Stigmatization is a pervasive issue for people living with a substance-use disorder, said Anthony Esposti, chief executive officer at the Community Addictions Peer Support Association, during a session at Benefits Canada’s Chronic Disease at Work conference in February.
Stigma is best understood as a deeply held set of false beliefs about a group of people with at least one attribute in common — and allows the judgement, oppression and discrimination of those people to take place either by overt actions or people’s silence, he noted. “The good news is that these are false beliefs. And false beliefs can be eradicated through education.”
Eleven criteria are used to diagnose a substance-use disorder, said Esposti, highlighting the three key ones as: the individual compulsively seeks and uses substances; they’re unable to make healthy choices with respect to substance use; and the behaviour continues despite negative consequences. “So all of the stories of tough love, all of the stories of employers placing people on performance-improvement plans and the attempt to get through to someone with a substance-use disorder have no impact, because that behaviour will continue despite negative consequences.”
Stigma perpetuates oppression, he said, noting this is experienced at three different levels: internalized self-stigma (how someone feels about themselves in relation to their substance use); social stigma (how someone interacts with their social groups and the attitudes of others towards them); and structural stigma (policies and procedures built into systems that continue to discriminate against people with a substance-use disorder).
The symptoms of a substance-use disorder manifest in behaviours that are deemed socially unacceptable, like unreliability, cheating and lying, said Esposti, which ultimately keep people from addressing it as a health concern. “While there are societal attitudes towards people with substance-use disorder, it also impacts the person at the individual level, resulting in lower self-esteem, self-deprecating behaviour, deeper deprecation and decreased self-efficacy — all play important roles in the workplace.”
Those living with a substance-use disorder face barriers to a wide range of services. In fact, only 10 per cent of these individuals ever make it through the doors for help, he said, which is associated with poor health outcomes and puts people at higher risk for chronic stress and poor corporate coping responses.
There’s also a misconception when it comes to recurrence, said Esposti. Neuroplasticity takes time to rewire the brain and so does changing the way it operates. When someone with a substance-use disorder has a relapse, people often think they can’t be trusted and that they’re unwilling or don’t care about others, but the brain takes time to heal, he added. “The standard for residential treatment is that, within one year, 60 per cent of people who attend for a substance-use disorder will have a recurrence. And that’s not out of line with other chronic conditions.”
Layers of intersectional stigma compound the problem, too — for people of colour or those from a different culture, religion or level of education. It’s not just a linear relationship, he said. “These are exponential layers that increase or decrease health outcomes for people with substance-use disorder.”
A year after the start of the coronavirus pandemic, 33 per cent of people who consumed cannabis in Canada were consuming more and 25 per cent of those who drank alcohol were drinking more, noted Esposti. Alongside the wave of increased substance use was a lack of information for people to make healthy choices about it, he added.
In 2017, substance use cost the Canadian economy $20 billion in lost productivity and those numbers are expected to increase, he said, noting the cost to private insurers was $25 billion. This is the sheer economic impact of the general population’s missed work and insufficient job functioning. For every dollar spent on addressing issues of substance use, three dollars is returned, he noted.
“So there’s a huge opportunity to address issues early and help people make informed decisions and seek help. The numbers are high. The economic costs are high. But the cost of stigma is also high — and the cost is that people continue to suffer.”
To help those living with a substance-use disorder, Esposti suggested people change the associated language. Using words that respect a person’s worth and dignity and focus on medical terminology rather than pejorative labels promotes their wellness journey and avoids perpetuating negative stereotypes and biases, he said. “So instead of ‘substance abuse’ and ‘junky,’ it’s ‘substance use’ and ‘person who uses substances’ — placing people first, not the label.”
And what can employers do? First and foremost, he recommended they engage in training on stigma and person-first language to begin creating a safer environment for people to talk about their substance use. They can also help provide resources on substance use and discuss how these resources can be integrated within benefits plan discussions.
“Assess your policies and procedures to ensure substance use is addressed as a health concern rather than a performance issue. And, most importantly, be an ally.”
Read more coverage of the 2023 Chronic Disease at Work conference.