A new campaign in Scotland is reigniting an old discussion about the social harms caused by stigmatising reporting practices.

Stigma is another word for ‘shame’ or ‘disgrace’, and it tends to be associated with marginalised behaviours and communities. In 1963, sociologist Erving Goffman described stigma as the mark of something or someone “less desirable”, which remains one of the most concise ways of capturing what stigma is and how it is used to wound people and enforce social hierarchies.

For people who drink and use drugs, stigma can manifest as “being excluded, talked about as a ‘problem’ for society, and denied equal rights; it can sound like prejudice towards them by equating their identity with their drug use, belittling their value based on their drug use, and dehumanising them through labels”. Stigma can have a profound material impact on people’s lives, and even “make a person feel like their life doesn’t matter”.

‘Interrupting the transmission’

In April 2023, Scottish Health Action on Alcohol Problems (SHAAP), The Salvation Army, and the University of Stirling launched a project called See Beyond – See the Lives – Scotland, which aimed to share the stories of people whose loved ones have died of drug- or alcohol-related causes.

The project team wanted to bring attention to this “powerful content”, but they faced a dilemma, according to Professor Tessa Parkes and Dr Hannah Carver.

“Our contributors are beyond brave, sharing with brutal honesty many of the emotions that come with bereavement, and battling the stigma that surrounds alcohol and drug use. They speak of the pain, loneliness, frustration and anger they feel over not only the loss of life, but the reactions others have to the way that life was lost.”

“It wasn’t surprising that media outlets were keen to share this very powerful content. However, it was a tricky path to navigate. The University of Stirling, Scottish Families Affected by Alcohol and Drugs, Scottish Health Action on Alcohol Problems, and The Salvation Army – the partners behind See Beyond – believe that the media plays its part in perpetuating alcohol and drug-related stigma.”

The team’s approach was to take an active role in shaping the media discourse – to interrupt the transmission of stigma by giving journalists and editors the tools to make ‘better choices’.

The See Beyond team created a section on their website dedicated to tips for the media and encouraged every journalist they engaged with to follow the five tips. These recommendations originated from the Reporting of Substance Media Toolkit, which was produced in 2022 by Scottish Families Affected by Alcohol and Drugs and Adfam. Up to August 2023, a reported 29 out of 30 media outlets who worked with See Beyond cooperated with the tips and with the team’s wishes for non-stigmatising coverage.

Guiding journalists and editors

The media has a strong bearing on public perceptions of drugs and alcohol. Some authors and publications are notorious for their pejorative and punitive ways of writing about people who drink and use drugs. Many others have good intentions but still use words and images that reinforce stigma. Inspired by the media tips above, here are five ways that stigma can creep into articles about substance use – or, ‘five things to avoid before hitting publish’.

1. Don’t use terms that ‘other’ or marginalise people who drink and use drugs

There are several helpful language guides on the topic of substance use (see list of resources), which offer suggestions on ‘what to say’ and ‘what not to say’ if you want to cultivate a discourse of dignity and respect, rather than stigma. A good starting place is “Words matter”, which was produced by the International Network of People who Use Drugs (INPUD) and Asian Network of People who Use Drugs (ANPUD).

Language guides identify two categories of stigmatising language. Firstly, there are words and phrases which are overtly offensive or dehumanising (e.g. ‘junkie’). Secondly, there are words and phrases that cause harm in more insidious ways, for example, through reducing people to their substance use or diagnosis (e.g. ‘injector’), dismissing someone’s agency or choice (e.g. saying that they are ‘non-compliant’ if they do not follow treatment recommendations), or implying that someone is personally guilty and deserving of punishment for the harms they experience (e.g. ‘substance abuser’).

In the news media, people who drink and use drugs are often talked about by people who don’t share their lived experience. And many people reading the stories will not share their lived experience either. In this context, people who drink and use drugs can be easily cast as ‘other’ – a group that is fundamentally different from ‘the rest of us’, and in some way “inferior or morally flawed”.

2. Don’t sensationalise or misrepresent substance use interventions

Articles can also reinforce stigma by using terms that present a biased or unfair view of the substance use interventions from which people who use drugs stand to benefit.

