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

Chapter 3 – Stigma towards people with problem drug use

SSA 2021/22 included seven questions examining public attitudes on compassion and recovery from problem drug use in Scotland. These questions were designed to elicit views on how compassionate and understanding the public are towards people with problem drug use and how such perceptions have changed in the last 12 years. They also sought to measure to what extent people in Scotland think that recovery from problem drug use is possible and how they perceive individuals who are seeking recovery and in recovery, in the present day and over time.

This chapter analyses the following seven questions around public attitudes towards people with problem drug use:

'Thinking about someone who has become homeless because they have a problem with drugs, how deserving of help, if at all, do you think they are?'

'Thinking about someone who has become homeless because of a family break up, how deserving of help, if at all, do you think they are?'

'Say you heard that you would be working with someone whowas getting help to stop using heroin. How comfortable or uncomfortable do you think you would feel about this?'

'Say you heard that someone who was getting help to stop using heroin was moving to a house or flat very near to you. How comfortable or uncomfortable do you think you would feel about this?'

'To what extent do you agree or disagree that 'Most people who use heroin can never stop using drugs completely?'

'Thinking about people with a drug problem, in general how much of a risk, if any, do you think they pose to the safety of other people?'

'Say a child aged 5 has parents who are taking heroin. Which of the following options comes closest to what you think should happen in this situation?

1. The child should stay with the parents while the family gets regular help from social workers.

2. The child should be taken away and looked after by foster parents until the parents stop taking heroin.

3. The child should be taken away and permanently adopted by new parents.'

This chapter analyses people's responses to these questions and provides a comparison with 2009 findings where available, alongside a breakdown of responses by various demographic and attitudinal sub-groups.

Attitudes towards people who are homeless because of problem drug use and because of a family break-up

In order to gauge public attitudes in Scotland towards people with problem drug use, SSA 2021/22 asked respondents 'Thinking about someone who has become homeless because they have a problem with drugs, how deserving of help, if at all, do you think they are?'. For a point of comparison, and to ensure stigma towards people with problem drug use was captured, rather than stigma about people who are homeless, SSA 2021/22 also asked respondents' views of homelessness where the cause was a family break up:'Thinking about someone who has become homeless because of a family break up, how deserving of help, if at all, do you think they are?'. Comparing the distribution of responses to both items allowed for views towards people whose personal circumstances had been adversely affected as a result of problem drug use to be assessed against a more neutral benchmark.

As demonstrated by Figure 3, the vast majority of people interviewed felt that both individuals who were homeless due to problem drug use or due to a family break up were either 'very' or 'fairly deserving' of help (87% and 98% respectively). However, there was a marked gap of 26 percentage points between the proportion who felt that individuals who have become homeless because of problem drug use were 'very deserving' of help (70%) and the proportion who felt that individuals who have become homeless because of a family break-up were 'very deserving' of help (44%). Conversely, a larger proportion (43%) felt that individuals who have become homeless because of a drugs problem were 'fairly deserving' of help compared with those who become homeless due to a family break-up (28%). Around one in ten (11%) reported that individuals who have become homeless because of a drugs problem were 'not very' or 'not at all deserving' of help, compared with just 2% who felt the same about those who have become homeless because of a family break-up.

How do attitudes vary between sub-groups?

Attitudes towards individuals who have become homeless due to problem drug use were largely consistent across key demographic sub-groups with the exception of gender. Women were more likely than men to feel that people who have become homeless because of problem drug use deserved help (91% of women stating that such individuals were either 'very' or 'fairly deserving' of help compared with 84% of men). No statistically significant variations were observed by age, educational level, or area deprivation.

Opinions did differ according to whether or not people had themselves tried drugs at some point in their lives; 95% of those who reported having taken illegal drugs felt that individuals who have become homeless because of problem drug use were 'very' or 'fairly deserving' of help, while people who have never tried drugs this figure stood at 85%.

