Is there such a thing as ‘good’ stigma? - Blog from Dr James Morris

As drug-related deaths continue to rise across the globe, debates about what can be done to tackle society’s addiction problems continue. Although stigma is generally recognised as major barrier to addiction recovery, arguments can sometimes be heard that stigma – or at least societal ‘disapproval’ - towards substance use is in fact, a ‘good’ thing.   

This view is of course controversial, but the argument essentially goes that the extent society accepts or disapproves of substance use or ‘addiction’ has an important influence on how likely people are to use drugs (or gamble) in the first place, or how incentivised they may be to pursue recovery. Intuitively, the premise makes sense and it is well established that people’s behaviour is influenced by social norms (i.e., what people think is ‘normal’ or acceptable). People tend not to litter in public, in part because they know others will disapprove, and in turn people may feel a sense of guilt, regret, or shame if they act in ways that are frowned upon by others.  

Despite this, people obviously still engage in behaviours which they know are deemed anti-social or illegal, but the reasons for this are complex. Most actions (such as taking a drug) come with potential costs and benefits. Some of these are more certain or immediate, whilst other consequences are unknown. Indeed, ‘addiction’ itself is partly characterised by cognitive biases in which immediate benefits (e.g., feeling good or alleviating pain) are heavily valued over later costs (e.g., health effects, or rejection from others). As such, how societal attitudes influence behaviour is highly dependent on the individual, the behaviour and the context in which it takes place.  

‘Stigma’ is bad, but can ‘disapproval’ be good? 

Whether society can use types of social signalling to influence addiction-related behaviours is therefore a question that requires careful empirical attention, as myself and colleagues set out in the journal Addiction Theory & Research. This largely follows from an argument that societal disapproval can be separated from stigma, and that it should be used to reduce addiction. That is, whilst stigma is a harmful practice of unfair treatment and social devaluation (and therefore can’t be ‘good’), it is suggested that society has become too lenient towards harmful substance use. In turn, it is argued anti-stigma campaigns are unintentionally removing an important disincentive towards addiction – society’s ‘disapproval’ of it.  

In the first case, it is certainly true that idea of stigma as a force for good is a contradiction in terms and should be rejected. Stigma experts agree that stigma itself is fundamentally harmful since dehumanization, social devaluation and discrimination are hugely damaging to individuals and society. Stigma can exist in many harmful ways, and as history shows us, stigmatizing narratives serve to dehumanize the ‘other’, in turn facilitating mistreatment, oppression and even genocide.  

Recognizing the role of ‘norms’ in shaping substance behaviour 

Stigma is of course a major barrier to addressing addiction problems, not only via the discrimination and devaluation people experience, but via self-stigma, when people internalise negative stereotypes to themselves. This process of ‘self-stigma’ is particularly harmful through reducing people’s sense of sense worth and belief in their capacity to recover, and in turn potentially increasing feelings of guilt, shame, and more harmful use. 

However, cultural attitudes and norms can also shape behaviour in ways which are not inherently stigmatizing. Social norms are beliefs about other people’s actions or attitudes towards certain behaviours. Such perceptions can therefore influence us as we tend to consider - including subconsciously - whether others will ‘approve’ or ‘disapprove’ of our actions. For example, generally people think one should wash their hands after using the bathroom. So if we see someone leaving a bathroom without washing their hands, we might ‘disapprove’ of this as violation of hygiene-related norms. We might even feel a sense of disgust and instinctively give them a ‘dirty look’, or tell others what we saw in an attempt to strengthen the norm of handwashing. However, whilst someone who doesn’t wash their hands might get individually shamed, ‘non-handwashers’ are not a labelled group in society and therefore are not stigmatized in the way people labelled as ‘addicts’ are. Stigma involves ‘spoiling’ a person’s identity, not just violating a social norm.  

So for many behaviours, people might adhere to norms, or loosely to ‘follow the crowd’, but without being stigmatized if they don’t. Indeed in certain contexts, drug and alcohol use is influenced by social norms without stigmatization. For instance, in university settings hundreds of studies have shown how perceptions of other people’s drinking behaviours and attitudes shape how and why students drink. Sometimes, drinking can be reduced by correcting student’s beliefs if they overestimate heavy drinking or approval of it amongst students in general (a type of ‘nudge’). It would therefore be a mistake to suggest societal attitudes hold no influence on these behaviours, but the crucial question is can norms be deliberately changed to reduce addiction without causing harm (e.g., inadvertently increasing stigma)? 

Can ‘disapproval’ reduce addiction?  

The appeal of ‘disapproval’ then is that society can curb ‘unwanted’ behaviours via changing or strengthening social norms. Indeed, in a broader context, some advocate for more use of shame to incentivise better behaviour, although generally advise this should be targeted at corporations or policy makers rather than individuals. What about in the case of substance use and addiction? 

We argue this is a question that needs more research first, although some important evidence exists. For example, some studies suggest guilt-prone people may be less likely to engage in addictive behaviours, thus social disapproval may have some preventative value (although the studies are limited in proving cause and effect). However, there is another important catch. These patterns only seem to apply to groups who do not have ‘addiction’. In fact, amongst people with addiction, higher levels or guilt or shame have been proposed to be counter-productive. Simply put, whilst permissive attitudes might increase the likelihood of uptake or use of drugs in some contexts, shaming people with addiction is harmful. Whilst cliché, addressing addiction problems is most effective when coming from a place of compassion, social support and building people up. 

The importance of resisting stigmatizing blame 

This is not to argue there should be no consequences for people’s actions just because they may be experiencing ‘addiction’. There is a crucial distinction between responsibility (e.g., to not harm others) and blame (‘it’s their own fault’) often motivated by anger or contempt. Of crucial importance, however, is recognising the societal drivers of addiction, including inequalities, poverty and weak drug and alcohol policy. Placing too much responsibility on individuals for ‘addiction’ is itself a harmful practice which feeds blame and stigmatization, distracting from the need for evidence-led drug policy and compassion towards people who so often have histories of severe trauma or abuse.  

Addiction does not result from a lack of disapproval or judgment from society. It is a complex problem for which society places too much emphasis on individual’s as making a ‘choice’, rather than recognising the complexity of the issue. We must tread very carefully before putting people at risk of more stigma in the name of ‘disapproval’.