污名與社會歧視：成癮者康復遭遇的攔路虎｜清醒壹佰006

02-12

My name is Song. I am currently an intern supervisor at xxx. I started with xx four years ago as a Master level intern. Prior to that, I was a practicum counselor at a partial hospital. There, I can still vividly visualize the facial expressions of my previous colleagues when they learned that I would pursue my Master-level internship at xxx. Their facial expression said, 「Oh, that』s disgusting.」 That was my first experience of addiction stigma.

我的名字是Song。我是xxx機構的實習生督導。４年前，我以碩士實習生的身份加入了xxx機構。在那之前，我在一家日間精神病醫院做實踐。當我告訴當時的同事，我的碩士實習要在一家成癮機構做時，他們的面部表情給我留下了深刻的印象。「Oh，好恐怖」，他們的面部表情似乎這麼說。這是我第一次經歷有關成癮的歧視。

My internship started at xxx in 2012. The question in my mindwas 「why do people choose to use drugs?」 A semester later, I realized that Iasked the wrong question. I discovered that most individuals became addicted to opiates as a result of lack of choices. Many get hooked on opiates through pain medications prescribed by physicians. They take their painkillers diligently, as directed, without aclear knowledge of opiate dependence, until their doctors stop prescribing.2012年，我開始了在xxx的實習。剛開始，我有一個疑問，「為什麼人們會選擇吸毒呢?」一學期後，我意識到，我問錯了問題。我發現絕大多數染上海洛因癮的人，是因為缺乏選擇。很多人的海洛因癮始於醫生開的(阿片類)止痛藥。他們非常遵循醫囑得服用這些止痛藥，卻對這些葯的成癮性缺乏了解，直到醫生停止開藥。

Others though seem to have had a choice. Unfortunately at some point in their lives, heroin was offered to them and they took it. But as I looked deeper into their stories, there are always reasons behind their heroin use. Everyone that I work with has mental health symptoms. A large number of them have trauma histories as well. Using drugs is their way to cope with their symptoms: Flashbacks, grief, unstable mood, panic attacks, depression, or lack of meaning in their lives. Most of them did not know that their symptoms can be treated or where to access treatment. Drugs are a more accessible though unfortunate intervention. 另一些人，看似好像自己選擇吸毒的。在不幸的某一天，有人把海洛因遞到了他們面前，他們接受了。但當我進一步了解他們的故事後，總能發現更深層的原因。我服務的每一個人，同時都被心理疾病困擾。他們中的很多人還經歷過創傷。創傷記憶的閃現，哀傷，不穩定的情緒，驚恐發作，抑鬱，找不到生活的意義：吸毒是他們應對這些癥狀的方式。很多人都不知道這些癥狀通過治療可以緩解，也不知道去哪接受治療。毒品變成了最易上手卻也是最不幸的應對方式。

So think, if what people with addiction really need is primarily mental health treatment, why are they treated differently than others who have mental or physical health issues. Why are they called addicts，junkies, dirty users?

所以，請想一想，如果有毒癮的人真正需要的是心理健康方面的服務，他們為什麼被區別對待？我們為什麼叫他們癮君子，垃圾，覺得他們臟？

I always invite people I work with to share their experiences of stigma. This question has never failed me. No matter how quiet they are,this question always opens them up.我總是請當事人分享他們遭遇的有關成癮的歧視。這個問題極其靈驗。即便是非常沉默的人，這個問題也能打開他們的話匣子。

They feel shamed about their addiction. 「I am so ashamed about this」「I feel terrible that I relapsed」, they say. Their shame comes from the belief that people who use drugs are inherently bad and immoral. They are afraid that once others find out about their addiction, they become less of a person but just an addict. 「This is some dirty little/big secret that I need to hide,」「I will never tell my family abou-t this」, they say. Stigma makes it harder for them to seek treatment「It took me a lot to pick up the phone and make the call」, a person told me. Ironically, as much as we would like them to get help, receiving agonist therapy and counseling itself is something they need to hide as well. Many of the individuals I work with expressed their fear of being kicked out by their landlord, being fired at work if others find out that they are on Suboxone treatment. And more sadly, they feel they are being judged by healthcare professionals and are sometimes hiding their addiction treatment from other doctors.他們為自己的毒癮感到羞恥。「我感到十分羞愧」，「我的毒癮複發了，我感覺糟透了」，他們說。他們的恥辱感來自於人們普遍認為吸毒的人是不道德的，本質是壞的。他們害怕一旦他人發現了他們的毒癮，他們就不再是完整的人，而僅僅是個癮君子。「這是我必須死守的骯髒的秘密」，「我絕不會讓家人知道我吸毒」，他們說。而有關毒癮的歧視也成了成癮者求助的障礙。「我花了很大的勇氣才播了你們的電話」，一位當事人這樣說。更諷刺的是，接受成癮治療這件事，也得藏起來。很多人提到他們的擔心：一旦別人發現他們在接受成癮治療，他們會被房東趕走，會丟掉工作。

