Perspective: Stigma of addiction can sabotage treatment

Perspective: Stigma of addiction can sabotage treatment

The stigma surrounding drug addiction may sabotage effective treatment, a new piece in the New England Journal of Medicine says.

According to a perspective piece by Dr. Nora Volkow, director of the National Institute on Drug Abuse, addiction leads to behavioral changes that defy societal norms, which makes compassion for the drug addict more difficult, even for family members trying to help.

In her piece, “Stigma and the Toll of Addiction,” Volkow looks at decades of research that demonstrates how drug use alters brain circuitry involved in self-regulation and reward processing. Over time, she said, these changes overtake the drug addict’s ability to stop taking drugs, leading to irrational drug seeking. Yet, she said, these same behaviors reinforce incorrect assumptions by those around the drug addict that the drug user can stop using drugs through willpower and personal responsibility.

“Tacit beliefs or assumptions about personal responsibility — and the false belief that willpower should be sufficient to stop drug use — are never entirely absent from most people’s thoughts when they interact with someone with a drug problem,” Volkow wrote. “Health care professionals are not immune to these assumptions. Indeed, they may hold stigmatizing views of people with addictions that may even lead them to withhold care.”

Volkow said the stigma is often internalized by the patient, which creates a sense of isolation, which can further encourage drug taking. Study show, she said, that there is a strong overlap between the neurological underpinnings of drug rewards and social rewards.

Research at NIDA has shown that while rats will repeatedly choose social interaction over self-administration of heroin or methamphetamine when social reinforcers were penalized, the rats would relapse into drug taking. Volkow says if stigma reduces “social connectedness and promotes discrimination towards the person who is addicted, then it will contribute to perpetuating drug taking and interfere with treatment.”

Volkow suggested health care professionals promote the idea of addiction as “a chronic relapsing and treatable brain disease.” In addition, she pointed out that common sense should show those who work with drug addicts that compassion and access to care are more effective than stigmatizing and isolating patients for something they can no longer control.