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Prevention

Stigma Reduction

Stigma is a major barrier to care for people with Substance Use Disorders (SUD). Multiple types of stigma, rooted in misunderstanding and moral judgment, lead to discrimination, shame, and isolation, affecting individuals’ physical and mental health, access to care, adequate treatment support, and social support. Many see SUD as a personal failure rather than a medical condition, fueling harmful stereotypes, even in healthcare. Addressing stigma is essential for providing compassion and support for recovery. Learn why your words matter and how to reduce stigma. Explore the mental health and additional resources provided. Be sure to check out our educational materials that support OPEN’s stigma initiative.

Defining Stigma

Stigma is a negative assumption about a person, or a group of people, based on a specific belief or behavior.1 Stigma affects everyone. A World Health Organization (WHO) study ranked substance use as the most stigmatized condition globally, with alcohol use fourth.2 Ending the stigma toward people experiencing addiction is more important now than ever, as the rates of substance use disorder and mental health concerns have risen dramatically during the COVID-19 pandemic.3,4 Social distancing measures have introduced additional barriers to receiving care for substance use and mental health concerns.

Stigma can affect how someone is treated by society. Patients with SUD are often stigmatized, despite SUD being a medical disease that patients do not choose to have. Stigma may also be compounded by other types of bias, such racial, gender, religious, age, and economic biases, further worsening experience and access to care.

Stigma Reduction

Learn how understanding and addressing stigma can make a profound impact on care, recovery, and wellbeing.

Types of Stigma

Stigma can be categorized into several types: public stigma, clinical stigma, internal stigma, and stigma within the recovery community.5 Public stigma refers to the negative attitudes and perceptions held by society at large, often fueled by stereotypes and misinformation. Clinical stigma is encountered within healthcare settings, where biases and prejudiced attitudes from medical professionals can hinder effective treatment. Internal stigma occurs when individuals internalize these societal prejudices, leading to feelings of shame and worthlessness. Lastly, even within the recovery community, stigma can persist, manifesting as judgment or lack of support among peers who are also striving for recovery. Understanding these diverse forms of stigma is crucial for creating more inclusive and supportive environments.

Public Stigma: Driven by stereotypes about people with SUD: such as the perception they are dangerous, perceived moral failings, SUD is a choice rather than a disease. 

  • Deters the public from wanting to pay for treatment and allows insurers to restrict coverage. 
  • Restricts funding for research.

Internalized Stigma: Blame self, feel guilt, fear, adopt negative attitude towards themselves. 

  • Leads to shame and isolation and potential for increased substance use. 
  • Disengage from care and relationships, don’t seek treatment. 

Clinical Provider Stigma: Belief that treatment is ineffective, impacts clinical care and treatment decisions. 

  • Can lead to inadequate pain management, lack of caring conversation and relationship building, and premature discharge and neglect.

Recovery Community Stigma: Medications versus “abstinence”, belief that the person is not in recovery.  There is evidence-based treatment for Opioid Use Disorder with Medications for Opioid Use Disorder.  Recovery and sobriety are two different things. Sobriety is the absence of any substances. Recovery is defined as a process of change through which individuals improve their physical, psychological, and social well-being, live a self-directed life and strive to reach their full potential.6 

  • Lack of MOUD access and support leads to increased risk of overdose and death by up to 50%. 
  • Lack of residential & 12 step programs that support people receiving MOUD.
  • Lack of support and treatment for co-occurring mental health disorders.
“
At that time, people were not talking about mental illness, they were not talking about SUD. It was a real thing of shame. We lived in a really small town and when people got wind of what was going on with my daughter, they would go to the other side of the street to not have to walk by me. We were really shunned. We really didn't have anyone to reach out to.
Parent of Child in Recovery

Stigma in Healthcare

How Does Stigma Affect Healthcare? 

Due to the stigma surrounding substance use, there are negative assumptions about patients with SUD.1 Consequently, it can be difficult for people, including healthcare workers, to recognize SUD as a medical condition that requires treatment just like high blood pressure, heart disease, or diabetes. It is important for healthcare providers to recognize risk factors for SUD and symptoms of SUD so patients can receive appropriate medical treatment.

Learn more about how to approach patients who may be at risk for SUD, screening tools, provider-patient conversation starters, and other SUD care resources on OPEN’s SUD Care Coordination website.

Did You Know SUD is a Disease?

SUD is a chronic medical disease that is listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and requires ongoing medical treatment from a physician.8,9 There are genetic and environmental risks to developing SUD, just like with heart disease, cancer, and diabetes. Similarly, SUD, like many other medical conditions, can be treated with medications, therapies, and lifestyle changes.  

