A new Rutgers study aiming to better understand the ideologies that create stigma for people trying to recover from opioid addiction (i.e., an ostensibly positive behavior) finds that despite engaging in the difficult work of recovery, people in recovery for opioid use disorder might also need to combat the stigma and negative perceptions of others.
“Our study presents a unique way of looking at this issue,” said Associate Professor of Communication Kristina M. Scharp, who co-authored the study with Brooke H. Wolfe of the University of Washington. “Most scholars are interested in outcomes such as relapse. We were more interested in the societal pressures people overcoming opioid addictions must face.”
Their paper, “A (In)curable Disease? Making Meaning of Addiction from the Perspective of People in Recovery from Opioid Use Disorder,” was published in the journal Health Communication.
Their study found the “very meaning of addiction is up for grabs,” because the meaning of opioid addiction can vary significantly between people in recovery, treatment providers, healthcare professionals, and community members. Scharp said members of the public and treatment providers often associate addiction with chronic illness, personal failure, and/or crime, which can both perpetuate and exacerbate addiction stigma.
Their study, Scharp said, suggests that helping the public better understand the complex ways that opioid addiction is environmental, relational, and situational – that it is not simply a personal choice – would be useful, and communicating this idea might be accomplished through the media or other forms of public education.
Their research, Scharp said, also found that the notion of “‘personal responsibility’ can be limiting for people in recovery for opioid use disorder. In other words, because opioid use disorder gets painted as a personal choice, recovery treatments also focus on individuals making a different choice without always taking into consideration the contextual and systemic obstacles to recovery. We argue that recovery is not a personal journey but likely takes a village.”
It is important to reframe addiction as an ongoing incurable disease, as opposed to something of which people can be cured, Scharp said. “Emphasizing the on-going responsibilities of opioid use disorder recovery is important to understanding the labor required and support needed.”
Scharp and Wolfe said healthcare “clinicians frequently act as though patients taking methadone or buprenorphine, medications which help patients stay sober, are still using illicit drugs, which spreads misinformation about the critical distinction between active use and medication for OUD. This misconception is dangerous as the recommendation to taper off medication early can significantly increase the risk of fatal overdose.”
Another complication Scharp and Wolfe found is while the public can, on the one hand, want people in recovery to receive medical help for their addiction, on the other hand, communities across the U.S. have opposed the creation of treatment facilities offering medication for OUD located in their neighborhoods.
To conduct the study, Scharp and Wolfe used contrapuntal analysis, which Scharp said is a type of critical discourse analysis that corresponds to the use of relational dialectics theory. Contrapuntal analysis enables researchers to identify the social norms that can create pressure and stigma for certain groups.
Scharp and Wolfe studied two different ways to look at OUD. These perspectives contribute to the perceptions people in recovery form about themselves as people recovering from opioid addiction. One they term Discourse of Addiction as a Disruptive Choice (DADC). The DACD discourse, Scharp said, generally holds that “addiction can be stopped with one choice, if only the person had enough personal strength.” In other words, proponents of this theory assert that opioid addiction is ‘curable,’ but ‘the curability depends on the profit-producing benefits of rehabilitation centers, medications, and treatments paid for by insurance and out-of-pocket by people in recovery.’
The opposing perspective they found they termed “Discourse of Addiction as Bad Luck (DABL). People in recovery whose beliefs align with DABL perceive addiction as the result of environmental, relational, and situational circumstances, and further, that addiction is incurable, or in other words “that individuals in recovery for opioid use could reenter the [addiction] cycle at any time from any trigger.”
After analyzing these two competing discourses, and the ways they are communicated and perceived broadly in society beyond those in recovery, Scharp and Wolfe coined a new term: “mobbing.” Scharp said this is the most important theoretical contribution of this study.
“Mobbing,” they said, occurs when the followers of the DADC theory, which is the dominant discourse in American society, form a mob along with other ideologies to remain the dominant discourse and extinguish alternative perceptions of opioid addiction.
“When the dominant discourse forms a mob around the marginal discourse, all the dominant social norms gained a stronger footing. This reification strengthens the DADC by constructing individuals in recovery as dependent not only on a cure for addiction, but also on medical providers, rehabilitation facilities, and insurance companies,” Scharp and Wolfe wrote. “This mob gains power as healthcare providers, insurance companies, rehabilitation staff, and community members help determine when, where, and what treatment for people in recovery looks like. This leaves individuals in recovery at the mercy of healthcare institutions that are informed by and perpetuate ideologies that serve to disenfranchise and stigmatize those who need treatment.”
Their broad findings, Scharp said, have practical implications for people in recovery from opioid addiction. First, “given the complexities of the recovery process and the different options for treatment, recovery, and sobriety, framing addiction as a choice is simplistic and likely a grave generalization of how individuals become addicted to active use of opioids. Furthermore, treating the disease without accounting for circumstantial factors is not conducive to supporting long-term recovery. The treatment of addiction should include not only physical and physiological symptoms but the circumstantial factors including the social determinants of health that contribute to relapse.”
Given their findings specifically relating to mobbing, Scharp and Wolfe said, “treatment programs should work toward the integration of medical plans for people in recovery. In disrupting the isolation of addiction treatment, representatives from insurance companies, primary care providers, and community members can work to fight stigmatization together through the integration of holistic support for the environmental, relational, and situational obstacles to recovery. In this sense, it will ‘take a village" to stand up to the ideological mob . . . [these] systemic changes to better support people in recovery long-term are necessary, as people in recovery traverse the cycle of addiction for the remainder of their lives.”
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