Dr. Stephanie J. Wong, PhD – Clinical Psychologist – Veterans Hospital – Addiction

Stigma of Addiction

Charles:

Hello and welcome. I have with me today Dr. Stephanie J. Wong, PhD is a Licensed Clinical Psychologist who works in a private practice in California as well as the Veterans Hospital. She specializes in treatment of addictions, career and relationship issues. We will be discussing the Stigma of Addiction. Hello Dr Wong, how are you today?

Stephanie:

Great! Thank you for having me!

Charles:

It is our pleasure to have you here; thank you for joining us. I would like to start by letting the readers get to know a little about you and what you do. Can you tell us a little about yourself?

Stephanie:

I work with veterans in a Veteran Hospital. I work in a Vocational Rehabilitation Program that works with veterans on gaining employment. This entails working with veterans with co-morbid diagnoses. One of the primary presenting problems are Substance Use Disorders

I also work in the community in private practice with a number of people struggling with similar issues.

Charles:

Excellent so in your day to day work you come in contact with many issues dealt with by people with substance abuse disorders and their loved ones. I am very interested in the employment element as it pertains to the stigma of addiction. Do you find that known substance abusers have a harder time finding employment?

Stephanie:

It is very difficult to find and maintain employment when you have a history of SUD’s.

Typically, individuals are struggling with other underlying issues, such as depression, anxiety (e.g., PTSD), severe mental illness substances are often used as a coping mechanism for these issues.

Charles:

The stigma of addiction is clearly a real thing. From your experience once an individual is in treatment does being unable to get gainful employment further delay their recovery and if so how?

Stephanie:

Employment provides individuals with a sense of meaning, purpose, in addition to boosting their self-confidence

Stephanie:

It provides them with extra income depending on where they are in their recovery, it could be very beneficial to work As you know, coming to work under the influence is not beneficial to maintaining employment So I assist individuals in developing and implementing beneficial work behaviors

Charles:

I understand that for every individual the length of time and support required will vary; is there any current way for someone with SUD’s to imporve their chances of success at gaining employment and breaking the stigma they may have on themselves. I am referring mainly to individuals that have shown positive advances in their own treatment and rehabilitation and although still stigmatized are very much capable of being a great addition to the workforce.

Stephanie:

Surrounding themselves with a support network is one of the most important things. Working a Vocational Rehabilitation Specialist, a Clinical Psychologist, and interacting with peers who support recovery is key!

The Vocational Rehabilitation Specialist (with person’s permission) can assist him/her in negotiating work schedules, conditions, etc.

Clinical Psychologist can address mental health and psychosocial issues.

Peers reduce the chances that the individual will stay isolated.

Having a social life in addition to work teaches individuals that there is more to life!

Charles:

In many cases recovering individuals with SUD’s find themselves in a circle of individuals walking through the same path in life. This may be the case due to relationships built in a rehab center or support networks such as NA and other support groups. What has always aroused my curiosity is if this actually helps or hinder them when it comes to interacting beyond their new found circles and if this further stigmatizes them or supports them. What is your take on this subject?

Stephanie:

It depends. (Re)-building relationships with family, friends, sons, daughters, etc. have a profoundly positive impact on one’s recovery building and keeping that trust motivates individuals to maintain their sobriety again, I assist them in weighing the pros/cons of connecting with specified individuals or groups.

You have to ask the fundamental questions: Is this person sober? Is he/she knowledgeable about your recovery? Is he/she supportive?

Some individuals have fears about reconnecting with their children. They may not feel ready to take on that parental role. In this instance, it may be a challenge to their recovery if they connect with others and they cannot responsibly engage with them

Charles:

Basically if I am understanding correctly as a clinician you ensure that they do not put their recovery at risk by over extending themselves or placing themselves in at risk situations. In terms of stigma though; do you feel that whom they select to interact with will impact the way a potential employer may look at them; possibly also how family members may look at them?

