Stigma in addictions, a barrier to recovery
People with addiction disorders face many challenges, especially adolescents. In most of them, the presence of dual pathology —that is, an addiction plus another mental disorder— is more common than exceptional (Erskine, 2015), which significantly complicates the prognosis. In addition, in addition to the particularities of adolescence, the fact that a mental health disorder at this stage can have long-term repercussions , due to the loss of opportunities that it can mean for the person.
Improving the effectiveness of interventions is essential, but it is not the only challenge we face in the care of addiction disorders. To begin with, access to treatment is a major problem : most people with an addictive disorder do not receive care. It is estimated that, in 2023, only one in twelve people with substance addiction accessed some type of treatment. In the case of women, the figures are even lower: globally, it is estimated that only 5.5% of women with a substance use disorder receive treatment, compared to 13.6% of men with the same disorder (United Nations, 2024). In behavioral addictions, these figures could be even more worrying.
The difficulties in addressing addictions and dual pathology are closely related to the stigma that persists around them. Stigma can prevent people from seeking help, impair mental health, hinder recovery, and act as a barrier to establishing positive relationships.
Adolescents may also be particularly vulnerable to health-related stigma (Earnshaw et al., 2022). According to the World Health Organization (WHO), many adolescents have negative perceptions of health services, as they believe that they do not sufficiently respect privacy and confidentiality, and they fear stigmatization, discrimination, and that professionals will try to impose their moral values on them (WHO, 2023).
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Impact of stigma on access to mental health services
There are several explanations for why stigma influences help-seeking . On the one hand, the general stigma around mental health leads to a lack of knowledge about the disorders and only negative stereotypes are perceived. Thus, some young people do not detect that they may have a problem, as they do not identify with the information appearing in the media.
Stigma can prevent people from seeking help, impair mental health, hinder recovery, and act as a barrier to establishing positive relationships.
On the other hand, adolescence is a vital period of social identity development, and the stigma associated with mental health can threaten this identity and identification with recovery groups (Blyth et al., 2023). Thus, there may be some fear of changing identity, of how one perceives oneself and how one is perceived.
According to a study by Sheikhan et al. (2023), young people, especially those who have been treated at some point in the mental health network, have experienced imposter syndrome or have had the feeling that they must be very bad to be treated and that they have only received care when they were in "a visible crisis". They also describe that some commonly used concepts, such as "treatment resistant", make them feel shame, guilt and a sense of judgment, for not feeling better after treatment. (Sheikhan et al., 2023)
It is also common for young people and their families to have difficulty understanding what is happening to them. On the one hand, the impact of symptoms and diagnosis seems to be underestimated , and they feel that they should be able to control, for example, irritability, apathy, cravings for alcohol or other common symptoms. This makes them feel ignored regarding their emotional discomfort and the need for intervention. At the same time, some young people blame the disorder for some of their own behaviors, a fact that reduces the person's sense of responsibility and change, and is known as self-stigma of controllability.
The factors described complicate the first contact of adolescents with addictions with mental health services, but stigma has other impacts and is associated with (Topkaya et al., 2021):
- Less self-efficacy (belief in one's own abilities to execute the necessary actions to face a situation).
- Less therapeutic adherence.
- Decrease in social support.
- Increased severity of symptoms.
What should we know about stigma?
Family stigmatization and professional prejudices
We also need to talk about family stigmatization , which means an overload, an impoverishment of the social network and an added discredit for these families who are already living very complicated situations with sons and daughters with addictions and, very commonly, with another mental disorder.
In addition, some healthcare professionals perceive people with dual pathology as complex and tend to label them before the first contact. Attitudes towards consumption (low awareness, lack of training and stigma) can lead to rejection of the group and can have indirect effects on the effective management of dual pathology and promote adverse therapeutic outcomes (Calderón, 2021). Some studies describe how the training of healthcare personnel is essential to improve attitudes and clinical practice (Merrick et al., 2022).
Some healthcare professionals perceive people with dual pathology as complex and tend to label them before the first contact, with attitudes that do not favor recovery.
In conclusion, we know that stigma is still very present when we talk about addictions, both what has to do with self-stigma and family stigmatization, and what refers to the prejudices of professionals towards addictions and young people towards health services . This stigma, which challenges all the agents involved in addictions and dual pathology, influences the outcome of the intervention and is one of the main barriers to recovery.
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