Understanding Addiction

Addiction is a complex and multifaceted condition that affects millions of people worldwide. It is not simply a matter of willpower or moral failing; rather, it is a chronic brain disorder with profound biological underpinnings. The journey of addiction involves changes in the brain’s structure and function, particularly in areas related to reward, motivation, and memory.10 These changes create a profound compulsion to seek and use substances, despite a multitude of harmful consequences.

 

“
Recovery is a known disease of remission and relapse and most people aren't able to change so much so quickly that they never relapse. When you've spent 10 years in addiction like I have, that's all that you really know is just that lifestyle, and it's the only way you know how to cope.
Person in Recovery

When communicating with patients, it is important to avoid stigmatizing language. There are several strategies to help reduce stigma in your community, including sharing stories of people in recovery and altering the type of language you use.

Words Matter!

A graphic that shows someone experiencing stigma.

Language plays a pivotal role in reducing stigma associated with Substance Use Disorder (SUD) by shaping perceptions, influencing behaviors, and promoting empathy.11 How we talk about opioid misuse and substance use can either contribute to or reduce stigma, making it crucial to use language that emphasizes SUD as a chronic medical disease, not a personal choice or failing. A shift in language not only impacts how individuals with SUD view themselves—reducing internalized shame and encouraging recovery—but also influences the attitudes and behaviors of healthcare providers, fostering more respectful, unbiased care. 

While there are many examples of words to use and words to avoid when talking about SUD, here are some common words and phrases to consider:

 

Instead of saying:Try saying:
Addict/abuserPerson with SUD/person living with substance use disorder/person who uses drugs
AlcoholicPerson with alcohol use disorder/person living with alcohol use disorder
Clean/dirty urine (urine testing)urine negative/positive for or substance not detected/detected
Clean (person)Person in recovery from substance use/person in remission from substance use disorder or addiction
Criminal/felon/ex-conperson with justice involvement/person with criminal legal system involvement
Drug abuse/habitSubstance misuse
Drug offenderPerson arrested or prosecuted for substances
Fired/terminatedGuided to more appropriate treatment setting
IllicitCriminalized
Medication assisted treatment (MAT)/opioid replacement therapyMedications for opioid use disorder (MOUD/Medication for addiction treatment (MAT)
Nonadherent/noncompliantNot using as prescribed
Reformed addictRecovering patient
Relapse/slipResume use/restart use/recurrence of use
Strike/deviationConcern

 

Language Makes a Difference

In a study by the Recovery Research Institute, participants were asked how they felt about two people “actively using drugs and alcohol.”12 One person was referred to as a “substance abuser” and the other person as “having a substance use disorder.” No further information was given about these hypothetical individuals. In this study, Kelly and colleagues were interested in whether the language we use to describe individuals with substance related problems may evoke different types of stigmatizing attitudes.

The study showed that participants felt the “substance abuser” was:

  • Less Likely to benefit from treatment
  • More likely to benefit from punishment
  • More likely to be socially threatening
  • More likely to be blamed for their substance related difficulties
  • Less likely that their problem was the result of an innate dysfunction over which they had no control
  • They were more able to control their substance use without help

Using the language of “substance abuser” generally led to a stronger perception of personal blame and a preference for punitive measures compared to “substance use disorder” which was associated with a greater perceived need for treatment. 

Person-centered Language

Person-centered language is a communication approach that emphasizes the individuality, dignity, and inherent worth of people by focusing on the person rather than their condition or behavior. This kind of language helps reduce stigma by avoiding labels and descriptions that marginalize or dehumanize individuals. By acknowledging their experiences and their humanity first, it promotes empathy, respect, and inclusivity.

Instead of referring to someone as a “substance abuser,” using person-centered language would involve saying “a person with a substance use disorder.” Similarly, rather than saying “alcoholic,” one would say “a person who uses alcohol.” These adjustments in language help shift the focus from defining individuals by their substance use to recognizing them as people first.

Addiction Language Guide – Shatterproof

Comprehensive addiction language guide to reduce use of stigmatizing language.

 

“Substance Abuser”

Stigmatizing Label: Being called a “substance abuser” often feels stigmatizing and judgmental, as it implies moral failure or personal weakness rather than recognizing the condition as a medical issue.

Negative Self-Perception: This term can foster negative self-perception and shame, making individuals feel labeled and boxed into a negative stereotype that ignores their broader identity and struggles.

Reduced Empathy: It may contribute to a lack of empathy from others, as the term focuses on the behavior in a negative light, potentially decreasing the likelihood of receiving compassionate support and effective treatment.

“Person with Substance Use Disorder”

Humanized Language: Being referred to as a “person with substance use disorder” acknowledges the individual first, emphasizing their humanity and dignity beyond their condition.

Medical Recognition: This terminology frames the issue as a medical disorder, highlighting that it is a health condition that requires treatment and understanding, rather than blame.

Empathy and Support: It can evoke greater empathy and support from others, as the language is more neutral and respectful, encouraging a more compassionate and supportive response.