Stephanie:

There are many instances that employers do not know about an individual’s SUD history. However, experiencing a SUD and the resulting damage (e.g., using, homelessness, stealing, not keeping commitments), there may be stigma on the part of family and possibly, employers who have experienced the aforementioned

Some family members have a limited understanding of addiction they may focus on the individual’s behaviors vs. individual struggling with a disease when someone has a heart attack, friends and family tend to be concerned and supportive but when someone is diagnosed with a SUD, it is more difficult to grapple with; a lot of time as a result of the damage

Charles:

I can completely agree with you on this having had a family member suffer from heart problems; the disease impacted his ability to work but unlike the way society and family members look at the damage caused by addiction; (which is also classed as a disease) the family was supportive and understanding even when the disease negatively impacted them. With this in mind what is this best way to root out stigma especially within a family dynamic?

Stephanie:

Involving one’s family in treatment (if they are willing) can substantially help; also opening up dialogue and taking ownership for some of the things that that person has done
that is not to say he/she was not ill, but the perception of addiction, as mentioned is viewed differently than other diseases and there are some reparations that need to be made to reduce stigma that way this can open communication to psycho-education Another activity, bring a family member to a meeting or encourage Al-anon or Gam-anon

Charles:

So unlike other diseases it seems the SAU has to take on more of the blame – unlike possibly someone with cancer or another disease where one would not have to do so. It feels as though society consistently interprets a substance users disease as self-inflicted. Is this an accurate or inaccurate perception?
Or any addiction for that matter.

Stephanie:

To an extent, yes. I never like to generalize, as I promote examining different variables and perspectives. There are many instances where loved ones may view it as self-inflicted

The individual may even consider it self-inflicted

Psycho-education and psychotherapy assists individuals in exploring the ‘root causes’ of their substance use maybe he/she has anxiety in social situations and wants to be accepted for instance.

Charles:

I would like to veer us back a little to the self-inflicted versus not self inflicted argument. From your experience and studies: Is addiction generally self-inflicted or is it a matter of some individuals having a higher susceptibility to addiction?

Stephanie:

It is a bit of both. Some people begin using to party and fit in. Some people use and don’t become ‘fully’ addicted or do not meet full criteria for a SUD. There are many people that at risk for developing an addiction–parents used, family members use/used; also environment exposed to during development; parents excessively drinking or requesting the child “bring them a beer” there is that interaction between the age old nature vs. nurture

Charles:

You bring up an important with nature vs nurture; I would like to compare for a moment the disease to a disease such as cancer. I do want you to correct me if I am wrong which is one of the reasons I have you (a professional in the field) here. Someone who has been living in an environment conducive to cancer or working in an environment that may increase the risk of cancer is not blamed for such a thing especially if the individual was not aware of such risks. Would you say that on the other hand an individual who might have grown up in a substance abuse or addiction lifestyle household has also been exposed unintentionally?

Stephanie:

Many cases, yes. Children tend to come in the world expecting their parents to protect them. They may then expect that this is a ‘normal’ environment parents may also drink and use in response to stress; this becomes the modeled coping strategy

Charles:

So part if recovery is remoulding and rebuilding new coping mechanisms that were through no fault of their own programmed into them? In a sense a lot of the stigma might be misdirected due to not considering this fact?
(in cases where this is the case of course)

Stephanie:

Programmed, meaning modeled or taught. Consideration of this background variable, could foster empathy in others and not ‘judge’ the individual as much

Charles:

I believe empathy is a very important skill for all of us to have and I assume it is an important tool in helping individuals with SUD’s and addiction be more accepted. I appreciate you taking the time to have this conversation with me today. You have been a phenomenal guest so before we end our conversation I want to ask you a difficult question that I think will be important to our readers. What in your opinion is the single most important thing for an addict and their loved ones to understand about addiction to reduce the stigma surrounding it?

Stephanie:

It is a complicated disease, which is a symptom of an underlying problem that requires a variety of sources of support, including recovery groups, possibly medication (e.g., for depression, anxiety, psychosis), loved ones, friends, inpatient programs, outpatient programs, individual psychotherapy, etc.

Charles:

I would like to thank you for your time with us today and your insightful answers.

Stephanie:

Thank you, Charles! It was a pleasure!