August 8, 2022
Let’s look at key historic events to help us unpack the complex relationship of stigma and addiction.
In the US, various projects and programs are aimed at reducing stigma or negative attitudes, beliefs, and behaviors concerning mental illness at any given time. Studies have long discussed these negative responses to mental disorders. With its recent recognition within the confines of mental illness, the substance use disorder or addiction stigma has recently received similar research attention.
Studies on stigma related to mental illnesses point to the same thing: persistent stigma presents a major barrier on individual recovery as well as implementing effective mental health reforms. For today’s article, we will look at some key historic events to help us better understand the complexity of stigma and addiction.
Stigma refers to negative attitudes toward those suffering from substance use disorders that arise because of the likely impact to the physical, psychological, social, or professional well-being of the person suffering from addiction. The development of stigma is often complex and hinges on various factors.
Stigma can be related to a specific substance’s legality. However, how drugs or substances are classified is complicated and often influenced by harmful effects of a drug, as well as economic and political decisions. Moreover, how substances are regulated varies across time, and location.
One great example is how a category of drugs called psychoactive is regulated. Under this umbrella term are; caffeine, nicotine, alcohol, marijuana, cocaine, heroin, LSD, amphetamines, etc. From this list alone, we can deduce which ones are legal and generally accepted and which are illegal or criminalized.
The 19th century brought forth the expansion of the international opium trade. Driven by British colonists manufacturing opium in India and selling it to China, the opium trade also brought widespread dependence in various parts of the world.
In the United States a rise in its use for recreational and medicinal purposes resulted in the 19th-century opiate addiction epidemic. Apart from the boom of opium production, there were also no strict regulations at the time to control the substance. Moreover, opium and its derivatives were not yet well-studied, and so its adverse addictive properties were not very well-known at the time up until the early 1830s.
Certain populations were affected by opium addiction in the 19th century. In the late 1800s, almost 60% of the people with opium addiction were female. This is because opium, morphine, and their derivatives were prescribed to female patients to address problems related to menstruation like cramps and even morning sickness during pregnancy. Even infants were given opium to help with their teething pains. Both have become the face of opium addiction during this period. A public health emergency was raised by some doctors, which led to managing and fighting the spread of opium misuse and addiction.
In the 1910s, a new face of addiction surfaced–the Chinese immigrants operating opium smoking dens in major cities, particularly on the West Coast. This shift, along with the abundance of alcoholic products available for public consumption, created an opening for substance prohibition and the temperance movement. It was a minor issue if the addict was a sickly old lady. However, people were less sympathetic when the typical drug user was a young man hanging out with his friends and snorting heroin in a street corner.
This shift in demographics spurred the trend of punitive policies against drug users. It also increased the idea that addiction is a moral failure instead of a medical concern. This version of addiction stigma remains to be a common thread that runs through the discourse surrounding substance use even today.
The Industrial Revolution was a period of rapid development that transformed rural agrarian societies into industrialized urban centers. Goods crafted by hand were mass produced by machinery in factory settings, thanks to new technologies, tools, and techniques. This point in history also marks a shift in the public attitude toward substance use in the workplace, particularly alcohol.
Before the industrial revolution, alcohol consumption and labor had long been intertwined. During that time, drinking was associated with hard work. A drunken worker is generally frowned upon, especially among Puritans, but drinking in the workplace was considered normal.
The condemnation of substance use in the workplace is a relatively recent reaction, arising largely over the past 100 years, especially when juxtaposed with the presented occupational hazards. However, it can be argued that the relationship between labor or productivity and substance use has a long history and this issue still pervades today.
Connected to the industrial revolution, the golden age or the gilded age was an era extending roughly from 1870 to 1900 characterized by rapid economic growth, especially in the Northern and Western United States. During this time, American wages grew much higher than those in Europe, especially for skilled workers, and industrialization demanded an ever-increasing unskilled labor force. This resulted in an influx of millions of European immigrants.
