LESSON 3 - SUBSTANCE USE, ADDICTIONS, MENTAL HEALTH,

STIGMA AND DISCRIMINATION AND IN THE WORKPLACE

INTRODUCTION

Many people don't understand why or how other people become addicted to drugs. They
may mistakenly think that those who use drugs lack moral principles or willpower and that they
could stop their drug use simply by choosing to. In reality, drug addiction is a complex disease,
and quitting usually takes more than good intentions or a strong will. Drugs change the brain in
ways that make quitting hard, even for those who want to. Fortunately, researchers know more
than ever about how drugs affect the brain and have found treatments that can help people
recover from drug addiction and lead productive lives.

LEARNING OUTCOMES: At the end of this lesson, you should be able to:

1. Know the nature of substance use and addictions

2. Understand the different ways of substance abuses

3. Appreciate the nature of mental illness and avoiding stigmatization

4. Understand the ways of improving mental health in the workplace

COURSE MATERIALS

What Is drug addiction?

Addiction is a chronic disease characterized by drug seeking and use that is compulsive,
or difficult to control, despite harmful consequences. The initial decision to take drugs is
voluntary for most people, but repeated drug use can lead to brain changes that challenge an
addicted person’s self-control and interfere with their ability to resist intense urges to take drugs.
These brain changes can be persistent, which is why drug addiction is considered a "relapsing"
disease—people in recovery from drug use disorders are at increased risk for returning to drug
use even after years of not taking the drug.

It's common for a person to relapse, but relapse doesn't mean that treatment doesn’t
work. As with other chronic health conditions, treatment should be ongoing and should be
adjusted based on how the patient responds. Treatment plans need to be reviewed often and
modified to fit the patient’s changing needs.

What happens to the brain when a person takes drugs?

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 Most drugs affect the brain's "reward circuit," causing euphoria as well as flooding it with
the chemical messenger dopamine. A properly functioning reward system motivates a person to
repeat behaviors needed to thrive, such as eating and spending time with loved ones. Surges of
dopamine in the reward circuit cause the reinforcement of pleasurable but unhealthy behaviors
like taking drugs, leading people to repeat the behavior again and again.

The brain’s reward circuit

As a person continues to use drugs, the brain adapts by reducing the ability of cells in
the reward circuit to respond to it. This reduces the high that the person feels compared to the
high they felt when first taking the drug—an effect known as tolerance. They might take more of
the drug to try and achieve the same high. These brain adaptations often lead to the person
becoming less and less able to derive pleasure from other things they once enjoyed, like food,
sex, or social activities.

Long-term use also causes changes in other brain chemical systems and circuits as
well, affecting functions that include:

 learning
 judgment
 decision-making
 stress
 memory
 behavior

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 Despite being aware of these harmful outcomes, many people who use drugs continue to
take them, which is the nature of addiction.

Why do some people become addicted to drugs while others don't?

No one factor can predict if a person will become addicted to drugs. A combination of
factors influences risk for addiction. The more risk factors a person has, the greater the chance
that taking drugs can lead to addiction. For example:

Biology. The genes that people are born with account for about half of a person's risk
for addiction. Gender, ethnicity, and the presence of other mental disorders may also influence
risk for drug use and addiction.

Environment. A person’s environment includes many different influences, from family

and friends to economic status and general quality of life. Factors such as peer pressure,
physical and sexual abuse, early exposure to drugs, stress, and parental guidance can greatly
affect a person’s likelihood of drug use and addiction.

Development. Genetic and environmental factors interact with critical

developmental stages in a person’s life to affect addiction risk. Although taking drugs at any age
can lead to addiction, the earlier that drug use begins, the more likely it will progress to
addiction. This is particularly problematic for teens. Because areas in their brains that control
decision-making, judgment, and self-control are still developing, teens may be especially prone
to risky behaviors, including trying drugs.

Can drug addiction be cured or prevented?

As with most other chronic diseases, such as diabetes, asthma, or heart disease,
treatment for drug addiction generally isn’t a cure. However, addiction is treatable and can be
successfully managed. People who are recovering from an addiction will be at risk for relapse
for years and possibly for their whole lives. Research shows that combining addiction treatment
medicines with behavioral therapy ensures the best chance of success for most patients.
Treatment approaches tailored to each patient’s drug use patterns and any co-occurring
medical, mental, and social problems can lead to continued recovery.

