The Effect of Stigma on Health
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. Here is what SAMHSA says:
Health – overall wellbeing begins with addressing symptoms of addiction that complicate physical and emotional health. Abstinence from alcohol, non-prescribed medications and illicit drug use is recommended so that any psychiatric disorders can be addressed and treated. This leads to more informed and healthier choices that will sustain ongoing recovery.
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.
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.
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.
Furthermore, stigma negatively impacts the remaining three broad areas outlined in SAMHSA’s Strategic Initiative:
- 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.
It is for reasons like these that peers have found residential and day-treatment centers helpful until they can get back on their feet and into a stronger position of self-advocacy.
In lieu of such affordances, moving out of the old community and taking shelter with an understanding elder or relative has proven well worth the efforts involved in temporary relocation.
If stigma has been an on-going issue for the greater part of a peer’s life, special therapy should be sought to counteract the negative conditioning associated with long term exposure to social family, and community stigma. As the internal meta-programming will need to be released in order for the peer to pursue success in a total and holistic program of health and wellbeing, which is after all, the long-term goal of all recovery.
All of the 10 Guiding Principles are adversely affected by stigmatization, in one way or another. Guiding Principle number 10 addresses this directly (‘Recovery is based on Respect’). Here is the expanded version which accompanies GP #10:
Community, systems, and societal acceptance and appreciation for people affected by mental health and substance use challenges –including protecting their rights and eliminating discrimination- are crucial in achieving recovery. There is a need to acknowledge that taking steps towards recovery may require great courage. Self-acceptance, developing a positive and meaningful sense of identity, and regaining belief in one’s self are particularly important.
Additionally, guiding principle # 8 addresses the need to seek counter programming for stigma on the same basis as for trauma-based therapies:
The experience of trauma (such as physical or sexual abuse, domestic violence, war, disaster, and others) is often a precursor to or associated with substance use, mental health challenges and related issues. Services and supports should be trauma informed to foster safety (physical and emotional) and trust, as well as promote choice, empowerment, and collaboration.