Framing Matters: How Sharing Personal Stories May Help Dismantle Addiction Stigma and Increase Access to TreatmentAmy Edmonds
Sheena is a young woman raising two young sons on her own in North Carolina. She ferries her children to daycare, prepares their meals, and every week makes her way to UNC Horizons at Sunrise Drug Treatment Center for substance-use screening. Sheena was introduced to opioids as a teenager and struggled with addiction until after the birth of her younger son, who was born with neonatal abstinence syndrome (NAS). His birth was a critical time for intervention; it wasn’t until after her son’s birth that she received the integrated and supportive addiction care she needed. Tragically, although substance-use disorder is preventable and treatable, only a small fraction of people with addiction issues receive care. Sheena was recently featured in a segment by PBS that highlights both her immense struggles and her bright outlook; the story concludes with Sheena telling the special correspondent, “I’ve come so tremendously far.”
Sheena’s challenges with opioid addiction during pregnancy are not uncommon. In the midst of an opioid epidemic, NAS is becoming a growing burden across the U.S., especially in rural communities. In West Virginia, over 3% of babies are born with NAS; as a nation, NAS incidence has increased by 300% between 1999 and 2013. The rise of NAS is not only linked to an increase in child protective services cases, it also incurs higher costs for the state, because NAS-affected babies often spend upwards of two weeks in hospital care. Compassionate, integrated care strategies have the potential to mitigate development disadvantages among children born with NAS. These involve treating addiction issues in parents and providing comprehensive support for families in recovery.
Unfortunately, common personal, provider, and policy level responses create roadblocks to successful addiction treatment. Many clinicians are underprepared to address addiction issues at the primary care level. Patients with substance-use disorders often struggle with mental health conditions and are more likely to experience financial barriers to health care, and they too frequently rely on health systems that are poorly equipped and unprepared to provide high-quality care for them. What’s more, policies may serve to further stigmatize these conditions. For example three states criminalize women who give birth to babies with NAS. That is why sharing individual stories is so important; they humanize issues, resulting in more thoughtful and compassionate policy.
Speaking to Washington state legislators and watching a committee meeting in session, I recently witnessed the critical role that stories can play in the policymaking process. Prior to voting, a number of representatives stood up to tell stories, hoping to persuade colleagues either to support or decline new legislation. My fellow graduate students and I were told that sharing experiences is a crucial part of engaging legislators when lobbying in support of health and social justice related bills.
Last year, two graphic images of opioid overdose with child bystanders became viral. Photos are powerful, but how often do they help tell a nuanced story or highlight promising solutions? When it comes to stigmatized health issues such as addiction, there are two critical elements that seem to be missing from the public narrative – treatment and recovery. Dr. Emma McGinty and colleagues found that less than 5% of news stories on opioid addiction described expanding treatment. In another study, she and colleagues showed how portrayals of successful mental illness and drug addiction treatment could reduce discrimination and stigma against people with these conditions. For example, when presented with narratives of successfully treated schizophrenia, prescription painkiller addiction, and heroin addiction, participants had less desire for social distance and greater belief in treatment effectiveness. They were also less likely to discriminate against people with these conditions. The presentation of Sheena’s story on PBS was unique because not only did it reveal an intimate struggle with opioid addiction, it focused on the treatment and recovery process. Her story stands in deep contrast to other media coverage I have seen. It elicits a different emotional response that will perhaps lead to more effective policy.
Although news outlets may not curb their reactionary approaches, more than ever, we need narratives around addiction that elevate effective practices and change leaders. Are you interested in using the power of storytelling to garner support for addressing a stigmatized population health issue, such as addiction? The Berkeley Media Studies Group is an organization that empowers population health practitioners with knowledge around framing health issues for policy impact. Another organization working toward this goal is Solutions Journalism Network, a community of journalists dedicated to reporting how people address problems like substance disorders and other urgent health issues. As highlighted in a recent article by Hatzenbuehler and Phelan, stigma deserves greater attention as a social determinant of health. Population health researchers can advance action by further exploring how stigma shapes health policy and outcomes, and ensuring that more stories of hope and recovery are told.