Embarking on Recovery: When Does Stigma End? Investigating the Experiences of Discrimination and Aspirations in Recovery From Substance Misuse

Abstract

Background: Research into the impact of stigma and discrimination occurring while in treatment and recovery from substance abuse has reported that participants experience discrimination in areas such as employment, housing, and health care. Further research has suggested that there is increased anticipation of discrimination in these areas. Studies reported that fear of discrimination can impact on an individual’s willingness to disclose information about their addiction and recovery. Aim: The aim of the study is to fill a gap within current knowledge by exploring how experiences of stigma and discrimination impact on individuals’ aspirations in recovery from substance abuse. Method: A purposive sample of seven participants were recruited to take part in semistructured interviews, from which data were recorded for analysis using interpretative phenomenological analysis. Findings: Three superordinate and 10 subordinate themes were highlighted through analysis: “Forever an Addict,” “The Broken Social Contract,” and “A New Social Identity.” Conclusion: The findings of the study raise issues in the current approach to supporting those in recovery and suggest that there is a need for increased awareness and education at various levels in society.

Keywords

discrimination addiction substance abuse recovery IPA

Introduction

Models of Addiction

Addiction can include alcohol and drug addiction, gambling, and sex addiction. The model of addiction most commonly referred to by Alcoholics Anonymous (AA) is that of the disease model. The disease model describes addiction as being a disease with biological, neurological, genetic, and environmental causes (Kurtz, 1991). The creation of AA in 1935 and the publication of The Big Book of Alcoholics Anonymous (Wilson & Cohen, 2015), along with medical advances, recognized the idea that addiction is a disease, although this was originally developed with only alcoholism in mind (Friedman, 2014). It is concluded from this approach that alcoholism is a chronic and progressive disease that cannot be cured but can be arrested by the cessation of all alcohol and treatment using the 12-step model of the AA (Wilson, 2002).

Recent theories of addiction state that it is not a disease in the conventional sense but rather a disease of choice as the individual makes the initial decision to consume the substance(s). According to McCauley and Clegg (2010) abstinence is the most effective form of treatment over current medical interventions, such as drug replacement (methadone). Not all of those who experience addiction to drugs or alcohol conform to the idea of the disease model. Although belief in the disease model can go some way to reducing feelings of responsibility and blame, which can be helpful to some, it can also permanently fix the label of addict to an individual. It is, therefore, more acceptable for some to believe in the life-process model of addiction (Kalivas & Volkow, 2005), or psychological resources model (Eysenck, 1997). The life-process model of addiction views addiction not a disease, but rather a habitual response, and a source of gratification and security that can be understood only in the context of the individual’s social relationships and experiences (Nestler, 2013). This is similar to the psychological resource model by Eysenck (1997); however, here it is stated that the use of substances fulfils a psychological need within the individual, suggesting that they have a prior disposition to addiction. This model still recognizes that an individual remains able to make the choice on how to fulfil any unmet need. The model also states that there is a biological predisposition in some individuals, which results in an enhanced susceptibility to addiction. This is often triggered by corresponding social influences, such as a trauma, in the person’s life.

Negative Attitudes Toward Addiction

Social identity theory, as described by Tajfel (1979), states that discrimination occurs as a result of intergroup processes and the awareness of differences between one’s own societal group (the “in-group”) and an outside group (the “out-group”). Tajfel and Turner (1979) state that people need to maintain a positive sense of personal identity, and this is reinforced through increasing the positive esteem and desirability of one’s own groups in comparison with that of the “lesser” group or the out-group. Often prejudice and discrimination occur as a result of this observed difference between two groups.

Research surrounding the stigma and discrimination of those with current or historical substance abuse has reported on the negative attitudes of various societal groups toward such individuals (De Vargas & Luis, 2008; Stanbrook, 2012; Van Boekel, Brouwers, Van Weeghel, & Garretsen, 2013). There is also evidence to support the fact that negative attitudes will often continue to be an issue within recovery from substance abuse (Earnshaw, Smith, & Copenhaver, 2012; Luoma et al., 2007; Sanders, 2012). Reports of discrimination have not only been identified from those in addiction and recovery but also from those working with people in active addiction and recovery, and the general public (Daibes, Al-Btoush, Marji, & Rasmussen, 2016; Long & Vaughn, 1999; Mackert, Mabry, Hubbard, Grahovac, & Steiker, 2014; Storti, 2002; Van Boekel, Brouwers, Van Weeghel, & Garretsen, 2015b).

