Stigma by association among alcohol and other drug and harm reduction workers: Implications for workplace outcomes.

INTRODUCTION: The negative attitudes people hold towards those who use alcohol or other drugs (AOD) can also affect the people who work with this community, leading to lowered productivity and wellbeing. The impact of this stigma by association in the AOD and harm reduction sector is particularly significant because workers may have lived experience of AOD use and identify strongly with their client group. This study aimed to examine how stigma by association among health workers in the AOD/harm reduction sector relates to workplace outcomes. A secondary aim was to explore how lived experience influences experiences of stigma by association. METHODS: The research used a cross-sectional survey design and data collection occurred in 2023. Australian AOD/harm reduction workers (n = 228) completed an online survey assessing stigma by association as well as various workplace outcomes measures. RESULTS: Participants who reported experiencing more stigma by association experienced poorer workplace wellbeing, higher burnout and greater intentions to leave the AOD/harm reduction field. Experiences of stigma by association were unrelated to job satisfaction. Additional analyses revealed that participants with lived experience reported higher levels of job satisfaction and lowered intentions to leave the sector, but findings of stigma by association and its impacts on workplace outcomes did not differ from those without lived experience. DISCUSSION AND CONCLUSIONS: Identifying staff experiences of stigma by association and developing support and advocacy mechanisms to address this is likely to be key to reducing these experiences and ultimately to increasing positive workplace outcomes for AOD and harm reduction staff.

Learning that cannot come from a book: An evaluation of an undergraduate alcohol and other drugs subject co-produced with experts by experience.

Alcohol and other drugs (AOD) use is a significant public health issue and is associated with high mortality and morbidity rates. Despite this, people who use drugs are often reluctant to seek care due to the lack of trauma-informed treatment and harm reduction treatment options, as well as experiences of stigma and discrimination in health services. Arguably, AOD education that is co-produced with people who use alcohol and drugs can enhance future health professionals' ability to practice in ways that support the needs of this population. This paper reports on a qualitative co-evaluation of a co-produced undergraduate nursing AOD subject. The AOD subject was co-planned, co-designed, co-delivered, and co-evaluated with experts by experience, who have a lived experience of substance dependence and work as advocates and peer workers. Following the delivery of the subject in 2021 and 2022, focus groups were undertaken with 12 nursing students. Focus group data indicate that the co-produced subject supported participants to understand and appreciate how stigma impacts on nursing care and how to recognize and undertake 'good' nursing care that was oriented to the needs of service users. Student participants noted that being co-taught by people who use drugs was particularly powerful for shifting their nursing perspectives on AOD use and nursing care and took learning beyond what could be understood from a book. Findings indicate that co-produced AOD education can shift nursing students' perceptions of AOD use by providing access to tacit knowledge and embodied equitable and collaborative relationships with people who use drugs.