By Marianne Coulavin, Student - MA Program 'Policies and Practices in International Organizations', Sciences Po Grenoble*
Stigma usually stands for a mark of shame, discredit or public disapproval. Stigmatisation involves the artificial categorisation of a group of people as a distinct social entity associated with undesirable social/physical perils. These characteristics are framed as the group’s essential identity and are often blamed on the group itself, which, in turn, is weaponised to justify their marginalisation.
The stigmatisation of people who use drugs bears serious consequences. It isolates people and undermines their self-esteem and sense of self-worth. It can also deter people experiencing difficulties related to their drug use from seeking treatment and accessing harm reduction facilities, whether to avoid being stimatised or as a result of internalised feelings of being underserving of solidarity and support. Healthcare workers can perpetuate stigma and even refuse to provide service to people who use drugs. As such, stigma is a significant barrier to health promotion, treatment and support. What is more, the stigmatisation of people who use drugs has contributed to normalise discrimination. People who use drugs are discriminated against in a variety of ways, including in relation to access to health services, housing and employment. It is therefore essential to reduce the stigma on drug use and people who use drugs.
How the words we use affect our feelings
It is commonly understood that the vocabulary that we use can influence the feelings and perceptions of our audience. But how exactly? According to Dr Antonis Kousoulis, Director of the Mental Health Foundation, ‘a word brings [to mind] an idea and an idea triggers many other ideas’, and our brain ‘keeps making connections between all those by resurfacing memories, which in turn recall emotions, that then bring other reactions’. So, the way we process and store language, memories and emotions is intimately linked.
Equating a person's identity with their substance use, questioning and diminishing the value of that person on the basis of that use, and dehumanising them through negative labels not only has a significant impact on that person's [mental] health, but also affects public opinion. And these generalised [mis-]understandings, or narratives, condition policy and legal decisions. Consequently, stigmatisation leads to policies and laws that do not prioritise access to health and welfare services, but rather punishment and marginalisation. Breaking this cycle requires sustained and comprehensive efforts, including through the use of non-stigmatising language.
Drug shaming and userphobia: Everyday stigmatisation of people who use drugs
Stigmatising language in relation to people who use drugs is pervasive and corrosive. Terms like ‘junkie’, ‘addict’ or ‘crackhead’ are used to otherise and trivialise challenging experiences with drugs often steeped in trauma and alienation. Other expressions perpetuate the idea of drug use as deviance or impurity, such as the use of ‘clean’ for people who no longer use drugs. International authorities, health institutions and state laws play their part too. ‘Drug abuse’, a catch-all term for a disparate collection of behaviours related to drug use, implies the existence of an ‘abuser’ and precludes the possibility of safer, positive experiences related to drug use.
Userphobia is based on stereotypes and assumptions about people who use drugs that are hard to dispel. Such stereotypes are constructed, conveyed and reinforced by formal and informal structures of power, like governments, religions and families. For example, people who use drugs are often portrayed as criminals, unemployed, a burden on public finances and guilty victims of their own behaviour. These assumptions are used to shame and denigrate people who use (or are assumed to use) drugs. They are humiliated, their morality is viewed as damaged, and their actions are all artifically portrayed as the result of their drug use. Discrediting people or explaining their wrongdoings through their drug use, especially regarding public figures, is unfortunately a common practice.
The responsibility of the media in spreading drug-user-phobia and drug shaming is more than evident. Using kinder, precise and respectful language when covering drug-related issues can contribute to bringing about change and reduce stigma.
Importantly, stigma does not affect all people who use drugs equally. Legality, perceptions of harm, but also social status and context play an important role in mediating stigmatisation and its corollary, criminalisation. As such, people who are the most targeted and impacted by stigma belong to groups who are poorer and in other situations of vulnerability.
Stigma in the time of coronavirus
If under regular circumstances people who use drugs are discriminated against in terms of access to healthcare, during the pandemic these barriers can be magnified. As we already mentioned, stigma can prevent people from seeking help or treatment even though they are at particular risk of contracting and succumbing to COVID-19, due to many factors, and can also result in people being turned down by service providers. In addition, where health facilities are overwhelmed by demand during the pandemic, medical staff may be pushed to make trade-off decisions that could play at the detriment of people who use drugs and other marginalised communities. Stigma is a matter of life and death. Which is why a commitment to undoing stigma, including through the use of person-first language, is more important than ever to ensure the right to health of people who use drugs.
If you wish to know about precise, kinder and respectful language with regard to people who use drugs, check out Words Matter! Language Statement & Reference Guide, by the International Network of People who Use Drugs and the Asian Network of People who Use Drugs (ANPUD).
* This blog post was produced within the framework of a 4-month volunteering experience placement at the International Drug Policy Consortium as part of the student's MA Program 'Policies and Practices in International Organizations' at Sciences Po Grenoble.