More good news is that drug use and addiction are preventable. Results from NIDA-funded
research have shown that prevention programs involving families, schools, communities, and
the media are effective for preventing or reducing drug use and addiction. Although personal
events and cultural factors affect drug use trends, when young people view drug use as harmful,
they tend to decrease their drug taking. Therefore, education and outreach are key in helping
people understand the possible risks of drug use. Teachers, parents, and health care providers
have crucial roles in educating young people and preventing drug use and addiction.

Stigma, Prejudice and Discrimination Against People with Mental Illness

More than half of people with mental illness don't receive help for their disorders. Often,
people avoid or delay seeking treatment due to concerns about being treated differently or fears

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of losing their jobs and livelihood. That's because stigma, prejudice and discrimination against
people with mental illness is still very much a problem.

Stigma, prejudice and discrimination against people with mental illness can be subtle or
it can be obvious—but no matter the magnitude, it can lead to harm. People with mental illness
are marginalized and discriminated against in various ways, but understanding what that looks
like and how to address and eradicate it can help.

The Facts on Stigma, Prejudice and Discrimination

Stigma often comes from lack of understanding or fear. Inaccurate or misleading media
representations of mental illness contribute to both those factors. A review of studies on
stigma shows that while the public may accept the medical or genetic nature of a mental health
disorder and the need for treatment, many people still have a negative view of those with mental
illness.

Researchers identify different types of stigma (See chart below).

 Public stigma involves the negative or discriminatory attitudes that others have about
mental illness.
 Self-stigma refers to the negative attitudes, including internalized shame, that people
with mental illness have about their own condition.
 Institutional stigma, is more systemic, involving policies of government and private
organizations that intentionally or unintentionally limit opportunities for people with
mental illness. Examples include lower funding for mental illness research or fewer
mental health services relative to other health care.

Stigma not only directly affects individuals with mental illness but also the loved ones who
support them, often including their family members.

Stigma around mental illness especially an issue in some diverse racial and ethnic
communities and it can be a major barrier to people from those cultures accessing mental
health services. For example, in some Asian cultures, seeking professional help for mental
illness may be counter to cultural values of strong family, emotional restraint and avoiding
shame. Among some groups, including the African American community's, distrust of the mental
healthcare system can also be a barrier to seeking help.

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 Media representations of people with mental illness can influence perceptions and
stigma, and they have often been negative, inaccurate or violent representations. A study
published in April 2020 looked at a recent example, the popular film Joker (2019), which
portrays the lead character as a person with mental illness who becomes extremely violent. The
study found that viewing the film "was associated with higher levels of prejudice toward those
with mental illness." Additionally, the authors suggest, "Joker may exacerbate self-stigma for
those with a mental illness, leading to delays in help seeking."

The stigma of mental illness is universal. A 2016 study on stigma concluded "there is no

country, society or culture where people with mental illness have the same societal value as
people without mental illness."

Harmful effects of stigma and discrimination

Stigma and discrimination can contribute to worsening symptoms and reduced likelihood
of getting treatment. A recent extensive review of research found that self-stigma leads to

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negative effects on recovery among people diagnosed with severe mental illnesses. Effects can
include:

 reduced hope
 lower self-esteem
 increased psychiatric symptoms
 difficulties with social relationships
 reduced likelihood of staying with treatment
 more difficulties at work

A 2017 study involving more than 200 individuals with mental illness over a period of two
years found that greater self-stigma was associated with poorer recovery from mental illness
after one and two years.

An editorial in the Lancet notes that the impacts of stigma are pervasive, affecting political
enthusiasm, charitable fundraising and availability, support for local services and underfunding
of research for mental health relative to other health conditions.

Some of the other harmful effects of stigma can include:

 Reluctance to seek help or treatment and less likely to stay with treatment
 Social isolation
 Lack of understanding by family, friends, coworkers, or others
 Fewer opportunities for work, school or social activities or trouble finding housing
 Bullying, physical violence or harassment
 Health insurance that doesn't adequately cover your mental illness treatment
 The belief that you'll never succeed at certain challenges or that you can't improve your
situation

Stigma in the Workplace

A 2019 national poll from the American Psychiatric Association (APA) found that mental
health stigma is still a major challenge in the workplace. About half of workers were concerned
about discussing mental health issues at their jobs. More than one in three were concerned
about retaliation or being fired if they sought mental health care.

