Attitude and Stigma

Excerpted from the Preface to Treating Concurrent Disorders: A Guide for Counsellors - Approaching Concurrent Disorders

Most of us—and this includes professionals as well as lay people—at some point in time will experience negative feelings and thoughts that we will project onto people with substance use or mental health problems. These  feelings reflect attitudes that have been formed through the influence of our families, our society, our personal experiences and our own level of understanding. Negative feelings such as fear, moralism, pity, derision and even contempt may be subtle or strong, but, either way, they can have immense power to shape and construct the perceptions we hold of the person toward whom they are directed.

It is not incorrect to describe the effects of these feelings and attitudes as hurtful. In time, these hurtful effects are shaped not just by the external attitudes of others toward people with substance use or mental health problems, but also by the internalized attitudes people with these problems have toward themselves. The mark left by these negative feelings, or stigma, can be more long-lasting than the illnesses themselves.

Attitudes change slowly. Much progress has been made toward people’s accepting mental health problems as illnesses, but less so with addiction. Although both can be chronic and relapsing health problems, people tend to make a distinction between the two. Some mental health workers, for example, may see people’s psychiatric problems as real illnesses, and their substance use problems as intentional behaviour. Addiction workers, on the other hand, may firmly believe that most people can recover from substance use problems, but think people with serious mental health problems are not capable of significant change. As more mental health and addiction workers learn to work with clients with co-occurring problems, and their understanding of the relationship between substance use and mental health problems increases, client care will become more responsive and effective.

The chapters in this book are intended to serve as an introduction to each of the different aspects of identifying, understanding and treating concurrent disorders. The first part provides an introduction to the field, the second looks at the programs offered here at CAMH, and the third offers some theoretical and therapeutic perspectives. The concluding section looks at what is being done here to expand the capacity of our concurrent disorder services, and what can be done in services outside CAMH to better serve these clients.

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