'The+Junkie'+Moral+panic,+stigma+and+the+road+to+recovery

=Leah Higl (n8851816)= ==



= Cultural artefact =

The artefact I have chosen to represent my public health issue is a collation of media headlines from the single year of 2008. These headlines all have two things in common that when displayed collectively represents a major issue that plagues public health. The first similarity of these news headlines is that individually, each relates to an individual problem drug user or ‘addict’. The second similarity which lies underneath the context of drug use is the rhetoric employed to conjure a negative emotion within the reader aimed at problem drug users.



=__The public health issue__=

There has been a substantial lack of successful rehabilitation programs and services for current problem drug users due to a full-fledged moral panic surrounding the issue along with its created stigma. The question is not whether illicit drug abuse is a real public health issue but whether the responses put in place to approach it are being received positively and effectively by problem drug users. Nevertheless, correlations have been drawn between moral panic, stigma associated with the perceived threat and ineffective drug policy and programs along with their underlying lack of positive receptivity within a social and professional context.



__ **Literature review** __

Since moral panic surrounding problem drug users (PDUs) peaked in the mid to late nineties, the stigmatisation and resulting marginalisation of these ‘deviants’ has impeded both policy within public health as well as individual recovery of PDUs. Those who deviate from ‘social norms’ in a commonly undesirable way are generally marginalised within society. Which in terms of drug use, can exasperate deviance. With this being said current literature supports the notion of normalised social theory and its relation to moral panic and stigmatisation resulting in the marginalisation of the transgressive other and the way in which it impedes public health’s approach to illicit drug use.

Stigma is a long lasting social disgrace of an individual or group and it has an often detrimental effect on the stigmatised. Studies have shown that stigma surrounding problematic drug users (PDUs) is common among the general public and has confrontational and hostile effects on the drug users (Lloyd, 2013). This stigma is a reflection of wider public fears of drugs as well waves of public concern in the form of moral panics, often based on individuals and small groups (Kurzban & Leary, 2001). The impact of this extreme stigmatisation results in both barriers to recovery for individuals as well as distorted ideologies supporting associated public policy and services. Furthermore, studies have confirmed not only the prevalence and negative effect of this social stigma but attributed its presence to widespread perceived threat and blame (Lloyd, 2013).

Numerous general population surveys and studies around the world have outlined the attitudes towards PDUs. Surveys undertaken in the US and UK found that blame in most often attached to PDUs despite under a medical paradigm addiction is classified as a ‘disease’ rather than the result of deviant mentality (Crisp et al., 2005; Room, Rehm, Trotter, Paglia & Ustun., 2001). These particular studies also confirmed a greater level of stigmatisation and decreased level of empathy for those with addiction to those suffering of mental illness despite medical similarities. Nevertheless, social issues associated with blame makes it difficult for the general public to empathise with such individuals (Corrigen et a’, 2009).

An interesting study by Martin et al.’s (2006), focused on the recognition of facial expressions. They define six universal facial expressions depicting emotion: happiness, sadness, fear, anger, disgust and surprise. The results of the study were expressed by the samples’ ability to recognise these facial expressions. With a group of 20 current opiate users, 20 abstinent people and a sample of 20 controls the study concluded that whilst those who were current opiate users overall had a slower recognition time they were significantly more likely to recognise the facial expression of disgust. The author of this study concluded that possible sensitisation to this facial expression through repeated exposure may have been the reasoning behind the study’s results. However, due to such a small sample size no conclusive evidence is available to support this notion. Despite this, it is clear that stigmatisation has a strenuous effect on drug users and their self-concept.

Stigma associated with drug use is not only relevant to the general public but recently has drawn parallels with those practicing as health professionals. Research from Australia and the USA has distinctly shown both limited coverage of addiction-related subjects within medical school and courses as well as an overall negative perception of drug users among primary care health workers (Miller et al, 2001). Also, within general health care settings, reports from the United Kingdom and Australia discussed the work of nurses in public hospitals and their relation and encounters with drug users. Furthermore, the research concluded that whilst attending to a patient that was a drug user, their care was impeded by interwoven prejudice and stigma relating to drug use. This same research paper also drew upon the stigma experienced by PDUs within health care settings, both primary and emergency, due to the common perception of their lifestyle and the nature of their ‘self-inflicted’ problems. However, in drawing conclusions it is important to note that overall PDUs experiences within the health care system were not universally negative and users reported both positive and negative examples of treatment (Peckover and Childaw, 2007). In saying this, the reports of treatment in which the user experienced stigmatisation rather reflects lack of training of health care professionals to treat those who are marginalised and stigmatised by the general population. Moreover, it is also unsurprising that the stigmatisation within a health care setting of PDUs seems to stem from the minority of drug users which act in a manner that demonstrates aggressive and manipulative behaviour.