Reintegration and Recovery

Insight into the difference between actual experiences of discrimination and perceived or expected discrimination has been gained through research from the viewpoint of the individual (Earnshaw et al., 2012; Hill & Leeming, 2014; Luoma et al., 2007; Storti, 2002; Tran et al., 2016; Van Boekel, Brouwers, Van Weeghel, & Garretsen, 2015a; Van Boekel et al., 2015b). It has been found that there is fear of rejection in the areas of employment, housing, and access to education (Long & Vaughn, 1999; Luoma et al., 2007; Tran et al., 2016; Van Boekel et al., 2015a, 2015b). Experiences of the individual have led to a fear of discrimination that can impact on their willingness to disclose information about their addiction and recovery to outside groups and society members (Hill & Leeming, 2014; Sanders, 2012; Storti, 2002; Tran et al., 2016; Van Boekel et al., 2015b; Woodford, 2001).

Research states that the views of societal groups toward addiction and those in treatment or recovery continues to show negative assumptions being made, which impacts on their successful reintegration into the community. Mackert et al. (2014) reported that students undertaking an advertising course at university would be more likely than those on a social work course to avoid those with an addiction history. This suggests that those not in contact with people in recovery are likely to reject or fear contact with these groups. Daibes et al. (2016) reported on the views of nurses, being that addiction was an untreatable condition and that this group of individuals were liars, cheats, and thieves.

Stigma and discrimination have important implications for the mental health and recovery efforts of people in treatment (Ahern, Stuber, & Galea, 2007; Bahm & Forchuk, 2009). Therefore, it is important to understand how experiences of stigma can impact on an individual’s recovery.

Rationale and Aims of the Study

Research to date has generally focused on the experiences of those in active addiction or treatment and has not, as yet, investigated the implications of stigma and discrimination for personal aspirations in recovery. In previous research, participants have reported that they fear stigma and discrimination from others, even when in recovery (Sanders, 2012). However, whether or how this hinders reintegration and achievement of personal goals remains largely unexplored. The aim of the present study is, therefore, to explore the impact of stigma and discrimination on aspirations for recovery, so as to improve understanding of the ways in which recovery can be supported.

Research Questions

The research questions guiding the present study were “How do those in recovery from substance abuse make sense of their experiences of stigma and discrimination?” and “How do experiences or perceptions of stigma and discrimination relate to the future aspirations of those in recovery from substance abuse?”

Method

Design

The study was of qualitative design using semistructured interviews and interpretative phenomenological analysis (IPA) to explore individual participants’ experiences and views of the topic area. Each participant was asked the same open-ended questions, to facilitate exploration of their experiences within the interview.

Interpretative Phenomenological Analysis

Following completion of the semistructured interviews, the data were subjected to IPA using the guidelines set out by Smith, Flowers, and Larkin (2009). Due to its roots in phenomenological psychology (Husserl, 1927), hermeneutics (Heidegger, 1927), and idiography (Harré, 1979), IPA allows qualitative data to be analyzed in a rigorous manner, focusing on the lived experience of the participant along with how they have attached individual meaning and made sense of those experiences (Smith, 1999).

Using the guidelines of Smith et al. (2009), interview data were searched systematically for extracts of interest that stood out to the researcher, completing a line-by-line analysis. Following this, the extracts were used to capture emerging themes across the first data set to encapsulate what the participant might have been trying to convey. The emerging themes were then extended and clustered together to form “superordinate” themes under which “subordinate” themes were contained. Once this was completed, the themes were then checked against the original data to ensure that they remained true to the text, before moving on to the next transcript and repeating the same process.

