Residential and Outpatient Handbook - Plymouth - 25

Early recovery from substance use disorder is going to
involve pain. As in childbirth, pain is to be expected-
but when the initial painful labor is completed, a new
life will begin. So the first step is having the courage to
experience some initial discomfort, understanding that
pain can be an indicator of progress.
Stigmatized groups and
self-acceptance
Examining other stigmatized groups can offer us some
clues as to how people with substance use disorder can
overcome their stigma. Some individuals in stigmatized
groups adopt and internalize society's beliefs. Despite
being considered different by the general population,
they maintain a sense of self-normalcy and selfacceptance.
In Stigma, Goffman noted " insulated by his
alienation, protected by identity beliefs of his own, he
[the stigmatized person] feels that he is a full-fledged
normal human being, and that we are the ones who are
not quite human. He bears a stigma but does not seem
to be impressed or repentant about doing so. " 6
Just as individuals in stigmatized groups are able to feel
normal and accept themselves, so are many people with
substance use disorder. The question is, " How do I do it? "
Goffman lists two conditions that characterize groups of
people who maintain a sense of self-acceptance despite
their social stigma.
1. They are insulated by alienation.
2. They are protected by identity beliefs of their own.
The following example will help us better understand
the relationship between identity beliefs and selfacceptance.
Sue
and Jill are eight-year-old identical twins about
to fly in a jet for the first time. While Sue anticipates a
thrilling roller coaster ride, Jill has visions of crashing
into a mountain. What accounts for the different
reactions? Their beliefs about flying differ, and so do
their emotional responses. If Jill could adopt Sue's
beliefs about flying, her fear would be transformed to
excitement.
Similarly, some recovering people with substance use
24
disorder are filled with shame while others are selfaccepting.
The condition is the same but the feelings are
different. Those consumed by shame have internalized
society's stigmatized belief that they are weak and
immoral. Those who are self-accepting have been able to
replace beliefs that they are worthless with beliefs that
reinforce personal value.
The disease concept
Understanding the disease concept of substance use
disorder will help the stigmatized person overcome
feelings of self-blame and shame. The disease concept
defines substance use disorder as an involuntary
condition caused by factors largely outside a person's
control. As we begin to believe we are victims instead
of moral degenerates, feelings of shame will give way
to self-acceptance. Because substance use disorder
was often considered a moral issue, pioneers of the
disease concept faced strong opposition. Until the
1940s, professionals advocating the disease concept
often encountered the same criticism as the sufferers
themselves. Today, it is widely accepted by both
physicians and professional groups. Most general
practitioners believe alcoholism is a disease, and so
do the American Medical Association, American
Psychiatric Association, American Public Health
Association, American Hospital Association, American
Psychological Association, National Association
of Social Workers, World Health Organization and
American College of Physicians.
While acceptance of the disease concept has grown, it's
still controversial. Although substance use disorder may
not fit a rigid definition of a disease, it's important to
understand why it is considered a disease.
It's primary
Substance use disorder is a primary problem that must
be treated directly. For years substance use was believed
to be a secondary problem usually caused by deep
emotional trauma. It was assumed that when emotional
problems were addressed, the substance use would fade
away. This approach did not work. Substance use often
causes mental, emotional and physical problems that
will often disappear when abstinence is achieved.
Residential and Outpatient Handbook - Plymouth

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