Stigmatization of people with drug dependence in China: A community-based study in Hunan province
Introduction
Drug abuse remains a serious problem in China (Lu et al., 2008, Tang and Hao, 2007). The number of registered drug abusers in 2010 was 1.545 million, with almost 70% of the registered drug abusers primarily abusing heroin (China National Narcotic Control Commission, 2011). However, the actual number of drug abusers in China is estimated to be far higher (UNODC, 2010). Drug abuse becomes a major threat to the public health and social security because of its impact on risk for HIV/AIDS and criminal behaviors. Currently, it is estimated that there are about 740,000 persons living with HIV/AIDS in China (Yang et al., 2010), and drug abusers account for approximately 40% of this population (Chawarski et al., 2011). Furthermore, in some areas of China, drug-related crime represents 70–80% of all crimes (Lu et al., 2008).
For decades, the Chinese government has made a great effort to control drug abuse. Prior to 2008, the Chinese government advocated a punitive approach to drug abuse. The Chinese Anti-Drug law issued in 1990 stipulated that first-time drug users might be detained for up to 15 days, those who developed drug dependence were placed in compulsory rehabilitation centers for 1–6 months for detoxification, and drug users who relapsed after the compulsory detoxification faced placement in compulsory re-education-through-labor centers for 1–3 years. In recent years, political ideology has shifted from a punishment-oriented philosophy to an assistance-oriented philosophy toward drug abusers. According to the new Anti-Drug law issued in 2008, the approach of drug rehabilitation has been stipulated as a process of three steps: medical institution-based detoxification, community-based rehabilitation, and compulsory isolation for rehabilitation. People with drug dependence were encouraged to admit themselves voluntarily to medical institution for detoxification. Following detoxification, they were referred to a community-based rehabilitation center to maintain abstinence for 3 years. Only those who refused or did not improve in the community based rehabilitation were sent to a compulsory isolation center. As the community becomes the primary site for drug rehabilitation in China, it is important to understand attitudes of the community toward the person with drug use disorders.
Hunan province is located in the central south of China, geographically adjacent to Guangdong province, Guangxi province, and Guizhou province. This special geographical position plays an important role in trafficking illicit drugs to other regions and cities of China. By the end of 2010, the total number of registered drug abusers in Hunan was about 100,000 (Hunan Province Centers for Disease Control and Prevention, 2010; Unpublished internal report). Of the newly registered drug-abusing individuals between 2005 and 2008, most are male, young, single, and had 9 or fewer years of education (Deng et al., 2012). Heroin is the predominant primary drug of abuse in Hunan (78%), followed by ketamine (14%) and amphetamine-type stimulants (ATS; 7%, Deng et al., 2012).
Stigma was initially defined by Goffman as an “attribute that is deeply discrediting” and that reduced the possessor “from a whole and usual person to a tainted, discounted one” (Goffman, 1963). Recently, the concept has been redefined in a variety of ways. According to Link and Phelan, stigma occurs when the following interrelated components converge: (1) labeling: people distinguish and label human differences; (2) stereotyping: the labeled is linked to undesirable characteristics; (3) separating: the labeled is separated as an out-group; (4) those so labeled experience status loss and discrimination; and (5) a power situation is necessary to allow these processes to unfold (Link and Phelan, 2006).
Studies conducted in North America, Western Europe, and South Africa suggest that drug use disorders are highly stigmatized in a community (Corrigan et al., 2009, Crisp et al., 2000, Kallen, 1989, Link et al., 1999, Sorsdahl et al., 2012). Negative views such as those implying that drug abuse is an act of personal choice or moral failure, and therefore those affected are responsible for their condition, and are bad, weak and dangerousness, are widespread. Coinciding with these negative stereotypes, discrimination toward drug abusers has been found to exist within a community (Ahern et al., 2007, Angermeyer and Dietrich, 2006). Research further indicates that the stigma the drug addicted contributes to a host of adverse outcomes, including not only the exclusion from useful social interactions (Link and Phelan, 2001), but also poor mental and physical health, non-participation and non-completion of drug use treatment, delayed recovery and reintegration process, and increased involvement in risky behavior (Ahern et al., 2007, Bobrova et al., 2006, Brener et al., 2010, Brewer, 2006, Digiusto and Treloar, 2007, Latkin et al., 2010, Semple et al., 2005).
Research on the stigma of drug use disorders in China is extraordinarily limited. One notable study from Yunnan province shows that drug abusers experience entrenched stigma and overt discrimination in Dai community, creating a vicious cycle of social isolation, marginalization and relapse (Deng et al., 2007). Another study suggests the negative attitudes about drug abusers by Chinese doctors who are providing the expertise for planned drug and alcohol education and training (Tang et al., 2005). It is unclear how the general public views the person with drug dependence.
As noted by Murthy (2002), a striking aspect of stigma about mental disorders, including drug dependence, is its universality; stigmatization of drug dependence probably exists everywhere, even though the form and nature of it may differ across cultures. We hypothesized that stigmatization of drug dependence would exist in China. The present study is an initial attempt to assess public stigma toward the person with drug dependence in China, based on Link and Phelan's concept of the stigma process.
Section snippets
Sample
The respondents were recruited in an urban community in the Tianxin district in Changsha city and a rural community in Junshan farm in Yueyang city in Hunan province. Participants were randomly selected based on the community households sample using Excel software. A majority of households were renting from local authorities. Eventually, there were 513 households selected from a total of 3253 households in the urban community and 500 households selected from a total of 946 households in the
Results
Of the 1013 adults identified, 165 (16.3%) could not be contacted. Thus, 848 (83.7%) participated in the survey. As shown in Table 1, the mean age was 38 (16.9); 54.1% were male; 64.5% were married; 37.7% had 13 or more years education; 40.0% had ¥ 2000 or more income per month, 49.2% were urban residents.
Public knowledge about drug dependence
The findings of this study reveal that knowledge about drug dependence is very poor in this community in Hunan, China. The opinion that the person's own weak will and own hedonistic lifestyle is the causes of drug dependence is widespread. Despite the fact that a chemical imbalance in the brain is a determinant factor of drug dependence (Kalivas and Volkow, 2005, Koob and Moal, 2008), less than one-third of the respondents chose it as a possible cause. These misconceptions may translate to a
Role of funding source
This study was supported by State Key Program of National Natural Science of China (Grant No. 81130020), National Key Technology R&D Program in the 12th Five-Year Plan of China (Grant No. 2012BAI01B07), and National Key Basic Research and Development Program (Grant No. 2009CB522000).
Contributors
Tao Luo and Wei Hao designed the study and wrote the protocol. Jing Wang, Yanhua Li, Xuyi Wang, Linxiang Tan and Qijian Deng managed the literature searches and summaries of previous related work. Tao Luo undertook the statistical analysis, and wrote the first draft of the manuscript. Jaya Prishni Devi Thakoor checked out the text for style and syntax. All authors contributed to and have approved the final manuscript.
Conflict of interest
None.
Acknowledgments
We thank all investigators and local community organizers for their assistance in conducting the study.
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