Lloyd (2013), brought light on the issue for whether or not this stigmatising response among health professional was causing reluctance of problematic drug users to seek help within these professional outlets by stating, “….This seems likely given the views expressed by PDUs in these research projects, however it is hard to show conclusively. However, perceived stigma on the part of the clinical staff may also prevent PDUs from revealing their drug use, which may put them at risk.”

In contrast, whilst perception of prejudice may impede individuals seeking help with their addiction through health professionals the social stigmatisation discussed previously has been shown to encumber problem drug users from seeking and maintaining treatment within available services. Radcliffe and Stevens (2008), interviewed 53 PDUs who had dropped out of English treatment services and conclusively described their samples attitudes towards these services. According to the research paper majority of the interviewees were seeking conventional goals and lifestyles through the treatment, however, found them-selves labelled as junkies among other prejudices associated with their current lifestyle and therefore led to their discontinued treatment. Nevertheless, this suggests that within this particular approach to illicit drug use there is an underlying narrative placing drug users in the role of a deviant; stigmatising and marginalising the user, which presents the issue of lack of access to appropriate and effective abstinence based care. Conclusively, stigma associated with treatment is a major impediment to the receptivity needed by communities to successfully reintegrate PDUs into society.



=__Cultural and social analysis__=

Widespread moral panic around illicit drug use arose in the mid to late nineties in response to the high number of heroin over-doses within that time period. Although majority of this panic was generated by groups not normally associated with outbreaks of moral panic, it was no less, a moral panic (Zajdow, 2008). Nonetheless, generally speaking a moral panic is usually instigated through a right wing moral crusade by the media and associated public, however in this case the panic was created by political progressives in the field of drug use, victims of addiction and their families in an effort to ‘help’ PDUs. Though their efforts were intended to make a positive change to the lives of PDU’s, the social stigma surrounding their lifestyle was exasperated (Zajdow, 2008).

Furthermore, social theory explains that even though under a medical paradigm addiction is a clinically labelled a disease, under a social paradigm drug use is not tolerated (Kurzban & Leary, 2001). The normalisation of an action is outlined and defined by currently accepted social structure. Nonetheless, social structures are underlying socially constructed frameworks that are used to interpret social phenomena and are based on a particular way of thinking. Those who do not ‘fit’ within the resulting social structure are consequently viewed as a social/moral deviant (Cohen, 1972). According to social psychologists, members of the public are stigmatised when their deviance is associated with a devalued social status or behaviour (Kurzban & Leary, 2001). Stigmatisation can involve prejudiced attitudes, stereotypes and discrimination (Cohen, 1972).

The more one falls victim to stigmatisation the worse their psychological well-being becomes. Mental health and well-being is a major concerning point of ones-self when attempting to deal with the complex issue of addiction, especially due to a psychological and/or emotional dependency. The further degradation of a PDUs mental health is undesirable and adversely affects their success in treatment. Nonetheless, may even increase their dependency or want/need to be intoxicated with illicit narcotics (Kurzban & Leary, 2001).

However, not all drug addicts experiencing stigmatisation are affected to the same extent. Socioeconomic status largely effects how stigmatisation and discrimination affects individuals. Moreover, those with a higher socioeconomic status have more personal resources, social capital and attributes that can be drawn upon to help cope with the stressors associated with stigmatisation and also to foster resilience (Hing, 2010). On the other hand, evidence suggests that negative effects of stigmatisation have a greater and more damaging effect on those of low socioeconomic status, including having a low education level and lower income. This is due to those of low socioeconomic status lacking in personal and social resources that ‘buffer’ out the effect on being ostracised and discriminated against. Also, those with higher socioeconomic status have been shown to have more control and flexibility in how they respond to their attached stigma as well as more psychological resources such as a higher self-esteem (Hing, 2012).

In terms of facilitating rehabilitation for current PDUs and to increase positive receptivity of existing outlets, it would be extremely beneficial for public health experts to combat the stigma that drug users encounter on a day to day basis. The stigma displayed by both the public and health professionals is a large barrier to the recovery of problem drug users despite rehabilitative centers and programs being in place to provide support. Therefore, in order for drug programs to be successful this prejudice must be eliminated or the pressure associated with it alleviated from those seeking help, which a defined focus on those of low socioeconomic status which are affected by social stigma to a greater extent.

