Stigma Reduction through Contact Strategies (Bill White and Tom Hill)

“We can be convinced logically of the need for intervention and change. But it is the story of one individual that ultimately makes the difference—by offering living proof.”  ― John Capecci and Timothy Cage

Ruth Bader Ginsburg

Eighty-year old Supreme Court Justice Ruth Bader Ginsburg recently commented on the changing American attitudes toward gay people: “The change in people’s attitudes on that issue has been enormous. In recent years, people have said, ‘This is the way I am.’ And others looked around, and we discovered it’s our next-door neighbor — we’re very fond of them. Or it’s our child’s best friend, or even our child. I think that as more and more people came out and said that ‘this is who I am,’ the rest of us recognized that they are one of us….Having people close to us who say who they are — that made the attitude change in this country.”  Justice Ginsburg’s observation offers observed testimony to the power of contact strategies—public disclosure of personal stories by individuals who share a concealable stigma for purposes of changing social attitudes and social policies. 

But does such contact REALLY change such attitudes?  A new study led by Emma McGinty and published in the journal Social Science & Medicine suggests that it does.  In a randomized national sample of more than 3,900 U.S. adults, McGinty and her colleagues compared responses to vignettes portraying untreated and successfully treated addiction and the extent to which these responses indicated a desire for social distance, belief in the effectiveness of treatment, and willingness to discriminate.  Study findings suggest 3 major conclusions.

Silence PosterFirst, “concealment, which is driven by stigma, also likely perpetuates stigma by preventing second-hand experience of successful treatment by family members, friends, and acquaintances” (p. 80).  This confirms the proclamation of recovery advocates that, “By our silence, we let others define us.”  While the wide range of motivations for concealment may be understandable, the broader social consequences of such concealment are becoming increasingly clear.  

Second, the over-telling of addiction-related pathologies and the biological roots of addiction without reference to recovery prevalence, at best, may have little effect on desired social distance, perceived effectiveness of addiction treatment, or willingness to discriminate, and, at worst, may inadvertently increase stigma and discrimination. 

Third, exposure to successful stories of addiction recovery result in “less desire for social distance, greater belief in the effectiveness of treatment, and less willingness to discriminate against persons with these conditions” (p. 73).   Findings from this study confirm the power of contact strategies in reducing the stigma attached to addiction recovery. 

There are clear and simple messages that permeate my writings on this subject over the past 15 years. Nearly everyone in America knows someone in long-term addiction recovery, but most are not aware of the recovery status of these acquaintances, colleagues, friends, and even family members because the person in recovery has carefully concealed this status.  Attitudes toward addiction, addiction treatment, and addiction recovery will not change in this country until we reach a critical mass of people who are aware of the recovery experience among their family, social, and professional network.  That is unlikely to occur until a vanguard of people in long-term recovery disclose their recovery status and stories at a public level.  That is what the new recovery advocacy movement is bringing to America and to other countries that is fundamentally new. 

In 2001 Recovery Summit in St. Paul, Minnesota that launched this new movement, the first author shared the following:

“We cannot confront stigma in the outside world until we discover how stigma works within us and our relationships with the world.  The internal consequences of such stigma must be excised before one experiences the worthiness and the power to confront its external source.  We must excise that stigma so that we can move beyond our own healing to find our indignation, our outrage, and our sorrow that people who could be recovering are instead dying.  We have to move beyond our own serenity and retrieve the fading memories of our own days of pain and desperation.  Before that day, we need leaders who will jar us from our complacency and challenge us to hear the cry of the still suffering.  Stigma is real, but we need to confront the fact that our own silence has contributed to that stigma.  Listen to the words of Senator Harold Hughes who before he died proclaimed: 

Senator Harold HughesBy hiding our recovery we have sustained the most harmful myth about addiction disease–that it is hopeless.  And without the example of recovering people it is easy for the public to continue to think that victims of addiction disease are moral degenerates–that those who recover are the morally enlightened exceptions….We are the lucky ones, the ones who got well.  And it is our responsibility to change the terms of the debate for the sake of those who still suffer. 

