Stigma is a major reason why people facing substance use challenges, and their families, often hesitate to seek mental health support. A recent literature review on the Experience of Family Members of Relatives With Substance Use Disorders (May 2024*) emphasized this point, highlighting stigma as a significant barrier to accessing help for both individuals with Substance Use Disorders (SUDs) and their families. One statement from the review caught our attention:
*Source: (Monari, E. et al. May 2024. Experience of Family Members of Relatives With Substance Use Disorders: An Integrative Literature Review. DOI: 10.1177/10784535241252169 found here: /https://journals.sagepub.com/doi/pdf/10.1177/10784535241252169)
“The experiences of family members across different studies revealed various forms of stigma, from social isolation to self-imposed secrecy and feelings of shame and guilt.”
Let's unpack this a bit.
Self-Imposed Stigma: Not Your Fault
When we talk about “self-imposed” stigma, it suggests that the shame and guilt experienced are somehow a choice, implying that it’s the individual's fault. This interpretation can be damaging, as it overlooks the very real and harmful experiences that youth and adults face when seeking support.
The Britannica Dictionary defines self-imposed as “required by you of yourself: not given to you by someone else; voluntary.” But here’s the thing: while it may seem voluntary, it’s often a result of external pressures, current policies that criminalized families, and societal judgment, not a personal choice.
Read our report here to experience some of the stories shared with us, including:
"I didn't reach out for help because I didn't want my siblings and I to end up in foster care."
"I didn't reach out because I was called an enabler one too many times by professionals".
'I want people to know how much criminalization hurts"
Maybe "Self-imposed stigma" has gotten confused with self-stigma, but they really do have distinct meanings. Self-imposed implies a sense of personal responsibility for the shame and guilt they feel. But, if the driver of the shame and guilt is external judgments, lack of support, or harmful interactions, is that really "self-imposed?
In contrast, self-stigma is the process by which individuals internalize and accept negative stereotypes and discrimination directed at them, leading to diminished self-esteem and self-worth. While self-imposed stigma focuses on the perceived voluntary nature of the shame, self-stigma highlights the internal acceptance of societal negativity, both of which significantly impact mental health and willingness to seek support
Structural Stigma: A Bigger Picture
Even if past experiences of being shamed or guilted don’t guarantee it will happen again, structural stigma means that people often continue to face shame, blame, and marginalization from those in positions of power, creating a distrust of systems and fear of harm. This ongoing issue significantly hinders access to essential services and affects the mental health, decision-making, and overall well-being of family members (Clement et al., 2015; O’Shay-Wallace, 2019; Tsai et al., 2019). This shame, guilt, and secrecy is not self imposed, it's a survival mechanism-if I don't share, I wont to get hurt, I wont be shunned to the margins, I wont be told its my fault that my family is struggling.
Did the article dive into some (already highlighted), but decent points? YES.
Impact on Families:
The behaviors associated with SUDs have profound effects on family dynamics.
Support Needs: There’s a critical need for structured support programs, education initiatives, and collaborative efforts.
Children and Caregivers: Parental SUDs significantly impact children, causing stress for caregivers and affecting family relationships.
Tailored Approaches: Community reinforcement, family training, and culturally responsive treatments are essential.
Proposed Solutions
To effectively support families dealing with substance use issues, the review suggests several strategies:
Comprehensive Support Systems: Develop tailored, evidence-based interventions.
Community and Family Training: Empower families with solution-focused approaches.
Integrated Services: Address the intersections of homelessness, mental health, and substance use.
Holistic Support: Consider the emotional turmoil family members face.
Improved Service Delivery: Enhance health and social care services.
Combat Stigma: Implement policies, educational programs, and awareness campaigns.
Support Programs: Develop and promote supportive programs for families.
Collaborative Efforts: Encourage collaboration between various stakeholders.
Cultural Responsiveness: Promote culturally appropriate approaches in treatment.
Early Intervention: Invest in prevention and early intervention programs.
Research and Coordination: Support research on effective interventions and create coordinated responses across sectors.
Moving Forward
At Starlings, we recognize the critical importance of breaking down stigma and providing unwavering support to youth growing up with parents struggling with substance use. This review highlights all of that. But, the literature greatly influences current beliefs, policies, and practices, so we must be mindful of how we frame the experiences, emotions, thoughts, and behaviours of families striving to survive. But stigma is real, and it's not self-imposed, but it does get internalized by the repetitive negative experiences families have when seeking out support.
So, if you are a family member, particularly a youth growing up with the stress and stigma of a parent's substance use, it's not your fault.
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