The Persistent Stigma of Substance Use Disorders

“Stigma is a five dollar word for a two dollar concept. It’s prejudice.”

Stigma, a set of negative stereotypes tied to behavioral health conditions, is not a new problem. Results of a recent survey suggest that views may be changing when it comes to mental illness. Advocacy efforts are getting results, and the public is beginning to recognize that mental illness is, in fact, a health condition.

We need a similar evolution to start when it comes to substance use disorders. Public perception of what it means to be addicted hasn’t shifted significantly. This is a problem.

In a study of Americans conducted by Johns Hopkins University, only 22% of people surveyed were willing to work closely with someone suffering from drug addiction, yet 62% were willing to work closely with someone suffering from mental illness.

Every person struggling to manage a substance use disorder, and every family stigmatized while supporting a loved one, are part of this broader landscape. Our current culture of stigma creates resistance to funding prevention and treatment. Belief that persons with substance use disorders are immoral, not ill, reduces support for behavioral health-centered policy.

Funding for treatment of substance use disorders isn’t commensurate with the scope of the problem. If substance use were recognized by the public as a health issue, it’s likely that prevention would be a higher priority.

We must help each other, and our communities, reshape the distorted image of substance use disorder as criminal and deviant. A person with a substance use disorder remains a person first. Examples of person-first language for substance use are included in this chart shared by Michael Botticelli, Director of Office of National Drug Control Policy. Note: Mr. Botticelli is himself a person in long-term recovery.

Language for addiction

Of course, stigma-free language is only one step and changing a stereotype takes time. We should see this as part of the process of removing structural roadblocks to health. As we break the persistent stigma that clings to substance use disorders, we’ll turn the focus instead to very real opportunities that exist for health and recovery.

Education and Training Versus Experiential Learning

Having recently spent the weekend co-facilitating a leadership programme and then attending a job interview for a part-time communications position at a high-profile charitable organisation, I find myself reflecting on how much I do and have done that I haven’t actually been educated or trained to do.

I began learning to facilitate about twenty to 25 years ago, using my counselling training — communicating through questioning and reflective listening one on one — and applying it to a group situation. The process maps almost seamlessly — all that changes is the content, from an emphasis on personal issues and feelings to social issues and opinions (though feelings also often feature predominantly as well).

1176923_50609724When deciding to apply for the communications role I realised that, though not specifically, communications has featured in just about every role I’ve undertaken to date, but I’ve never trained in media or communications. From managing publications for the Human Rights Commission in the mid-90s, to promoting myself as a comedian, to writing and managing several blogs and websites for Diversity New Zealand and Diversityworks Trust, I’ve done it all, from traditional media releases to social media and networking.

The only other formal education and training I’ve  engaged in was school in the 70s and 80s, followed by two years of social work training in the early 90s.

Of course being self-employed builds the muscle for self-directed learning — anyone who has run a small business, particularly one that’s service-related, knows that you say, “Yeah, I can do that,” first and work out how to do it later.

Furthermore, particularly in the last decade or so of the internet’s existence, there’s probably not a single professional skill or attribute that hasn’t been blogged, tweeted, Facebooked or YouTubed about — and the twenty or thirty different ways of doing it.

Which brings me to the point I want to make. Formal education and training often focuses on only one or two “right” knowledge and ways of doing things, whereas experiential learning clearly highlights there is no single “right” information or way to do anything.

I’m not advocating against formal education and training — my schooling, counselling and social work training have served me well, not to mention various generic leadership and professional development programmes I’ve done over the years.

But in a world that is requiring people to hold far more breadth than depth of knowledge and competence, it’s useful to take stock of those secondary skills you pick up along the way in employment. They may pave the way to fascinating new careers, without the cost and time needed to formally retrain.

Tell Your Story or Someone Else Will: Child Welfare’s PR Problem

Ones’ opinion regarding the field of child welfare is largely influenced by what they have read or viewed in the media. Less often, it is influenced by their interactions or experiences with ‘the system’.  In either case, it is generally the testimony of the more vocal dissatisfied observer that draws attention. In child welfare, case workers are often perceived as child-snatchers or uncaring public employees whose inexcusable failures result in child injuries or deaths. Foster parents are often accused of ‘being in it for the money’. Administrators may be characterized as over-paid paper shufflers who rarely do any ‘real’ work, and advocates are perceived as whiners who want more money to fund this dysfunctional system. This is not far off from the general impression one gets from reading news reports about child welfare.

