End the Stigma

Stigma and Substance Use Disorder

What is Stigma?

The term stigma refers to a negative societal perception of something. A stigmatized view of something often lacks context and understanding, leading to a perception that is not accurate with reality. Mental health and substance use disorders (SUDs) are often stigmatized due to public perceptions and norms that view these illnesses as overwhelmingly negative.[1]  Stigma related to these illnesses is a result of a lack of knowledge and understanding, along with a history of misrepresentation in media, costumes, harmful stereotypes, and commonly used phrases to describe other people’s behaviors. [2]

Other diseases associated with drug use tend to be stigmatized as well. This includes human immunodeficiency virus, more commonly known as HIV, and hepatitis C. Because these diseases can be transferred through needle exchange, those who have been diagnosed with them often face the perception that they became afflicted due to their own actions and are therefore less deserving of sympathy or care.[3]

What are the effects of Stigma on treatment and recovery?

Stigma has a real and lasting impact on the treatment and recovery of patients with a myriad of different conditions and disorders. This can manifest in a variety of ways from a general reluctance to seek out treatment to a lack of understanding among friends, family, and medical professionals. Because substance use disorder (SUD) is one of the most stigmatized conditions in the world today, seeking and receiving treatment comes with unique barriers and challenges. [4]

Many of those with SUD may not seek out available resources even if they know they’re available. This happens for a variety of reasons - among them is the reluctance among those with SUD to be seen as a “drug addict” or “drug abuser.” People with SUD often internalize the language used to refer to those who use drugs and wish to avoid those sorts of labels or perceptions. [5] In order to avoid the stigma, they may avoid seeking treatment.

One in 14 Americans has reported experiencing a substance use disorder, but there is largely the attitude that substance use disorder is not an illness is instead a result of only personal actions and choices.[6] Those without SUD tend to assume that it does not impact them or their community, but substance use and substance use disorder is found across the country in a wide range of diverse communities.

Stigma against those with SUD is not limited to the general public – healthcare providers can be susceptible to it as well. Evidence suggests that some treatment providers tend to view those with SUD as less trustworthy than those without SUD and to view entering a treatment facility for SUD as a sign of personal failure.[7] When stigma against those with SUD exists in healthcare providers then effective and safe treatment, such as Medication-Assisted Treatment (MAT), is more difficult to obtain and maintain.

Stigma can lead to people not seeking treatment that would help them, facing barriers to treatment that don’t exist for other conditions and poorer health outcomes overall that are preventable in many cases. By actively working to reduce stigma, we can prevent these outcomes and help those with SUD and associated conditions receive effectively, quality care.

How can we actively work against Stigma?

Substance use disorder is a disease, not a character flaw. Those who suffer from SUD are not people with a lack of willpower or people who have made poor choices. They are individuals suffering from treatable disease and should be treated as such. The most important way to end stigma is to remember that when interacting with and treating those with SUD.

Another actionable way to work against the stigma that surrounds SUD and other related conditions is to change the way that these conditions and those that have them are discussed and treated in society. Offering support, listening without judgment, and treating people with respect and dignity are all ways to help reduce stigma towards people with substance use disorders. Language and how substance use disorder is discussed and characterized impacts stigma as well. Using “person-first” language that focuses on the person, not the disease, can help destigmatize and reduce negative perceptions of substance use disorder[8]

Many studies demonstrate more contact with people with substance use disorder is associated with lower levels of stigma toward substance use disorders.[9] The negative stigma associated with SUD and other related conditions is not accurate with reality – when people learn more and leave preconceived notions behind they are able to help end the stigma.

Suggested Resources and Further Reading

• InROC Resources – Ending the Stigma
  • International Overdose Awareness Day – Sharing Stories to End the Stigma
  • Ending the Stigma – The Indiana Rural Opioid Consortium
  • Stigma Reduction – Katrina Norris
  • Stigma Reduction Training – Jeff Skaggs

• Understanding Stigma
  • Stop Overdose by Reducing Stigma – Centers for Disease Control and Prevention
  • Understanding the Stigma of Mental and Substance Use Disorders
  • NextLevel Recovery: Stigma
  • Hepatitis C and The Layering of Disease-Related Stigma
  • HIV Stigma and Discrimination – Centers for Disease Control and Prevention

• Stigma and Language
  • Language Matters - Infographic
  • Resources for Providers – Reducing Discriminatory Practices in Clinical Settings
  • Reducing Stigma Through Language – Indiana University

• Recovery Events and Organizations
  
  • Summer of Recovery
  • IU Center for Rural Engagement - Ending Stigma Webinar Series

Sources:

[1] NextLevel Recovery: Stigma; https://www.in.gov/recovery/know-the-facts/stigma/

[2] Language Matters; https://www.thenationalcouncil.org/resources/language-matters-infographic-addiction/

[3] Sulaiman, A. https://www.qualityhealth.org/wpsc/2020/08/17/stigma-bias-in-healthcare-the-obstacles-consequences-and-changes-needed/

[4] Stigma Reduction; https://www.cdc.gov/stopoverdose/stigma/index.html

[5] Language Matters; https://www.thenationalcouncil.org/resources/language-matters-infographic-addiction/

[6] Stigma Reduction; https://www.cdc.gov/stopoverdose/stigma/index.html

[7] Kulesza, M. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5675578/

[8] Language Matters; https://www.thenationalcouncil.org/resources/language-matters-infographic-addiction/

[9] Sulaiman, A. https://www.qualityhealth.org/wpsc/2020/08/17/stigma-bias-in-healthcare-the-obstacles-consequences-and-changes-needed/