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Consider this. Addiction is still not embraced as an illness by individuals, families, and institutions alike, including healthcare organizations. As a result, if someone admits to having an addiction to alcohol, opiates/opioids, and other drugs, they are likely to experience a health-related stigma and significant barriers to care. JD Livingston defines health-related stigma as a “process in which social groups are devalued, rejected and excluded [from services] on the basis of a socially discredited health condition” (Livingston et al. 2011, brackets and bold added). He explains that health-related stigma manifests on three distinct levels:

  • Intrapersonal or “self-stigma”
  • Interpersonal or “social stigma”
  • Institutional or “structural stigma”

In other words, addiction is still a socially-discredited health condition, which has profoundly negative outcomes.

Let’s examine how this plays out in everyday life and how each form (or layer) of stigma inhibits our ability as a society to transform addiction and overdose from a shameful experience to a casserole illness and event. Self-stigma occurs within the individual who struggles with addiction when they ignore or deny the addiction and, thus, forbid themselves the benefits of getting help. Social stigma occurs when family members, friends, or co-workers ignore or deny the existence of addictive illness within loved ones or colleagues and, thus, prohibit possibilities of treatment. Institutional stigma occurs when people who work in healthcare, criminal justice, and governmental systems ignore or deny that addiction is an illness, fail to address it systematically and compassionately, and, thus, do not create systemic and standardized access to life-saving interventions.

Notice how each stigma builds upon the other. For a moment, personalize the experience. Imagine yourself as a person with addiction:

The process begins when I refuse to get help for my own addiction, because I am too ashamed to admit that my life is out of control. When I finally ask for help, I am labeled by family, friends, colleagues, and physicians as an addict or alcoholic who has caused my own problems and does not deserve assistance. When I end up at the hospital, when I am assigned to a social worker, or when I end up in front of a judge, I am given more labels that dehumanize me as a substance use disorder, a drug seeker, an irresponsible parent, a common criminal. I am no longer a person with an illness. I have become an object of disdain.


We don’t talk about addiction, because on a personal level, many of us do not know what to do about it. We don’t even know where to start. Cancer? Go to the hospital. Car trouble? See the mechanic. Water leak? Call the plumber. Addiction? That’s the tricky one. An effective response is more elusive and baffling: should we confront the person; should we call a primary care doctor, a therapist, or a local priest, pastor, or rabbi for spiritual counseling? The problem seems so big and the situation so hopeless that it’s easier to pretend nothing is happening. When we hear about a colleague or friend struggling with addiction, many of us shrug our shoulders and shake our heads, secretly relieved that it’s not occurring in our own families. Beware! There’s a good chance that addiction is already occurring somewhere in the family tree—in that extensive network of aunts, uncles, and cousins.

"People seem to understand cancer and heart disease as acute and chronic conditions whose causes and consequences are, for the most part, outside the control of the person who is ill. . . . Many people fail to view addiction in a similar light."


One of the reasons I started Club HOPE was to ensure that addiction, overdose, and other “invisible conditions” could be openly and safely talked about by anyone. I wanted to create a place where people could go to give and receive assistance from others who are in similar situations. During my ex-husband’s illness, there was no place to go that was separate from Twelve-Step meetings or treatment centers to acquire accurate information, sound advice, or access to a listening ear.

Luckily, I did find support in Al-Anon, and my ex-husband went to Alcoholics Anonymous, but I also know that many individuals are too scared or intimidated to walk into those rooms where meetings occur. Additionally, not every treatment program has a track specifically for spouses or family members. If such programs do exist, not every family can access these services because of financial circumstances. I longed for a space similar to the Gathering Place in Beachwood, Ohio, which provides individuals and families impacted by cancer with a supportive environment of reliable information and support. That organization inspired me to start building a similar place for those of us impacted by addiction.


Club HOPE is not yet a physical reality: we are looking for the right building in the right location. However, we do have an online presence which is creating connections. We believe there are ways to build a welcoming community in your own family and neighborhood before Club HOPE has a ribbon-cutting ceremony to open its first location. Here are few questions and suggestions to get you started:

  • Is there someone in your own family or circle of friends who admits having an addiction, has survived an overdose, or recently completed a program at an addiction treatment center?
  • Might they need transportation to aftercare or a Twelve-Step meeting? Maybe you can give them a ride.
  • Might they need some assurance that they are loved? Maybe you can send a card, make a phone call to them, meet them for coffee or dinner, or bring them a casserole.

I envision a day when addiction is a casserole illness—a condition which is openly acknowledged and supported in our families, neighborhoods, and institutions with compassionate care. Until then, I invite you to take steps toward that future reality with one practical, thoughtful, loving gesture at a time.


  • Livingston JD, Milne T, Fang M, & Amari E. (2011). The effectiveness of interventions for reducing stigma related to substance use disorders: a systematic review. Addiction, 107, 39–50.

Editing by Paul M. Kubek of PMK Consulting, LLC.

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