Dread of Being Stigmatized

Holistic Dignity

The Effects of Stigma
on Healthy Recovery

Health is the first of the four broad areas in SAMHSA’s Recovery Support Strategic Initiative (Health, Home, Purpose, and Community). While SAMHSA is right to be concerned that the Recovering Peer needs to abstain from substance use first in order to improve the prospect of successful recovery, there is more to Health than just abstinence


Psychobiological Wellbeing


In SAMHSA’s  10 Guiding Principles, Holistic is listed near the top. Holistic is a large category and surely Holistic Health is an important aspect of that.

Not so very long ago, leading edge medicine was telling us that genetic predisposition was the chief cause of health problems, including the ‘medical model’ of alcohol and substance use; exacerbated of course by environmental exposure.

Since the completion of the Human Genome Project however, a new picture has emerged. It turns out that the expression of the genes is dependent upon a biological dialogue that the organism and the environment engage in together. Beneficial surroundings, activate the health giving qualities of genes while threatening and adverse environments switch on the detrimental aspects of our genes. This model is known as ‘epigenetic expression’ and recently great strides have been taken in the understanding of psychobiological gene expression.

Photo by Alex Chernenko
Photo by Frank Holleman


Psychobiological Gene Expression

Gene Expression/ Protein Synthesis Cycles:

Gene Expression

Approximate time

Major function

Research Domain










A Lifetime






Functional genomics

Clock Genes




Late activated

4-8 hours



Immediate & early activated

1-2 hours

Environmental response

Psycho-neuro Immunology

Behavioral State Related


Wake/Sleep, Dreams, Mood


Activity dependent

Minutes to hours

Memory, Learning


Immediate early

Seconds to minutes

Arousal states






The Psychobiology of Consciousness is a continuous energy, experiential state of neurogenesis in the dynamics of Self-Reflection and co-creation of Self (Psychosocial Genomics), which is a combination of:

  1. Chronobiology (Clock Genes)
  2. Behavioral State-Related Gene Expression (Arousal)
  3. Activity-Dependent Gene Expression and Neurogenesis (enhanced by novelty, environmental enrichment, vivid conscious experience, and voluntary physical exercise (play) ) and,
  4. Immediate Early Gene Arousal (within seconds to a minute or two)

Here we find that the Psychobiology of Consciousness is largely the intersection of these, especially numbers 2, 3, and 4.


Stigma is something that almost all peers face when actively in recovery. Stigma may also be present prior to recovery (indeed, perhaps throughout almost the entire lifetime) and continue long after a peer has recovered.


Furthermore, stigma negatively impacts the remaining three broad areas outlined in SAMHSA’s Strategic Initiative:

The Stigma of drug use, mental health issues, institutionalization, incarceration, sexual abuse, and health and living matters can be an impediment to any aspect of the Guiding Principles and their healing aspects. Stigma is not confined to the area of recovery and social and community related stigma can compound and bring complications to an otherwise solid recovery effort.

Strategic Areas affected by Stigma

  • Home – having a consistent, peaceful and stable place to return to each day will help remove uncertainty and anxiety that can lead to self-destructive behavior.


However, Peers may face intense stigma  from family, extended kin, and landlords where they rent (bringing problems in obtaining satisfactory and safe housing). Living in a stigma charged environment is not peaceful and stable and frequently leads to arguments, labeling, and stressful relations.


  • Purpose – being productive, whether through volunteer work, employment or going to school, provides meaning for every person, especially those who are rebuilding a life in recovery.


However, schools, employers and volunteer opportunities are reticent to take on ex-convicts, Mental Health patients, and recovering drug users or alcoholics. The peer is then isolated from meaningful employment, socialization, and the beneficial aspects of feeling productive.


  • Community – an essential aspect of recovery from mental illness and addiction is understanding that others have experienced similar difficulties and struggles. Having non-judgmental support from friends, family members and others in recovery can be just the thing to help an individual gain momentum in recovery.


However, stigma isolates and marginalizes its victims, leading to disenfranchisement and despair in the areas of community integration and contribution. Rather than non-judgmental support, the recovering peer meets with judgment, labeling, and stigma which inhibits momentum in recovery.

Stigma and Epigenetic Expression

As if all this were not enough, the above factors are related to the adverse expression of the epigenetic factor because the surrounding environment is not conducive to trust and healing and is in fact detrimental. This in turn negatively impacts the overall health and wellbeing of the recovering peer at the most vulnerable time when he or she is needing help and support.