A current and relatively high-profile example is drug consumption rooms, which offer hygienic and supervised spaces for people to inject (or sometimes inhale) illicit drugs. The term ‘drug consumption room’ provides a neutral description of what takes place in the facilities. Alternative terms are ‘overdose prevention facilities’ or ‘safer injecting facilities’, which emphasise the harm reduction aims of the intervention.

In the media, however, drug consumption rooms have been called ‘drug dens’, ‘fixing rooms’, and ‘shooting galleries’. Far from being neutral labels, these kinds of terms delegitimise the intervention and detract from valuable and measurable outcomes, such as preventing fatal overdoses.

3. Don’t resort to ‘shock value’ in headlines

Headlines serve various purposes. Editors want a headline to entice people to read the story. Journalists want it to be a fair and accurate representation of their article. Readers want the headline to pique their interest and manage their expectations. And, according to research by the American Press Institute, these functions should all be served in eight words or fewer.

The limitation on words increases pressure on the editor (it’s usually an editor who will write the headline) to hook readers. They may include pejorative terms or metaphors in order to connect with readers on an emotional level. Or they may feature ‘colloquial shortcuts’ that quickly communicate the subject of a story but aren’t necessarily kind or precise.

The impact of a stigmatising headline is hard to calculate. But it is safe to assume that many people will scan headlines without reading the full stories, and walk away with impressions of the news (and people in the news) that they won’t be conscious of or have time to think critically about. The presence of stigmatising language in headlines could, therefore, reasonably be assumed to sew negative perceptions of people who drink and use drugs despite only being a few words long.

4. Don’t glamourise or demonise drugs and alcohol in photos

Articles are made up of text-based components (e.g. headline, standfirst, body text, pull-out quotes) and images. Most of the discourse around stigma tends to focus on an author’s words, but accompanying images are just as important. An image can reinforce harmful stereotypes and tropes about drugs and alcohol on a visceral level.

Dr Stephen Parkin, author of An Applied Visual Sociology: Picturing Harm Reduction, says that it has become “almost standard and expected procedure to incorporate stock images of discarded injecting paraphernalia, people injecting substances, communal drinking scenes, drug-related litter, close-up shots of alcohol, and semi-clothed people in varying states of ecstasy and agony”. These can harm communities and people at the centre of stories by reinforcing negative stereotypes, showing only a small part of a person’s experience, triggering cravings, and diminishing the social consequences of substance use problems.

5. Don’t feed ‘moral panics’ with unsubstantiated claims

Media coverage of substance use often supports one of two narratives: the link between substance use and crime; and the destruction substance use causes to individuals, families, and the social environment. Illicit drugs, in particular, are depicted as “instantly addictive, impossible to resist, and sure to bring violence, insanity, or economic and social ruin”. These narratives can help to generate or participate in moral panics about drugs and alcohol  – “false or exaggerated perception[s] that some cultural behaviour or group of people is dangerously deviant and poses a threat to society’s values and interests”.

Public health crises, such as the opioid overdose epidemic in North America, present a significant challenge for journalists and editors on this front. The difference between a crisis and a panic is that a crisis will cause concern and inspire pragmatic solutions. In contrast, a panic will typically feature irrational or unsubstantiated claims and lead to responses based on instinct or fear.

Useful resources

Language matters: using respectful language in relation to sexual health, substance use, STBBIs and intersecting sources of stigma. Published by the Canadian Public Health Association (2019).

Insert standard stigmatising headline and image here: rewriting the media’s portrayal of addiction and recovery. Published by Scottish Families Affected by Alcohol and Drugs and the Scottish Recovery Consortium (2020).

Moving beyond ‘people-first’ language: a glossary of contested terms in substance use. Published by the Scottish Drugs Forum (2020).

Overcoming stigma through language: a primer. Published by the Canadian Centre on Substance Use and Addiction (2019).

Reporting about alcohol: a guide for journalists. Published by the World Health Organization (2023).

Statements and guidelines: ​addiction terminology. Published by the International Society of Addiction Journal Editors (2015).

The world drug perception problem: countering prejudices about people who use drugs. Published by the Global Commission on Drug Policy (2017).

Words Matter! Language statement and reference guide. Published by the International Network of People who Use Drugs and Asian Network of People who Use Drugs (2020).

by Natalie Davies

The opinions expressed in this post reflect the views of the author(s) and do not necessarily represent the opinions or official positions of the SSA.

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