One of the highlights of the recent Australian Nurses and Midwives Conference was Professor Dan Lubman’s presentation on rethinking addiction.
Dan is the executive clinical director at Turning Point, Australia’s leading national addiction treatment, training and research centre. The key points of his presentation were that the stigma around addiction reinforces the discrimination that people with addiction issues experience, and this this has direct impacts on help-seeking behaviours and treatment access. However, public attitudes are changing and there have been some encouraging policy reforms over the past few years.
Stigma and stereotypes
Compared to other mental health problems, addiction is more likely to be seen as a moral issue. ‘Illicit drug dependence is the most stigmatised health condition globally, with alcohol dependence coming in fourth,’ Dan said. ‘Because of that stigma, there’s a reluctance from the government to invest in any real evidence-based treatment approaches or policies, so we see underinvestment in this whole area.’
The stigmatisation of drug and alcohol use has a long history and is highly politicised. ‘There’s often underlying moral panic, driven by broader concerns around the economy, immigration, and fear that our society is going to change,’ he explained.
What the issue has never been about is health. By way of example, Dan quoted John Ehrlichman, the Assistant to the President for Domestic Affairs under Richard Nixon:
‘You want to know what this [war on drugs] was really all about? The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and black people. We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.’
The cost of stigmatisation
‘These issues – alcohol, drugs, gambling and smoking – cost the economy $80 billion per year,’ Dan explained. ‘That’s the cost of one of the most expensive programs in Australian history: the JobKeeper program, which for one year was $79 billion dollars. This is $80 billion every year.’
This includes tangible and intangible costs in terms of workforce productivity and healthcare, as well as the human cost: people who die because of alcohol, drugs, gambling and smoking-related issues.
National data reveals there were 62,757 drug-related hospitalisations in 2021. ‘That’s 172 per day. And when you put the figures together, people are dying. Australians are dying from alcohol, drug and gambling harm almost every hour.’
So why aren’t we talking about this? ‘This is costing us a lot of money,’ Dan said. ‘It’s having a huge impact on our workplace. But we’re not really talking about this at all.’
Stigma within healthcare leaves people feeling devalued, dismissed and dehumanised
There are several major risk factors for addiction, including genetics, other mental health conditions, social disadvantage and isolation, poverty, and trauma. Despite this, stigma continues to exist within healthcare settings. A recent Turning Point study of people with lived experience of alcohol and drug harms revealed three key themes:
- the way in which we talk about the issue in healthcare settings positions people who use alcohol and drugs as undeserving of healthcare.
- The way in which the issue is communicated blames people for their alcohol or drug use, instead of asking: what’s happened to make you make those choices?
- The way in which we separate alcohol and drug users from other patients positions the issue as not being a legitimate health disorder.
‘There is also a lot of therapeutic pessimism,’ Dan said, whereby healthcare workers – including those in alcohol and drug services – overwhelmingly tend to think that treatment doesn’t work. ‘We did a study of Australian alcohol and drug workers. When we asked them what the rates of recovery were for alcohol and drug use disorders, we’ve got a figure of about 33 per cent.
‘The true figure is around 67 per cent. Compared to other chronic health conditions, it’s got one of the most positive recovery rates.’
How do we change?
Thankfully, we are already seeing change ‘in the way that people think about drugs and talk about drugs, and the interventions that we have for drugs,’ Dan explained. ‘It’s really positive. So how do we capitalise on this momentum to tackle stigma and create meaningful change?’
They key is humanisation, familiarisation, and changing the conversation. Campaigns that bring together education alongside first-person narratives from people with lived experience are twice as effective,’ he said, pointing to successful examples from Australia and overseas that have changed the conversation around mental health, voluntary assisted dying and HIV.
‘The most important thing is empowering people to talk about their condition. This boosts their self-esteem, gives them confidence, gives them purpose. It’s a really important thing that we can do for people with lived experience.’
A good example of this is the SBS documentary series Addicted Australia. Produced by Turning Point and Blackfella Films, it first screened in 2020 and has been available on SBS On Demand since. The show features 10 Australians struggling with addiction, who invited cameras into their lives as they sought help and went through treatment.
‘We wanted a documentary that humanises people, situates them within the community, and tells their stories,’ Dan said. ‘I think it’s fair to say it has changed viewers’ attitudes around what addiction is and how we perceive it. We were worried that we would have a lot of negativity, but instead we saw almost universal positivity around talking about the bravery of these individuals.’
Addicted Australia led Turning Point to launch the Rethink Addiction campaign to promote and share real stories, address public misconceptions and stereotypes, and put out a call to action: ‘We all have a role to play as health advocates in helping to change Australia’s approach to alcohol, drugs and addiction, and to tackling stigma. We need to do it, if not for a human perspective, then for the economic perspective. We cannot afford to keep doing the same thing.’
For nurses and midwives seeking change, Dan suggests the following as key:
- calling out stigma and discrimination when we see or hear it, and modelling non-stigmatising language
- empowering people with lived experience to tell their stories, and to access our services
- Engaging with social media to share your thoughts
- getting involved with your colleagues, professional associations, and the ANMF to support advocacy and structural policy change
- watching Addicted Australia, and encouraging others to watch
- advocating to your local member of parliament
- and, if possible, skill building through placement and learning opportunities.