Jon Soske, PhD, Delivers Anti-Stigma Training to PCF HEZ

Jon Soske, PhD, a research associate who focuses on addiction medicine at Lifespan, is deeply involved with community initiatives and has collaborated with groups like Second Act, which uses the arts to address addiction-related stigma. Before joining Lifespan, he held several roles in harm reduction advocacy, including his directorship at RICARES, and was part of Rhode Island Hospital’s Center of Biomedical Research Excellence (COBRE) on Opioids and Overdose research team, and a co-investigator on the CDC-funded EMPOWER project.

With a strong background in both racial justice and harm reduction, Dr. Soske has worked to bring programs on addiction medicine, including how community health workers can assist in emergency departments, to front line emergency and care givers. He is a strong advocate for a multi-pronged approach to addiction-related stigma that combines public education, policy changes, and community engagement.

Dr. Soske recently led a series of trainings with members of the Pawtucket Central Falls Health Equity Zone Mental Health Task Force and key partners in the community to bring awareness about addiction as a treatable medical condition, and the importance of using non-stigmatizing language to foster empathy and understanding.

What are the most critical steps society needs to take to further reduce stigma and improve health outcomes? 

“Any discussion of stigma or improved health outcomes, has to first start with the decriminalization for personal possession of substances. The criminalization of substances has been used to fuel mass incarceration, especially for Black communities. Any conversation about substance use disorder needs to start there – we cannot destigmatize a criminalized activity. Second, we need to celebrate recovery and make visible the fact that overcoming addiction is possible. There are 23 million Americans who have recovered from a drug or alcohol problem in this country and their stories need to be told and their experiences need to be honored. Third, we need to recognize the fact that many people use substances who don’t have a problematic relationship with those substances. Substance use is not equivalent to addiction, and we need to accept that substance use is a part of our social life and treat it not as a criminal or moral issue, but as a public health issue."

What role does language play in shaping public perception and how can changing the language we use reduce stigma?

We know from research, that language plays a critical role in framing substance use disorder. We specifically have research that shows that clinicians who use stigmatizing language tend to respond more punitively and more judgmentally to substance use disorders and less supportively and less optimistically. Changing language won't eradicate stigma, but it's a concrete, evidence-based step that everyone can take that can have immediate impact.

We can choose words to demean, or we can choose words to empower — and how we talk about these things really does matter.

What specific terms contribute to stigma, and what alternatives should we adopt to foster a more compassionate understanding?

Research points to five specific words that are highly stigmatizing. They're substance abuse, addict, alcoholic, relapse, and clean or dirty. We misuse substances; we don't abuse substances. Abuse conjures images of some of the most serious crimes in our society, and it's a mistake to talk about abusing a substance. Terms like alcoholic and addict reduce people to a diagnosis, and we are all far more than our diagnoses, and far more than our worst moments.

“Relapse” tends to have a blaming element to it, and it also confuses returning to clinical substance use disorder with possibly a single act of substance use which can be more or less problematic. To use “clean” about a person, a syringe, a tox-screen implies that people can be dirty — and that in and of itself is demeaning. There are other words that people discuss and debate, but these are the words that we have substantial amount of evidence about showing that they negatively impact clinical decision-making.

So it's really not a question of “political correctness,” It's one way that the science tells us we can improve our addiction care and treatment.

How do you see the relationship between harm reduction and racial justice?

In the United States, the starting point is the war on drugs and mass incarceration, and in particular, how that has impacted the BIPOC communities. Many of the greatest harms associated with substance use are not about the substance at all. They're about society's responses to substance use. It's commonly said by people in recovery, as destructive as addiction is — and it is profoundly destructive — our response to substance use has been even more destructive.

So, we can't reduce the harms related to substance use unless we address the social context and the upstream drivers of those harms. Unfortunately, in many cases, the center of this social context is racism. Harm reduction rests on the belief that people have the power to make decisions for themselves and they have the right to make decisions about what goes into their body. That's a radical position in today's America, and trusting some of society's most stigmatized people, such as people who use drugs, to be able to make their own decisions is likewise a radical position, though it shouldn't be. If it wasn't for stigma, we would see harm reduction as common sense, much like safer sex and other strategies to reduce risk.