BOSTON - Even after resolving a problem with alcohol and other drugs, adults in recovery report experiencing both minor or "micro" forms of discrimination such as personal slights, and major or "macro" discrimination such as violation of their personal rights. These experiences are associated with increased distress and lead to both diminished quality of life and a decrease in resources needed to successfully sustain recovery, investigators from the Recovery Research Institute and Center for Addiction Medicine at Massachusetts General Hospital (MGH) and Harvard Medical School (HMS) report.

The findings, which have important implications for both substance use disorder treatment and public policy, are published in the journal Drug and Alcohol Dependence.

Although previous studies of persons with substance use disorder found evidence of discrimination while symptomatic, or when incarcerated, or in other stigmatized situations, this is believed to be the first study to look at the prevalence and types of discrimination experienced among those who report that they have resolved a problem and are in recovery, says lead author Corrie L. Vilsaint, PhD, a research fellow at MGH.

She and her colleagues surveyed a nationally representative sample of 2,002 US adults who reported resolving an alcohol or other drug problem and asked, "Since resolving your problem with alcohol or drugs, how frequently have the following occurred because someone knew about your alcohol or drug history?"

The questions solicited information about micro discrimination such as "people assumed I was likely to relapse" and "people said I looked like an alcoholic or addict" and macro discrimination such as job loss, denial of a loan or housing, denial of the right to vote, or insurance refusals.

"In general, we found that nearly 50 percent of the people said that others 'assumed I would relapse', and 38 percent said they felt like at times they were being held to a higher standard than other people. We also captured that about 18 percent reported that they felt like they had been treated unfairly by the police," she says.

In addition 16.2 percent of respondents said they were denied employment, 7.7 percent said they were denied the right to vote, 15.2 percent said that it was hard for them to get medical insurance, 11.2 percent said that insurance would not cover some of their medical costs, and 9.4percent said that they were denied housing, all because someone knew of their prior history of alcohol or other drug problems.

After adjusting for the severity of addiction and years since resolution of the problem, the investigators found that respondents who reported greater levels of discrimination were significantly more likely to suffer from higher psychological distress, lower quality of life, and decreased "recovery capital" - the sum total of resources needed for successful recovery.

"These findings have social and policy implications" Vilsaint says. "It is tough enough struggling with the physical and psychological demands of recovery without having to contend with the kinds of discrimination reported fairly frequently here. Some of these residual tolls that you see in these people's lives from past drug history or past criminal history related to their drug use can block them from seeking addiction recovery, block them from seeking treatment and block them from disclosing that they need help."

The investigators note that additional study is needed to determine which discriminatory experiences are most likely to have a negative effect on recovery efforts.

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Co-authors of the paper in Drug and Alcohol Dependence are Lauren A. Hoffman, PhD, and John F. Kelly, PhD, from the MGH Recovery Research Institute.

The study was funded by the MGH Recovery Research Institute. Vilsaint's and Kelly's work is supported by awards from the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health, and Hoffman's work is supported by an award from the NIH National Institute on Drug Abuse. The authors declared no conflicts of interest.

About the Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH Research Institute conducts the largest hospital-based research program in the nation, with an annual research budget of more than $1 billion and comprises more than 8,500 researchers working across more than 30 institutes, centers and departments. In August 2019 the MGH was once again named #2 in the nation by U.S. News & World Report in its list of "America's Best Hospitals."