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TelmoMotaRonzaniEditor
Social
Stigma and
Drug Use
Gender Perspectives, Family Contexts
and Intersections
Social Stigma and Drug Use
Telmo MotaRonzani
Editor
Social Stigma and Drug Use
Gender Perspectives, Family Contexts
andIntersections
ISBN 978-3-031-94812-1 ISBN 978-3-031-94813-8 (eBook)
https://doi.org/10.1007/978-3-031-94813-8
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2025
The original submitted manuscript has been translated into English. The translation was done using
articial intelligence. A subsequent revision was performed by the author(s) to further rene the work
and to ensure that the translation is appropriate concerning content and scientic correctness. It may,
however, read stylistically different from a conventional translation.
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specically the rights of reprinting, reuse of illustrations,
recitation, broadcasting, reproduction on microlms or in any other physical way, and transmission or
information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar
methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specic statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
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If disposing of this product, please recycle the paper.
Editor
Telmo MotaRonzani
Department of Psychology
Universidade Federal Juiz de Fora
Juiz de Fora, Minas Gerais, Brazil
v
Preface
Social Stigma has been widely discussed in various sectors, especially in the eld of
health. From the work of Goffman, several authors from different areas of knowl-
edge have been deepening conceptually the theme and producing derived concepts,
which in turn have allowed for the production of some theoretical reections, under-
standings of contexts, formulation of hypotheses, and empirical investigations. In
particular, attention is drawn to the fact that Social Stigma and all its conceptual
derivations have a signicant impact at different levels, from individual and daily
life to public policies that affect people with certain characteristics.
For more than 20 years, our research group has been investigating the theme,
especially in relation to the area of alcohol, tobacco, and other drugs, and other
health conditions. Over these decades, our research has also been improving and
seeking to understand more complex and dynamic processes about the impacts that
stigma has on the life of certain groups. Our initial studies focused on a more inter-
actionist base and on the stigmatized/stigmatizer relationship, from a specic frame
that characterized the interaction between the groups and how theoretically we
could understand such a relationship.
Our research pointed to a high degree of stigmatization of people who use drugs
or experience some type of mental suffering, especially among professionals in
Primary Health Care or even Mental Health professionals. In addition, we sought to
evaluate the impacts of stigma from the perspective of stigmatized groups (self-
stigma). From such data, we sought to develop or adapt interventions to reduce
stigma among people who use drugs, whether from self-stigma or stigmatization by
professionals. From such work, we closed a cycle of our research, focusing on dif-
ferent social actors involved in the process of stigmatization. However, from eld
observations, theoretical deepening, and qualitative research, we discussed that
there was a very important contextual and social substrate to understand such pro-
cesses. Especially, we understand that the discrimination of specic groups and the
issue of drug use in general occur from a specic social reality and not directly due
to a given behavior or certain health condition, but in relation to the social context.
In this sense, we published the book entitled “Drugs and Social Context. Social
Perspectives on the Use of Alcohol and Other Drugs,” where we sought to address
vi
how the social context inuences the social perception of consumption, prevention,
treatment and policies on drugs, mainly from specic social categories. In the same
direction, we expanded our discussion that social stigma plays an important role in
the formulations and implementations of drug policies, especially in the denition
of repressive and excluding strategies of care for people who use drugs and their
relationship with the violation of Human Rights.
Thus, we emphasize the importance of considering the Social Determinations in
Health, which fundamentally inuence access to care, the quality of prevention
actions, treatment and social reintegration, and public policies. That is, from social
categories like race/ethnicity, gender, territory, and social class, among others, the
impacts of alcohol and other drug use and social stigma are better qualied.
Therefore, in this work we advance in the direction of understanding, in a con-
textual and intersectional way, how social stigma impacts the lives of people, draw-
ing special attention to the issue of gender and family contexts, important topics but
often neglected or even discussed in a decontextualized way and based on moraliz-
ing discourses. In this book we discuss, from a gender perspective, how such cross-
ings impact the lives of people who use drugs in different conditions or even,
indirectly, through the concept of Courtesy Stigma, aimed at people who do not
present certain characteristics or are the direct target of stigmatization, but who are
part of their daily lives, like the relatives of people who use drugs. Here, we draw
attention mainly to women, especially mothers and partners of users who, due to the
expectation of the social role of “caregiver,” are often blamed for the condition or
worsening of the family member’s situation and, as a consequence, face prejudice,
discrimination, increased mental care load, social isolation, etc.
Thus, this book is the result of the research and studies of the Research,
Intervention and Evaluation Center on Alcohol and Other Drugs (CREPEIA), from
the Federal University of Juiz de Fora (UFJF)—Brazil, which has been coordinating
the Ibero-Latin American Network on Stigma and Drug Use for years. This book is
funded by the National Council for Scientic and Technological Development
(CNPq), through the Call CNPq/MCTI N° 10/2023, process 402075/2023-4. The
authors are from different nationalities such as Brazil, Chile, Colombia, Spain,
Mexico, and Uruguay and are also characterized by interdisciplinarity, from areas
such as Biology, Social Sciences, Nursing, Medicine, Dentistry, Psychology, and
Social Work.
