Providers Accept the Challenge of Combating Stigma

Clinicians who treat patients with addiction and mental health diagnoses become accustomed to celebrating successes while lamenting the journeys that don’t end well. In all of healthcare, that comes with the territory. Those professionals who take a broader view of their mission, advocating greater change within the industry, encounter a barrier that can make any victories difficult to come by: stigma toward patients with behavioral health challenges.

Those who fight for dignified care for the marginalized often find themselves colliding with indifferent lawmakers, policy-makers committed to the status quo, and a public that seems unwilling to face the reality of need right before its eyes. Success in educating communities about the importance of access to high-quality substance use and mental health care usually happens in small increments.

In his final action as director of the Office of National Drug Control Policy (ONDCP) in the Obama administration, Michael Botticelli shared with the heads of executive branch agencies a document titled Changing the Language of Addiction. Botticelli, the first national drug czar with a known personal recovery history, was widely credited with advancing a public health approach to addiction in his time coordinating the national anti-drug effort. His last act as ONDCP director produced a document suggesting use of alternative terminology to the typical language of treatment and recovery.

Botticelli’s vision was to replace common but stigmatizing references such as “denial” and “relapse” with alternatives such as “ambivalence” and “recurrence.” He said in a 2017 interview with Addiction Professional, “In every talk I gave as director, I encouraged people to think about different language. But if we expected other people to change their language, we at the federal level had to do the same thing.”

While there has been progress across the industry in advancing language that reflects the disease concept of addiction, stigmatizing references remain part of the industry’s everyday vocabulary. Even the names of the main federal agencies that fund addiction research and services, such as the National Institute on Drug Abuse and the Substance Abuse and Mental Health Services Administration, appear set in stone — it would take an act of Congress to alter them.

In the extreme, as Botticelli remarked in the Addiction Professional interview after departing ONDCP, “I can’t think of another disease where we would identify the results of tests as ‘dirty’ or ‘clean.’”

Tennessee’s state behavioral health agency defines stigma as presenting in three forms:

• Public, where belief in stereotypes about people with behavioral health challenges can influence everything from the quality of a health visit to a person’s job prospects;

• Systemic, where the same stereotypes result in reduced access to resources and care on a broader scale; and

• Self, where individuals come to internalize others’ stereotypes, often resulting in feelings of hopelessness that discourage them from seeking help at all.

“Addressing the influence of stigma and working to reduce it is vitally important in addressing the behavioral health needs of our state,” Tennessee department officials wrote in a post on the state government website. “Stigma serves as a barrier to treatment, keeping  a person in a potentially life-threatening situation.”

At the state and local level, treatment providers consistently battle stigma as they seek to offer more humane services to individuals in need. Even in a state such as Rhode Island, where forward-thinking policy leaders have established regulations for what is expected to be the country’s first state-sanctioned overdose prevention center (where individuals can use drugs in a safe environment without fear of punishment while also receiving medical and social support), one of the planned facility’s partners says stigma continues to run deep and affect patients, providers and communities.

CODAC Behavioral Healthcare CEO Linda Hurley hopes the overdose prevention center will become an environment where patients see their autonomy protected and where providers become trusted partners. Other initiatives at CODAC, such as its planned establishment of a fleet of mobile methadone treatment units to serve the entire state, are designed to improve access to what has historically been an evidence-based but highly stigmatized treatment for opioid use disorder.

We at Sigmund Software see our partnerships with providers as another step toward destigmatizing substance use and mental health care. Our tools for coordinated care and real-time evaluation will help allow patients to experience the same level of quality and dignity in behavioral health that they have come to expect from other health specialties.

And for the providers who serve these patients, making the work experience more efficient and data-informed can give them the time to look beyond the everyday and to join the effort to eradicate stigma, a priority that must continue.