People I work with also talk about their family members』unrealistic expectations. Basically, they are expected to recover in a very short time and not allowed any relapses. Addiction is still considered as a moral issue - not a health issue. I too, initially held this expectation, untilI realized that recovery was far more than just stopping using drugs. Have you ever thought of what a Heroin user』s day looks like? If not, you can follow me.They wake up in withdrawal, desperately searching for drugs, if they are lucky,there are some leftovers. They prepare the drug and use it, get high for a bit but then withdrawal kicks in. They get hold of a drug dealer and figure out a time and place to meet. Then they need to figure out where they can get the money. Then they go, meet the drug dealer, get the drug and start the whole cycle again.我服務的群體也會講到家人不現實的期待。基本上，家人希望他們短時間內康復，且不能複發。毒癮仍然被當做一個道德問題，而不是健康問題。其實我自己一開始也抱有這樣的觀點，直到我意識到，康復遠不只停止吸毒這麼簡單。你們有沒有想像過海洛因成癮者的一天是什麼樣子的？如果沒有的話，你可以跟著想像一下。他們在戒斷反應中醒來，抓狂得尋找海洛因。如果幸運的話，能找到一些昨天剩下的。他們著手準備，接著吸食，享受短暫的「高」，然後戒斷反應又襲來了。於是他們一邊聯繫毒販子，一邊想辦法搞錢。接著，他們出發，去和毒販子會面，拿到毒品，再次開始整個過程。

Imagine that one day, one of them starts on Suboxone treatment. All of the sudden he experiences no more withdrawal symptoms. But a new challenge occurs, how is he going to spend the whole day in a drug free way when using drug was the center of his everyday life? A huge void needs to be filled up. For people who use drugs to numb themselves from mental health or trauma symptoms, this is even worse. All of a sudden, they experience every bit of their symptoms. Without proper treatment, without alternative coping strategies, without solid social support, what can they do, when they keep in touch mostly with others who also use drugs and when the waiting list for treatment is at least a month-long?想像一下，某一天，他們中的某一個人開始接受納洛酮治療。突然，毒品的戒斷反應消失了。但更大的問題出現了：之前每天的生活都是圍繞著毒品展開的，現在不用吸毒了，需要如何打發一整天的時間？一個巨大的空白需要填補。對那些用毒品應對心理疾病，創傷癥狀的人，情況更糟。突然，他們能切膚得感到自己的每一點癥狀和痛苦。如果沒有相應治療，沒有其他應對癥狀的方法，沒有強有力的社會支持，他們能怎麼辦？尤其當他們的身邊只剩下吸毒者，而想接受治療又得排上一個月的隊。

I also ask people I work with how they want to be treated by others. I heard this same message from almost every one of them. 「We want to be valued as a whole person」, they say. They are fathers, mothers, daughters, sons,friends, and colleagues. They have dreams, strengths, and weaknesses like we do. They are one of us. It may be shocking to hear, 「they are one of us」. But think more deeply. Are you not struggling with some life challenges? Are you also wanting to make changes but finding yourself relapse again and again? The difference may be that whatever you are struggling with, it』s considered more acceptable by our society.

我會問服務的對象，他們希望如何被對待。幾乎每個人都這樣回答：「我們希望被當做一個完整的人」，他們說。他們是母親，父親，女兒，兒子，朋友，同事。他們和我們一樣，有夢想，有優點，有缺點。他們就是我們中的一員。聽到「他們是我們中的一員」，你也許很吃驚。但請想想，你是否也在攻克生活的一些難關？你是否也想做出一些改變，但發現自己一次又一次回到原點？唯一的區別可能是，你們正在攻克的內容，更被社會接受。

Another message I frequently hear from people I work with is that they want their family and friends to be more patient and realistic about their recovery. As an

addiction counselor, I know that entering a treatment does not mean that a person will become clean right away. I see the limitations of the system. For example, after several months』 waiting, someone finally gets into a program, but she or he may need to wait for another month or so to be evaluated by a psychiatrist.

