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      Stigma and Self-Stigma in Addiction

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          Abstract

          Addictions are commonly accompanied by a sense of shame or self-stigmatization. Self-stigmatization results from public stigmatization in a process leading to the internalization of the social opprobrium attaching to the negative stereotypes associated with addiction. We offer an account of how this process works in terms of a range of looping effects, and this leads to our main claim that for a significant range of cases public stigma figures in the social construction of addiction. This rests on a social constructivist account in which those affected by public stigmatization internalize its norms. Stigma figures as part-constituent of the dynamic process in which addiction is formed. Our thesis is partly theoretical, partly empirical, as we source our claims about the process of internalization from interviews with people in treatment for substance use problems.

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          Most cited references27

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          An investigation of stigma in individuals receiving treatment for substance abuse.

          This study examined the impact of stigma on patients in substance abuse treatment. Patients (N=197) from fifteen residential and outpatient substance abuse treatment facilities completed a survey focused on their experiences with stigma as well as other measures of drug use and functioning. Participants reported experiencing fairly high levels of enacted, perceived, and self-stigma. Data supported the idea that the current treatment system may actually stigmatize people in recovery in that people with more prior episodes of treatment reported a greater frequency of stigma-related rejection, even after controlling for current functioning and demographic variables. Intravenous drug users, compared to non-IV users, reported more perceived stigma as well as more often using secrecy as a method of coping. Those who were involved with the legal system reported less stigma than those without legal troubles. Higher levels of secrecy coping were associated with a number of indicators of poor functioning as well as recent employment problems. Finally, the patterns of findings supported the idea that perceived stigma, enacted stigma, and self-stigma are conceptually distinct dimensions.
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            Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)

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              Stigma and the ethics of public health: not can we but should we.

              In the closing decades of the 20th century, a broadly shared view took hold that the stigmatization of those who were already vulnerable provided the context within which diseases spread, exacerbating morbidity and mortality by erecting barriers between caregivers and those who were sick and by imposing obstacles upon those who would intervene to contain the spread of illness. In this view, it was the responsibility of public health officials to counteract stigma if they were to fulfill their mission to protect the communal health. Furthermore, because stigma imposed unfair burdens on those who were already at social disadvantage, the process of stigmatization implicated the human right to dignity. Hence, to the instrumental reason for seeking to extirpate stigma, was added a moral concern. But is it true that stigmatization always represents a threat to public health? Are there occasions when the mobilization of stigma may effectively reduce the prevalence of behaviors linked to disease and death? And if so, how ought we to think about the human rights issues that are involved?
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                Author and article information

                Contributors
                stephen.matthews@acu.edu.au
                r.dwyer@curtin.edu.au
                anke.snoek@students.mq.edu.au
                Journal
                J Bioeth Inq
                J Bioeth Inq
                Journal of Bioethical Inquiry
                Springer Netherlands (Dordrecht )
                1176-7529
                3 May 2017
                3 May 2017
                2017
                : 14
                : 2
                : 275-286
                Affiliations
                [1 ]ISNI 0000 0001 2194 1270, GRID grid.411958.0, Plunkett Centre for Ethics, Centre for Moral Philosophy and Applied Ethics, , Australian Catholic University (ACU), Institute for Religion and Critical Inquiry (IRCI), ; 7 Ice Street, Darlinghurst, Sydney, NSW 2010 Australia
                [2 ]ISNI 0000 0004 0375 4078, GRID grid.1032.0, Social Studies of Addiction Concepts (SSAC) Research Program, National Drug Research Institute (Melbourne Office), Faculty of Health Sciences, , Curtin University, ; Bentley, Australia
                [3 ]ISNI 0000 0001 0396 9544, GRID grid.1019.9, Centre for Cultural Diversity and Wellbeing, College of Arts, , Victoria University, ; Melbourne, Australia
                [4 ]ISNI 0000 0001 0481 6099, GRID grid.5012.6, Faculty of Health, Medicine and Life Sciences, , Maastricht University, ; Peter Debyeplein 1, 6229 HA Maastricht, The Netherlands
                Author information
                http://orcid.org/0000-0001-7269-9947
                Article
                9784
                10.1007/s11673-017-9784-y
                5527047
                28470503
                1ffc734d-6012-4eb4-b0ca-29819802fc35
                © The Author(s) 2017

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 16 August 2015
                : 25 November 2016
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000923, Australian Research Council (AU);
                Award ID: DP1094144
                Award Recipient :
                Funded by: Laurdel Foundation
                Categories
                Original Research
                Custom metadata
                © Journal of Bioethical Inquiry Pty Ltd. 2017

                Ethics
                addiction,self-stigmatization,shame,stereotype,stigma
                Ethics
                addiction, self-stigmatization, shame, stereotype, stigma

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