=__Analysis of artefact and reflection__=


 * //Panic, horror, fear and threat scream headlines //**<span style="font-family: Arial,sans-serif; font-size: 12pt;">. The collation of these media headlines from 2008 are a visual embodiment of the moral panic and stigma surrounding problem drug users. “Addict attacks, threatens, murders”. The media cunningly plays on the existing fear displayed by the public associated with drug addicts and the ‘threat’ they pose to society by taking an incident of one individual and regurgitating it with rhetoric, bias and manipulation. Why? It is all too obvious. More scandal, more fear, more sales. However, the agenda of the media would not be able to spark such horror without playing on existing panic and stigma underlying the centre of their articles, the moral and social deviant. However, personally I believe that only the ignorant could see past the fact that stigma and prejudice is a day to day aspect of lives of drug addicts but what I and possibly many hadn’t realised is its very real effect on these individuals. This moral panic and associated stigma not only damages their self-concept but their ability to become abstinent and to seek and maintain treatment within professional health contexts.

=References=

<span style="font-family: Arial,sans-serif; font-size: 12pt;">[|Cohen, S.] (1972). //Folk Devils and Moral Panics: The Creation of the Mods and Rockers//. London : MacGibbon & Kee

<span style="font-family: Arial,sans-serif; font-size: 12pt;">[|Corrigan, P]., [|Kuwabara, S].&[|O’Shaughnessy J]. (2009). <span class="nlmarticle-title" style="font-family: Arial,sans-serif; font-size: 12pt;">The public stigma of mental illness and drug addiction: Findings from a stratified random sample <span style="font-family: Arial,sans-serif; font-size: 12pt;">. <span class="citationsource-journal" style="font-family: Arial,sans-serif; font-size: 12pt;">//Journal of Social Work// <span class="apple-converted-space" style="font-family: Arial,sans-serif; font-size: 12pt;">, <span class="nlmfpage" style="font-family: Arial,sans-serif; font-size: 12pt;">139 <span style="font-family: Arial,sans-serif; font-size: 12pt;">– <span class="nlmlpage" style="font-family: Arial,sans-serif; font-size: 12pt;">147.

<span style="font-family: Arial,sans-serif; font-size: 12pt;">[|Crisp A], [|Gelder M], [|Goddard E], [|Meltzer H]. <span class="apple-converted-space" style="font-family: Arial,sans-serif; font-size: 12pt;"> (2005). <span class="nlmarticle-title" style="font-family: Arial,sans-serif; font-size: 12pt;">Stigmatization of people with mental illness: A follow-up study within the changing minds campaign of the royal college of psychiatrists <span style="font-family: Arial,sans-serif; font-size: 12pt;">. <span class="citationsource-journal" style="font-family: Arial,sans-serif; font-size: 12pt;">//World Psychiatry// <span class="apple-converted-space" style="font-family: Arial,sans-serif; font-size: 12pt;">, <span class="nlmfpage" style="font-family: Arial,sans-serif; font-size: 12pt;">106 <span style="font-family: Arial,sans-serif; font-size: 12pt;">– <span class="nlmlpage" style="font-family: Arial,sans-serif; font-size: 12pt;">113.

<span style="font-family: Arial,sans-serif; font-size: 12pt;">Grazyna Zajdow. (2008). Moral panics: The old and the new//. Deviant behaviour, 29(7),// 640-664. Doi: 10.1080/01639620701839476

<span style="font-family: Arial,sans-serif; font-size: 12pt;">Kurzban, R., & Leary, M. R. (2001). Evolutionary origins of stigmatization: The functions of social exclusion. //Psychological Bulletin//, //127//(2), 187-208. doi:10.1037/0033-2909.127.2.187

<span style="font-family: Arial,sans-serif; font-size: 12pt;">Lloyd, C. (2013). The stigmatisation of problem drug users: A narrative literature review. //Drugs: education, prevention and policy, 20(2),// 85-95. doi: 10.3109/09687637.2012.743506

<span style="font-family: Arial,sans-serif; font-size: 12pt;">[|Martin L], [|Clair J], [|Davis P], [|O’Ryan D], [|Hoshi R], [|Curran HV]. <span class="apple-converted-space" style="font-family: Arial,sans-serif; font-size: 12pt;"> (2006). <span class="nlmarticle-title" style="font-family: Arial,sans-serif; font-size: 12pt;">Enhanced recognition of facial expressions of disgust in opiate users receiving maintenance treatment <span style="font-family: Arial,sans-serif; font-size: 12pt;">. <span class="citationsource-journal" style="font-family: Arial,sans-serif; font-size: 12pt;">//Addiction// <span class="apple-converted-space" style="font-family: Arial,sans-serif; font-size: 12pt;">, <span style="font-family: Arial,sans-serif; font-size: 12pt;">//101//, <span class="nlmfpage" style="font-family: Arial,sans-serif; font-size: 12pt;">1598 <span style="font-family: Arial,sans-serif; font-size: 12pt;">– <span class="nlmlpage" style="font-family: Arial,sans-serif; font-size: 12pt;">1605.