“How can addicted people experience hope when the legions of recovering people in this culture are not seen or heard?  Where is the proof that permanent recovery from addiction is possible?  We need a vanguard of recovering people to send an unequivocal message to those still drug-enslaved that they can be free.  We need a vanguard willing to stand as the LIVING PROOF of that proposition….There are whole professions whose members share an extremely pessimistic view of recovery because they repeatedly see only those who fail to recover.  The success stories are not visible in their daily professional lives.  We need to re-introduce ourselves to the police who arrested us, the attorneys who prosecuted and defended us, the judges who sentenced us, the probation officers who monitored us, the physicians and nurses who cared for us, the teachers and social workers who cared for the problems of our children, and the job supervisors who threatened to fire us.  We need to find a way to express our gratitude for their efforts to help us, no matter how ill-timed, ill-informed, and inept such interventions may have been.  We need to find a way to tell all of them that today we are sane and sober and that we have taken responsibility for our own lives.  We need to tell them to be hopeful, that RECOVERY LIVES!  Americans see the devastating consequences of addiction every day; it is time they witnessed close up the regenerative power of recovery.”  

Those words were shared in 2001 in the belief that contact strategies, even more than education and protest strategies, would be crucial to dismantling the stigma attached to addiction recovery.  We still believe that, and, needless to say, we are delighted to see research confirming the power of recovery disclosure as a strategy for social change.  What would be the state of LGBT quality of life in the U.S. if all members of that community had remained hidden in the closet these past decades?  In decades to come, we can hopefully ask this same question in reference to the recovery community. 

 

References on the Power of Contact Strategies to Reduce Stigma and Discrimination

Corrigan, P.W., Kuwabara, S.A., & O’Shaughnessy, J. (2009). The public stigma of mental illness and drug addiction: Findings from a stratified random sample. Journal of Social Work, 9(2), 139-147.

Corrigan, P.W., Morris, S.B., Michales, P.J., Rafacz, J.D., Rusch, N. (2012).  Challenging the public stigma of mental illness:  A meta-analysis of outcome studies.  Psychiatric Services, 63(10), 963-973.

Corrigan, P.W., River, L.P., Lundin, R.K., Penn, D.L., Uphoff-Wasowski, K., Campion, J., et al. (2001). Three strategies for changing attributions about severe mental illness.   Schizophrenia Bulletin, 27, 187-195. 

Couture, S.M., & Penn, D.L. (2003). Interpersonal contact and the stigma of mental illness:  A review of the literature. Journal of Mental Health, 12, 291-305.

Keys, K.M., Hatzenbuehler, M.L., McLaughlin, K.A., Link, B., Offson, M., Grant, B.F. & Hasin, D. (2010).  Stigma and treatment for alcohol disorders in the United States, American Journal of Epidemiology, 172(12), 1364-1372. 

Lavack, A. (2007). Using social marketing to de-stigmatize addictions: A review. Addiction Research and Theory, 15(5), 479-492.

Livingston, J.D., Milne, T., Fang, M.L. & Amari, E. (2011).  The effectiveness of interventions for reducing stigma related to substance use disorders:  A systematic review.  Addiction, 107, 39-50. 

McGinty, E.A., Goldman, H.H., Pescosolido, B. & Barry, C.L. (2015).  Portraying mental illness and addiction as treatable health conditions:  Effects of a randomized experiment on stigma and discrimination.  Social Science & Medicine, 126, 73-85. 

White, W. (2014).  Waiting for Breaking Good:  The media and addiction recovery.  Counselor, 15(6), 54-59.

White, W.L., Evans, A.C. & Lamb, R. (2009).  Reducing addiction-related social stigma.  Counselor, 10(6), 52-58.