我服務的對象也經常提到，希望他們的家人和朋友更耐心和實際得看待他們康復的過程。作為成癮諮詢師，我知道從進入治療到停止吸毒還有很長一段距離。我們目前的治療系統有很大的局限。比如，某人排了好幾個月的隊，終於被一家機構收了，可能還得等上一個月，才輪到TA第一次與精神病醫生會面。

In addition, we have all tried to make major changes in our lives. We all know how hard it is. How many of you have ever tried to have a healthier diet? Say eating more vegetables and less chips and soda? Where are you now? Have you ever relapsed? Then, why do we expect our loved ones to recover from addiction in one night, one week, or one month? Acknowledging how hard it is to stay clean, complimenting her or him on the, and encouraging her or him to go back for treatment when relapse happens.我們每一個人都嘗試過做重大的改變。我們知道這個過程的艱難。你們中多少人嘗試過讓飲食變得更健康？比如多吃蔬菜，少吃薯片少喝汽水？你們現在堅持得怎樣呢？有複發過嗎？所以，我們為什麼要求我們的愛人一晚上，一周，一個月就完全從毒癮中康復呢？承認康復之路的艱辛，肯定TA的每一點進步，複發時，鼓勵TA回到治療中。

On the other hand, it is extremely hard to witness your loved ones struggling with addiction. You are dealing with the fear that their lives can be taken away any second. You do get burned out, just like caretakers ofpeople who have other chronic health issues. On top of everything, you experience the stigma of addiction as well. You, too, are ashamed. You feel that you have failed as a parent or a spouse. You, too, are trying your best to hide this addiction. As a counselor, I know the importance of taking care of myself before I can help others. Put your own oxygen mask on first. If you have flown in an airplane,you have heard about this phrase. This is exactly the same for family members of people who have addiction. Talking to a counselor, joining a support group, and gaining help from your personal support system. These are some ways that you don』t have to deal with this all by yourself.但換一個角度，眼睜睜得看著你心愛的人在毒癮中掙扎，確實很難。毒癮隨時能帶走TA的生命，你（家屬，下同）時刻都在恐懼。在這個過程中，你感到耗竭，和那些照顧有其他慢性病的病人的家屬一樣。而你自己也深深得被有關毒癮的歧視困擾。你，同樣也感到羞辱。你覺得自己作為父母或伴侶很失敗。你，同樣也想方設法得隱藏這個毒癮。作為諮詢師，我知道必須把自己照顧好了，我才有能力幫助他人。「首先帶上你自己的氧氣面罩」，如果你搭過飛機，對這句話一定不陌生。這就是你需要做的。給你自己找一位諮詢師，加入一個支持小組，向他人尋求支持。這些方法讓你不再用孤立得面對愛人的毒癮。

Nationwide, the number of heroin overdoses has experienced a 6-fold increase from about 2000 cases in 2001 to almost 12 thousand cases 2014.Last year, in the Lehigh valley, 117 heroin overdose deaths and 21 suspected overdose deaths happened. That』s 138 heartbroken families.從2001年到2014年，美國因海洛因使用過量而喪生的人，從2000變成了12000，翻了整整六倍。去年，僅在理海地區，就有117人因海洛因使用過量而喪生，還有21人被懷疑因海洛因使用過量而喪生。這是138個心碎的家庭。

Four years ago, I started with xxx thinking that I would never have become dependent on Heroin. Over those four years, my ideas have changed.I am no better than them. I just have the pure luck of not going through what they have gone through. So, if you are currently struggling with addiction, be patient with yourself and hang in in treatment. If your loved one is struggling with addiction and you wonder how youcan help them. The answer is in your heart. If you and they are really the same, how would you like to be helped? The answer is in your heart.四年前，剛開始在xxx實習時，我想「我絕不可能染上毒癮」。四年後，我的想法變了。不是我比他們好。我只是比他們幸運，不用去經歷他們所經歷的。所以，如果你正在和毒癮搏鬥，對自己耐心一些，並堅持接受治療。如果你的愛人正在毒癮中掙扎，你想知道自己如何能幫到TA。答案，其實就在你心裡。如果你，和他，沒有區別。你想如何被幫助？答案就在你心裡。

注：本文中引述，均為作者以共性主題為藍本再次創造，而非直接引用來訪者的話。文章首發於作者微信公號，授權清醒人生「清醒壹佰」專欄轉載。

作者介紹：宋歌，北京林業大學心理學本科，理海大學諮詢心理學碩士、博四，物質成癮心理健康諮詢師，義大利精神分析軀體治療師馬龍翻譯，現任賓州某物質成癮與心理健康機構督導，關注弱勢群體，從事歧視相關研究。

延伸閱讀之過往「清醒壹佰」故事：

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