A survey of the British public’s attitudes towards drug dependence

JASON LUTY† and PARDEEP GREWAL‡

† Maudsley Hospital Rotation, London, UK‡ Royal Free Hospital, London, UK

Aims To determine the attitude of the British public towards people with drug dependenceand their treatment.Design A postal quota survey of the British public was performed to determine attitudetowards people with illicit drug dependence and treatment policies.Results Respondents disagreed with the idea that ‘drug addicts’ have a mental illness andregarded them as untrustworthy, deceitful and unreliable.Clinical implication Respondents had a stigmatized view of ‘drug addiction’, althoughthey may be more sympathetic to the concept of an individual ‘drug addict’. However, theydid not have strong views concerning professional treatment decisions, including childprotection issues.

Keywords: Drug dependence; public attitudes; stigma

INTRODUCTION

Stereotypical beliefs about substance abusers are common

(Dean and Rud 1984, Crawford et al. 1989). For example, a

survey of 2679 adults in the UK found that respondents

perceived drug addicts as unpredictable and dangerous and

believed that drug addiction was self-in¯ icted (Crisp et al.

2000).

Practical steps to change stigmatized attitudes have been

suggested (Wolff et al. 1996). One stage of such a process

involves identifying the concerns of people whose attitude is

to be changed. The objective of the current study was to

determine the attitude of the British public towards people

with drug dependence and their treatment.

METHOD

A series of attitude statements were constructed regarding

substance misusers and treatment policies. These were

distributed to 20 subjects selected at random from the

British Telecom online directory. Respondents were

interviewed by telephone. Items were discarded if the

interpretation of questions by respondents differed from that

intended by the authors. This pilot work allowed

construction of the ® nal questionnaire. Pilot studies

revealed that terms like `drug-dependent person’ or `drug

misuser’ were poorly understood and irritated respondents.

These terms were spontaneously equated with the more

pejorative term `drug addict’ when an explanation was

given. Consequently, the latter term was used in the survey.

Survey subjects were selected at random from the British

Telecom online directory. They were sent a self-comple-

tion questionnaire containing fourteen attitudinal state-

ments (Table 1). All responses were made by circling one

response from a ® ve-point Likert scale ranging from

`Strongly agree’ to `Strongly disagree’ . Responses were

collapsed to `Agree’ and `Disagree’ , while `Don’t know’ and

`Neutral’ responses were collapsed to `Undetermined’.

Respondents were given the following instructions: In

the survey the term ` drug addict’’ refers to someone who

uses illegal ` hard’’ drugs such as heroin or cocaine on most

days. The survey would not regard people who use alcohol,

tobacco, cannabis or drugs which are prescribed by their

doctor as drug addicts.’

RESULTS

The overall response rate was 29%. Questionnaires from

505 respondents were selected for the quota survey based on

UK national statistics of the adult population for age, sex and

employment status (UK Government Statistics 2001).

Fewer than 4% of questions were unanswered. Test-retest

reliability studies showed 97% of responses were unchanged

after 2 weeks (n = 40). Responses are shown in Table 1.

DISCUSSION

The pilot studies indicated that the questionnaire was likely

to be reliable and valid. The statement I found it easy to

Correspondence: Jason Luty, MB ChB PhD MRCPsych, Laurel House, 2 Blean Grove, Penge, London SE20 8QU, UK. Tel: +44 020 865 92151ext. 213; fax: +44 020 8676 0748

Journal of Substance Use (2002) 7, 93–95

Journal of Substance UseISSN 1465-9891 print/ISSN: 1475-9942 online # 2002 Taylor & Francis Ltd

http: //www.tandf.co.uk/journalsDOI: 10.1080/1465989021013212 6

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understand the questions in this survey’ was included as a

further test. All respondents agreed with this statement.

A major drawback of postal questionnaires such as this is

the selective response rate. The survey obtained a 29%

response rate. This is comparable to other surveys (Blum et

al. 1989). A quota survey technique was adopted so that the

results would approximate more closely to those of the

target population.