The book is a collection composed of two parts and 17 chapters. The rst part,
called “Social Stigma and the Use of Psychoactive Substances Among Different
Groups,” begins with the chapter “Stigma in Problematic Uses and Public Health in
Latin America and Spain,” by Rodrigo Goycolea Martinic, Aldo Gabriel Tomassini
Urti, Laura Pérez-Martorell de Vicente, and Víctor José Villanueva-Blasco, who
provide a general conceptualization of the different types and levels of stigma and
discuss their impacts in the context of alcohol and other drug use. In the second
chapter “Stigma, Morality and Intersectionality in Drug Use,” by Andrés Felipe
Tirado-Otálvaro, Sandra Milena Velásquez-Vergara, and Edgar Orlando Arroyave-
Álvarez, the authors present a critical perspective on how the topic is intersected by
Preface
vii
intersectionality, especially by gender, ethnicity, and social class categories and how
it perpetuates situations of discrimination against specic groups. The chapter
“Poverty, Gender, Drug Use and Stigma: An Intersectional Discussion from the
Perspective of Homeless Women” by Weverton Corrêa Netto, Gabriel Martins
Silva, Aldo Tomassini, Alexandre Aranha Arbia, Marina Fernandes Toledo
Lourenço, Viviane Souza Pereira, and Telmo Mota Ronzani presents a discussion on
the intersection of gender, social class, and race, from the scenario of homeless
women, users of alcohol and other drugs. The chapter “Stigma in Vulnerable Drug-
Using Populations: Migrants, Incarcerated Individuals, and Women,” by Bárbara
González Amado, Carolina Gorlero, Raquel Gallego and Víctor José Villanueva-
Blasco, goes in the same direction, with a focus on people in refugee, immigration,
and deprivation of liberty situations, and how such situations affect women who
use drugs.
In the chapter “Stigma and Diagnostic Overshadowing in People with Mental
Disorder and Substance Addiction,” Concepción Martínez-Martínez, Leticia Olave,
Vicente Gea-Caballero, and Víctor José Villanueva-Blasco bring a discussion on
how the wrong ways of making and treating the diagnosis of mental disorders and
problems with drug use are often loaded with stigma and bring direct consequences
to the treatment and life of these people. The chapter “Stigma and Behavioral
Addictions: Problematic Gambling and Video Game Addiction” by Víctor José
Villanueva-Blasco, Dalila Eslava Pérez, and Antonio Rial-Boubeta discusses a
growing topic which is game and internet dependencies, especially among young
people, which are also loaded with stigma, and explores what are the consequences
for these people. The chapter “Evaluation of an Online Intervention to Reduce
Stigma Among Healthcare Workers in Latin America” by Jazmín Mora Ríos, Hugo
Noel Valdivia Ramos, Jimena Kalawski Isla, and José Luis Vázquez Martínez is an
empirical research where the effectiveness of an online intervention aimed at health
professionals was evaluated with the aim of promoting changes in attitudes about
drug use. The results suggest that such an intervention was promising in relation to
the objectives.
In the chapter by Mario J.Domínguez García and Hugo César Moreno, “Extreme
Experiences: Social Exclusion of Young Users of Inhalants, Crack, and Heroin in
Mexico,” through qualitative research among young Mexican drug users, accounts
are presented and discussed regarding how the stigmatizing view turns into dis-
crimination, especially with some cuts based on ethnicity and social class. The last
chapter of the part by Jazmín Mora Rios, Marcela Tiburcio Sainz, and Adán Emir
Aranda Reynoso “Stigma, Discrimination, and Substance Use. An Intersectionality-
Based Approach” precisely highlights the importance of analysis through intersec-
tionality, highlighting gender, race/ethnicity, and social class for a more
contextualized understanding of the stigmatization processes affecting certain
groups that consume alcohol and other drugs.
Part II, “Social Stigma, Gender, Family Contexts and Drug Use” begins with the
chapter “Stigma, Prejudice and Media: Impacts on the Care of Relatives of People
Who Use Drugs” by Joanna Gonçalves de Andrade Tostes-Bianchetti, Telmo Mota
Preface
viii
Ronzani, Rodrigo Goycolea Martinic, and Pollyanna Santos da Silveira, where it is
discussed how the media in general are a source of dissemination and reinforcement
of stigmas, especially about gender role expectations and at the same time an impor-
tant means of disseminating knowledge and awareness for the reduction of stigma.
