Research is like insurance, it is often sold but seldom bought.

Robert 0. Phillips, NAADAC Southwest Regional Vice President, Committee Workshop, September 8, 1997, Albuquerque, NM

Effects of Stigma

Stigma is a special problem for the drug abuse treatment field in many ways. As with other chronic, relapsing medical conditions, there is no cure for addiction, but the existing treatments allow for successful management of addiction and prevent the development of more expensive medical disorders. The major difference is the public's perception of chronic diseases, such as hypertension, diabetes, and asthma as clearly medical conditions, where addiction is more often viewed as a social problem or character deficit. There is no serious argument against supporting health care systems for hypertension, diabetes, or asthma, but there is still much debate regarding support for treatments of addiction (O'Brien and McLellan, 1996).

People who work in drug abuse treatment programs may face a very personal problem of stigma. In many places working in this field is considered a mark of failure. The existence of the programs is often in doubt. Public drug treatment programs often are inadequately funded and staffed and have long waiting lists. The NIMBY syndrome defeats many efforts to site new drug treatment facilities (see Chasnoff et al., 1996, and Box 2.3).

There are few advocates for drug abuse treatment. Persons who have other chronic disorders, or who have family members with those disorders, benefit from disease specific advocacy efforts like the American Heart Association, the American Cancer Society, or the American Lung Association. These organizations educate the public about these disorders, and they provide some (although usually limited) direct services to their "victims." They raise money to support research and educate policymakers to help obtain additional funds for research and treatment. Because people see those with heart disease, cancer, or birth defects as "victims," they are willing to contribute through private channels and with tax moneys to fight those disorders. Unlike these fields in which patient groups provide a strong voice for treatment and research, generally little is heard from people who suffer from addictive disorders.

Some advocacy groups have been successful however. The Gay Men's Health Crisis and other AIDS advocacy groups have been very successful



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