Vanyukov Michael M
Departments of Pharmaceutical Sciences, Psychiatry, and Human Genetics, University of Pittsburgh, Pittsburgh PA, USA.
Addict Res Theory. 2024;32(2):83-92. doi: 10.1080/16066359.2023.2238603. Epub 2023 Jul 23.
Many experts in the etiology, assessment, and treatment of substance use/addiction view stigma and stigmatization - negatively branding addiction and substance users - as obstacles to the solution of the substance misuse problem. Discussions on this topic impact research and policy, and result in oft-repeated calls to remove the stigma from substance use and users. The goal of the article is to analyze the stigmatization concept as applied to substance use/addiction. It is widely accepted in the literature that stigmatization negatively affects substance users because addiction stigma interferes in both seeking and receiving professional care. It is argued that the societal disapproval of substance use/addiction is inappropriate because it is a mental disorder, involving biological processes. Nonetheless, neither those processes nor negative attitudes to substance use affirm the concept of stigmatization as currently applied. This concept conflates potential mistreatment and malpractice with the prosocial justified societal disapproval of a lethally dangerous behavior. Consequently, the stigmatization concept suffers from internal contradictions, is either misleading or redundant, and may do more harm than the supposed mistreatment of substance users that stigmatization connotes. On the contrary, the justified disapproval of harmful behavior may be a factor raising individual resistance to substance use. Instead of mitigating the effects of that disapproval, it may need to be capitalized on. If it is employed explicitly, conscientiously, and professionally, its internalization may be one of the resistance mechanisms needed to achieve any progress in the still elusive prevention of substance use and addiction.
许多物质使用/成瘾的病因、评估及治疗方面的专家认为，污名和污名化——给成瘾及物质使用者贴上负面标签——是解决药物滥用问题的障碍。关于这一话题的讨论影响着研究和政策，并导致人们屡屡呼吁消除对物质使用及使用者的污名。本文的目的是分析应用于物质使用/成瘾的污名化概念。文献中普遍认为，污名化对物质使用者有负面影响，因为成瘾污名会干扰寻求和接受专业护理。有人认为，社会对物质使用/成瘾的不认可并不恰当，因为这是一种涉及生物过程的精神障碍。然而，无论是这些过程还是对物质使用的负面态度，都无法证实当前应用的污名化概念。这一概念将潜在的虐待和不当行为与社会对一种致命危险行为合理的、支持社会公益的不认可混为一谈。因此，污名化概念存在内在矛盾，要么具有误导性，要么多余，而且可能造成的危害比污名化所暗示的对物质使用者的所谓虐待更大。相反，对有害行为合理的不认可可能是提高个人对物质使用抵抗力的一个因素。与其减轻这种不认可的影响，或许还需要加以利用。如果明确、认真且专业地运用这种不认可，其内化可能是在仍难以实现的预防物质使用和成瘾方面取得任何进展所需的抵抗机制之一。
