Winter 2021
Substantial Impact: Stigma and Substances
by Nina Ovian
People use substances to alter their minds in the hopes of alleviating mental anguish, whether this is prescribed and taken under the care of medical professionals, or bought from someone on the street and done alone. Although there is great variety in the ways people access mind-altering substances and how they consume them, stigma is a common thread across the board.
All substances, pharmacy and street, come with side effects or associated risks that people are best advised to make decisions on under the care of a medical professional and within their support systems. A relatively benign example is that some heart medications can make your skin incredibly sensitive to sunlight and burns. On the extreme end, chemotherapy for cancer patients can have debilitating and sometimes fatal effects. Psychiatric medications are known to cause a range of possible side effects, such as dry mouth, dizziness, fatigue, weight gain, gastrointestinal issues, sexual dysfunction, or even tics and tremors. 1
While taking medications for somatic health conditions is widely accepted in American society, using substances for behavioral health—even when accessed within the medical model—can be highly stigmatized. For example, taking antidepressants in many communities has become widely accepted (especially for short-term use), but being dependent on antipsychotics over a long term can still carry the risk of discrimination and isolation.
Engaging in illegal street drugs carries much more risk than taking prescribed drugs by a medical professional, but this does not need to equate to increased stigma and shaming when seeking medical care for any reason. In some spaces, illegal substance use is more normalized and more available than traditional psychiatric medications. Not everyone has access or interest in the western medical model. Cultural perspectives about health/illness are often thought of first as the reason for this, but it can also be due to more common (and often quite American) experiences like past medical trauma, lack of competent medical professionals in the area, inadequate or absence of health insurance, or even something as simple as lack of transportation and childcare.
Stigma makes it difficult to discuss when substance use becomes problematic. Prejudgments and shame around usage encourage isolation and increased engagement in risky behaviors. 2 When people feel ashamed of usage they will be more likely to try to hide it. This can include using alone without any safety precautions for overdose, failing to create or maintain a sterile environment resulting in contamination, and rushed use leading to miscalculated dosing.
No discussion of substance use should disregard the harmful impact of the past focus on intertwining substance use with the criminal justice system. Criminalization is a known barrier to healthcare and health outcomes, as it can cause or exacerbate cycling in and out of care, disrupted housing, inability to access a formal job with health insurance, isolation, and trauma. 3 So, not only do you have the stigma and health risks associated with substance use, but also as someone who is tied to the criminal justice system.
Pitting non-prescribed or illegal substance use against prescribed or legal substance use detracts from getting people the actual healthcare and rehabilitation they need in order to find their path to recovery. When we better understand that people will use whatever coping mechanisms that are available and accessible—whether or not it’s legal or carries other health risks—we can work together to better address and treat mental health challenges.
1 - https://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml