We are all aware of the stigma sometimes attached to those suffering from alcohol and drug addiction. But somebody said to me the other day – “what about the stigma of being dry?” This struck me as an interesting reversal of the usual way of looking at things. It represents a potential barrier to those in recovery treatment.
What does stigma mean? The dictionary definition is a “mark of disgrace”. This sounds a bit hard-hitting. It almost conjures up the image of being forced to walk around wearing a badge saying “unclean”.
Why is stigma attached to alcoholics and those suffering from drug addiction? There are various reasons, including some or all of the following:
· Weakness – addicts are viewed by many as fundamentally weak-willed, unable to get a grip on themselves in response to circumstances, though this fails to acknowledge background factors that may have contributed to addiction
· Lack of self-control – related to the first point, this exhibits itself in an inability to exercise self-control both in private and in public
· Poor behaviour – this results in poor behaviour in social or work situations
· Harm to self – persistent abuse of alcohol and drugs is a form of self-harm and is therefore seen by many as irrational and a sign of personal failing
· Harm to others – addiction causes harm to others around the addict, including family
· Burden to the health system – as a result of requiring treatment, whether voluntary or not, the treatment of addiction is an expensive use of economic resources
We could tackle each of these in turn with some observations and counter arguments. Indeed, some of these topics have been addressed in previous blogs. But it’s not the primary focus of this piece.
With these obviously negative elements in mind, the approach taken by some medical professionals is to discourage terminology such as “alcoholic” or “addict”. Instead, the term “substance use disorder” is employed. This is partly to recognise that there is a spectrum of misuse. But it is also to avoid stigmatising people. The argument here is that stigma might prevent people from coming forward for treatment.
Did stigma stop me from coming forward? Not really, because treatment was in some sense “forced” on me when I was taken into hospital and confessed to the underlying cause of my collapse. I was given a “brown envelope” with all of the details to hand on to my GP and the outcome was referral to an alcohol treatment unit.
I hadn’t volunteered myself for treatment, as it were, and I’m not actually sure whether there was some subconscious awareness of stigma that had prevented me from seeking medical help before. I had told some people who were close to me that I had a “drinking problem”. Admittedly, however, I didn’t announce myself in business meetings as “Hi, I’m Andy, I’m an alcoholic, here to tell you my outlook for the Dollar”.
It’s interesting to me, however, that I rarely, if ever, hear people confessing at fellowship meetings that they suffer from “substance use disorder”. Instead, they will openly self-declare as alcoholics or addicts. That is because they have reached acceptance – not always – and have come to believe that taking ownership of their problem is an important first step toward recovery. Self-description using well-known terminology is an act of confession and self-acknowledgement.
True, I’m saying these things from a standpoint of more than twenty years of sobriety but, nonetheless, experience has taught me that failure to self-identify as an alcoholic can also be a barrier to getting well, despite what some medical practitioners might say.
What about the stigma of being dry? Am I marked out as a “person of disgrace” because I don’t drink? Here are some of the perceived (and sometimes actual) reasons why stigma can be attached to sobriety:
· Social outcast- the non-drinker is sometimes seen as being a loner and not very sociable
· "Party pooper" – he takes himself too seriously and doesn’t let his hair down
· Unfriendly – he or she is not very approachable
· Not part of the crowd – the non-drinker is not a good team-player and is not supportive of efforts at “team bonding”
· Uninteresting – the non-drinker is perceived as boring and somebody who won’t join in with banter. In reality, some of the “old timers” I’ve met over the years have very interesting things to say about their journey
Some of these supposed “marks of disgrace” might of course relate to other underlying issues that contributed to the use of alcohol and drugs in the first place. That’s why it’s important to form a comprehensive assessment and design of a recovery treatment programme.
The supposed stigma of not drinking is, I suspect, part of what lies behind the desire of so many of my mentees to return to “controlled drinking” when I first talk to them. For those who instead choose abstinence as a goal, it’s why I spend a lot of time talking with them about preparing strategies for when they encounter alcohol.
Here are some of them:
· Prepare in advance for what you will choose to drink
· Choose an alcohol-free beer, perhaps – personally I don’t recommend this for those newly in recovery and I avoided this for many years – the range and quality of what is now available has improved dramatically over the years
· Say you don’t drink for fitness and health reasons – some people are genuinely intolerant of alcohol
· Be honest – I told people that I couldn’t control my drinking and it used to lead to some interesting reactions
· Ultimately, move on from those who are uncomfortable with you not drinking – are they your true friends? Why should you participate in their desire to get drunk?
Forget about the supposed stigma of sobriety. I’m loud and proud of my sobriety. I actually laughed out loud when I was told that I might be exhibiting a “mark of disgrace”. What a load of nonsense! I’ve been sober for more than twenty years – wide awake, (reasonably) fit and (reasonably) healthy, and certainly better able to cope with the problems life keeps throwing at me.
Don’t hide your sobriety! Use your sobriety to help others!