Dr. Oliver AldridgeEdinburgh, Midlothian & East Lothian DTTO I and DTTO II

Theory

Client

Communication

Agency

Conclusions

Ancient Greeks physically scarred people to permanently “mark” them

Today: amputation of a finger to denote someone who is deemed to be a “grass”

May be part of the survival mechanism of group living

Some of the original driving force behind drugs legislation – San Francisco 1865

Reciprocity Threat: housing, benefits,

treatment/support, theft, “infecting others” by introducing to drugs.

Downward comparison Belief in a “Just” world/ “Protestant Work

Ethic” – you get what you deserve and you deserve what you get

Drug users are bad parents Drug users are dishonest Drug users are manipulative Drug users are self-indulgent Drug users are wasters Drug users destroy communities Drug users choose to be drug users

Stereotyping facilitates stigmatisation

Stigmatisation encourages stereotyping

May be linked to depersonalisation

Needs to be openly discussed so that it can be managed on an individual level.

Differing levels of stigma sensitivity between clients

Cannot make automatic assumptions about the effect on a client

Cannot make automatic assumptions about the main sources of stigma

Usually drug use is only one factor: Poverty Poor education Unemployment Criminal record Drug taking Injecting Parenting

Difficult childhood Learning difficulties May contribute to feeling excluded Social acceptance may be sought in a

marginalised peer group As part of that group, drug

taking/experimenting may be the norm Effect of criminalising groups?

Physical Signs

Treatment Stigmata

Social Stigmata

Visible signs of drug use include:Injection sitesPoor dentitionPoor nutritionAppearing intoxicated/withdrawn

Managing these appropriately may increase the range of options in managing stigma

You’ve got to know when to hold ‘em…..Know when to fold ‘em…..

Managing disclosure is a highly individual, situation specific problem

If stigma is not overtly discussed, it is not possible to devise an effective, individualised strategy to deal with it

Exposure of a previously, largely hidden level of drug use

Loss of employment Peer group rejection Relationship breakdown Increased intervention e.g. Children &

Families Labelling Disempowerment Social Isolation

Local vs. Centralised treatment services – pros and cons

Failing to treat people holistically Perpetuating or increasing stigma in the

treatment environment Recovery = Abstinence Information sharing vs. “raw data” being

communicated to people without specialist knowledge

Some treatment options may feel less stigmatising to the client e.g. DHC vs. Methadone

Treatment needs to have a solid evidence base and be effective and appropriate for the client at that time

May be stigmatising

Alterations to pharmacy may impact positively

May reduce stigma

Effect is individual and, therefore, policy should allow individual assessment/decision making

Method – supervised urine collection processes

Rationale – is it being done to “catch” people?

What is the context of a result?

May help to combat negative attitudes

Wraparound care essential Helping people integrate into new social

groups The role of “ex-user” does not work for

everyone

As specialist agencies we have a responsibility to provide good quality, objective information to:

Communities Media Government Professionals Students

Views/hypotheses may impact on stigmatisation

Is it better to be viewed as someone with a genetically determined problem or as someone with a social problem?

Facilitating appropriate contact with people who don’t conform to stereotypical views may catalyse change

Caveat: Stigmatisation may paradoxically be increased by contact with someone who is massively different to the stereotypical view

Does the “exception” prove the “rule”?

May be stigmatised by the communities in which it works – “NIMBYism”

Workers may need support – e.g. outreach, needle exchange workers

Related professionals/disciplines may stigmatise those who work in this field

We may stigmatise each other by perpetuating false debates e.g. Harm Reduction vs. Abstinence

Funding wars may increase stigmatisation by threatening survival

Stigma is here to stay – we have to learn to manage it effectively

Management of stigma has to be individualised

Stigma cannot be dealt with if it’s not openly addressed

Treatment can contribute to stigmatisation: agencies need to consider this in service planning/delivery

Commissioning needs to look at the range of treatment services available to increase choice

Agencies have to play a positive role in educating/communicating