Interrater Analysis

To increase the reliability and validity of the findings, interrater analysis was carried out whereby both the author and the clinical research supervisor completed individual analysis of the data and shared the results of this before making the final report. Due to using IPA as the methodology, this is not something that is often necessary as the researcher’s interpretation of the data are key in reporting on the findings of the study (Yardley, 2000). It was, therefore, decided that the clinical research supervisor would conduct their individual analysis and report on what they found to be major themes within the data. However, the final decision on how to interpret and report on findings remained with the first author.

Setting

The research was carried out at an independent (non-National Health Service) rehabilitation service for substance misuse clients. To enter the service clients must present with difficulty in managing their addiction with or without the use of community services or family support. The clients accepted to the program are often suffering with serious health conditions, such as liver damage, as a result of their addiction and are assessed thoroughly before admission to ascertain their motivation to change. The service has two sites in different counties of the United Kingdom. These services are both residential facilities where clients remain for an 18-week abstinence-based treatment program. The first 14 weeks of the program are referred to as the “therapy phase” with the remaining 4 weeks being reserved for a “resettlement phase,” After this time, clients recommence living in the community but may return to the service for aftercare treatment should they require it. The interviews were carried out at the most convenient of these two centers for each of the participants. Rooms were available at each facility for the interviews to be conducted in an intimate, safe setting, for both the researcher and the participant.

Ethical Approval

Ethical approval for the study was granted by Staffordshire University, and any amendments to previous proposals were returned to the same panel for approval before the study commenced.

Ethical Considerations

The nature of the study encouraged the participants to think about past experiences when they had felt stigmatized or discriminated against on the basis of their addiction. The researcher was aware of this throughout the study, and participants were encouraged to seek support from their therapist at the center, or other support facilities, if they felt distressed through taking part in the study. Support information was provided to all the participants and was also acknowledged prior to them agreeing to take part.

Informed consent was gained from each participant before they could take part in the study. They were also made aware of their right to withdraw from the study at any time, and the confidentiality of the material collected through the interviews and research process was also addressed as part of the consent process.

Sampling and Recruitment

A purposive sampling method was chosen as this provides the ability to select participants based on their potential to offer specific experiences and views regarding the research question (Smith et al., 2009). Potential participants for the study were identified by the clinical research supervisor and additionally through advertisement of the study using posters, which were displayed at each of the centers. Those who wished to take part in the study were asked to contact the researcher via e-mail, in order to opt in, and were then sent a full information sheet or would collect this from the research supervisor if they preferred.

Inclusion Criteria

The research aimed to investigate the experiences and views of those who were most likely to experience or be thinking about the research topic of stigma or discrimination based on addiction. It was, therefore, important that participants who engaged in the study had completed the “therapy” component (first 14 weeks of the program) and were either in the “resettlement” phase or had graduated from the full 18-week program within the past 4 weeks. During this time, it was thought that participants would be most able to offer insight into the research question. Participants had to be older than 18 years.

Participants

Eleven clients across the two centers made e-mail enquiries about taking part in the study. Of those 11, only 7 met the inclusion criteria for the study. Of the seven that took part, one was female and six were male. Their ages ranged from 32 years to 47years, and all fulfilled the inclusion criteria by having completed the rehabilitation program in full and were recently graduated clients, or in the remaining 4 weeks of resettlement.

Materials

A Dictaphone was used to record the interviews so that the data could subsequently be transcribed for analysis. Consent forms and information sheets were also provided prior to a participant taking part in the interview.

Findings

Three superordinate themes were generated, containing 10 subordinate themes. Details of superordinate and subordinate themes, along with how many participants supported each theme can be found in Table 1. Codes were identified from each individual transcript and clustered into emergent themes. The emergent themes were then searched for connections to map out superordinate and subordinate themes.

Table 1.

Table of Themes.

