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Addiction Specialist Priority: Addressing Client Shame


Public perception of substance use disorders (SUD) has been slow to change. People will continue to judge what they do not understand, so those afflicted by SUD are often blamed as the cause of addition. This leads to a plethora of challenging attitudes that are reflected in the patients themselves.

Shame and the negative stigma of addiction are major barriers to seeking treatment for many suffering from substance use disorders. This article explores what an addiction specialist can do to help his or her clients overcome shame and embrace addiction treatment in a healthy, positive way.

Addiction Specialists Battle Public Perception

The shame of addiction frequently compounds the reluctance to seek treatment. While substance abuse and mental health have become a part of the national dialogue, Americans still have deeply rooted belief systems that these disorders are caused by moral failing. Subsequently, guilt, shame, and embarrassment all contribute to the difficulties of treating these disorders.

This is not simply anecdotal evidence; Johns Hopkins studied the issue and determined that Americans stigmatize those with drug addiction as having a great failure of moral character and not a medical condition. The study illustrated that Americans generally do not support public policies in housing, employment, or insurance that benefit those with SUD.

So where does that leave the addiction specialist tasked with dealing with the stigma as part of treatment?

Addiction Specialist as Change Catalyst

Psychology Today suggests that deeply ingrained shame is one of the biggest barriers to effective treatment. Patients entering rehab may have felt the stigma of their disease in the workplace, and from friends and family members who simply do not understand these disorders. It is crucial that the process of education and rehabilitation occur as part of the addiction specialist’s assessment and treatment program.

The clinical treatment provider must recognize that the stigma associated with SUDs may have even been leveled at the patient as part of their journey in the healthcare community. For example, studies have shown that many nurses have a negative attitude toward patients affected by substance abuse.

The American Society of Addiction Medicine encourages addiction clinicians to take action to help change attitudes about SUD in three ways:

  1. Increase the level of discussion around addiction, while seeking out better forms of evidence-based treatment. They suggest: “People with addiction deserve to be treated like any other patient with a medical disease, and physicians are helping the nation to do this.”
  2. Prescribers of controlled substances should register for prescription drug monitoring programs as a tool to identify drug-seeking behaviors and to help identify when a patient needs counseling from an addiction specialist.
  3. Preventative measures must be initiated early, as teenagers adopt gateway behaviors. Screening for co-morbidity should be an active part of the patient assessment process.

Addiction specialists must recognize that the stigma exists and that the SUD patient likely has internalized these negative views as shame.  Clinicians should educate, not add to the stigma at all levels of the healthcare paradigm.

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