<span style="font-family: Arial,sans-serif; font-size: 12pt;">[|Miller NS], [|Sheppard LM], [|Colenda CC], [|Magen J]. (2001). <span class="nlmarticle-title" style="font-family: Arial,sans-serif; font-size: 12pt;">Why physicians are unprepared to treat patients who have alcohol- and drug-related disorders <span style="font-family: Arial,sans-serif; font-size: 12pt;">. <span class="citationsource-journal" style="font-family: Arial,sans-serif; font-size: 12pt;">//Academic Medicine// <span class="apple-converted-space" style="font-family: Arial,sans-serif; font-size: 12pt;">, <span style="font-family: Arial,sans-serif; font-size: 12pt;"> //76//, <span class="nlmfpage" style="font-family: Arial,sans-serif; font-size: 12pt;">410 <span style="font-family: Arial,sans-serif; font-size: 12pt;">– <span class="nlmlpage" style="font-family: Arial,sans-serif; font-size: 12pt;">418.

<span style="font-family: Arial,sans-serif; font-size: 12pt;">[|Peckover S], [|Chidlaw RG]. <span class="apple-converted-space" style="font-family: Arial,sans-serif; font-size: 12pt;"> (2007). <span class="nlmarticle-title" style="font-family: Arial,sans-serif; font-size: 12pt;">Too frightened to care? Accounts by district nurses working with clients who misuse substances <span style="font-family: Arial,sans-serif; font-size: 12pt;">. <span class="citationsource-journal" style="font-family: Arial,sans-serif; font-size: 12pt;">//Health and Social Care in the Community// <span class="apple-converted-space" style="font-family: Arial,sans-serif; font-size: 12pt;">, //15,// <span class="nlmfpage" style="font-family: Arial,sans-serif; font-size: 12pt;">238 <span style="font-family: Arial,sans-serif; font-size: 12pt;">– <span class="nlmlpage" style="font-family: Arial,sans-serif; font-size: 12pt;">245.

<span style="font-family: Arial,sans-serif; font-size: 12pt;">[|Radcliffe P], [|Stevens A]. (2008). <span class="nlmarticle-title" style="font-family: Arial,sans-serif; font-size: 12pt;">Are drug treatment services only for ‘thieving junkie scumbags’? Drug users and the management of stigmatised identities <span style="font-family: Arial,sans-serif; font-size: 12pt;">. <span class="citationsource-journal" style="font-family: Arial,sans-serif; font-size: 12pt;">//Social Science and Medicine// <span class="apple-converted-space" style="font-family: Arial,sans-serif; font-size: 12pt;">, <span style="font-family: Arial,sans-serif; font-size: 12pt;">//67//, <span class="nlmfpage" style="font-family: Arial,sans-serif; font-size: 12pt;">1065 <span style="font-family: Arial,sans-serif; font-size: 12pt;">– <span class="nlmlpage" style="font-family: Arial,sans-serif; font-size: 12pt;">1073

<span style="font-family: Arial,sans-serif; font-size: 12pt;">[|Room R], [|Rehm J], [|Trotter R.T., II], [|Paglia A], [|Üstün TB]. (2001). <span class="nlmarticle-title" style="font-family: Arial,sans-serif; font-size: 12pt;">Cross-cultural views on stigma, valuation, parity and societal values towards disability <span style="font-family: Arial,sans-serif; font-size: 12pt;">. <span class="citationsource-book" style="font-family: Arial,sans-serif; font-size: 12pt;">//Disability and culture: Universalism and diversity// <span style="font-family: Arial,sans-serif; font-size: 12pt;">, //15(1),// <span class="nlmfpage" style="font-family: Arial,sans-serif; font-size: 12pt;">247 <span style="font-family: Arial,sans-serif; font-size: 12pt;">– <span class="nlmlpage" style="font-family: Arial,sans-serif; font-size: 12pt;">291.

<span style="font-family: Arial,sans-serif; font-size: 12pt;">Son Hing, L. (2012). Responses to stigmatisation.//Du Bois Review, 9,// 149-168. doi: 10.1017/S1742058X11000592


 * Reflections**

[]

[]