Addiction Medicine: Closing the Gap between Science and Practice

One survey of New York City residents found
that 39 percent said that ‘‘Most people think less
of a person who smokes” and 21 percent said
that “Most people believe smoking is a sign of
personal failure.”^110

Over 40 percent (41.4) of respondents to the
NABAS reported that discrimination against
people in recovery* from addiction involving
nicotine, alcohol or prescription or illegal drugs
is a very (15.8 percent) or somewhat (25.6
percent) serious problem in their community;
51.0 percent of those who had their own history
of addiction thought it was a very (24.5 percent)
or somewhat (26.5 percent) serious problem.^111

Thirty-eight percent of the respondents to the
NABAS reported that the main reason why
people with addiction do not get the help they
need is a fear of adverse consequences like
losing a job, getting expelled from school or
losing child custody. Treatment providers also
see this as a barrier to treatment access: CASA
Columbia’s survey of treatment providers in
New York State found that a significant
proportion of the respondents said that the fear
that one will be discriminated against
“somewhat” (48.2 percent of program directors
and 51.4 percent of staff providers) or “very
much” (39.8 percent of program directors and
30.4 percent of staff providers) stands in the way
of people looking for needed addiction
treatment, as does fear of losing one’s job (96.3
percent of directors and 94.2 percent of staff
providers said this “somewhat” or “very much”
stands in the way of people looking for needed
treatment).^112

Another recent study found that while there are
no significant differences in employment rates
between people with a history of addiction and
those without, those with a history of addiction
report significantly higher rates of involuntary
job loss. The analyses conducted for the study,
which controlled for other factors that predict
employment outcomes, suggest that employer
discrimination may be an important contributing
factor to job instability in this population. The
authors speculate that while the Americans with

• Defined as effectively managing their disease.

Disabilities Act of 1990 is successful in

protecting those with a history of addiction from

experiencing discrimination in the hiring

process, it might be less successful in protecting

those people from job termination.^113

Individuals with a lifetime diagnosis of

addiction involving alcohol are less likely to

access treatment or support services† if they

perceive that addiction carries a stigma.^114

Respondents to the NABAS admit that they

would discriminate against people who have a

history of addiction, being less likely to hire

former smokers or those in recovery from

addiction involving alcohol or other drugs.^115

 53.6 percent of respondents said that they

would be less likely to hire a qualified

applicant upon learning that he or she is in

recovery from addiction involving illicit

drugs;

 41.1 percent would be less likely to hire a

qualified applicant in recovery from

addiction involving controlled prescription

drugs;

 27.9 percent would be less likely to hire a

qualified applicant in recovery from

addiction involving alcohol; and

 6.6 percent would be less likely to hire a

qualified applicant who is a former

smoker.^116

In comparison, 18.0 percent said they would be

less likely to hire a qualified applicant who had

been treated for depression, about nine percent

said that they would be less likely to hire a

qualified applicant who had been treated either

† Defined in this study as including services delivered

in an inpatient ward, outpatient clinic, rehabilitation

program, halfway house, emergency room or crisis

center or by a private physician, psychiatrist,

psychologist, social worker or other professional;

alcohol or other drug detoxification; and self-

help/mutual support programs (e.g. AA) or social

services (family services or services delivered by an

employee assistance program or by clergy).