Views towards individuals who have become homeless due to problem drug use also differed significantly according to attitudes towards other related issues. Around two-thirds (65%) of people who agreed^[35] with the statement that individuals with problem drug use 'have only themselves to blame', believed that those who have become homeless due to problem drug use are 'very' or 'fairly deserving' of help, considerably less than the 96% among those who disagreed^[36] with this perspective.

Attitudes towards working with and living near someone getting help to stop using heroin

To further develop a picture of attitudes towards people living with problem drug use, SSA 2021/22 included the following two questions designed to gauge views on working with, and living in close proximity to, someone receiving drug-related support:

'Say you heard that you would be working with someone whowas getting help to stop using heroin. How comfortable or uncomfortable do you think you would feel about this?'

'Say you heard that someone who was getting help to stop using heroin was moving to a house or flat very near to you. How comfortable or uncomfortable do you think you would feel about this?'

As Table 2 demonstrates, people appeared more comfortable with the prospect of working alongside someone getting help to stop using heroin than with the idea of someone getting help to stop using heroin becoming their neighbour. Almost six in ten (59%) indicated that they would be either 'very' or 'fairly comfortable' working with someone getting help to stop using heroin, around twice the proportion (30%) who suggested that they would be either 'very' or 'fairly comfortable' if someone getting help to stop using heroin moved into a home nearby. Moreover, while 14% asserted that they would feel either 'fairly' or 'very uncomfortable' working with someone getting help to stop using heroin, the proportion who stated that they would feel either 'fairly' or 'very uncomfortable' living near someone getting help to stop using heroin stood at more than double this figure (32%).

Table 2: Attitudes towards those getting help to stop using heroin – level of comfort with working with them or living nearby, 2021/22

Working with someone getting help to stop using heroin	(%)	Living near someone getting help to stop using heroin	(%)
Very comfortable	20	Very comfortable	6
Fairly comfortable	39	Fairly comfortable	23
Neither comfortable nor uncomfortable	25	Neither comfortable nor u uncomfortable	37
Fairly uncomfortable	10	Fairly uncomfortable	23
Very uncomfortable	4	Very uncomfortable	9
(It depends)^	1	(It depends)^	1
Don't know/Refusal	2	Don't know/Refusal	1
Unweighted base	1130	Unweighted base	1130
Weighted base	1130	Weighted base	1130

^ This answer option was not shown to respondents but was recorded where respondents gave this as a spontaneous response.

The question on attitudes to living in close proximity to someone getting help to stop using heroin had previously been presented to SSA respondents in 2009. Figure 4 shows that while in 2009, 26% of people in Scotland felt either 'very' or 'fairly comfortable' with the idea of living near to someone getting help to stop using heroin, and was a similar proportion to the 30% who adopted this view in 2021/22. The percentage who felt either 'very' or 'fairly uncomfortable' with the idea of someone recovering from using heroin moving close by fell from almost a half (49%) in 2009 to just under a third (32%) in 2021/22. Meanwhile, the proportion who said they would feel 'neither comfortable nor uncomfortable' in this scenario increased from just under a quarter (24%) in 2009 to over a third (37%) in 2021/22^[37].

How do attitudes vary between sub-groups?

Attitudes in 2021/22 towards both working with someone and living near someone who is receiving help to stop using heroin differed by educational attainment. Around three in ten (29%) of people with at least a degree-level qualification were 'fairly' or 'very uncomfortable' with the idea of living in close proximity to someone receiving help to stop using heroin, compared with over a half (56%) of those with no formal qualifications. Views on living near someone receiving help to stop using heroin also differed by area type; almost one third (32%) of people living in an urban area reported feeling either 'fairly' or 'very comfortable' living near someone getting help to stop using heroin, while among those living in rural areas this figure stood at a quarter (25%).

