As the alcohol and other drug field tries to craft public messages aimed at increasing treatment resources and preventing the stigmatization of people with addiction, an old foe stands in the way: blame.According to preliminary results from a report on language and public attitudes, commissioned by the Center for Substance Abuse Treatment (CSAT), the key attitudinal issue that messages about addiction must address is the "weakness/illness/responsibility continuum."
"Those in the substance abuse/addiction field tend to minimize the individual's role and responsibility in becoming addicted or needing treatment," noted the report prepared by the Lewin Group consulting firm. In contrast, "Those in the general public tend to focus largely on personal weakness and responsibility, paying little attention to the scientific evidence of physical (brain) changes, the contributory role of mental illness for some, and the role of genetic predisposition," the report said.
CSAT initiated the study in response to a request from a panel on reducing stigma and changing attitudes, formed as part of the agency's National Treatment Plan initiative. The report drew upon a series of focus groups with members of the addiction field and the public, as well as an audit of the language currently used by field agencies and organizations, to reach its conclusions.
Researchers said that little field consensus currently exists on which terms should be used to describe addictive disorders and the people who have them. "For example, some participants considered "substance abuse" to be an acceptable and appropriate term for use within the treatment community; others considered the term to be stigmatizing because of its link to other forms of criminal abuse, such as child, domestic, and sexual abuse," the report noted.
Illustrating this lack of agreement was an accompanying terminology review conducted by Lewin researchers, who looked at materials published by the Office of National Drug Control Policy, the Substance Abuse and Mental Health Services Administration, the National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Drug Abuse, as well as field groups like the American Society of Addiction Medicine, Narcotic Anonymous, and the National Council on Alcoholism and Drug Dependence.
While most of these agencies and groups used the term "substance abuse," for instance, many also used "alcohol and drugs" or "alcohol and other drugs" to describe the same concept. Federal agencies were more likely than field organizations to refer to individuals who are addicted to drugs as "abusers," and NIDA, ASAM and ONDCP did not use the term "recovery."
Field focus-group members preferred language that focuses on individuals, separate from their behavior, environment, or disease. Members of these focus groups also preferred terms that support the disease concept of addiction and do not reinforce criminal stereotypes about people with addictions.
Many participants called for encouraging the use of more clinical language to describe addiction -- terms like "relapse" and "in remission" -- while others cautioned that overly technical language would simply encourage the public to continue using more familiar, stigmatizing terms.
The public still does not accept that addiction crosses all socioeconomic and geographic boundaries, the field focus groups agreed. "Broadly speaking, focus-group discussions centered on the need to recognize individuals who suffer from substance abuse/addiction as normal people who have a treatable disease," the report said.
Public Doesn't "Buy" the Disease Concept
The results of the public focus groups, however, show the challenges of getting such messages across. The CSAT report noted that when members of the general public think of people with addictions, their thoughts focus on issues of personal responsibility and weakness. "People often find it difficult to sympathize with substance abusers, who are seen as shirking their responsibilities by choosing a destructive lifestyle," the report noted.
Treatment is viewed with skepticism, and many distrust people in recovery, fearing that they could be a "time bomb" waiting to go off. "Few participants seemed to understand the addiction process as a disease, and fewer still knew how to approach someone close to them who they suspected might be a substance abuser," according to the report.
On the other hand, the CSAT report holds out hope that the public is ready to accept a well-crafted education campaign on addiction. "Most participants indicated being touched by the issue of substance abuse in some way, and this personal experience -- both individual and familial -- has made the public more open to hearing, learning, and talking about the subject," the report noted.
While public knowledge about addiction is not extensive, many focus group members had a basic understanding of the disease, the report said. And even though many don't believe that treatment works, the public does accept the idea of seeking treatment for addiction.
Support for treatment as an alternative to incarceration remains strong; however, the public fails to grasp the chasm between treatment need and availability. "Almost all of [the focus-group members] believe that treatment is easy to access, if a substance abuser is serious about getting help," the report said.
Recovery Heroes
To overcome these attitudes, field messages need to be clear, educational and informative, delivered by a trusted messenger, and utilize effective media, from TV commercials to billboards, the report said. Messages also should focus on the areas of commonality found between the field and the public, including an interest in:
- hearing and learning about personal stories of addiction, treatment and recovery
- the fact that addiction becomes a physical illness at some point
- the fact that treatment has become more effective
- the fact that overcoming addiction can be very difficult for an individual
"The message should focus on success stories -- those who have fought addiction and won," the CSAT report stressed. "One option would be to design a message focusing on family members who take pride in the determination that their loved one displayed ... From this perspective, those in recovery are portrayed as individuals who have summoned their strength to overcome a major problem."For a copy of the report, "Language and Attitudes: Report of Preliminary Research" (June 2001), write to Yesenia Flores, CSAT - National Treatment Plan, 5600 Fishers Lane, Rockwall II Bldg., Suite 618, Rockville, MD 20857.
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