Superordinate theme	Subordinate theme	Number of participants
Forever an Addict
	Illness or Choice?	7
	The Impact of the Label	4
	Discrimination in Employment	5
The Broken Social Contract
	We Know We’ve Done Wrong	7
	Dipping My Toe In	7
	Secrecy and Concealment	5
A New Social Identity
	I’m Not Like the Others	5
	Active Addicts	5
	Rejecting Society	5
	The Recovery Family	6

Forever an Addict

This superordinate theme describes the participants’ views on addiction being a lifelong condition, whether in active addiction, treatment, or recovery. The subordinate theme “Illness or Choice?” describes the personal beliefs of the participants regarding whether addiction is an illness or developed through choice and, therefore, whether or not there can be a “cure.” The theme “The Impact of the Label,” highlights the views of participants’ regarding reintegration into society and how being labelled as an “addict” maintains the societal divide. This relates to the superordinate theme as it addresses concerns raised about being permanently labelled as an addict by society. Finally, the theme of “Discrimination in Employment” describes the participants’ views on how addiction affects their employability and places a “cap” on their potential achievement. It appears that this is the area most prominent in the thoughts of the participants as where they fear that they will continue to experience a lack of understanding and continue to be judged for their previous addiction behaviors.

Illness or Choice?

All seven participants described their personal view on whether addiction is an illness or a choice. All the participants made reference to addiction being a disease or illness and, therefore, not something that was within their control.

The way it happened to me, is something that could happen to anybody, you know, it wasn’t that I just decided one day I was going to use heroin. (Lucy)

One of the participants spoke about addiction in a similar context to epilepsy, classifying it as a medical condition.

And plus, you know, I also suffer from epilepsy as well. (George)

The participants spoke about being in control of their recovery and this being something that they had personal responsibility for. It was a concern to Harry that defining addiction as an illness would allow him and others to use this as an excuse to continue abusing substances or relapse. Harry explains that despite addiction being an illness, he still takes responsibility for his behaviors.

I think people—myself included—when we use this illness term it’s not used as—although in the past I have used it as a justification—I’d like people to understand that I don’t use that as a justification now. (Harry)

The participants’ beliefs regarding addiction as an illness reveal some external level of control. This can be a protective factor, helping them find commonality with those who have not suffered with addiction by believing that they had a susceptibility or predisposition making them vulnerable to addiction. It has also been highlighted that despite addiction being an illness, it is still the participants’ responsibility to remain abstinent and recovery is possible.

The Impact of the Label

Being labelled as an “addict” has an impact on how the participants feel they are being viewed by others in society. For four of the participants, it was important to convey the need to lessen this divide by looking for similarities with nonaddict peers and working together to overcome the negative view of addiction. Lucy described how she was working with services to reduce the negative perception of addiction.

There’s a thing that I’m getting involved with . . . all the services that deal with people that have got a potential to have, alcohol and substance misuse problems. And the wider public . . . (to)give the wider public a more balanced insight into the realities of addiction. (Lucy)

Martin felt that the label of being an addict was something that could not be removed and that this would result in a permanent divide in society. His concern was that people, even in recovery, would never be considered as good enough compared with a “nonaddict.”

I think they look down on me to be honest and viewed me “them up there and me down there in the gutter.” (Martin)

William described how “playing the part” of a nonaddict during active addiction was important in order to reduce the potential for the label of addiction to create negative experiences.

I always thought, you know, kept myself really clean, fresh, clean clothes, clean—yeah, I wouldn’t—I tried playing the part—look the part that I wasn’t actually feeling inside. (William)

Labelling by society creates a “difference” between those in recovery and those who have not experienced addiction. The idea that this label is permanent can damage the future reintegration of participants into society.

Discrimination in Employment

Five of the participants directly commented on how having a history of addiction would impede them in finding future employment. Here, it was discussed that having to explain gaps in their employment history may lead to discrimination in being offered employment. Employment gaps often occurred during their time in active addiction when they are unable or unwilling to work and also through their time being in rehabilitation. Three of these participants spoke about their decisions regarding whether to reveal their history during applications for employment.

I was thinking “Well should you say, should you not say” and I think it’s best to be honest because then if somebody finds out later about it and you’ve not disclosed it, you could potentially lose your job. (Martin)

One of the participants talked about his previous experience in working within the recruitment sector and acknowledged that during his work he would raise concerns about people who had “gaps” in their employment history. Being in treatment for 18 weeks himself has now created a sufficient gap within his own working history, alongside times when he was unable to work due to the effects of his addiction.