How to Reduce Stigma

Reducing stigma is essential for fostering inclusive, understanding, and supportive communities. Whether the stigma revolves around mental health, substance use disorder, physical disabilities, racial and ethnic identities, or any other aspect of human diversity, taking active steps to mitigate it can lead to significant improvements in individual and societal well-being. Addressing stigma involves a multi-faceted approach that focuses on changing perceptions, policies, and behaviors. Through these efforts, we can create environments where all individuals feel valued, respected, and empowered. By exploring action steps to reduce stigma, we can identify practical strategies to promote empathy, awareness, and positive change in our broader society.

  • Explore your own biases. Acknowledge unconscious biases or assumptions you may have about addiction and people with SUD. Consider where these beliefs came from.
  • Recognize the impact of stigma: Stigma affects not only individuals with SUD, but their families, friends, and communities. Stigma can deter people from seeking help.
  • Accept that we all have the capacity to judge others unconsciously. It takes effort to become more empathetic and open minded.
  • Learn about addiction as a chronic medical condition and stay informed of evidence-based research. Normalize evidence based. medication treatment that is not contingent on engaging in counseling.
  • Familiarize yourself with remission/recovery: Learn and align with patient goals and acknowledge multiple pathways to remission/recovery including embracing a harm reduction philosophy. 
    • “MOUD allowed me to begin my life. I’ve been under the influence of some mind-altering substance for so long that I didn’t know what living a life actually felt like or how good it could be. I went from living with my parents to having my own apartment. I have my own transportation; I can hold a job now. Issues with my health have finally been addressed. I can set healthy boundaries. I respect myself. I find enjoyment in doing things again. I’m no longer ridden with the shame and guilt that I was before over my addiction. Really, I never imagined my life could be as good as it is now.” – Person in Recovery
  • Understand the effects of trauma. Among people with SUD’s lifetime prevalence of PTSD is thought to range between 26-52%.13 Recognize the profound ways in which trauma can affect a person’s physical, mental, emotional, and social well being. This includes recognizing that trauma can lead to various coping mechanisms, such as substance use.
  • Train healthcare providers about the biological and psychological nature of addiction as a medical condition, not a moral failing. 
    • “I think it should be mandatory for healthcare providers to be educated both on mental illness and on SUD. It’s a disease just like any other physiological disease just like Cancer or Diabetes and that people are to be treated with respect and that their illness should be treated the same as any other illness.” – Parent of Child in Recovery
  • Create and support public awareness campaigns that inform the general public about the realities of SUD, highlighting that SUD is a chronic medical disease with similar relapse rates to other chronic health conditions such as Diabetes and High Blood Pressure. SUD does respond to appropriate treatment.
  • Listen to lived experiences of people in remission/recovery from SUD using multiple treatment pathways. Listen to people who have used Medication for Opioid Use Disorder (MOUD) in their recovery. Seek to understand the challenges and successes of those who’ve faced addiction.
    • “When I first started MOUD, it got me out of the cycle of constantly having a craving and withdrawal. It allowed my mind to be free of using or getting things to use. Thankfully, this gave me the time to think about jobs and relationships with other people.” – Person in Recovery
  • See the whole person and understand that people are not their diagnosis. Disease does not define a person’s potential.
  • Offer support to people with SUD in a way that is non-judgmental and compassionate. Avoid lecturing or offering unsolicited advice, and instead, offer understanding and encouragement.
    • “There were times when my daughter felt empowered by a couple doctors. One was the cardiologist she went to who performed her surgery. When she went, she was 5 months sober. He stopped and said to her. “That is fantastic, you should be so proud of yourself. That is really big!” She called me after that just elated, even though she found out she was going to have to have surgery on her heart.” – Parent of Child in Recovery
  • Words matter! Use non-judgmental first-person language. This impacts how individuals with SUD view themselves, potentially reducing internalized shame and encouraging recovery. Language also influences the attitudes and behaviors of healthcare providers leading to more respectful and unbiased care. 
  • Avoid moralizing terms.
  • Challenge stigmatizing remarks by speaking up when someone makes a judgmental comment about an individual with SUD. Gently offer facts or a compassionate perspective. Encourage others to rethink stereotypes.
  • Promote inclusive spaces where people feel safe discussing mental health, addiction, and recovery without fear of judgment or exclusion. This can include your workplace, community groups and social circles.
    • “At that time, people were not talking about mental illness, they were not talking about SUD. It was a real thing of shame. We lived in a really small town and when people got wind of what was going on with my daughter, they would go to the other side of the street to not have to walk by me. We were really shunned.” – Parent of Child in Recovery
  • Support reform laws to treat addiction as a public health issue rather than a criminal justice problem. This includes promoting harm reduction measures and alternatives to incarceration for substance related offenses 
  • Support funding for affordable and accessible addiction treatment services to ensure that people with SUD receive proper medical care rather than punitive responses.
  • Promote peer-led initiatives. People in recovery can play an important role in changing the conversation about SUD by sharing their experiences and successes, helping others feel less isolated. 
  • Engage with organizations that promote stigma reduction and the rights of people with SUD. This can include participating in campaigns, donating to causes and attending events.
  • Call for responsible representation of addiction and recovery in the media. Stereotypical or sensationalized depictions should be replaced with stories that show the complexity of addiction and the humanity of those affected.
  • Highlight success stories. Media outlets should be encouraged to tell stories of recovery and resilience, showing that people with SUD can and do recover.
  • Foster understanding in workplaces and schools. Provide education on addiction in work environments and schools to reduce fear and misinformation. Implement policies that support people in recovery, such as non-punitive leave for treatment.
  • Support family and community dialogue. Offer spaces for families and communities to talk openly about addiction, which can reduce the shame often associated with it.


