1. Dr. Oliver Aldridge Edinburgh, Midlothian & East Lothian DTTO I and DTTO II

2.  Theory  Client  Communication  Agency  Conclusions

3.  Ancient Greeks physically scarred people to permanently “mark” them  Today: amputation of a finger to denote someone who is deemed to be a “grass”  May be part of the survival mechanism of group living  Some of the original driving force behind drugs legislation – San Francisco 1865

5.  Reciprocity  Threat: housing, benefits, treatment/support, theft, “infecting others” by introducing to drugs.  Downward comparison  Belief in a “Just” world/ “Protestant Work Ethic” – you get what you deserve and you deserve what you get

6.  Drug users are bad parents  Drug users are dishonest  Drug users are manipulative  Drug users are self-indulgent  Drug users are wasters  Drug users destroy communities  Drug users choose to be drug users

7.  Stereotyping facilitates stigmatisation  Stigmatisation encourages stereotyping  May be linked to depersonalisation

9.  Needs to be openly discussed so that it can be managed on an individual level.  Differing levels of stigma sensitivity between clients  Cannot make automatic assumptions about the effect on a client  Cannot make automatic assumptions about the main sources of stigma

10. Usually drug use is only one factor:  Poverty  Poor education  Unemployment  Criminal record  Drug taking  Injecting  Parenting

11.  Difficult childhood  Learning difficulties  May contribute to feeling excluded  Social acceptance may be sought in a marginalised peer group  As part of that group, drug taking/experimenting may be the norm  Effect of criminalising groups?

12.  Physical Signs  Treatment Stigmata  Social Stigmata

13.  Visible signs of drug use include: Injection sites Poor dentition Poor nutrition Appearing intoxicated/withdrawn  Managing these appropriately may increase the range of options in managing stigma

14.  You’ve got to know when to hold ‘em….. Know when to fold ‘em…..  Managing disclosure is a highly individual, situation specific problem  If stigma is not overtly discussed, it is not possible to devise an effective, individualised strategy to deal with it

15.  Exposure of a previously, largely hidden level of drug use  Loss of employment  Peer group rejection  Relationship breakdown  Increased intervention e.g. Children & Families  Labelling  Disempowerment  Social Isolation

16.  Local vs. Centralised treatment services – pros and cons  Failing to treat people holistically  Perpetuating or increasing stigma in the treatment environment  Recovery = Abstinence  Information sharing vs. “raw data” being communicated to people without specialist knowledge

17.  Some treatment options may feel less stigmatising to the client e.g. DHC vs. Methadone  Treatment needs to have a solid evidence base and be effective and appropriate for the client at that time

19.  May be stigmatising  Alterations to pharmacy may impact positively  May reduce stigma  Effect is individual and, therefore, policy should allow individual assessment/decision making

20.  Method – supervised urine collection processes  Rationale – is it being done to “catch” people?  What is the context of a result?  May help to combat negative attitudes

21.  Complex issue  Multilayered  Stigmatisation may predate drug use  Identity may be sought and found in a marginalised community  Entry into treatment may risk stigmatisation by society at large and the marginalised community  Social isolation may result

22.  Wraparound care essential  Helping people integrate into new social groups  The role of “ex-user” does not work for everyone

24. As specialist agencies we have a responsibility to provide good quality, objective information to:  Communities  Media  Government  Professionals  Students

25.  Views/hypotheses may impact on stigmatisation  Is it better to be viewed as someone with a genetically determined problem or as someone with a social problem?

26.  Facilitating appropriate contact with people who don’t conform to stereotypical views may catalyse change  Caveat: Stigmatisation may paradoxically be increased by contact with someone who is massively different to the stereotypical view  Does the “exception” prove the “rule”?

28.  May be stigmatised by the communities in which it works – “NIMBYism”  Workers may need support – e.g. outreach, needle exchange workers  Related professionals/disciplines may stigmatise those who work in this field  We may stigmatise each other by perpetuating false debates e.g. Harm Reduction vs. Abstinence  Funding wars may increase stigmatisation by threatening survival

29.  Stigma is here to stay – we have to learn to manage it effectively  Management of stigma has to be individualised  Stigma cannot be dealt with if it’s not openly addressed  Treatment can contribute to stigmatisation: agencies need to consider this in service planning/delivery  Commissioning needs to look at the range of treatment services available to increase choice  Agencies have to play a positive role in educating/communicating