Breaking+the+'drug+user'+mold

Name: Elim Cheng Student Number: n8795231 Tutor: Michelle Newcomb **ARTEFACT ** This artefact I have chosen is a cartoon done by Esteban Diaz, depicting the improper ideology on drug users who are often associated to fit specific societal groups. The story behind this cartoon was to represent a law change in Florida, MI, which enforced mandatory drug testing for those seeking welfare payments. Not surprisingly, there was public outcry opposing this legislation - it was passed under the assumption that it would save money and identify drug users. Failing to do both, there was great scrutiny into the socioeconomic discrimination that welfare recipients were linked with 'predominantly' using drugs as opposed to others in the community.

Although statistics provide information on the demography of illicit drug users, there continues to be a stigma attached to people associated with illicit drugs. The public health issue lies in a ‘drug user stigma’, formed through multifaceted social constructs involving prejudice, stereotypes and discrimination (Latkin, Davey-Rothwell, Yang, & Crawford, 2012). Drug user-related stigma appears so widespread and deeply ingrained in our communities that challenging may seem futile. However, while there is growing awareness of this issue, there has been little research on the effects of stigmatisation (AIVL, 2012).
 * PUBLIC HEALTH ISSUES **

In this paper I will focus on public attitudes and behaviours towards illicit drug users and review past and current research into the effect of stigma with drug use. Firstly, I will highlight Australian statistics and subpopulation groups associated with illicit drug use. Then I will briefly address the methodologies used to discover more about stigma in society and limitations in research.
 * LITERATURE **** REVIEW **

The 2010 National Drug Strategy Household Survey (NDSHS) provides extensive information on the social characteristics, perceptions and attitudes on illicit drugs. Throughout the report, it was found that a high proportion of illicit drug users include those who were unemployed (24.9%), had never been married (24.4%), identified as being Aboriginal or Torres Strait Islander (25.0%), and were homosexual/bisexual (35.7%). In addition, the most likely age groups who have used illicit drugs in the last 12 months were 20 - 29 year olds and 18 - 19 year olds. Likewise, the highest illicit drug use among people was males and females aged 20-29 (AIHW, 2010). Knowing statistics is only part of the picture; as there is underlying issue of drug use stigma towards these people (Oliveria, Fernandes Martins, Richet & Mota Ronzani, 2012).

Stigmatisation has always been a part of society, a process in which individuals are ‘labelled’ according to their differences. In relation to drug users, examples of labelling include terms such as ‘junkie’, ‘druggo’, ‘scum’ etc., as seen in the ‘Stigma’ illustration. These ‘labels’ carry the same weight as any racial or sexual orientation slurs, manifesting as discrimination and social exclusion. Stigma involves two psychological components: recognising the difference between individuals based on distinguishable characteristics or marks and in doing so, the devaluation of the individual with the characteristic (Oliveria et al., 2012). Moreover, Link and Phelan (2006) present that stigma is generated from five interrelated components:
 * 1) People identifying and labelling human differences
 * 2) Process of stereotyping in which labelled person/s are linked to undesirable characteristics
 * 3) Group who is labelling separates from the stigmatised group
 * 4) Stigmatised people experience discrimination and loss of status
 * 5) The exercising of power

Although we can breakdown what stigma entails, there is little research on how drug use stigma and discrimination can negatively affect individuals psychologically and physically (AIVL, 2012). Much of current research shares a common notion that drug user stigma effects the treatment and quality of healthcare and is a critical issue needing to be addressed. Evidence suggests that drug use stigma is associated with reduced and inequality in health care (AIVL, 2012; Oliveria et al., 2012). On the other hand, a UK study found that almost two-thirds of employers would not employ former heroin or crack users, regardless of their eligibility for the job and employment ceased when history of drug use was discovered (UK Drug Policy Commission, 2010). These are factors highlight the mistreatment and disparity in opportunity for stigmatised drug users, both ex and current.