Mental Health Resources

  • https://www.nimh.nih.gov/health/find-help

OPEN'S RESOURCES

Resources

Addiction Language Guide – Shatterproof

Comprehensive addiction language guide to reduce use of stigmatizing language.

 

Michigan Opioid Collaborative – Addressing OUD Stigma Presentation

Emily McCall and Tim Shewcraft from the Michigan Opioid Collaborative (MOC) share information about stigma and MOC’s resources for MOUD providers. Tim, a peer recovery coach, shares his personal experience with stigma and the impacts that provider stigma can have on a patient’s OUD treatment.

Words Matter Video – Shatterproof

Changing our language improves outcomes for those struggling with addiction. Watch this brief video to learn more.

Stigma Reduction Impact Report

Learn about OPEN’s impact with Stigma Reduction.

REFERENCES

  1. Tsai, A.C., Kiang, M.V., Barnett, M.L., Beletsky, L., Keyes, K.M., McGinty, E.E., Smith, L.R., Strathdee, S.A., Wakeman, S.E., & Venkataramani, A.S. (2019). Stigma as a fundamental hindrance to the United States opioid overdose crisis response. PLoS Medicine, 16(11), 1-18. https://dx.doi.org/10.1371/journal.pmed.1002969
  2. Room R, Rehm J, Trotter RT, Paglia A, Ustun TB. Cross cultural views on stigma valuation parity and societal attitudes towards disability. Seattle, WA: Hofgrebe & Huber; 2001. pp. 247–291. [Google Scholar]
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  4. Czeisler MÉ , Lane RI, Petrosky E, et al. Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1049–1057. DOI: http://dx.doi.org/10.15585/mmwr.mm6932a1
  5. Committee on the Science of Changing Behavioral Health Social Norms; Board on Behavioral, Cognitive, and Sensory Sciences; Division of Behavioral and Social Sciences and Education; National Academies of Sciences, Engineering, and Medicine. Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change. Washington (DC): National Academies Press (US); 2016 Aug 3. 2, Understanding Stigma of Mental and Substance Use Disorders. Available from: https://www.ncbi.nlm.nih.gov/books/NBK384923/
  6. Substance Abuse and Mental Health Services Administration (2024, September 5). Recovery and Recovery Support. https://www.samhsa.gov/find-help/recovery
  7. Larochelle, et al. Medication for opioid use disorder after nonfatal opioid overdose and association with mortality. A cohort Study (June 19, 2018). http://annals.org/aim/article/doi/10.7326/M17-3107
  8. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
  9. Murphy, B. (2018, September 13). 4 factors that add to stigma surrounding opioid-use disorder. American Medical Association. https://www.ama-assn.org/delivering-care/overdose-epidemic/4-factors-add-stigma-surrounding-opioid-use-disorder
  10. NIDA. 2011, July1. Preface. Retreived from https://nida.nih.gov/research-topics/addiction-science/drugs-brain-behavior-science-of-addiction on 2024, September 19.
  11. National Institutes of Health. (2021, November 29). Words matter – Terms to use and avoid when talking about addiction. National Institute on Drug Abuse: Advancing Addiction Science. https://nida.nih.gov/nidamed-medical-health-professionals/health-professions-education/words-matter-terms-to-use-avoid-when-talking-about-addiction
  12. Kelly JF, Westerhoff CM. Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms. Int J Drug Policy. 2010 May;21(3):202-7. doi: 10.1016/j.drugpo.2009.10.010. Epub 2009 Dec 14. PMID: 20005692.
  13. Vujanovic, A. A., Bonn-Miller, M. O., & Petry, N. M. (2016). Co-occurring posttraumatic stress and substance use: Emerging research on correlates, mechanisms, and treatments—Introduction to the special issue. Psychology of Addictive Behaviors, 30(7), 713–719. https://doi.org/10.1037/adb0000222)