If I can see documented on their CV for the application that they’d give in that they’ve got lapses in their employment history . . . if, they weren’t for a specific reason that I thought was justifiable then it would be a big negative. (George)

It appeared that as a result of fear regarding discrimination in the workplace, participants found it difficult to see themselves working within mainstream employment. For one of the participants, however, they had recently had a positive experience regarding employment and had been offered a position.

She was brill and the reason it was so good for me was I explained to her that I had meetings, so sometimes I can’t work certain hours in the day. That’s why it was important. And she was very flexible when I called her back and she said it was no problem. (Daniel)

The Broken Social Contract

This superordinate theme demonstrates an issue with regard to a breakdown in trust between participants and society. This issue of trust appears to flow both ways, and the subordinate theme of “We Know We’ve Done Wrong” highlights that participants are aware of the damage caused in relation to gaining the trust of others. The theme of “Dipping My Toe In” reflects the level of doubt participants have about society accepting them. Finally, the theme of “Secrecy and Concealment” explains how the participants felt that—to protect themselves from rejection or discrimination—they must conceal their history of addiction.

We Know We’ve Done Wrong

All the participants discussed how their actions in active addiction impacted on their relationships with family, friends, and others around them. Participants often acknowledged and empathized with the fears of others. They discussed how, through their past behaviors, they had given society reason to doubt them. It was acknowledged by William that as he has relapsed in the past when trying to abstain from addiction and his family and friends seem reluctant to trust him to remain in recovery.

They’ve seen me try loads of times and they’ve all seen me fail so they can only base it on what they’ve seen I suppose. (William)

For five of the participants, it was recognized that those close to them may be trying to protect themselves from further hurt or disappointment by maintaining a distance to them.

I mean, it was something that they tried to help me with at first, but when they couldn’t really see me moving on then it was almost as if they’d just cut me off. (George)

Four of the participants spoke about being able to rebuild the broken trust and achieve acceptance from others if they worked hard to repair the relationships over time. Jeff explained his experience with a housing support service who he had been in contact with.

And in time, if I engage with all the support networks probably, you know, they bend over backwards to get my own property in time to come. (Jeff)

Participants are aware that their behaviors in active addiction continue to impact on the relationships with people around them. This is demonstrated through difficulty in rebuilding trust.

Dipping My Toe In

All seven of the participants spoke about taking time, while early in their recovery, to gradually reintegrate into the “mainstream” society through taking part in voluntary work. Three participants spoke about using voluntary work as a way back into more permanent work and specifically within areas that are accustomed to having volunteers who are in recovery. There was an element of this being a “safer” way to reintegrate, as the services they are working with are aware of them being in recovery and, therefore, less likely to discriminate against them.

I’ve started working . . . doing some voluntary work to sort of help build my confidence of being back out there in a community . . . but these are agencies that deal with people that have had, alcohol and substance misuse problems. (Lucy)

The participants also spoke about slowly reintegrating as a way to rediscover their interests and abilities. Voluntary work offers them the opportunity to try something new.

Voluntary work’s what I definitely want to do—because I’ve got all this knowledge now and I’ve got understanding for people so it’s something I want to just dip my toe in and have a look to see if I like that side of things. (William)

Participants spoke about feeling untrusting toward society as a result of negative experiences while in active addiction. There was a fear that this would continue to be the experience in recovery. Martin commented that his previous experiences of rejection have led him to a worry that this will continue.

So, even if I didn’t know them I’d still—it was running through my head they’d be thinking things like that about me. (Martin)

Secrecy and Concealment

Five of the participants spoke about making the decision to conceal their history of addiction in order to guard them from potential discrimination or negative judgment. William did not wish to lie about his addiction but was concerned about the consequences of being honest.

I’m proud of the fact that I’ve done it and I’d rather—I’d rather just—for me now, I’ve just got to be honest with everything in my life so I’m not worried about what other people think about me. It might affect me, I’m not sure. (William)

There was a desire from participants to be accepted back into society. Lucy spoke about not revealing her history to other parents as she felt that in doing so she would be seen as a bad mother. Being in recovery has increased the confidence to share some information; however, the concerns about the views other people will take remain a concern.

