Americans often understand that individuals with substance use disorder are not responsible for their addiction. However, a new study by Indiana University researchers finds that has not stopped them from stigmatizing this group of people.
"Historically, drug use disorders have been the most stigmatized of all psychiatric or medical conditions," said Brea Perry, study co-author and professor of sociology at IU. "People with drug use disorder are disproportionately viewed as having bad character, more blameworthy and less deserving of help. This stigma impedes progress toward reversing the opioid epidemic by discouraging people with opioid use disorder from seeking health and substance use services and increasing secondary harm."
The study is co-authored by Bernice Pescosolido, a distinguished professor of sociology at IU, and Anne Krendl, associate professor in the Department of Psychological and Brain Sciences at IU, and was published in the journal Addiction.
Perry and her team used data from the 2018 General Social Survey, a nationally representative, face-to-face survey, to compare the attitudes of 1,169 people toward those with opioid use disorders and those with depression, schizophrenia, alcohol use disorder and typical daily troubles and stresses that don't meet the threshold for any psychiatric disorder.
The team found that a majority of people (73 percent) considered opioid use disorder a physical disorder, more than any other condition in the study. However, only 39 percent labeled it a mental illness. This is important because mental illnesses tend to be more stigmatized than physical illnesses.
The study also found that people are significantly less likely to attribute opioid use disorder to bad character (only 36 percent) or poor upbringing (only 17 percent), and only 33 percent of Americans attribute the disorder to a genetic or inherited problem.
"The nature of public stigma toward opioid addiction, and particularly people's ideas about what causes it or where it comes from, is different than what we have observed for other substances, like alcohol or cocaine," Perry said. "Attributing a condition to physical illness versus social or psychological causes, like bad character or poor parenting, is usually associated with less stigmatizing attitudes and behaviors because people are not held personally responsible for biological causation."
Perry and her co-authors were optimistic that these patterns related to beliefs about what causes opioid addiction would result in less stereotyping and discrimination. Surprisingly, this was not the case.
When it comes to perceptions of how capable those with substance use disorder are to manage their own finances or make treatment decisions, Americans perceive those with opioid use disorder as less capable than those with alcohol use disorder, depression or typical troubles. The public is also more willing to coerce those with opioid use disorder into some type of treatment (64 percent) compared to alcohol use disorder (50 percent) and depression (30 percent). Perhaps most telling, 52 percent of Americans believe that people with a substance use disorder are likely to be violent toward others.
Those perceptions, Perry said, could contribute to the willingness to socially exclude people with opioid use disorder. Of adults surveyed, 36 percent are unwilling to have a group home for opioid use disorder in their neighborhood and 42 percent are unwilling to have such a person move next door to them.
Likewise, 47 percent are unwilling to spend an evening socializing with such a person; 44 percent would not become friends with someone with an opioid use disorder; 73 percent of Americans are unwilling to have a person with opioid use disorder marry into their family; and 77 percent would not want to work closely with such a person on the job.
"Looking at this data, it is obvious there are clear differences in public attitudes toward those with opioid use disorder and other conditions," Perry said. "Even when the public does not hold someone personally responsible for their opioid addiction, they still hold negative stereotypes, and most do not want to interact with them socially or in the workplace."
When it comes to addressing the issue, Perry suggests moving away from traditional anti-stigma campaigns that reinforce a biomedical disease explanation. Instead, the focus should be on creating an image of people with opioid use disorder as fighting against a serious condition with real prospect for remission, similar to cancer. We need to highlight their value, both to their loved ones and to their communities.
"These data have important implications for how we tackle stigma," Perry said. "We should focus anti-stigma efforts on improving perceptions of people with opioid addiction or in recovery rather than putting resources into campaigns that educate the public about addiction as a brain disease. In this case, knowing that addiction has biological roots does not seem to move the needle on public stigma."
The Responding to the Addictions Crisis Grand Challengeinitiative engages a broad array of IU's world-class faculty, as well as IU's business, nonprofit and government partners. Working together, the groups are contributing to an initiative to implement a comprehensive plan to reduce deaths from addiction, ease the burden of drug addiction on Hoosier communities and improve health and economic outcomes. This initiative is one of the nation's largest and most comprehensive state-based responses to the opioid addiction crisis -- and the largest led by a university.
