Introduction
Addiction, ’drug addiction’ or ’drug abuse’ is a ’given about’ or
’devoted to something’ behavior (Alexander &Schweighofer, 1988) that
has a relationship with free will (Vohs&Baumeister, 2009). Addictive
behavior has been adapted to escape ’inner discomfort’. It is about
’powerlessness’ and ’unmanageability’ (Goodman, 1990). Users of
substances see addiction in terms of ’need’, ’urgent’ and ’reduced
control’ (Walters & Gilbert, 2000). Factors such as age (Chassin,
Presson, Rose & Sherman, 2007) and gender in heroin addiction
(Bokhan&Baturin, 2011) also influence behaviors. West & Brown (2013)
have discussed a few theories about addiction. Addiction, types
(Ausubel, 1961) recovery, scope (White, 2007) and ’opiate-like’
medicines (Lindesmith, 2017) have been handed down. Substance user in
general terms is a person who ”lives in the present” and is
”insufficiently motivated by the future” (Skog, 2003). Substance user in
the current study is a voluntary participant who used heroin in the past
and who was now admitted to a center for drug rehabilitation for
treatment.
Addiction stigma is more powerful as compared to mental illness and
disability (Corrigan, Kuwabara& O’Shaughnessy 2009). Addressing
addiction is an important matter (White, 2000a: Buchman & Reiner 2009)
and needs more studies (Livingston, Milne, Fang &Amari 2012). Addiction
is a serious social stigma that generates strong against the user
attitudes (Barry, McGinty, Pescosolido& Goldman 2014).It is a
stereotypic labeling of a person or family due to social attitudes or
rejection towards the stigmatized individual / individuals for discredit
or for causing shame (White, 2009b). Stigma is a moral condition that
shakes and threatens the sufferer as moral experience (Yang, Kleinman,
Link, Phelan, and Lee& Good 2007a).Substance dependents are subject to
stigma (Mahendran, Lim, Verma&Kua 2014). Addiction is found related
with shame and self-stigmatization (Matthews, Dwyer &Snoek
2017).Negative social labeling as addicts found is a cause of alienation
and shame amongsubstance dependents (Gray 2010). Substance users are
subject to public disapproval and stigma (Barry, McGinty, Pescosolido&
Goldman, 2014). Discrimination related with stigma brings in adverse
effects, however, less work is available on this very aspect
(Thornicroft, Mehta, Clement, Evans-Lacko, Doherty, Rose, …&
Henderson 2016). Despite treatment advancement stigma and discrimination
towards substance users is constant (McGinty, Goldman, Pescosolido&
Barry, 2015). Negative social environment could add into addictive
diseases (Kreek, 2011) and stereotypes about addiction effect helping
behaviors (Corrigan, Kuwabara&O’ Shaughnessy, 2009).
Structural vulnerability and moral experience shape stigma (Yang, Chen,
Sia, Lam, Lam, Ngo, … 2014a). Social functioning is related to
serotonin. Serotonergic function effects individual as well as dynamics
of group actions (Krakowski, 2003). Moreover, emotionality and
regulations predict social functioning (Eisenberg, Fabes, Guthrie
&Reiser, 2000). Illness identity effects social functioning (Yanos, Roe
&Lysaker, 2010) and acceptance of illness (Lysaker, Roe &Yanos 2006).
Internalization has emotional consequences and these are related to
cultural norms (Bessenoff& Snow, 2006). Cultures affect emotions,
however, size varies in different cultures (Diener, Gohm, Suh.,&Oishi,
2000). Stigma deserves to be studied in socio-cultural context (Ng,
1997) because it is more culturally proscribed matter like alcohol
(Sewilam, Watson, Kassem, Clifton, McDonald, Lipski, …&Nimgaonkar,
2015).
Stigma is related to quality of life (Sibitz, Amering, Unger, Seyringer,
Bachmann, Schrank., …&Woppmann, 2011),it affects stigmatize through
threats to personal and social identity and self-esteem (Major,
&O’brien, 2005). Stigmatizing attitudes towards addiction affect
individuals (Sattler, Escande, Racine &Göritz, 2017).Self-concept
viewed as ”dynamic, active, forceful, and capable of change” construct
(Markus &Wurf 1987). Self-concept is the collection of various selves
(McConnell 2011).Illness negatively influences hope and self-esteem.
Awareness of illness is related to hope,self-esteem and stigma (Lysaker,
Roe &Yanos, 2006).Internalized stigma found to bring in negative
changes in identity (Yanos, Roe &Lysaker 2011a).Adverse consequences of
the experiences of internalization of stigma are related with hope and
self-esteem and psychosocial situations (Livingston & Boyd 2010a).