I think it’s generally something that before going through the program and now being in recovery—it’s something that I would never want to admit to anybody because of being judged, because of the stigma attached to having, erm, substance misuse problems and especially being a mother. (Lucy)

A New Social Identity

In this superordinate theme, the social identity of the participants is described. The theme “I’m Not Like the Others” describes how the participants retrospectively compare themselves with other people in addiction. The themes of “Rejecting Society” and ”Active Addiction” highlight how the participants now feel that they cannot fit within either of these social groups, leading them to acceptance of being in “The Recovery Family,” where participants describe feeling part of a new societal group from which they can build confidence and self-esteem.

I’m Not Like the Others

Five of the participants referred to themselves in addiction as being different from other addicts. They spoke about the idea of being a “Functional User,” meaning that they remained in employment, and had partners and children, which enabled them to mask their addiction for a longer period of time. For some of the participants, this concept of being a “Functional Addict” before treatment allows them to believe that they have a higher chance of being accepted back into society.

I mean I was drinking very heavily at the time and, erm—and the job I was in, I didn’t lose my job through drinking, it was a very good and a very well paid job. (George)

Martin used this sense of being different to explain that he can be more successful in recovery and feels proud of having the strength to seek help and treatment.

I’ll be straight with people, most people in the world wouldn’t do rehab anyway if they’ve got an addiction problem. Most people wouldn’t have the strength to do it, so I’m quite proud of myself in that regard, very proud. (Martin)

Active Addicts

Due to the need to protect their own resolve in abstinence, there was the explanation from five of the participants that they would no longer be able to socialize with people in active addiction. This was discussed as having to also limit the time spent with anyone who uses substances due to the temptation it may create for them.

So, I’m keeping away from anyone who’s doing—anyone who’s not good for my recovery I keep away from. So yeah, it’s mostly the people I want to do things with now are people who have either gone through recovery or completely clean. (William)

Being around people who remain in active addiction felt dangerous to the participants, and this required them to keep a physical distance between themselves and others whom they knew while in active addiction themselves. This is due to feeling vulnerable in early recovery and not wanting to be around temptation that could influence potential relapse.

I wouldn’t have lasted five minutes, you know, it’s the area. The area’s the hardest situation for me. It triggers off the young people and they’re all criminals, drug addicts. Yeah, I do know loads of people round there but they’re just a minority. (Jeff)

Rejecting Society

Five of the participants spoke about not feeling aligned or connected to the “mainstream” society. It was highlighted that this was experienced through both society maintaining a distance from them, or them rejecting others in society, due to feeling that they lacked the understanding and empathy needed to support and connect with the participant. Being able to understand recovery was important to the participants as they firstly needed to remain abstinent, and this needed to be something that others in society would fully support (i.e., not offering them alcoholic drinks or trying to encourage nights out in pubs). Daniel expressed his belief that those without experience of addiction cannot understand his needs.

If they don’t know–if you don’t know you don’t understand, you can’t understand it. (Daniel)

Two of the participants describe not being able to influence or change the views of others, so the result of this would be to stay away from such people.

I’ll be open and honest with absolutely anyone about it, I don’t—and then if they want to see it in a certain way that’s their problem not mine. (William)

Harry spoke about society not respecting or listening to those with histories of addiction, further creating a sense that it was hard to accept the mainstream society.

To better understand the guy that is stood on the street with a needle in his arm, to better understand the position he’s in. If he’s trying to explain the position he’s in, people don’t want to listen. (Harry)

As a result of not feeling understood by others, and being powerless to alter this, the participants make the decision to step out of the normal societal group, and there is a reduction in the ability to connect with those who have no experience of addiction.

The Recovery Family

Six of the participants describe being part of the recovery community following treatment. This is regarded as their new social group within society, from which they can continue to grow in confidence and self-esteem.

The support of my peers, AA and NA, erm, it’s just built my self-esteem, built my confidence, made me see that I am a person, I’m not my addiction. It’s a part of my past, a big part of my past, but it’s not who I am as a person, you know. It’s given me a lot more confidence in who I am now as a person, the whole therapy program. (Lucy)

Two of the participants draw strength and confidence from the recovery group and notice that self-esteem is higher by being a part of this group.

I want to keep them in like a social circle, like a social network where, you know, I can do more things. (William)

Jeff spoke about feeling safe as a result of being within the recovery group.

