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Query: UMLS:C0277787 (stigma)
 13,352 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Alcoholism, the most prevalent form of drug dependence, has become a problem for large numbers of women. The research literature on alcoholism in women is reviewed, with suggestions for treatment and future research. The greater stigma placed upon female intoxication has made it difficult to obtain reliable data and has contributed to the tendency to ignore the problem altogether. Furthermore, the greater stigma has resulted in guilt because the woman alcoholic is likely to share society's opinion of herself, and this stigma/guilt/shame factor is viewed by the authors as one of the main difficulties in recovery. Certain recurring characteristics among alcoholic women are listed, and the impact on children is briefly discussed. Treatment suggestions include offering women alternatives during rehabilitation.
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PMID:Alcoholism and women. 35 25

Substance abuse is known to be our nation's number one public health problem. Physicians and other health providers can develop chemical dependency problems that create significant quality assurance and risk management dilemmas. Not all of society understands drug dependence to be a treatable medical disease and behavioral problem. Sometimes impaired providers are ignored or punished rather than treated and rehabilitated. This results in an enormous waste of human and monetary resources. In the last 10 years, impaired physician programs have developed focus and credibility. But certain difficulties exist in these programs: namely, that such programs are affected by tensions between medical societies and state licensing boards; that substance-dependent providers escape detection by moving to other states; that existing impaired provider programs have limited practical application within the federal health care system; and that liability risks are incurred if institutions rely on impaired provider policies that do not include all members of the medical staff. Hence, we argue that existing impaired provider policies might be worth rethinking. To promote that dialogue, we offer a sample policy for consideration and review. It includes specific actions and procedures for the identification, referral, and reentry of impaired providers and allows for National Practitioner Data Bank reporting in that process. The Data Bank has been in place for only a few years and offers society and the health community a new opportunity to better control chemically dependent, licensed medical staff without dismantling existing impaired provider programs. The policies for managing chemically dependent health professionals are changing from a focus on stigma and prosecution to one of early identification, rehabilitation, and reentry. We hope to advance that process.
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PMID:Quality improvement and substance abuse: rethinking impaired provider policies. 870 3

Although comprehensive strategies to promote recovery from the abuse of alcohol and other drugs require a significant commitment of resources and time, these strategies are considered ultimately to be cost-effective in both dollars and human lives, especially concerning perinatal populations. The development and funding of innovative approaches and the continued support of existing programs are important steps in recognizing and addressing the problem of perinatal substance abuse, and encouraging family and community stability. The extensive use and abuse of alcohol and other drugs in our society clearly necessitates innovative ways to integrate prevention, treatment, and relapse prevention efforts along with a variety of existing social, health, and support efforts. While the stigma associated with alcohol and drug dependence continues to act as a barrier, professionals and policymakers are recognizing the intertwining and clustering of social problems. Addressing those problems will require additional efforts aimed at inducing individual behavioral change within the context of social changes that support and enhance a drug-free lifestyle. Given the changing funding streams and the likely reductions in public funding of treatment, health, and social service programs, policymakers and programs will need to be especially creative in developing strategies that respond to the needs of AOD-dependent women and their children. Understanding the necessity of early investment in prevention and treatment and the personal cost savings associated with these efforts is essential to the creation of cost-effective and responsive strategies that produce ongoing and long-term benefits.
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PMID:Afterword. Future directions for perinatal alcohol and drug treatment services. 911 Feb 72

Alcohol and drug abuse and dependence are common disorders in our society, and the vast majority of those who recover do so without formal treatment. Although this phenomenon appears to be more common among women than men there has been no gender-sensitive research. This qualitative study explored the barriers to formal treatment seeking among women who self-managed change in their alcohol and other drug dependence. The principal barriers identified included social stigma and labelling; lack of awareness of the range of treatment options, concerns about childcare, the perceived economic and time costs of residential treatment, concerns about the confrontational models used by some treatment services, and stereotypical views of clients of treatment services. A number of recommendations were made regarding program reach and content.
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PMID:A qualitative study of barriers to formal treatment among women who self-managed change in addictive behaviours. 925 63

With increasing pressure on general physicians by managed care organizations and the public to treat and advocate for drug and alcohol addicted patients, it is more necessary than ever that physicians have the knowledge and skills to appropriately address this segment of the population. Specifically, physicians need a better understanding of the prevalence of alcohol and drug dependence in a variety of populations, along with increased awareness of the economic impact of addictive illnesses on our society. Routine screening questions should be incorporated into patient encounters, and physicians should be able to identify environments that may pose a risk for the development of addiction. Physicians need training and practice in referring patients to treatment teams, monitoring patients in recovery, and providing interventions that will eliminate or reduce substance abuse before it becomes addiction. The treatment outcomes in abstinence-based programs, particularly those combined with referral to AA, have been encouraging, demonstrating that addiction is a treatable illness and not a character defect. In addition, several studies provide evidence that addiction treatment is cost-beneficial, resulting in reduced medical costs, lowered absenteeism, and increased productivity. Despite these encouraging results, there is still room for improvement. Treatment is not always effective, and it is not sufficiently available to everyone who needs it. Addicted individuals are both stigmatized and marginalized, and many are too ill to advocate for themselves. Widespread recognition in the medical community of addiction as a treatable illness will contribute to a greater understanding of addictive disorders and reduce the stigma attached to the diagnosis and treatment of addiction. For this to occur, better training for physicians in the recognition and management of addictive disorders, starting at the medical school level, is necessary. The approval of addiction medicine as a clinical specialty by the American Medical Association also has helped to advance the legitimacy of addiction as a treatable illness, and provides a focal point for the synthesis and integration of clinical, teaching, and research activities central to addiction medicine. The combination of knowledge, skills, and attitudes outlined in the article will go a long way toward increasing physicians' abilities to assist their patients with recovery from addiction.
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PMID:The role of the physician in addiction prevention and treatment. 1038 46