A recent study by AIVL (2012) found that people reported to ‘happily’ discriminate against people who inject drugs. Although this finding is quite shocking, the majority of the people involved with this study admitted to not knowing any drug-users who inject. Several other studies confirm high levels of social disapproval and stigmatisation in public attitudes towards drug users (Luoma, Twohig & Waltz, 2005; Ross & Darke, 1992). Social exclusion leads to lack of social support, resulting in isolation and rejection of drug users. This causes drug users to find support elsewhere, usually through affiliation with active drug users. It becomes apparent that the challenge of removing oneself from this lifestyle is difficult and chances of relapse increased (Latkin et al., 2012). In addition, Oliveria et al. (2012) found that continued use of illicit substances and drug use stigma is linked to depression. Latkin et al. (2012) describes stigma as a ‘double edged sword’; with one side as a means of social control for licit and illicit drug use and the other side representing the repercussions of stigma such as discrimination, negative mental and physical health, lack of social support and depression.

Several limitations in the studies examined should be noted. Latkin et al. (2012) indicated that their study sample was not randomly selected, rather participants were selected in neighbourhoods with high level of drug use and had to fit HIV risk behaviours. Therefore, future research should involve randomised samples and study non-injecting and injecting users. AIVL (2012) explained the truth that there is little research into drug user-related stigma, in particular with drug-users undertaking their own research. Thus, future studies should be taken by people with experience on this issue, rather than perspectives from non-drug users. Furthermore, Oliveria et al. (2012) argues that lack of research in effective stigma reduction strategies, as they are currently underdeveloped.

'Anti-Stigma Week'
 * CULTURAL AND SOCIAL ANALYSIS **

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To breakdown stigma and discrimination, AIVL (2012) elaborates that: **STIGMA (the thought)** = “the collective sanctioning of a group as ‘other’, or separated from the ‘norm’, an acknowledgement of social rejection” **DISCRIMINATION (the action or outcome)** = “the physical and mental, visible or tangible response to stigma resulting in stereotyping, prejudice and social exclusion” In the video, the woman (interviewed around 1:36-1:41) stated, "The street people have been given a bad rap, so people should talk to them and get to them...and please don't stereotype them". Although she explained to not stereotype the 'street people', there were elements in her statement which could be easily misinterpreted (whether this be editing done by the news report). The assumption that 'street people' were associated with drug use in the town, which may be the case, could be seen as a stereotype, given the fact not all drug users are people who reside on the streets.

Moving on, the modern theories of stigma began with work of Goffman in the 1950s and 1960s:

The way Goffman describes stigma as being 'disgrace' and 'social disqualification' supports the concept that drug users are ostracised without regard to fundamental morals and human values. The long-term nature of stigma contributes to low self-esteem and prevents belief in recovery among drug users (UKDPC, 2010). The reality is, stigma is not static and continues changing with social beliefs and practices, economies and values

Does stigma change in accordance to an individual's drug habit? Take a drug addict compared with a first-time user. Who is more or less stigmatised, or are they equal? In Australia, 79.0% of people who tried an illicit drug for the first time stated their actions were based upon curiosity (AIHW, 2010). In addition, is the level of discrimination linked with drug use determined on the amount of drug-related harm inflicted on oneself? Also, considering the variety of illicit substances, is there an idea that "harder" drugs (e.g cocaine, heroin, meth etc.) carry greater stigmatisation than other drugs? (e.g alcohol and marijuana). It was found in the NDSHS that Australians above 14 years of age considered heroin as the drug most associated with a drug problem, followed by significant increases in people nominating cocaine and other hallucinogens.

In regards to groups affected, AIVL (2012) identified stereotypical drug users are considered as:
 * unemployed and unemployable and therefore not taxpayers
 * a drain on the public purse through use of drug treatments, needle and syringe programs, and so on
 * criminals—and consequently a cost to the community and the legal system
 * inflictors of harm on themselves through overdose, physical damage and disease
 * the cause of fear and hypervigilance as a result of the threat they pose from violence and contagion
 * from blood-borne viruses and potential needlestick injuries
 * not ‘innocent victims’ of their behaviour.