Because it’s only a small-knit community, you know, we all try and stick together kind of thing, yeah. (Jeff)

Discussion

IPA of seven semistructured interviews found 3 superordinate themes and 10 subordinate subthemes. The aim of the study was to explore how participants made sense of their experiences of stigma and discrimination and how this impacted on their aspirations in recovery from substance abuse.

The superordinate theme of “Forever an Addict” encapsulated the participants’ beliefs regarding addiction as an illness. For the participants, this was a protective factor, helping them find commonality with those who have not suffered with addiction and in believing that they had a biological susceptibility, or a predisposition, making them vulnerable to addiction. This theme has a strong connection to the disease model of addiction, in which addiction has been regarded as an illness with biological, neurological, genetic, and environmental sources of origin (Kalivas & Volkow, 2005).

While the view of addiction as an illness allows participants to feel less responsible for their addiction, it was also demonstrated that taking responsibility for maintaining their recovery lies with them. Four of the participants felt that others in society would doubt their recovery as a result of addiction being a lifelong illness and felt that this could hinder their reintegration. Labelling by society creates a “difference” between those without addiction histories and those with them. The idea that this label is permanent can damage the future reintegration of participants into society. This is consistent with previous findings in which participants spoke about feeling that society views them negatively (Hill & Leeming, 2014; Long & Vaughn, 1999; Luoma et al., 2007; Sanders, 2012; Tran et al., 2016; Van Boekel et al., 2015b).

It is acknowledged that, as much of the discrimination spoken about is perceived or anticipated, it may prove useful to encourage those in recovery to pursue their goals, as fear could be holding them back unjustly. This was particularly true in the area of employment, as five participants expected that they would be treated unfairly, without personal experience of this having occurred so far. One of the participants reported a positive experience in being offered employment. This is consistent with previous research by Van Boekel et al. (2015b) who found that 23% of participants anticipated discrimination from employers. Van Boekel et al. (2015a) reported that 52% of participants in recovery thought that they would be unable to find employment.

The superordinate theme of “The Broken Social Contract” demonstrates that there is a breakdown in trust between participants and society. This issue of trust appears to flow both ways and highlights that participants have an empathy for the people they have hurt through their actions in active addiction. Having relapsed in the past appears to impact on both the participants and their families, and participants are aware of the damage caused in relation to regaining the trust of others. Further contributing to the broken social contract, this theme also revealed a fear common to many participants, of being unable to regain acceptance back into society and therefore keeps them from believing that they are part of the “mainstream” society. This can lead to reluctance in divulging addiction history to others. Five participants believed that by keeping their history of addiction concealed from employers they are able to protect themselves from potential rejection or discrimination. This is consistent with the findings of Van Boekel et al. (2015b) in which 37% of participants reported that they would conceal their addiction regularly or always.

The third superordinate theme of the “A New Social Identity,” demonstrated that many of the participants have tried to create a new social group in recovery from which they can continue to build their confidence and self-esteem. This links to the theory of social identity (Tajfel, 1979) in which those in the “out-group” attempt to compare and contrast the strengths of their own group, making their own group feel more prestigious. Being part of a new social group, that of the “recovery family,” allows participants to feel protected and included. It is hypothesized that finding a group from which those in recovery can feel that they have an important role to others, either through educating others on the dangers of addiction or increasing the ability of services to support and understand addiction and recovery, helps them increase the esteem of their recovery group.

The research question of how perceptions and experiences of stigma and discrimination impact on future aspirations has been answered through the methods by which participants reintegrate within society. It was highlighted that participants remain hesitant to some degree and debate whether or not to disclose their history of addiction to others. Being hesitant and doubtful in their encounters with those in society could be holding those in recovery back from fully reintegrating into society, keeping them feeling that they are not supported and accepted by others.

Reflexivity has been at the forefront during the reporting of study findings, and it is important to acknowledge that the researcher’s interpretation of data may have influenced the themes that emerged through analysis. This has been minimized as far as possible through the use of interrater analysis to provide increased validity of themes.

