Stigma Reduction

Stigma Information

  • Stigma is defined as a set of negative attitudes, beliefs, and stereotypes that society holds about individuals with substance use disorder, which can lead to discrimination and barriers to care.

  • Stigmatizing language perpetuates harmful stereotypes and creates barriers to health and social services.

  • Use of substances does not mean that people forfeit their human rights for respect and dignity.

4 Types of Stigma:

  • Social-Stigma- Commonly held and generally accepted or normalized attitudes, beliefs, and behaviors that exclude and diminish people with SUD.  Examples: the perception that people with SUD are dangerous and morally flawed, that SUD is a choice, not a disease, patients with SUD are manipulative and less motivated for treatment

    • Results:

    • Limits job opportunities and resources

    • Inadequate pain management

    • Keep patients from seeking treatment

    • Perceived moral failing

    • Lack of quality relationships and support

  • Institutional Stigma- Policies, laws, and institutional practices that discriminate and foster prejudice against people with SUD.  Examples: some federal policies allow housing agencies to prohibit those with history of drug use from receiving assistance, “the war on drugs” campaign

    • Results:

    • Lack of access to resources like housing and food assistance

    • Insurance limiting reimbursements for SUD care

    • Minimal research due to lack of funding

  • Internalized Stigma- When individuals internalize the negative judgements made against them that effects the way that they see themselves.  Examples: believing they deserve pain and suffering, feelings of shame and guilt, viewing themselves as weak

    • Results:

    • Increased isolation

    • More easily accept social injustice

    • Loss of self-esteem, self-confidence, and self-efficacy

    • Discourages them from seeking treatment

    • Feelings of shame and failure can lead to increased use

    • Feelings of hopelessness

  • Recovery Community Stigma- Negative beliefs held by individuals and organizations surrounding multiple pathways, harm reduction, and medication assisted treatment.  Examples: people on MAT are not in recovery, MAT is “just trading one drug for another,” harm reduction gives permission to use, abstinence is the only way, discontinuing 12 step meeting attendance results in immediate assumption of relapse

    • Results:

    • Lack of residential and 12 step programs that support MAT

    • Lack of support and treatment for co-occurring disorders

    • Increased risk of overdose and death when OUD not treated

    • Social isolation

How Can We Reduce Stigma?

  • Education and Health Literacy: Public and Professional trainings help to reduce bias by being more knowledgeable about SUD.

  • Structural and Policy Reform: Promote harm reduction approaches, expand access to evidence-based treatment, remove punitive practices, and embed stigma reduction in policy

  • Peer Support and Recovery Identity: Peer-led supports reduce isolation, promote hope and recovery identity, and challenge self-stigma.  Encouraging stories of recovery helps to shift narrative.

Words Matter: Using Person-First Language

  • Person-first language is communication that prioritizes the individual over their condition.

  • It demonstrates that you value the person and are not defining them by their substance use

  • Language and labels can adversely affect quality of care as well as health outcomes

  • The term “abuse” has high association with negative judgements and punishment and seen in relation to child abuse, domestic abuse, animal abuse which are punishable crimes not a disease

  • Terms to avoid:

    • Addict/Junkie/Abuser/Drunk/Alcoholic---Use Instead: Person with substance use disorder, Person with alcohol use disorder Person who uses drugs, Person in recovery

    • Relapse---Use Instead: Recurrence, exacerbation

    • Habit---Use Instead: Substance Use Disorder

    • Clean---Use Instead: Testing negative, not actively using, abstinent from substances

    • Opioid Substitution/Replacement Therapy/Medication Assisted Treatment---Use Instead: Medication for opioid use disorder (MOUD), pharmacotherapy

    • Dirty---Use Instead: Testing positive, actively using substances

    • Abuse---Use Instead: Misuse, Problem use, Risky use, Harmful use