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A woman struggling with internalized stigma

Internalized stigma among those with substance use disorders or alcohol use disorders can be a significant barrier for accessing addiction recovery services.

SAMHSA data shows that 40 million over-12s in the U.S. had substance use disorder in 2020. Of those, just 4 million engaged with professional treatment.

While addiction is now widely viewed as a chronic but relapsing and treatable brain condition rather than as a moral failing, societal views surrounding drug addiction and alcohol abuse are still informed by many misconceptions.

Among the most harmful of these enduring myths is the scientifically baseless view that compulsive drug-seeking and drug-taking behaviors reflect deliberate and recurrent deviant choices. Regrettably, this belief remains widespread, leading to the ongoing stigmatization of substance use and addiction.

Internalized stigma addiction occurs when the person grappling with substance use issues is impacted emotionally by prejudices and challenges they face during their recovery.

When internalized, the backlash of stigma can have a major adverse effect on physical health and emotional wellbeing. Stigma also prevents many people with alcohol use disorder or substance use disorder from connecting with the professional treatment they need.

Even though attitudes around substance use are changing – especially surrounding substances like marijuana, legalized in many states for medical and recreational use – using and possessing drugs continues to be penalized. With punitive policies marking those who use drugs as criminals, even when they are suffering from a diagnosable disorder, stigma against those who use addictive substances is perpetuated.

What is Internalized Stigma?

People with substance use disorder (the clinical descriptor for drug addiction) have long been blamed for their condition. According to Dr. Nora Volkow (Director of the National Institute on Drug Abuse), the following thoughts are commonplace when someone is interacting with an individual with a drug problem:

  • Flawed beliefs and assumptions about personal responsibility.
  • The flawed belief that willpower is sufficient to stop substance use.

Stigma is broadly defined as a “mark of shame” or a “mark of discredit.”

Most stigmatized beliefs are based on generalizations, preconceptions, and assumptions rather than hard data.

As outlined, the stigma rippling outward from alcoholism and drug addiction can become a major treatment barrier. NIDA’s Dr. Volkow flags another consequence of stigmatizing addiction – internalized stigma.

According to Dr. Volkow, internalized stigma of substance abuse can trigger isolation and continued substance abuse, inflaming the substance use disorder or alcohol use disorder.

Self-Stigma in Addiction

NAMI (National Alliance on Mental Illness) categorized self-stigma as follows:

  1. Discrimination: Feeling directly discriminated against or feeling incapable of achieving your goals.
  2. Social withdrawal: Avoiding speaking about yourself or socializing because you imagine you are a burden to others. Feelings of inadequacy.
  3. Alienation: Feelings of embarrassment, shame, inferiority, and disappointment in yourself. Believing that your addiction is your fault.
  4. Stereotype endorsement: Considering yourself in terms of existing stereotypes.

NAMI warns of the following negative outcomes of self-stigma:

  • Barrier to recovery.
  • Worsens depression.
  • Reduces self-esteem.
  • Lessens empowerment.
  • Increases loneliness.
  • Impairs engagement with recovery.
  • Induces feelings of discrimination and devaluation.
  • Fear of criminal consequences shaping health decisions.

Before highlighting how you can connect with the treatment you need for addiction, a few words about one theory that suggests shame could be a part of addiction.

A man struggling with internalized stigma

Flanagan’s Shame Condition

Shame is a feeling directed at your whole self. Guilt, on the other hand, is when you feel a sense of culpability for your actions. In the context of addiction, the shame of addiction is then compounded by the accumulation of perceived guilt, initiating a vicious and downward spiral.

In 2013, Owen Flanagan of Duke University proposed a theory that substance use disorder includes a condition of shame. This is sometimes known as Flanagan’s shame condition.

According to this hypothesis, individuals with substance use disorders find fault with themselves in two important ways:

  1. Failing to maintain agency over themselves.
  2. Not meeting their own standards.

An awareness of these perceived personal failures can trigger negative attitudes including shame.

Flanagan proposes that the source of this shame is related to the person recognizing that they are unable to live up to their normative standards, especially with regard to behaviors.

Per Flanagan’s shame condition, feeling shame for substance use disorder is not a mistake, but rather part of the brain condition. Flanagan also suggests that shame can act as a powerful motivator for someone with an addiction to pursue treatment.

Fundamentally, Flanagan posits that there can be shame without blame when it comes to addiction.

Whether or not shame is an intrinsic component of substance use disorder, public stigmatization of addiction and the resultant internalized stigma among those addicted to alcohol or drugs remains a concern today.

Getting Help at Los Angeles Therapy Network

If you have been struggling with addiction to alcohol, prescription medications, or illicit drugs, there is no need to let stigma prevent you from getting specialist treatment.

Addiction is classified as a chronic and relapsing condition characterized by compulsive substance use despite negative outcomes. Fortunately, most addictions respond positively to a combination of the following evidence-based interventions:

  • MAT (medication-assisted treatment)
  • Psychotherapy (talk therapies like CBT and DBT)
  • Individual counseling
  • Group counseling

MAT is especially effective for the treatment of  alcohol use disorder and opioid use disorder.

Dual diagnosis treatment offers integrated treatment of co-occurring addictions and mental health disorders.

If you want to engage with treatment for addiction or mental health issues without heading to residential rehab for a month or more, outpatient therapy offers you access to the same services without the restrictions.

To kickstart your ongoing recovery from addiction to drink or drugs, reach out to Los Angeles Therapy Network right now by calling 833.604.1287.

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