Chemical dependence constitutes a significant public health problem with immeasurable physical and psychological sequelae. Pain management is generally undertreated in this population because of the associated stigma and misconceptions about both pain and chemical dependence. The plan of care in the perioperative period is complicated by the increased incidence of related trauma, medical and psychiatric problems, and the risk for withdrawal. An overview of assessment, anesthetic considerations, pain management, postoperative care, and treatment modalities for chemical dependence is presented in this article. Perianesthesia nurses need to become competent and confident when caringfor this population by increasing their knowledge base and confronting long-held myths and biases. Adherence to established standards of care will help to promote clinician accountability and quality patient care.
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PMID:Perioperative pain management in the chemically dependent patient. 1181 35

Managing pain effectively is one of the biggest challenges in medicine, let alone when dealing with the dying patient and his family. For palliative care specialists this is a daily challenge. However, ''To cure when possible, to give comfort always'' is an empty credo if physicians don't use every weapon in the medical arsenal to relieve the suffering caused by chronic pain. It's of course the opioids: morphine, heroin, their synthetic derivatives and other narcotics, a class of medications that conjure up visions of drug addiction and narcotic squads. To say that opioids are stigmatised by such allusions is putting it mildly. An unhealthy proportion of doctors and patients alike are afraid to have anything to do with them, even in when facing their final stages of life. This is particularly so in the Mediterranean society. It is here in Italy that an effort must be made to educate both physicians and the general public, an arduous task to change a long standing belief which requires a quick cultural turn around. Those who refuse opioids because they are afraid of addiction, and the doctors who refuse to prescribe them out of fear or pure unwillingness to address an apprehensive attitude on behalf of his patient, need to be better informed. Most misconceptions about opioids have to do with terminology, because words like ''morphine, addiction, dependency'' and ''tolerance'' mean entirely different things in popular and medical parlance. Add to this the perceptions and attitudes the patient can have with this terminology which then can have a profound effect on the success or failure of a pain control programme. In fact, most people think that medication such as morphine are only for people who are dying and as a consequence is synonymous with death itself. Is this why Italian physicians are not prescribing morphine even though great efforts have been made recently by the Health Ministry to facilitate prescribing laws and costs? It is worthy of serious consideration. Another important issue faced daily by palliative care physicians is the broad number of chronic conditions which could make use of opioids. Severe cancer pain is the most obvious example of an appropriate use of opioids, but hardly the only one. The North American Chronic Pain Association of Canada (NACPAC) advocates the use of opioids for a wide range of conditions causing severe chronic pain, including lower back pain, inflammatory bowel disease, migraines, AIDS, multiple sclerosis and arthritis. Concerns regarding under treatment of chronic pain have captured the attention of patient advocacy groups, policy makers and scientific organisations. Misconceptions of opioid laws, negative social stigma and lack of valid prescribing alternatives to overcome this, together with paucity of formal provider education confound the issue. Much education needs to be done before opioids will be seen as a safe and reasonable treatment for chronic pain here in Italy.
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PMID:Palliative care. Some organisational considerations. 1601 17

Accurate diagnosis of chemical dependence is possible with careful evaluation of the patient following the preceding general guidelines. While history is as critical in this field as it is in every other area of medicine or dentistry, we must remain cognizant of resistance in accurate history taking, since the patient has a need to keep the disease hidden. The need for corroborating history through interviews with significant others, spouses or other family members is critical. We all must be aware of the impact of social stigma on our willingness to make the diagnosis, particularly in colleagues, to ensure that we are willing to consider the diagnosis when necessary. Since physicians, dentists, nurses and the other professionals are at least as likely to have chemical dependence as the rest of the population, we must also be willing to identify and discuss with our colleagues issues of chemical dependence. This requires a great deal of courage, since it is often more difficult to confront a friend or colleague with evidence of chemical abuse or dependence. Yet a true friend is willing to confront, particularly when a colleague's family, well-being and professional life are at stake. In the case of chemical dependency, we must be our brothers' and sisters' keeper.
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PMID:Diagnosis and treatment of chemical dependency in professionals. 1625 17

African Americans purportedly have a higher prevalence of mental illnesses but are often misdiagnosed and less likely to seek treatment. Delayed treatment has been associated with the stigma related to these disorders. The demographic characteristics, length of stay, most prevalent psychiatric diagnoses, and hospital admissions of African Americans were compared to other U.S. populations using a nationwide sample (N = 4,474,732). African American participants were younger, had significantly longer lengths of stay, and were admitted more often through the emergency room than the other groups in this sample. Psychosis, alcohol/drug dependence, and depressive neurosis were the most prevalent psychiatric diagnoses reported for African American participants. Research is needed to explain these results so that strategies can be instituted to improve the poor mental health outcomes often observed in African American populations.
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PMID:Length of stay, admission types, psychiatric diagnoses, and the implications of stigma in African Americans in the nationwide inpatient sample. 1628 98

Family members of relatives with mental illness or drug dependence or both report that they are frequently harmed by public stigma. No population-based survey, however, has assessed how members of the general public actually view family members. Hence, the authors examined ways that family role and psychiatric disorder influence family stigma. A national sample (N = 968) was recruited for this study. A vignette design describing a person with a health condition and a family member was used. Family stigma related to mental illnesses, such as schizophrenia, is not highly endorsed. Family stigma related to drug dependence, however, is worse than for other health conditions, with family members being blamed for both the onset and offset of a relative's disorder and likely to be socially shunned.
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PMID:Blame, shame, and contamination: the impact of mental illness and drug dependence stigma on family members. 1675 99


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