As with attitudes towards who have become homeless due to problem drug use, views on those receiving help to stop using heroin differed significantly according to whether or not members of the public had themselves ever tried illegal drugs. When asked to indicate their level of comfort with the idea of working with a colleague who is getting help to stop using heroin, over three-quarters (76%) of those who had tried illegal drugs at some point in their lives said that they would be either 'fairly' or 'very comfortable' with this, while just over half (52%) of those who had never tried illegal drugs adopted this stance. Similarly, while 43% of those who had tried illegal drugs stated that they would feel comfortable having a neighbour who is receiving help to stop using heroin, among those who had never tried drugs the equivalent figure stood at 24%. A similar pattern is seen in relation to whether or not a respondent had friends or family who had ever regularly used drugs. Figure 5 shows that among those who knew of a close friend or family member who had been regularly using drugs, around four in ten (41%) reported being comfortable with the idea of living near someone getting help to stop using heroin compared with just under a quarter (23%) who did not know of a friend or family member who had regularly used drugs.

Those who agreed that people with problem drug use 'have only themselves to blame' were more likely than those who disagreed to report discomfort with the idea of working with someone getting help to stop using heroin (31% compared with 8%) and with the prospect of living near someone receiving help to stop using heroin (54% compared with 22%). While people who agreed that 'it's in all our interests' to support those with problem drug use were less likely than those who disagreed to report feeling uncomfortable with the idea of working with someone getting help to stop using heroin (11% compared with 43%) and with the prospect of living near to someone who is getting help to stop using heroin (29% compared with 65%).

Attitudes towards whether people who use heroin can stop using drugs completely

The SSA 2021/22 sought to explore public attitudes towards whether achieving abstinence from drugs^[38], for those with a history of heroin use, is possible. Respondents were asked to which extent they agreed or disagreed with the following statement:

'Most people who use heroin can never stop using drugs completely'

As shown in Figure 6, just under a quarter (23%) said that they either 'agree strongly' or 'agree' that most people who use heroin can never stop using drugs completely, while over a half (53%) said that they either 'disagree' or 'disagree strongly' with this statement.

Attitudes towards the possibility of people who use heroin being able to stop using drugs have softened over the past 12/13 years since this question was last asked as part of the SSA 2009. The proportion who agreed that 'most heroin users can never stop using drugs completely' in 2021/22 was 23%, six percentage points lower than the equivalent proportion in 2009 (29%), while the proportion who disagreed with this sentiment in 2021/22 was 53%, at nine percentage points higher than in 2009 (44%).

How do attitudes vary between sub-groups?

Views in 2021/22 on whether it is possible for people who use heroin to stop using drugs was consistent across demographic groups, with no statistically significant variations observed by factors such as age, educational level, or area deprivation. However, there was an association between whether an individual had taken drugs themselves and whether they thought it was possible for people who use heroin to stop using drugs completely. Almost seven in ten (69%) people who had taken drugs themselves disagreed that 'heroin users can never stop using drugs completely' compared with under five in ten (46%) of those who had never taken drugs. Similarly, there was an association between whether an individual had a close friend or family member who had regularly taken drugs and whether they thought it was possible for people using heroin to stop taking drugs. Around two-thirds (67%) of those who knew of a close friend or family member that had regularly taken drugs disagreed that 'heroin users can never stop using drugs completely' compared with 47% who did not know anyone who had regularly taken drugs.

In addition, those who believed that people with problem drug use 'have only themselves to blame' were more likely than those who disagreed that people who use heroin 'can never stop using drugs completely' (38% and 17%, respectively).

Risks posed by people experiencing problem drug use

Respondents to SSA 2021/22 were also asked the following question designed to explore societal perceptions of the level of risk that people with problem drug use pose to the safety of other members of society:

'Thinking about people with a drug problem, in general how much of a risk, if any, do you think they pose to the safety of other people?'

