SEVERAL weeks ago, an incident involving a youth with a substance addiction problem being punished by the local community, was widely shared on social media. It was reported that the youth was apprehended for theft.
In response to the unusual retaliation by the community, Health Minister Khairy Jamaluddin said stigma amongst members of society towards drug abuse and addiction is one of the factors that prevent those involved from seeking professional treatment for their problems. He said the fear of facing legal consequences and the possibility of being arrested prevented such individuals from seeking appropriate help.
This bold statement by the minister in zeroing in on the problem of substance addiction must serve as an eye-opener for us. The stigma associated with many mental health conditions is a well-recognised problem.
While considerable progress has been made in recent decades in reducing the stigma associated with those living with HIV-AIDS and even in the case of psychiatric disorders such as depression and anxiety, such change has been much slower in relation to substance use disorders. One obstacle is that stigma in substance addiction is more complex.
People who are addicted to drugs sometimes lie or steal and can behave aggressively, especially when experiencing withdrawal or intoxication-triggered paranoia. These behaviours are seen to be violations of social norms that make it hard even for their loved ones to show compassion, so it is easy to see why strangers or healthcare workers may be unsympathetic towards them.
The mistaken belief that willpower should be sufficient to stop drug use, is never entirely absent from most people’s thoughts when they interact with someone with a drug problem. Healthcare professionals too, are not immune to these assumptions.
Indeed, they may hold stigmatising views of people with addictions that may even lead them to withhold care.
It is often witnessed in Accident and Emergency Departments; for instance, healthcare professionals are being dismissive of someone with an alcohol or drug problem because they did not view it as a medical condition but rather as a flaw in the character of the patient. Such experiences may prevent addicted individuals from seeking healthcare altogether.
What is stigma?
Stigma is defined as a set of negative beliefs that a group or society holds about a topic or group of people.
According to the World Health Organization (WHO), stigma is a major cause of discrimination and exclusion, and it contributes to the abuse of human rights.
When a person experiences stigma due to substance addiction, they are seen as inferior or dangerous because of their real or perceived health status.
Family, friends and society too can carry negative feelings about drug use or behaviour, using derogatory terms and labels which create and perpetuate stigma.
Stigma is rarely based on facts but rather on assumptions, preconceptions and generalisations.
Hence, its negative impact can be prevented or lessened only through education and in some situations, by legal mandate.
According to the latest report by the National Anti-Drug Agency, there are about 130,000 drug and substance abusers and addicts in the country. Two-thirds of them are youth between the ages of 19 and 39, while significant numbers are unemployed.
Therefore, among the many challenges in delivering appropriate care to the 130,000 people with substance use disorders in Malaysia, is the chilling effect of stigma.
However, Dr Prem Kumar Shanmugam, a psychologist and psychotherapist in the field of substance abuse says, “Instead of battling the numbers, we should start focusing on preventive measures.
“It is obvious we are failing to meet the objective of treatment, underscoring the need to remove stigma to pave the way for preventive and curative measures.”
A brain disease
The real difficulty in tackling stigma is a reflection of continued resistance to the idea that addiction is a disease.
Drug use alters brain circuitry that is involved in self-control and reward processing, as well as the regulation of mood and stress.
For a person with a serious substance use disorder, taking drugs is no longer pleasurable or volitional, but is instead a means of diminishing excruciating distress and satisfying powerful cravings, regardless of the destructive outcome.
Some people are more vulnerable than others to developing a substance use disorder because of a genetic predisposition, adverse social environmental exposures, traumatic life experiences, or other factors, and many of these factors are out of the person’s control.
So clearly, becoming dependent on drugs can happen to anyone.
To recover, they often need external help and support such as evidence-based treatment, with medication when possible.
However, their encounters with healthcare providers need to be sympathetic and helpful otherwise it may serve only to reinforce their disorder.
Addressing the problem
The Health Minister highlighted the successful approach used by non-governmental organisations (NGOs), especially the Malaysian Aids Council, which has succeeded in changing society’s perception of those living with HIV-AIDS.
He explained that with the empowerment of the community and NGOs, the Health Ministry hopes to eliminate AIDS in 2030 through the National Strategic Plan for Ending AIDS 2016-2030.
If such transformation can happen in the area of HIV-AIDS and other communicable diseases like tuberculosis and leprosy, surely substance addiction can also benefit from such a well-planned approach.
Stigma is not the only factor impeding adequate treatment of people with substance use disorders.
But, if we are to achieve the public health goal of getting and retaining more people with substance use disorders in treatment, among other steps would be to enlighten medical personnel in providing compassionate care to patients who may display difficult, sometimes frightening behaviours associated with drug addiction and withdrawal.
It is also necessary to promote awareness of addiction as a chronic relapsing but treatable brain disease.
This effort should include promoting an understanding of the disease’s behavioural consequences as well as the factors that make certain people particularly vulnerable.
Conventional wisdom can guide us. Respect and compassion are essential.
Stigmatising people who are addicted to drugs inflicts social pain that not only impedes rehabilitation but also further cements the problem.
The truth is as clear as daylight – stigma in substance addiction is a public health issue, which contributes to high rates of death, incarceration and mental health concerns among those struggling with their addiction.
Dr. Andrew Mohanraj 