When it comes to substance abuse disorders, public health and the public at-large are hardly on the same page — in fact, they’re not even reading the same book. And that’s a serious problem for sustaining and strengthening efforts to treat addiction and advancing effective public health policy.
“We already know quite a bit about public attitudes toward mental illness and we were interested in learning more — especially in the context of prescription (painkiller) drug abuse — about what the public thinks about issues related to drug addiction,” Colleen Barry, who recently co-authored a study on how the public views drug addiction versus mental illness, told me. “The attitudes of the public can be linked in important ways to broader support for policy action.”
In the study, which was recently published in the journal Psychiatric Services, Barry and colleagues surveyed a representative sample of more than 700 U.S. adults, asking a variety of questions about stigma, social distancing and the acceptability of discrimination. For example, researchers asked questions such as: Would you be willing to have a person with mental illness/drug addiction marry into your family? Would you be willing to have a person with mental illness/drug addiction start working closely with you on a job? Do you favor or oppose requiring insurance companies to offer benefits for the treatment of drug addiction/mental illness that are equivalent to benefits for other medical services? And do you agree that landlords should be able to deny housing to a person with drug addiction/mental illness? Overall, the study found that respondents held significantly more negative views of drug addiction than of mental illness.
Specifically, researchers found that 62 percent of respondents said they’d be willing to work with someone living with a mental illness, but only 22 percent would be willing to work with someone living with addiction. Twenty-five percent said employers should be able to deny employment to people with mental illness; 64 percent said the practice should be allowed regarding drug addiction. Twenty-one percent of respondents opposed offering insurance parity for mental illness, while 43 percent opposed such parity for patients with drug addiction. Fifty-four percent thought landlords should be allowed to refuse housing to people with drug addiction, while 15 percent had a similar view about people with mental illness. Overall, researchers found higher opposition to public policies aimed at helping people struggling with drug addiction when compared to policies in support of people with mental illness. However, respondents did seem to agree in one area: About one in three believe that recovery from either drug addiction or mental illness is impossible.
Study co-authors Barry, Emma McGinty, Bernice Pescosolido and Howard Goldman write:
Less sympathetic views may result at least in part from societal ambivalence about whether to regard substance abuse problems as medical conditions to be treated (similar to other chronic health conditions, such as diabetes or heart disease) or personal failings to be overcome. More so than mental illness, addiction is often viewed as a moral shortcoming, and the illegality of drug use reinforces this perspective. It is likely that socially unacceptable behavior accompanying drug addiction (for example, impaired driving and crime) heightens society’s condemnation.
“It was surprising to me how negative the attitudes were,” said Barry, an associate professor in the Departments of Healthy Policy Management and Mental Health at Johns Hopkins Bloomberg School of Public Health. “From a policy perspective, we tend to roll mental illness and addiction together…but the way the public thinks about them is very different — more different than I would have expected.”
In efforts to reduce societal stigmas around drug addiction, Barry called for better public information about the treatability of drug addiction and media coverage that more accurately portrays the face of addiction. For example, many people might automatically associate drug addiction with the image of a strung-out drug user living on the streets. But that image misconstrues the growing reality of drug addiction and the idea that drug addiction can happen to anyone and in all walks of life, Barry told me. In fact, such a stereotypical image of addiction could significantly impact public support for policy action at a time when public health practitioners are struggling to contain increases in prescription painkiller and heroin-related deaths and overdose. In addition, such societal attitudes often prevent those who need treatment for addiction from seeking help. Barry noted that currently, less than 10 percent of people with an addiction disorder seek any treatment at all.
“We have a whole new population that needs treatment that is not going to get into treatment in the context of broader social attitudes,” she said, referring to the prescription painkiller abuse epidemic. “So this is a huge issue. …Public support plays a major role in determining which public policies get advanced and which don’t. When we look at the state of the substance abuse treatment system, it’s terribly underfunded and part of that has to do with an underlying lack of support among the public.”
To address the problem, the study calls for “portraying addiction or mental illness as treatable.” In this realm, Barry noted that with advancements in mental health treatments, such as the availability of selective serotonin reuptake inhibitors (SSRIs) to treat depression and anxiety, people became more comfortable talking publicly about their struggles with mental illness and thus, stigmas around mental health begin to break down. Unfortunately, on the addiction side, we’re behind in both treatment and public acceptance, she noted.
However, the arrow between public opinion and policy change is bidirectional, Barry tells me. In other words, policy can help shift public attitudes as well. She’s talking about the Affordable Care Act, which now requires insurance companies participating in the new health insurance marketplace to cover mental health and substance abuse services as essential benefits. Such a high-profile policy change could go a long way in mainstreaming mental health and addiction treatment, Barry said. Still, public attitudes on drug addiction seem far from the public health perspective that considers addiction a chronic disease.
“We need to transform the stories of addiction in our country,” she said. “We need to be more involved in communicating a more true face of what addiction looks like in the U.S. and how treatment can benefit individuals, and that includes influencing how the news media covers these issues as well as how politicians talk about this issue. We need to change the narrative to one of a chronic disease that can benefit from ongoing, effective treatment.”
To read more about the study, visit the Johns Hopkins Bloomberg School of Public Health.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.