Tackling substance use-related stigma: we need to do more but we also need to know what we are doing and why – let’s share ideas so that we can actually make a difference

Hi everyone, my name is Robin Falconer. I work for Dundee City Council in the Community Health Team – we use a community-led approach to health which involves building capacity of people to take action on issues that are important to them. For the past seven years I have provided leadership and support for a range of work in Dundee to tackle the stigma that surrounds substance use. This has included training for professionals and local communities, a Recovery Friendly Dundee initiative (which included a pledge for organisations and ambassadors who engaged with the public and local businesses), a Words can be Walls to Recovery campaign and decentralised funding for local communities, including people with lived experience of ‘problem’ drug use (I have placed ‘problem’ in inverted commas because it seems to be the current language being used but I am not in a position to judge whether it is problem use for other people) to develop projects to increase community-based support across Dundee and promote positive stories. One thing is certain – these developments have helped to increase awareness of what stigma is and why we need to tackle it. What is less certain is whether what we are doing is actually making progress towards reducing stigma. There is no doubt that tackling stigma is a long-term endeavour (as we have seen from the work of See Me Scotland which has made significant progress towards ending mental health-related stigma and discrimination) but we at least need to know whether we are heading in the right direction.

I need to make it clear that I am somewhat of an imposter – I don’t have direct lived experience of substance use but I am genuinely committed to working with people who do and I will never be an expert with all the answers. My interest in tackling stigma stems from my belief that everyone should be treated as human beings, with dignity and respect, regardless of their health condition or life circumstances, and that power should be used to help people, not to oppress, marginalise and satisfy the interests of those who seek to do this. Many people will be in a similar situation to me and my advice to you is to always be aware of the power you have in your professional role and seek to ensure this power is being used to empower others. Otherwise, you could inadvertently reinforce the unequal power distribution that keeps stigma in place. Whatever our personal and professional motivations are, stigma makes things worse for everyone and everyone has a role to play in reducing it (at least that’s my conclusion to date).

I have recently finished my Master of Public Health course at the University of Stirling for which my final research project focused on understanding how Alcohol and Drug Partnerships (ADPs) across Scotland were responding to stigma in their strategies. While it was clear that stigma was recognised as a priority across most ADPs, their strategic plans provided limited clarity on how they would tackle it. The strategic plans that did mention stigma did so only briefly. This gave the impression that it was either low on the long list of priorities or that ADPs were not clear about how stigma could be tackled (my hope is that it was the latter). The most frequently mentioned response was education and training. While this is undoubtedly important for providing an alternative narrative around substance use, away from one that is about individual blame and punishment towards one that is about empathy, complexity and support, this will not have sufficient weight to bring about the structural change necessary to tackle stigma.

The recently published Drug Deaths Taskforce final report Changing Lives has helped to move stigma away from the margins to the front and centre with its section titled Stigma kills people. As someone who has spent the past seven years trying to highlight why tackling stigma is a critical component of reversing the drug death trend in Scotland, this was extremely reassuring. Tackling stigma is not something that should be an afterthought – it needs to be integrated into all aspects of our responses to drug-related harm, from our policies and strategies, delivery of services and the support available within our communities. Tackling stigma is necessary for the successful implementation of a public health approach to drug-related harm in Scotland.

The Drug Deaths Taskforce’s report and its earlier published strategy for addressing stigma has pointed to some evidence-informed ways to tackle stigma, including protest, advocacy, education, contact with the stigmatised group, peer programmes and media campaigns. However, from my research, I found that these are not homogeneous interventions so there is no one-size-fits-all that can be simply transferred into all contexts. Furthermore, I actually found inconclusive evidence on what works to tackle stigma surrounding substance use. This makes the task of designing interventions challenging and there is a risk that poorly-informed responses could be ineffective, waste resources and at worst exacerbate stigma. There is a need to further generate evidence which means testing approaches that have not been tested already.

Call to action

This blog acts as a call to action to better integrate policy, practice and research on tackling stigma across Scotland. Initially, the ask is for those who have an interest in tackling stigma to come together on the DRNS online forum to share thoughts, reflections and ideas. What are Alcohol and Drug Partnerships doing to tackle stigma? What are the challenges? How are actions being evaluated? What do we need to do next? We all need to work together and integrate efforts between those operating and local and national levels to ensure a unified response to this important issue.

Thank you for your time – I look forward to exploring this further with you and finding ways to make a real difference.

Robin Falconer
DRNS Member