05 Mar Internalized Stigma Impacts Behavior of Injection Drug Users
Stigma is a term used to refer to a condescending, negative and/or overtly biased attitude held toward someone just because that person has a certain characteristic or attribute. Current evidence indicates that Americans as a whole have a largely stigmatizing opinion of people who have serious problems with substance abuse/addiction. In a study published in October 2014 in the journal Drug and Alcohol Dependence, researchers from two U.S. universities looked at the damaging impact that internalized or self-directed stigma can have on the practices of people who participate in injection drug use.
Injection Drug Use
All injection drug users introduce drugs or medications into their bodies with the combination of a needle and a syringe. Depending on the individual, injection can be intravenous (directly into one of the body’s veins), intramuscular (directly into muscle tissue) or subcutaneous (into the region just below the skin). As a rule, intravenous (IV) injection occurs more often than subcutaneous or intramuscular injection. An injection drug user can consume any drug or medication that breaks down in water. Prominent examples of injected substances include the opioid drug heroin, the stimulant drugs cocaine and methamphetamine, the opioid medication buprenorphine and sedative-hypnotic medications classified as barbiturates and benzodiazepines.
Injection is widely viewed by experts as a particularly risky form of drug consumption. People who inject themselves in unsanitary conditions are exposed to a range of highly dangerous infectious microorganisms, including the hepatitis C virus (HCV) and the human immunodeficiency virus (HIV). Unsanitary injection also exposes users to more than a dozen forms of localized infection at injection sites, as well as potentially deadly body-wide complications stemming from localized infection. Finally, people who inject street drugs and prescription medications expose themselves to a large variety of fillers, additives or adulterants in the substances they use that are capable of producing additional serious bodily damage.
Drug Use and Stigma
According to the results of a study published in 2014 in the journal Psychiatric Services, the average American is far more likely to hold a stigmatizing attitude toward someone dealing with drug addiction than toward some dealing with a mental illness such as schizophrenia or major depression. In some cases, stigma doesn’t have a direct effect on the lives of those individuals viewed in a negative light. However, stigmatizing attitudes toward drug addiction lead to such clearly discriminatory outcomes as a fairly widespread belief that people affected by addiction shouldn’t be hired by employers or have the same access to health insurance as other Americans. Unfortunately, stigmatized people (including injection drug users) sometimes internalize the attitudes of others and start viewing themselves as inherently inferior.
Impact of Self-Directed Stigma
In the study published in Drug and Alcohol Dependence, researchers from Columbia University and Georgia State University used a small-scale project to estimate the impact that internalized or self-directed stigma has on the habitual routines of injection drug users. A total of 132 people living in New York City took part in this project; all of the participants were injection drug users not infected with HIV. The researchers asked each individual to describe his or her daily routine of injection drug use; in addition, each participant described the attitudes he or she held toward people who inject drugs.
The researchers concluded that two groups of people had the highest chances of holding a self-stigmatizing attitude toward their injection drug use: individuals with a relatively low level of academic achievement and individuals with a Hispanic/Latino racial/ethnic background. Critically, the researchers also concluded that the injection drug users with strongly self-stigmatizing attitudes were substantially less likely than their counterparts with less self-stigmatizing attitudes to take advantage of syringe exchange programs designed to reduce the odds of unsanitary injection drug use. Not surprisingly, this led to increased use of syringes not verified as sterile.
The study’s authors note the negative impact that a self-stigmatizing outlook can have on the routine behaviors of injection drug users. They believe their work underscores the necessity of programs that combat internalized stigma in this population of drug consumers on an individualized level, as well as on an institutional level. The authors also call for additional research that further explores the reasons why a highly self-stigmatizing point of view has the observed effect on injection drug users’ sanitary practices.
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