National Coalition Against Prescription Drug Abuse
Saving Lives Through Collaborative Action
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Let's Talk about Stigma Reduction
Stigma reduction refers to the elimination of prejudice and discrimination against people with mental health and substance use disorders. When a disorder is stigmatized, people with that disorder are stigmatized. There is a misconception that these disorders only happen to people with “flawed character” or moral failure of some kind. In reality, these disorders can happen to anyone. Risk factors associated with these disorders – such as poverty, experiencing violence, or being from a marginalized group – are also heavily stigmatized.
According to the CDC, 1 in 7 Americans report experiencing SUD (Substance Use Disorder) and 1 in 5 Americans experience a mental health disorder in a given year. Co-occuring mental health and substance use disorders are also common. These disorders are not rare, but neither is recovery. With proper support, all mental health disorders can be managed and anyone with SUD can recover.
Risk factors for substance use disorder and mental health disorders overlap. These include experiences of:
- discrimination
- marginalization
- exposure to trauma
- lack of access to treatment services
- poverty
- social determinants of health
Promoting recovery should include addressing these underlying social determinants of health and promoting culturally responsive and trauma-informed treatment. Stigma reduction is an essential part of this.
Types of Stigma
The term “stigma” can be used to refer to a public, individual or systemic form of discrimination. Stigma refers to the negative stereotypes that people hold about mental illness and substance use disorders, as well as the discriminatory behaviors these negative stereotypes create.
Public stigma can refer to stereotypes of people with behavioral health conditions. Belief in those stereotypes and actions taken in response can affect job prospects, housing decisions, even the quality of healthcare that they receive.
Exists in the policies, laws and practices that are based on negative stereotypes about people with mental health conditions or substance use disorders.
Refers to the negative attitudes, including internalized shame, that people have about their own condition.
Stigma and Substance Use Disorder
How Does Stigma Impact People Who Use Drugs (PWUD)
Most adults who meet the criteria for SUD began using substances during their teen or young adult years. People may initially begin using drugs due to mental health issues, trauma, or when prescribed by a doctor. Whether or not someone develops SUD as a result of drug use is associated with their exposure to risk and protective factors.
The impact of stigma can be significant for individuals living with substance use disorders. It can lead to feelings of shame, isolation, and self-stigma, which can make it harder for people to seek help, access treatment, and maintain recovery. Stigma can also make it harder for people to find and keep employment, housing, and social support. In fact, around 90 percent of people with SUD do not receive treatment.
- The stigma associated with SUDs can cause people to hide their drug use due to fear of shame or discrimination. This may cause them to avoid treatment altogether.
- It can lead to social isolation as friends and family avoid contact with individuals who have a substance use disorder because they fear being stigmatized themselves.
- Negative attitudes also impact access to medical services for people who do seek treatment: insurance may not cover SUD related healthcare, and fear of the legal system can make people hesitant to ask for help.
- Additionally, internalized stigma can drive people to use drugs. Studies show that internalized shame and feelings of failure increase drug use, not curb it.
Impact of Stigma on SUD Treatment
Stigma has been shown to cause poor health outcomes for PWUD because it reduces the overall accessibility and quality of care. This is particularly true for PWUD who are homeless, have a criminal record or experience discrimination due to their race, ethnicity or socio-economic status. According to The National Institute on Drug Abuse (NIDA) “Black people experience delays of up to five years in getting treatment for a substance use disorder compared to White people, and young Black people are less likely to be prescribed medication for opioid use disorder than their White peers.”
Stigma reduction among healthcare providers is important. If a healthcare provider is stigmatized towards PWUD, they may not offer the same level of care that other patients receive. According to a 2019 national survey, primary care providers understand opioid use disorder as a treatable condition but still held stigmatizing attitudes which decreased the quality of care they provided to patients.
Misconceptions about Medication Assisted Treatment also decreases quality of care and limits access to MAT for their patients. MAT is a treatment option that combines the use of medications such as methadone and buprenorphine with counseling and behavioral therapies. MAT is considered to be an effective treatment for opioid use disorder, but it is misunderstood as being a “replacement” for illicit drugs. To reduce stigma for MAT, it is important to educate the public about the safety and effectiveness of this option and to increase access to this vital treatment.
Stigma and Mental Health
Stigma causes people to feel ashamed for something that is out of their control. Worst of all, stigma prevents people from seeking the help they need. For a group of people who already carry such a heavy burden, stigma is an unacceptable addition to their pain. According to a recent report, over 50% of those with clinical level mental health risks do not seek help. In the U.S., 25% of those not seeking treatment report it is due to not wanting others to know.