Industrialization brought forth factory labor, with men working long hard hours without benefits or safety concerns. This caused a large number of immigrant workers to become addicted to drugs, because it was the only way to relieve their stress and get through the strain of working more than 15 hours a day. This escalation in opium use led to the government controlling opium, with the Opium Exclusion Act of 1909 which bans the use of opium in the United States.
Stigma towards addiction during this period affected immigrants the most, as public opinion mainly blamed their population for the increase of drug use in the United States.
Probably the first American war in which drug addiction was documented, the Civil War from 1861 to 1865 created the ‘Soldier’s Disease.’ The creation of morphine from opium led to its prevalent medical use without further studies on its addicting effects. It was touted as a wonder drug and was administered as a general painkiller, a cure for diarrhea, and even a preventative medication for dysentery during the Civil War. Around 400,000 soldiers are said to have returned home with an addiction. Morphine and other opium derivatives were continuously used for physical and psychological war wounds, which still rings true to our present time but with modern versions of the substance.
The ill effects of opium to public health led to the government controlling the substance. However, the long history of war and substance use continued with a different drug: tobacco. During the first world war, the government wanted something for soldiers to ease their long periods of boredom and calm their high stress levels and the solution was cigarettes. Cigarettes were then distributed as part of the military rations for soldiers. By the end of the war, around 14 million cigarettes were being distributed on a daily basis.
Currently, there are around 50 million Americans addicted to tobacco products. Although the stigma against nicotine was not as bad as the stigma against addiction to ‘harder’ drugs, tobacco is still an addictive substance with established links to various diseases and health risks. This resulted in nationaly more and more programs to control tobacco use.
Amphetamines were the most popular drug used in World War II. Between 1939 and 1945, soldiers accounted for the largest number of amphetamine users. Originally synthesized for pharmaceutical use, amphetamines are powerful central nervous system stimulants that have become the ‘pep pills’ to boost the stamina and morale of soldiers in the second world war. It was said that governments on both sides of the war drugged pilots to keep them alert on long-haul missions.
The war-substance use link continues until today, with veterans returning home from deployment only to struggle with post-deployment alcohol use disorder and other drug addictions. Apart from the addiction stigma, they also have to deal with mental health stigma, as a lot of veterans develop Post Traumatic Stress Disorder.
Mental health illness and substance use disorders are more prevalent than most of us think and they are among the most highly stigmatized health conditions in the US. Globally, mental health illness and substance use disorders are leading causes of morbidity and mortality.
Despite the various programs for reducing the stigma of addiction and mental disorder being implemented in the recent years, stigma still persists and people struggling with these disorders continue to face prejudice and discrimination in many areas of civic life like finding work and housing.
Moreover, stigma impedes a person’s recovery. Studies have shown that only around 50% of people with mental health illness which includes substance use disorder were able to proceed with treatment and stigma contributes to this hesitancy. Stigma also creates unique stressors and psychological distress that can cause harm to the individuals with said illnesses, especially among those who are likely to suffer multiple stigmas or discrimination (based on gender, race or ethnicity, lifestyle, etc).
Addiction stigma comes from a complex process of labeling, judging, and stereotyping which can range from subtle to explicit. As mentioned, this process is complex and cannot be addressed fully in only one dimension. Thus, education is necessary to shift the public perception of these illnesses which can happen on an individual and community level.
If you know someone who is struggling with substance use and other mental disorders, always remember that developing an addiction can happen to anyone and it cuts across genders, ethnicities, and social status. It is not a moral failure but a disease that can be treated through therapies and medications.
To better understand addiction and other mental health disorders, you can read more rehab blogs here.
Struggling with addiction, along with the stigma that comes with it, can be overwhelming. More holistic programs are needed to better address the physical and psychological burdens of substance use disorder, and this is our pledge here at Another Chance. If you are unsure about the services and programs for you or a loved one, we at Another Chance are here to help. Here at Another Chance Drug & Alcohol Rehab Center of Portland, we offer evidence-based treatments and services to help our patients heal and experience life to the fullest. We create a unique and safe environment to address the specific needs of young adults and professionals on their road to healing.
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