This was the advice of a marketing professional during a chat on Twitter: tell your story or someone else will. So who is telling the child welfare story and what story are they telling? Using the key words ‘child welfare’ and ‘foster care’, a search of Google News yielded the following stories:storybook

Former Foster Kids Protest RI Funding Cuts

Cases Highlight What Many Consider a Broken Child Welfare System

Arizona CPS’ struggles mount as abuse, neglect reports rise

Minnesota’s child-protection system is inconsistent and underfunded

Oregon’s $40 million child welfare computer upgrade has glitches, some serious

Now, Russians protest against Norway’s child services

Death of Dominic James led to changes in foster-care system

These are just a few of the thousands of suggested pages. They were all in the top 15 matches.  What I did not find were stories about successful reunifications, adoptions, guardianships. I’m sure that if I had worked my way through pages of links using my search words, I would have found some. I know they exist. I follow several incredible foster and adoptive parents on Twitter who are living proof that they exist. And I have been fortunate to have worked with hundreds of dedicated foster and adoptive parents as well as committed, hard-working case workers, administrators, and advocates over the years. So why do their stories not show up on the first pages of an Google search?

I believe it is because child welfare, as a field, has been content to let other people tell their story. There are many reasons for doing so, including what is probably at the top of the list: confidentiality.  Yes, there are laws and restrictions regarding making public information about children and families involved in the child welfare system. However, there are ways to address this issue. Obtaining releases of information, de-identifying information, redacting or ‘sanitizing’ reports, or changing minor details to protect the confidentiality of individuals or families are possible solutions. These are all approaches that have been used when the press covers a story that includes sensitive information. They are used by the health profession in conducting medical research and in dozens of other fields dealing with sensitive issues. So why is it that the field of child welfare does not employ these strategies more often?

I suspect that the second reason or excuse is time and/or resources. People who work in this field generally are overworked, underpaid, and their programs under-resourced.  This usually is not a line-item in child welfare budgets. Maybe it should be. Maybe there should be a concerted effort to improve the image of the field in the media. Other fields have figured this out when addressing anything from environmental issues to employee satisfaction. If one thinks about various professions, it is easy to find good and not-so-good examples.

The railroad industry has successfully improved public perception through advertisements highlighting their essential role in the economy and energy-efficient transportation of valuable resources. At the other end of the spectrum, we all are familiar with the expression ‘going postal’ which describes a public perception that working for the postal service somehow is associated with unpredictable and sometimes violent behaviors. However, many people believe this statement holds some validity, and it pains me to even repeat these sentiments.

The child welfare stories we should be sharing are successful reunifications, adoptions, guardianships. We should be sharing outcomes for children forming attachments when it was thought impossible. What about sharing the success of newly created families with siblings, loyal friends and protectors, or youth finding the guidance needed to prepare for adulthood through college or a career? Should we not help share the stories of adult children who overcome child abuse and neglect with the support and love from their foster parents? Until we make it a priority to tell these stories, the press about Child Welfare will continue to be dominated by stories told by someone else using their lens.

Message in a Bottle…An Epiphany that Probably Won’t Reach Its Intended Recipient

“Message in a Bottle” was not only a romantic Kevin Costner movie, but once upon a time was a hopeful form of communication. Someone would have an epiphany or reflective moment that desperately needed to find its way to the target of their affection. A message in bottle was then thrown into the ocean hoping that fate will stir the bottle to its intended destination. Before telegraphs, telephones, and the internet, message in a bottle was the hope of connecting with someone outside of your reach, but are we still using a “message in a bottle” mentality in a technologically advanced society?

The internet is just as vast as the sea because the possibility of destinations seem limitless. Today, “message in a bottle” has been upgraded to a Tumblr, Facebook Note, Blogger, WordPress Blog or some form of electronic post.

There has been instances of calls for help, cries for support, profound confessions, or enlightened reflections which may or may not be heard depending on the number of followers, friends, or search engine optimization that allow search engines to find you in this vast world wide web. Does the profoundness of the message correlate with its ability to be heard?

Is Honeybooboo’s preferences more profound than someone battling Cancer who is sharing their experiences in hopes of helping someone else because her medium to be heard is bigger?  As a matter of fact, I would argue the less profound it appears, there is wider appeal. As social workers when we exercise the “message in a bottle” mentality, we lessen our ability to help someone else. It requires those in need to find us in a sea of darkness instead of being that Beacon of Light.

What can we do about it? Social Work Helper may not provide the be all solution for everyone, but it is my attempt at navigating the seas by offering a beacon.  As a Google news outlet with rss feeds placed in the top news aggregator mobile apps around the world, anyone can submit an original blog post or republish a blog post from their own blog to Social Work Helper to help expand their readership. How is this helpful to you? When you take your valuable time to share your dreams, triumphs, failures, and experiences that knowledge should reach as many people as possible in order to help advance someone else.

If you are trying to develop your own magazine, than Social Work Helper may not be the right platform for you. However, if you primary goals are increasing your professional profile, increasing awareness on issues, and reaching as many people as possible, than publishing on this vehicle will help expand your reach.

Work with me in creating a platform that  will better support professional or student development and relationships without having to randomly bump into each other on the world wide web.

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