Public awareness and understanding of stigmatisation is crucial to building equality in health care and opportunities for people who are and have been involved with illicit drugs. WHO (2007) established that in building a global movement in health equity - it means to go beyond contemporary concentration on immediate causes of diseases, focusing on the 'causes of the causes'. Whether this be health professionals, government or anti-drug organisations, all support networks should focus on the underlying causes of individual drug use behaviours and attitudes. The assumption that people never recover from drug depence must be broken (UKDPC, 2010). Throughout this process there is emphasis on empowering an individual's recovery for transition back into society.

** ANALYSIS OF THE ARTEFACT AND PERSONAL LEARNING REFLECTION **
Looking back on the artefact I have chosen, I believe it illustrates that labelling and drug use-related stigma can be so overlooked, yet continues to be damaging and detrimental. Regardless of what statistics may say, we must not be in the position to determine who a ‘typical’ drug user is and what societal mold they fit into.

In breaking these molds, I believe that the only way stigma can be somewhat controlled is through partnership between the government and the media. This would entail a universal approach to switch the focus from targeting drug users and their practices, to identifying their behaviours and empowering them for change. With respect for the individuals’ freewill for change, I would consider coming from a healthcare perspective rather than a legalistic one.

This assignment has also shed light on the importance of healthcare equality, where both illicit drug and non-drug users receive the highest level of care. Particularly in relation to my desired profession as a paramedic; I feel I have renewed my understanding to not judge patients involved with illicit drug use.



**REFERENCES **
Australian Injecting and Illicit Drug Users League. (2011). "Why wouldn't I discriminate against all of them?" - A report on Stigma and Discrimination towards the Injecting Drug User Community. Retrieved 30 of October, 2013, from []

Australian Institute of Health and Welfare. (2010). 2010 National Drug Strategy Household Survey report. Retrieved 14 September, 2013, from []

Castro de Oliveira, M., Fernandes Martins, L., Richter, K., & Mota Ronzani, T. (2012). Evaluation of an intervention to reduce health professional stigma toward drug users: A pilot study. Journal of Nursing Education and PRactice, 3(5), 138-146. Retrieved from []

Latkin, C., Davey-Rothwell, M., Yang, J., & Crawford, N. (2013). The Relationship between Drug User Stigma and Depression among Inner-City Drug Users in Baltimore, MD. Journal of Urban Health, 90(1), 147-156. Retrieved 22 of October, 2013, from []

Luoma, J. B., Twohig, M. P., Waltz, T., Hayes, S. C., Roget, N., Padilla, M., & Fisher, G. (2007). An investigation of stigma in individuals receiving treatment for substance abuse. Addictive Behaviors, 32(7), 1331-1346. doi:10.1016/j.addbeh.2006.09.008

Link, B., & Phelan, J. (2006). Stigma and its public health implications. The Lancet, 367(9509), 528-529. Retrieved 29 of October, 2013, from [|http://www.sciencedirect.com.ezp01.library.qut.edu.au/science/article/pii/S0140673606681841#]

Palamar, J., Halkitis, P., & Kiang, M. (2013). Perceived public stigma and stigmatization in explaining lifetime illicit drug use among emerging adults. Addiction Research and Theory, 21(6), 516-525. doi:10.3109/16066359.2012.762508

Ross, M. W., & Darke, S. (1992). Mad, bad and dangerous to know: Dimensions and measurement of attitudes toward injecting drug users. Drug and Alcohol Dependence, 30(1), 71-74. doi:10.1016/0376-8716(92)90038-E

United Kingdom Drug Policy Commission. (2010). Getting Serious about Stigma: the problem with stigmatising drug users. Retrieved 16 of October, 2013, from []

World Health Organisation (2007). //The social determinants of health: Developing an evidence base for political action//. Retrieved 28 of October, 2013, from http://www.who.int/social_determinants/resources/mekn_final_report_102007.pdf

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