Limitations

Being of qualitative design, only a small number of participants were used in this study. This makes findings difficult to generalize to the rest of the population. However, it is not unusual for qualitative studies to have a limited sample size (Smith et al., 2009), as depth of information is being sought, and this has been achieved through the study.

Participants used in the study had been through residential treatment over an 18-week period. During this time, the group aspect of treatment may have united their knowledge and views about recovery, stigma, and discrimination, creating an increased potential for their views to become aligned. Using a sample of participants from varying treatment methods would combat this and may provide support to the research findings, or conversely, it could expose differences that add to current findings.

Participants spoke about the idea of the “Broken Social Contract,” which has added to further questions raised by the research about the duration of time spent in active addiction and that in recovery. Its relevance here leads to questioning how long participants may expect those around them to take in repairing issues of trust, as many relationships were damaged through behaviors seen in addiction and may therefore take a much greater period of time to recover than the 18 to -22 weeks covered in the current research. This question has yet to be answered by the current research and may provide scope for future research to investigate this.

Clinical Implications

Findings from this study can be used to further provide insight into the research area and increase understanding around the negative impact of stigma and discrimination on recovery from substance abuse. Some of the themes that emerged have been consistent with previous research; however, there are also additions to these that increase understanding and awareness of challenges faced by those in recovery. This includes the perception of the “Broken Social Contract,” where participants revealed fear of not being granted acceptance from society. This knowledge increases the awareness of those working with such individuals and can support development of reintegration plans.

In clinical practice, services supporting individuals suffering from addiction should encourage a group-based approach to recovery as this has been proven to increase confidence and self-esteem. This has been encouraged through the work of the AA since 1935 and is supported through the findings of this study. It was also considered a successful intervention in the review of Livingston, Milne, Fang, and Amari (2011), where it was reported that a group-based acceptance and commitment therapy intervention had significantly reduced feelings of shame and internalized stigma.

More needs to be done to address issues of discrimination, whether actual or perceived, in the area of employment. Removing inclusion barriers here will increase the physical and emotional reintegration made possible in recovery from addiction as this has not only been highlighted through this research but also in previous research explored (Van Boekel et al., 2015a, 2015b).

Conclusion

The study has been a powerful tool in gaining insight into the effects of perceived discrimination for those in recovery from drug and alcohol addiction. Results from this research have shown that there are many considerations that need to be addressed from the point of view of the recovering addict, and these are both at an individual and societal level. A project of this sort has not been conducted before, and it therefore offers a much-needed perspective on the impact of how discrimination impacts on the fears of those in recovery, and this impacts on their aspirations. The researchers have found the themes both surprising and yet understandable, as themes not only reflect findings of other studies but also offer additional insight into the consequences of experiences and perceptions of discrimination. Future research may involve piloting group-based reintegration strategies, such as encouraging recovery communities to seek employment together. Further research into reducing the barriers into employment for those in recovery would help increase the effectiveness of reintegration.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author Biographies

Faye Louise Rwatschew is a senior clinical psychologist working for Adult Mental Health Services in Staffordshire. Her interests and experience lie largely within substance misuse and adult mental health, with particular interests and additional skills in the treatment of trauma and emotion regulation.

Kevin Langan is the program director at the Burton Addiction Centre (BAC). He is a qualified psychotherapist possessing a first class honors degree in counselling and psychotherapy and a masters in counselling practice, specializing in posttraumatic stress disorder. As well as being responsible for writing and implementing the BAC’s 12-week program of intense therapy, he is also responsible for training and supervising the BAC’s team of therapists having had more than 27 years of experience in the field. He is himself in recovery from addiction and uses his experiences and learnings to help other addicts enter into recovery. He is a father to two grown-up boys and likes nothing better than standing on the touch line cheering his sons on at rugby.

Helen Dent is professor emeritus of clinical and forensic psychology at Staffordshire University. She has trained several generations of clinical psychologists in various universities, promoting the social construction theory of mental health. Her early research concerned children as witnesses. Her findings have contributed to changes in the law and have helped shape modern police interviewing techniques. She currently works in the fields of autism, attachment, and trauma. Her latest book, Why Don’t I Feel Good Enough? Using Attachment Theory to Find a Solution (2019), reflects her concern to communicate psychological insights as widely as possible.

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