Research shows that knowing or having contact with someone with a mental health disorder is one of the best ways to reduce stigma. Individuals speaking out and sharing their stories can have a positive impact. When we know someone with a mental health challenge, it becomes less scary and more real and relatable.
Roughly 3 in 4 young teens seeking information online about depression said they were looking for personal anecdotes from people who had suffered in the past. This is why it is important to talk about Mental Health.
The National Alliance on Mental Illness (NAMI) offers some suggestions about what we can do as individuals to help reduce the stigma of mental illness:
- Talk openly about mental health. Share on social media and speak to friends.
- Educate yourself and others – respond to misperceptions or negative comments by sharing facts and experiences.
- Be conscious of language – remind people that words matter.
- Encourage equality between physical and mental illness – draw comparisons to how they would treat someone with cancer or diabetes.
- Show compassion for those with mental illness.
- Be honest about treatment – normalize mental health treatment, just like other health care treatment.
- Let the media know when they are using stigmatizing language presenting stories of mental illness in a stigmatizing way.
- Choose empowerment over shame – “I fight stigma by choosing to …”
How does Mental Health Disorders Intersect with SUD?
Individuals who experience a substance use disorder (SUD) during their lives may also experience a co-occurring mental health disorder and vice versa.
- Common risk factors can contribute to both SUDs and other mental health disorders.
- Mental health disorders can contribute to substance use and SUDs.
- Substance use and SUDs can contribute to the development of other mental health disorders.
- Mental health disorders and substance use disorders are involved in 1 out of every 8 emergency department visits by a U.S. adult. (estimated 12 million visits)
It is commonly hypothesized that individuals with severe, mild, or even subclinical mental disorders may use drugs as a form of self-medication.
When an individual develops a mental health disorder, changes in brain activity may increase the vulnerability for problematic use of substances by enhancing their rewarding effects, reducing awareness of their negative effects, or alleviating the unpleasant symptoms of the mental health disorder or the side effects of the medication used to treat it.
Stigmatizing Language
Learning about stigmatizing language is an important part of stigma reduction. Research shows that using person- first and non-stigmatizing language is effective for stigma reduction. For example, calling someone a “drug abuser” or “junkie” perpetuates negative stereotypes, while using person-first language such as “person with substance use disorder” decreases stigma.
Curious about non-stigmatizing alternatives? Check out the Addictionary to learn more.
Awareness and Education
Education and awareness programs are vital to the reduction of stigma. They can help people understand that substance use and mental health disorders are not a choice, but rather a chronic condition which can be treated or managed.
Education programs can focus on raising awareness about these disorders in order to reduce the shame surrounding them. The goal is to dispel harmful myths or misconceptions about mental health and substance use disorders by providing accurate information on what they are and how they are treated.
Media campaigns are an effective way to raise awareness about a topic, especially when combined with other strategies. Media campaigns can also be used to change public perception of an issue or generate support for policy change.
Policy
If we’re going to reduce stigma, then we must also:
- Develop policies and programs that help people with mental health and substance use disorders access the health care they need.
- Improve the quality of care provided in both public and private settings.
- Reduce discrimination against people with these disorders (ie. housing and employment discrimination)
The stigma associated with mental illness and substance use disorder is pervasive, affecting not only those living with a diagnosis but also their families, friends and communities. The impacts of stigma on people living with a substance use disorder are significant; it can interfere with accessing health care services, lead to poorer health outcomes and prevent individuals from having a strong support system. Stigma reduction efforts are critical for the success of any organization’s harm reduction or recovery programs.
Effective Strategies For Stigma Reduction
- Language: The way we talk about substance use disorders and mental illness can perpetuate stigma. It’s important to use person-first language, such as “a person with a substance use disorder” instead of “an addict.” Avoid using derogatory or stigmatizing language and instead use respectful and accurate language
- Education: Education and awareness campaigns can help to increase knowledge and understanding about substance use disorders and mental illness, and to challenge stereotypes and prejudices. This can include providing information about the causes of these conditions, as well as the available treatment options.
- Systemic Change: Stigma reduction requires systemic change. This can include changing policies and practices that perpetuate discrimination and marginalization. For example, reducing barriers to substance use disorder and mental health treatment by increasing access to healthcare, and implementing policies that prevent discrimination in employment and housing.
National Resources