Only about only about one in five workers were completely comfortable talking about
mental health issues. The poll found a generational divide: millennials were almost twice as
likely as baby boomers to be comfortable (62% vs. 32%) discussing their mental health.

On a more positive note, about half of workers were at least somewhat comfortable
talking about mental health and most workers said they would help guide a troubled co-worker
to mental health resources. However, even among those willing to help, about one in four
workers said they would not know where to turn for mental health help.

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Addressing Stigma

Research shows that knowing or having contact with someone with mental illness is one
of the best ways to reduce stigma. Individuals speaking out and sharing their stories can have a
positive impact. When we know someone with mental illness, it becomes less scary and more
real and relatable.

A 2016 review of research on addressing stigma concluded that efforts to reduce stigma
and discrimination can work at the personal and population levels. The strongest evidence was
for anti-stigma efforts involving contact with individuals with lived experience with mental illness
and efforts with a long-term commitment.

Many celebrities, such as Demi Lovato, Dwayne "The Rock" Johnson, Michael Phelps,
Taraji P. Henson and Lady Gaga have publicly shared their stories of mental health challenges
and brought the discussion much more into the general media and everyday conversation.
Young people are looking for information and for these personal stories online.

A 2020 national survey of 14- to 22-year-olds found that 90 percent of teens and young
adults experiencing symptoms of depression are researching mental health issues online and
most are accessing other people's health stories through blogs, podcasts, and videos. About
three in four young teens seeking information online about depression said they were looking for
personal anecdotes from people who had suffered in the past.

Social marketing campaigns can also be effective. For example, a research study looked
at the effectiveness of an anti-stigma social marketing campaign in California and found that the
campaign increased service use by helping people better understand symptoms of distress and
increasing awareness that help is available. The researchers estimated that if all adults with
probable mental illness were exposed to the California mental health campaign, 47% would
receive mental health treatment. If the same adults were not exposed to the campaign, 36%
would receive treatment.

The National Alliance on Mental Illness (NAMI) offers some suggestions about what we
can do as individuals to help reduce the stigma of mental illness:

 Talk openly about mental health, such as sharing on social media.

 Educate yourself and others – respond to misperceptions or negative comments by
sharing facts and experiences.
 Be conscious of language – remind people that words matter.
 Encourage equality between physical and mental illness – draw comparisons to how
they would treat someone with cancer or diabetes.
 Show compassion for those with mental illness.
 Be honest about treatment – normalize mental health treatment, just like other health
care treatment.
 Let the media know when they are using stigmatizing language presenting stories of
mental illness in a stigmatizing way.

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  Choose empowerment over shame - "I fight stigma by choosing to live an empowered
life. to me, that means owning my life and my story and refusing to allow others to
dictate how I view myself or how I feel about myself." – Val Fletcher, responding on
Facebook to the question, How do you fight stigma?

While stigma and discrimination are still prevalent in the workplace, employers are
increasingly addressing stigma against mental illness. The APA Foundation's Center for
Workplace Mental Health emphasizes the importance of both robust health care services and
specific efforts to break the silence that surrounds the topic of mental illness.

The Center for Workplace Mental Health suggests organizations strive to "create a culture in
which mention of depression, anxiety, post-trauma, and other common illnesses become as
mentionable as diabetes, hypertension, and migraines."

Employers who are leading efforts to address stigma offer some suggestions:

 Tailor programs/approaches to your company culture and existing strengths.

 Mention your commitment to leading a behaviorally healthy workplace every time you
mention the company's commitment to its overall culture of health, attracting and
retaining the best talent, and valuing its employees, etc.
 Train leaders to identify emotional distress and make referrals and to responding
promptly and constructively to behavioral performance issues.
 Be welcoming of the need for accommodations. Train managers to respond
appropriately.

SUGGESTED READINGS/REFERENCES:

Understanding Drug Use and Addiction DrugFacts.

[Link]

Stigma, Prejudice and Discrimination Against People with Mental Illness.

[Link]

ACTIVITIES/ASSESSMENT: (Group Work)

1. Why do some people develop substance-related disorders?

2. How does substance abuse affect personal, family, and occupational functioning?
3. Given that mental health stigma is high in the Philippines, what areas in the field of
Psychology could this stigma affect, especially in terms of access to care? For example:
free services, clients wanting discount, and offering pro-bono.

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