Over 50% of respondents thought the law was too soft

on drug addicts’ and disagreed with the suggestion that drug

addicts have a mental illness. Almost all respondents

regarded drug addicts as untrustworthy, deceitful and

unreliable. These results indicate a negative view of drug

addicts. This may be partly explained by the negative

connotations of the term addict’ . Unfortunately, pilot

studies revealed that less pejorative terms such as `drug

misuser’ and `dependent people’ were both annoying and

poorly understood by the general public and were

spontaneously equated with the term `drug addict’ when

an explanation was given. Blum et al. (1989) recognized that

there is an implicit tendency among both researchers and

practitioners to avoid expressing judgemental views and to

be more positively disposed towards concepts of disease that

are free from attributions of individual responsibility.

However, this does not appear to be the case among the

general public.

A signi® cant proportion of respondents disagreed with

the statements that `most drug addicts are criminals’

(question 2) and `drug addicts deserve whatever misfortune

befalls them’ (question 6). This compares with ® gures

exceeding 90% for those who thought that `drug addiction’

is both a menace to society (question 3) and a major cause of

crime (question 7). It is possible that respondents were more

sympathetic to the concept of an individual `drug addict’

suffering from an addiction while maintaining an uncom-

promising attitude towards the impersonal concept of `drug

addiction’ .

A signi® cant proportion of respondents chose the `Don’t

know’ or `Neutral’ options in regard to statements

supporting methadone maintenance (question 9), legaliza-

tion of cannabis and decisions regarding taking addicts’

children into care (questions 9, 10 and 14). This suggests

that respondents did not have particularly strong views

regarding professional treatment decisions.

Methadone maintenance is a controversial treatment

although there is good evidence of clinical effectiveness

(Ball and Ross 1991). Our survey suggests there is signi® cant

public support for this. Given the fact that the majority of

respondents felt that drug addiction is both a menace to

society and a major cause of crime, it would be reasonable to

assume some public support for more controversial

prescribing policies (Ball and Ross 1991).

CONCLUSION

The results clearly indicate a negative view of drug addicts.

However, it is possible that respondents were more

sympathetic when presented with the concept of an

individual suffering’ from drug addiction rather than the

impersonal concept of `drug addiction’. It may therefore

help to reduce the stigma suffered by substance misusers to

94 Luty and Grewal

Table 1 Results of quota survey

Statement Agree (%) Disagree

(%)

Undetermined

(%)

1 I regard most drug addicts as having a mental illness 28 59 13

2 I regard most drug addicts as criminals 38 44 18

3 I think drug addiction is a menace to society 94 1 5

4 I think most drug addicts are trustworthy 1 94 5

5 I think drug addicts are deceitful and unreliable 78 8 4

6 I think drug addicts deserve whatever misfortune befalls them 30 50 20

7 I think drug addiction is a major cause of crime 96 2 2

8 I think injectable drugs like heroin should be available to drug addicts on prescription 34 60 6

9 I think oral drugs, like methadone, should be prescribed to drug addicts for as long as they wish in

order to stop them buying drugs on the black market

54 8 38

10 I think cannabis should be legalised 31 41 28

11 I think heroin should be legalised. 4 90 6

12 I think the health service should spend more money treating drug addicts 35 47 18

13 I think the law is too soft on drug addicts 62 17 21

14 I think most drug addicts should have their children taken into care 40 27 33

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stress that services are provided for `patients’ or clients’

rather than for treatment of addiction’. Respondents often

chose neutral or undecided options regarding professional

treatment decisions, including child protection issues.

However, they were generally sympathetic to the principles

of methadone maintenance.

REFERENCES

Ball JC and Ross A (1991) The Effectiveness of Methadone Maintenance

Treatment. Springer-Verlag: New York.

Blum TC, Roman PM and Bennett N (1989) Public images of alcoholism:

data from Georgia Survey. Journal of Studies on Alcohol 50 (1): 5± 14.

Crawford JR, Thomson NA, Guillion FE and Garthwaite P (1989) Does

endorsement of the disease concept of alcoholism predict humanitarian

attitudes to alcoholics? International Journal of Addictions 24 (1): 71± 7.

Crisp AH, Gelder GG, Rix S, Meltzer HI and Rowlands OJ (2000)

Stigmatisation of people with mental illness. British Journal of Psychiatry

177 (1): 4± 7.

Dean JC and Rud R (1984) The drug addict and the stigma of addiction.

International Journal of Addictions 19 (3): 859± 69.

UK Government Statistics Website (2001) www.statistics.gov/nbase/

OnLine

Wolff G, Pathare S and Craig C (1996) Public education for community

care: a new approach. British Journal of Psychiatry 168 (4): 441± 7.

British public’s attitudes towards drug dependence 95

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