Table 3 shows, only 3% of respondents felt that people with problem drug use pose 'no risk at all' to the safety of others. Nearly four in ten (38%) believed that people with problem drug use pose 'a small risk' to the safety of others, with a similar proportion (41%) believing that the risk to society posed by people who use drugs was 'moderate'. A further 17% believed that people with problem drug use represented 'a big risk' to the safety of others.

Table 3: Perceptions of the level of risk posed to others by people with problem drug use, 2021/22

	(%)
A big risk	17
A moderate risk	41
A small risk	38
No risk at all	3
Don't know/Refusal	2
Unweighted base	1130
Weighted base	1130

How do attitudes vary between sub-groups?

Attitudes towards whether people with problem drug use pose a danger to others diverged between those who had ever taken drugs themselves and those who had never done so; 47% of the former group felt that people with problem drug use pose either a 'big' or 'moderate' risk to others, while among the latter group the equivalent figure was 63%. People who had a close friend or family member who had regularly used drugs were less likely (47%) than those who did not (62%) to think that people with problem drug use pose either a 'big' or 'moderate' risk to others.

As with other attitudes reported in this chapter, there was an association between views on whether people with problem drug use pose a danger to others with percpetions of whether problem drug use was the result of individual or societal responsibility. While over four in five (81%) of those who agreed that people with problem drug use 'have only themselves to blame' believed that they pose either a 'big' or 'moderate' risk to others. This view was shared by less than half (47%) of those who disagreed that people with problem drug use 'have only themselves to blame'. Perceptions of the level of risk posed by people who use drugs also varied between those who agreed that 'it's in all our interests' to provide support to people with problem drug use and those who disagreed with this; among those who agreed, 55% believed that people who use drugs pose either a 'big' or 'moderate' risk to others, while among the latter group this figure was measured at 79%.

Attitudes towards what should happen to children of people who use heroin

To further develop an understanding of how people viewed those who take drugs, respondents were also presented with the following item designed to explore public views on how authorities should respond to parental heroin use:

'Say a child aged 5 has parents who are taking heroin. Which of the following options comes closest to what you think should happen in this situation?

1. The child should stay with the parents while the family gets regular help from social workers.

2. The child should be taken away and looked after by foster parents until the parents stop taking heroin.

3. The child should be taken away and permanently adopted by new parents.'

Figure 7 shows that well over half (57%) believed that temporary foster care represented the most appropriate response in such circumstances, while around three in ten (29%) felt that a child should remain with their parents while the family received support from social workers. Just 7% felt that a child whose parents use heroin should be removed from the home and permanently adopted. These results provide additional evidence to suggest that the majority of people in Scotland feel that recovery from drug problems is possible.

^ This answer option was not shown to respondents but was recorded where respondents gave this as a spontaneous response.

This scenario was first presented to SSA respondents in 2009 allowing for an exploration of whether attitudes had shifted in the precedeing 12/13 year period. The proportion of people in 2009 who believed that the child should be permanently removed from the family home was 8%, relatively similar to that in 2021/22 (7%). However, the proportion who in 2021/22 believed that the child should remain with the parents while the family receives help from social workers (29%) was nine percentage points higher than was the case in 2009 (20%). This suggests an increased belief in the possibility of recovery from problem drug use. The proportion who in 2021/22 believed that the child should be temporarily placed with foster parents (57%) was seven percentage points lower than in 2009 (64%).

How do attitudes vary between sub-groups?

Perspectives on how authorities should respond to parental heroin use were relatively consistent across demographic groups, with no statistically significant variations by age, sex, or area deprivation. Further, views on what should happen in such a scenario did not vary according to personal experience of drug use with no significant differences between people who had taken drugs and those who had not, or between those who knew of a friend or family member who had regularly taken drugs and those who did not.

Attitudes did vary by parental status, with analysis indicating that those with at least one child under the age of 16 in their household were more likely than those without a child living in their household to feel that a five-year-old whose parents are taking heroin should be permanently removed from the family and adopted by new parents (13% compared with 6%).