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.