same story was told in two ways about a man relapsing in a drug treatment program. In one group, the man was referred to as a "drug abuser" and in the other, he was referred to as "someone with a substance use disorder." The groups were then asked what should happen to the subject.
 
The findings found that the group using the term abuser, were more likely to call for punishment and cast blame, were fearful and believed he "willfully did it." The other group were more likely to exonerate, refer to his struggles as a disease, and encourage treatment.
 
Michaels said that study shows that words matter. She is calling on people to replace the use of words like user, abuser, junky, addict, dependent, and instead, use "person first" language. She encourages referring to them as a "person with a substance use disorder" or patient. And she wants the general public to get to understand the facts. 
 
"People love to talk bad when they are ignorant and stigmatize," Michaels said.
 
Breaking down the stigma extends to how people get treatment, too, Michaels said. She said there are a number of drugs with proven records of helping people overcome serious drug addictions that are often treated negatively by the public — such as methadone, buprenorphine, naltrexone, and the overdose reversal drug naloxone. 
 
She said surveys show people reject those types of treatment programs but Michaels said those prove to have a better success rate the detox. She said it takes two years for a brain to heal &mdash to essentially undo the rewiring the drug had done to the brain &mdash and she recommends patients stay on prescribed medicine that long.
 
Once the brain is healed, the person can begin to wean themselves off to medication. 
 
"The slower the better and if they change their mind, we're fine with that," Michaels said.
 
This treatment, however, Michaels said needs to be coupled with an array of other recovery supports. She said basically all the help one can get to treat a drug addiction is welcomed.
 
Michaels talk was put on by the Central County Opioid/Heroin Work Group. The group, consisting of mostly organizations focused on curbing the opioid outbreak, meets monthly to discuss topics and share information relating to the issue.
 
"We hope today's information and discussion will empower us to help and figure out how we, ourselves, can help in our community to break down some of the evidence of stigma we see," said Facilitator and Pittsfield Health Director Gina Armstrong.
 
Armstrong said the stigma issue creates barriers between helping families and it is prevalent all over society.
 
"We see it on Facebook oftentimes, the comments people make. It shows there is a real lack of sensitivity of what people are going through."

Tags: drug abuse,   opioids,   substance abuse,   

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