In the following chapter “An Analysis of Bibliographic Productions About the Use
of Substances by LGBTQIA+ Youth in Brazil: Debating Stigma and Prejudice” by
Juliana Perucchi, Caroline Nazar Machado Cândido, Fernanda Zeloschi, Arthur de
Paula Ribeiro, and Thamiris Ribeiro, the authors present a systematic review that
analyzes scientic productions in Brazil that investigate drug use among sexual
minorities, more specically among the LGBTQIA+ population, pointing to the
consequences, not only of use, but also of prejudice toward these people. In the
same direction, Rafael Ballester-Arnal, Maria Dolores Gil-Llario, Cristina Giménez-
García, and Estefanía Ruiz-Palomino, in the chapter “When Drug Addiction
Coexists with HIV Infection: The Interaction of Two Powerful Stigmas” make an
important discussion between the intersections between stigma about drug use and
people with HIV/AIDS, relating to prejudices about sexuality and gender.
In the chapter “Intrafamily Violence, Substance Use and Gender,” Marianne
Ramos Feijó, Eroy Aparecida da Silva, and Richard Alecsander Reichert draw
attention to the contexts of intrafamily violence, mainly focused on gender issues
and alcohol and other drug use and the importance of implementing actions and
reinforcing public policies in the area. Antonio Vidal Infer, Juan Carlos Valderrama-
Zurián, and Andrea Sixto Costoya in the chapter “Accessibility Barriers to Treatment
from a Gender Perspective” discuss the main barriers to care in relation to alcohol
and other drug use due to still hegemonic models that disregard the perspective of
gender and sexuality as a way to improve access and quality of treatments. The
same authors present another chapter entitled “The Role of the Caregiver in the
Addiction Treatment Process” in which they draw attention to the need for support
and support for caregivers and family members of people who use drugs, emphasiz-
ing that they are subjects fundamental in care processes and bear a signicant bur-
den of care, and are also stigmatized due to the health condition of their relatives. In
the chapter “Stigmatization of Women Who Consume Alcohol in a Rural Indigenous
Community in Central Mexico” by Marcela Tiburcio Sainz, Jazmín Mora Ríos, and
Pilar Bernal Pérez, who also focus on the issue of gender in relation to the catego-
ries of territory and ethnicity with a study among indigenous women living in rural
Mexico, where accounts of these women are presented, highlighting the difculties
of access to care, prejudice, and discrimination due to these social categories. The
book concludes with the chapter “Addictive behaviors, gender and stigma: contribu-
tions to the understanding of the Portuguese case”, authors Sandra Mendes, Sara
Melo and Idalina Machado make a relationship between stigma, substance use and
gender, using drug policies in Portugal as a backdrop.
As can be seen, this is a book with varied themes, which has as its backdrop the
stigma in its different characterizations in relation to the consumption of psychoac-
tive substances and the understanding of such phenomenon from the perspective of
Preface
ix
intersectionality, mainly with the categories of gender, sexuality, race/ethnicity, ter-
ritory, and social class. As already mentioned, this is an interdisciplinary work with
a rich discussion on the topic and precisely for this reason the work is of interest to
various areas of knowledge, with different audiences such as academics and
researchers, health professionals, managers and policy makers, activists, among
others. We hope that with this work made by many hands and many perspectives we
can contribute to the advancement and mainly to the change of the conditions of
care and access to people who use drugs, as a form of basic human right.
Juiz de Fora, Brazil TelmoMotaRonzani
December 2024
Preface
xi
Contents
Part I Social Stigma and the Use of Psychoactive Substances Among
Different Groups
1 Stigma in Problematic Uses and Public Health in Latin
America and Spain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Rodrigo Goycolea Martinic, Aldo Gabriel Tomassini Urti, Laura
Pérez- Martorell de Vicente, and Víctor José Villanueva-Blasco
2 Stigma, Morality, and Intersectionality in Drug Use . . . . . . . . . . . . . . 15
Andrés Felipe Tirado-Otálvaro, Sandra Milena Velásquez-Vergara,
and Edgar Orlando Arroyave-Álvarez
3 Poverty, Gender, Drug Use, and Stigma: An Intersectional
Discussion from the Perspective of Homeless Women . . . . . . . . . . . . . 29
Weverton Corrêa Netto, Gabriel Martins Silva, Aldo Tomassini,
Alexandre Aranha Arbia, Marina Fernandes Toledo Lourenço,
Viviane Souza Pereira, and Telmo Mota Ronzani
4 Stigma in Vulnerable Drug-Using Populations: Migrants,
Incarcerated Individuals, and Women . . . . . . . . . . . . . . . . . . . . . . . . . 45
Bárbara González Amado, Carolina Gorlero, Raquel Gallego, and
Víctor José Villanueva-Blasco
5 Stigma and Diagnostic Overshadowing in People
with Mental Disorder and Substance Addiction . . . . . . . . . . . . . . . . . 59
Concepción Martínez-Martínez, Leticia Olave, Vicente Gea-
Caballero, and Víctor José Villanueva-Blasco
6 Stigma and Behavioral Addictions: Problematic
Gambling and Video Game Addiction . . . . . . . . . . . . . . . . . . . . . . . . . 71
Víctor José Villanueva-Blasco, Dalila Eslava Pérez, and Antonio
Rial-Boubeta