Why aren't we talking about addiction stigma in the way we're talking about mental health stigma?

By Lucy Nichol, Trustee

I’ve been involved in the Time to Change anti-stigma campaign for a few years now. In fact, most of my writing has been on the subject of mental health stigma. It’s something I’m hugely passionate about - not only because I’ve experienced it, but also because I work in media and communications, so media portrayals and the impact they have on everyday lives greatly interest me.

But one thing I continually notice is that addiction stigma, generally, isn’t part of the conversation.

The difficulty here is knowing where you need to start to tackle this. Do you start with the stigma, or do you start with the law, services and policy?

Is the stigma driving the policy, or is the policy feeding the stigma?

I guess the key thing to look at is what we have within our gift to change. As individuals we can’t magically create more drug and alcohol services or change policy overnight, but we can try to influence the way people think about addiction.

Addiction isn’t an attractive proposition for MPs and local authorities when it comes to prioritising budgets. There’s possibly two reasons for this. Firstly, the problem is so big, it’s going to be difficult to describe what success looks like - although I’m pretty sure there are ways and means. However, to get to that point, funding for addiction services needs to be met with public approval. After all, there are votes at stake when it comes to politics.

And this is where the issue of stigma plays a significant role. People still see addiction as a lifestyle choice, rather than an illness. But this couldn’t be further from the truth. Nobody chooses to be an addict.

It’s great to know that today, mental health problems are included in the equalities act. I know myself, having been through an employment tribunal process, that if a mental health problem impacts you on a daily basis and has done for a significant amount of time, then you are protected. But there doesn’t seem to be that protection for those of us in active addiction or recovery.

A colleague of ours from Recovery Connections told me that, in the US, alcoholism is, in fact, a protected characteristic. It doesn’t protect you from everything - you can still be fired for being intoxicated at work - but it’s certainly a step in the right direction. It recognises that alcoholism is not a choice.

But it’s the same with any kind of addiction - whether it be alcohol, drugs, gambling, sex or food. The very nature of addiction is compulsion, more often than not driven by distress, isolation and other mental health problems.

I would argue that you can view addiction as a negative behaviour associated with poor mental health. It’s a coping mechanism used by individuals who can’t see another way of escaping their pain. Much like people with eating problems binge, purge or restrict. And much like people who self-harm to find some form of pain release.

Yet addiction isn’t considered in this way. It’s seen as something separate even though, just as with all the other behaviours mentioned above, it is a form of self harm to cope with life. People who self-harm through cutting or restricting food are seen under mental health services. But people with addictions are often seen by local authority services (if they can be seen at all) rather than through health services. This demonstrates how the system is set up to fail addicts - because their mental health problems cannot be dealt with holistically - one problem has to be dealt with over here, one over there. And often, there’s an argument that if one problem isn’t successfully treated, an individual can’t begin treatment for their co-morbidity - and vice-versa.

Yet in reality, problems such as depression or anxiety impact significantly on addiction and vice versa, so treating the problems in isolation is unlikely to be the most effective way of finding and maintaining recovery. If you want your success figures policy-makers, isn’t it obvious you’re going the wrong way about it?

It’s time that addiction, given it’s propensity to kill huge numbers of people, is invited to the anti-stigma table. It’s time we looked at the bigger picture and stopped siphoning problems off to different services.

People are dying every single day. Rather than feel daunted at the scale of the problem, isn’t it time we at least looked at re-designing laws, services and policies to give people a better chance?