Self-concept is related to social success and failure (Bain & Bell,
2004). Negative self-concept leads to problematic behaviors (Ybrandt,
2008). Self and perceived stigma among addicts affects their health and
recovery (Bozinoff, Anderson, Basssicall& Stein 2018a). Public stigma
bars health seeking (Vogel, Bitman, Hammer & Wade, 2013: Conner,
Copeland, Great, Koeske, Rosen, Reynolds III ,. , & Brown, 2010:
Overton & Medina 2008). Culture plays a role in mental illness
development (Myers, 2011). In cultural context, stigma affects treatment
seeking (Loya, Reddy &Hinshaw, 2010). Less work has been reported about
drug stigma (Earnshaw, Smith &Copenhaver, 2013).
Stigma is a global phenomenon (Van Brakel, 2006); it prevails across the
globe (Shellenberg, Moore, Bankole, Juarez, Omideyi, Palomino … &Tsui
2011). The term stigma was articulated in 1960s by Erving Goffman in
(Kleinman& Hall-Clifford 2009). Link & Phelan (2001) explained the
factors that play a role in stigma occurrence. Perceived stigma is
experienced worldwide, with a 22% presence in developing and 11.7% in
under development countries (Alonso, Buron, Bruffaerts, He,
Posada-Villa, Lepine,, …&Mneimneh 2008). Stigma is related to
self-esteem and psychosocial situations (Livingston & Boyd 2010),
self-perception (Frable, Wortman& Joseph, 1997), identity (Yanos, Roe
&Lysaker, 2011a: Slay & Smith, 2011), attitudes (Yılmaz&Okanlı 2015),
status disclosure in HIV (Overstreet, Earnshaw, Kalichman& Quinn 2013),
hope (Mashiach-Eizenberg, Hasson-Ohayon, Yanos, Lysaker, & Roe, 2013),
psychiatric symptoms (Drapalski, Lucksted, Perrin, Aakre, Brown,
DeForge& Boyd 2013), psychopharmacological action of drugs on
personality (Khantzian, 1978), chronic illness (Earnshaw& Quinn 2012)
and recovery (Brohan, Elgie, Sartorius , Thornicroft& GAMIAN-Europe
Study Group, 2010).
Stigma is a measurable subjective experience (Ritsher,
Otilingam&Grajales 2003). Self-stigma (Rüsch,Angermeyer& Corrigan,
2005) emerges from public stigma when people internalize stereotypes
(Corrigan, Larson &Ruesch, 2009a). Race differences in self-esteem have
been observed among the people belonging to different races (Twenge&
Crocker, 2000). Some studies have provided comparisons of different
cultures related to stigma (Mohamed, 2011: Cheon&Chiao 2012: Yang,
Kleinman, Link, Phelan, Lee & Good 2007), cross cultural and historical
aspects are related to stigma (Pescosolido, Olafsdottir, Martin & Long,
2008 ) and similarity of stigma across the cultures in uniformed
communities (Gould, Adler, Zamorski, Castro, Hanily, Steele … &
Greenberg 2010) was observed. Brohan, Slade, Clement &Thornicroft
(2010) have presented a review of stigma studies; another review is by
(Mittal, Sullivan, Chekuri, Allee& Corrigan (2012). Heit, (2003) has
also defined addiction.
Heroin is a drug; experts have analyzed its constituents (Besacier,
Chaudron-Thozet, Rousseau-Tsangaris, Girard &Lamotte, 1997).Heroin
addiction influences self-concept (Shafiq, 1987) and personality (Dubey,
Arora, Gupta & Kumar, 2010).Heroin addiction has been studied in social
and cultural context (Burr, 1987). Heroin dependence has a tilt to be
labeled as negative across the cultures (Gureje,
Vazquez‐Barquero&Janca, 1996). Certain similarities of the heroin
dependent behaviors have also been reported across the cultures
(Griffiths, 2005), however, intake modes and quantity differences in
different areas have also been reported as different (Reissner, Kokkevi,
Schifano, Room, Storbjörk, Stohler, , … &Scherbaum, 2012). Heroin
dependents have been compared on neurocognitive tasks. Some context
gender studies have reflected different biological drug action on male
and female (Perry, Westenbroek& Becker, 2016), Researchers have
recommended methods for heroin treatment and symptoms (Koob, 2000).
Griffiths, (2005) has suggested an eclectic approach towards the
understanding of heroin dependence. The current has work studied heroin
users in a cultural, social and self-concept context.