Scottish Social Attitudes Survey 2021/22: Public Attitudes Towards People with Problem Drug Use

Chapter 5 – Conclusions

This module of questions on the Scottish Social Attitudes Survey 2021/2022 aimed to explore attitudes towards people in society experiencing problem drug use. Specifically, the questions explored views on levels of stigma and compassion towards people experiencing problem drug use and views on who should be responsible for helping them. As some of the questions have previously appeared on SSA surveys, we were also able to explore how attitudes have changed over time.

SSA 2021/22 indicated that over time the Scottish public have become more compassionate and hold less stigmatising attitudes towards people with problem drug use. On some issues, the public's perceptions of problem drug use have seen a marked shift. The proportion who agreed that most people who use heroin come from difficult backgrounds rose by 21 percentage points from under a third (29%) in 2009 to a half (50%) in 2021/22. Similarly, the percentage of those who agreed that people should not be prosecuted for possessing small amounts of heroin almost tripled from 15% in 2001 to 42% in 2021/22.

Since 2013, there has been a general shift to less stigmatising attitudes toward problem drug use. The proportion of those who felt comfortable living near someone getting help to stop using heroin rose from 26% in 2009 to 30% in 2021/22, and the proportion of the public who agreed that people who use heroin can never stop using drugs completely fell from 29% to 23% between 2009 and 2021/22. Drug policy changes in Scotland may have contributed towards the change towards less stigmatising views of these two health problems.

Although the findings showed higher levels of compassion for people with problem drug use there was still evidence that drug stigma is an ongoing issue in Scotland. While almost everyone (98%) felt that people who had become homeless because of a family break up were deserving of help, the proportion who felt the same for those who had become homeless because of a drug problem was lower at 87%. Moreover, around six in ten (59%) said they would be comfortable working with someone getting help to stop using heroin but this dropped to only three in ten (30%) when asked if they would be comfortable living near someone getting help for this reason. This may be related to perceptions of risk posed by people with problem drug use with the vast majority believing that people with problem drug use pose at least a small risk to others. Only 3% felt that people with problem drug use posed no risk, while the most common response was that they pose a moderate risk (41%).

Attitudes towards people with problem drug use showed some variation by sex, age and level of education but there were few or no associations between these attitudes by area deprivation or whether people were living in urban and rural areas. People with no educational qualifications were more likely to think that people with problem drug use 'have only themselves to blame' than those with at least a degree-level qualification. Over half (56%) of those with no qualifications felt that people with a drug problem 'have only themselves to blame' compared with 15% of people with a degree-level qualification or above. Those with no educational qualifications were also more likely to report being uncomfortable living near someone receiving help to stop using heroin than those with at least a degree-level qualification (56% compared with 29%, respectively).

On some issues, men held more stigmatising attitudes than women. For example, when asked whether people who become homeless because of a drug problem are deserving of help, 91% of women agreed, compared with 84% of men. There was also an association between age and the level of stigmatising attitudes. Over seven in ten (72%) of those aged 16-34 agreed that people who use heroin come from difficult backgrounds, compared with 35% of those aged 65 and over.

The level of stigma across a range of different questions was associated with people's attitudes towards those with problem drug use. People who perceived problem drug use as a societal rather than individual issue were more likely to display less stigmatising attitudes towards people experiencing this. For example, those who disagreed that people with problem drug use 'have only themselves to blame' were more likely to agree that people who have become homeless because of a drug problem are deserving of help; less likely to think that people with problem drug use pose a big or moderate risk to others; were more comfortable living and working near someone getting help to stop using heroin; and were more likely to think a child aged 5 whose parent is taking heroin should remain with the parent with regular support from social workers.

Across Scotland, an individual's personal history with illegal drugs was shown to influence the level of stigma they held towards people with problem drug use. People who had tried drugs themselves or who had a family member who had regularly used drugs were more likely to hold less stigmatising, and more compassionate, views towards people with problem drug use. For example, the vast majority (95%) of people who had tried illegal drugs themselves felt that people who had become homeless because of a problem with drugs were deserving of help with the proportion falling to 85% among those who had never tried illegal drugs.

The suite of questions on public attitudes towards people with problem drug use in SSA 2001, 2009 and 2021/22 provide an evidence base on which to assess the extent to which levels of stigma towards people experiencing such problems have changed over time. The evidence presented in this report suggests that levels of stigma are reducing towards those with problem drug use over time. This evidence can help to inform future policy direction for the Scottish Government and other organisations in Scotland which support the reduction of stigma towards people with problem drug use. Repeating these questions in future surveys would allow us to continue to track changes in stigmatising attitudes in Scotland over time and measure the effectiveness of policy changes in these health areas and qualitative research may be valuable to further explore the thinking behind these attitudes and the connections between them.