Reducing stigma associated with substance use disorder

Stigma refers to discrimination against a particular group of people, identifiable by a common nation, place, condition, or other attribute.¹ Some people have a stigma against those with a substance use disorder (SUD) because of inaccurate and outdated beliefs about addiction that perpetuate harmful stereotypes, assumptions, and negative attitudes.² The label used to describe a stigmatized group is sometimes perceived as a judgment. For example, when we call someone an “addict” — versus describing someone as “a person with a substance use disorder” — we are labeling them when, in fact, they are struggling with a diagnosable disease.² Despite advancements in our understanding of addiction and mental illness, both are stigmatized health conditions. Many individuals continue to wrongly view SUDs as an inherent character flaw or moral failing. Unfortunately, this way of thinking can discourage people from seeking treatment and may even discourage some medical professionals from treating individuals with SUDs.³

Despite the stigma surrounding addiction, it is in fact a treatable, chronic medical condition that consists of an intricate exchange between genetics, the environment, brain circuits, and life experiences.⁴ Addiction is diagnosed by mental health professionals as a substance use disorder. Drugs and alcohol affect the way neurons in the brain send and receive messages through neurotransmitters, which leads to abnormal communications being sent throughout the brain and body. Substances affect the areas of the brain that are responsible for life-sustaining functions, such as motivation and the ability to solve problems and make decisions. The misinformation being sent throughout the brain also contributes to the compulsive use of substances. More specifically, substances such as drugs and alcohol can release, signal, or activate the neurotransmitter dopamine. Dopamine is associated with the way we perceive pleasure and reward, but it also plays a role in reinforcing behavior. Thus, increased dopamine activity from substance use not only results in feelings of intense euphoria and pleasure, but at the same time, it also reinforces a compulsion to repeat the behavior of using the substances.⁵

Anyone who uses drugs or drinks alcohol can develop a SUD, but not everyone who uses drugs or alcohol will develop a SUD. Years of research has revealed certain risk factors that make a person more vulnerable to developing a SUD. These risk factors include:⁶

• Intergenerational trauma.
• Having parents who use drugs or alcohol.
• Having parents who have a mental illness.
• Experiencing childhood trauma, including mistreatment and abuse.
• Inadequate supervision in childhood. 
• Lack of family support.
• Violence in your community.
• Poverty. 
• Lack of economic opportunity. 
• Being a victim of racism or bias.

Millions of people across the country struggle with SUDs. 2021 research shows that:⁷

• 2.2 million people (8.5%) ages 12 to 17 had a SUD within the past year.
• 8.6 million people (25.6%) ages 18 to 25 had a SUD within the past year.
• 35.5 million people (16.1%) ages 26 and older had a SUD within the past year.

The stigma of addiction can result in harmful and dangerous consequences. Stigma can be a major deterrent for individuals struggling with SUDs who may want to get help. Research has found that 90% of those with SUDs do not receive the help that they need. Additionally, people who perceive high stigma regarding SUDs are half as likely to receive help for their disorders due to a desire to avoid being stigmatized.³

Healthcare providers treating mental illness and substance misuse may stigmatize their patients struggling with addiction. More specifically, bias among healthcare professionals can negatively affect their willingness to offer appropriate care. Many people with mental illnesses or SUDs internalize stigma, which is also known as self-stigma. When stigma is internalized, it can decrease a person’s self-esteem and belief in their ability to overcome addiction, which, in turn, makes them less interested in getting help.³

In summary, stigma can:²

• Decrease the willingness of those struggling with mental illnesses and SUDs to get the help they need.
• Negatively affect the perceptions of healthcare workers, which can influence the care and treatment they provide to people struggling with SUDs and mental illnesses.
• Create feelings of anger, pity, and fear in people without SUDs that can lead to detachment from those with SUDs.

One of the most effective ways that you can help reduce the stigma around SUDs is by educating yourself on the disease. Most often, stigmas are created and spread by misinformation and assumptions that are not fact-based. Treating everyone with respect and dignity can be impactful in reducing stigma and, in turn, can even help encourage those struggling with addiction to get the help they need. Being aware of the language you use to describe addiction and SUDs is essential in reducing stigma because words can affect the way people with SUDs are perceived.²

If you think that someone you love may be struggling with a SUD, there are things you can do to help. Loving someone struggling with a SUD can leave you feeling powerless. Knowing how to talk to your loved one can feel challenging and overwhelming. Strategies to help you talk to your loved one include:⁸

• Pick a time to speak to your loved one when they are sober.
• Use “I” statements such as “I think” or “I feel” to express how you feel. 
• Educate yourself and provide facts.
• Ask if you can attend a doctor’s or therapy appointment.
• Encourage and attend sober activities.
• Provide resources on recovery and treatment.
• Encourage them to attend therapy and other recovery activities such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) meetings. Offer to drive them if they need it.
• Be patient and remember that change takes time.
• Attend family therapy and other supportive activities with your loved ones. 
• Take care of yourself physically and mentally. 
• Attend support groups for yourself that can include Al-Anon and Nar-Anon.

If you or a loved one is struggling with a SUD, time is of the essence. Help is available to you, and you shouldn’t wait to get the help you need. Identifying options for treatment can help your loved one feel empowered. American Addiction Centers (AAC) offers comprehensive treatment in facilities across the country. Research has found that substance use disorder treatment has many benefits:⁹

• Safely and effectively detoxing from substances. 
• Reducing drug and alcohol cravings.
• Learning skills necessary to live a life without substances.
• Preventing relapse through recognizing, coping with, and avoiding situations that can increase the risk of relapse. 
• Improving overall family functioning through family therapy.
• Increasing a person’s social support system.

Sources:

1 Recovery Research Institute, Stigma (accessed September 2023): recoveryanswers.org.

2 National Institute on Drug Abuse, Words matter - Terms used to avoid when talking about addiction (accessed September 2023): nida.nih.gov.

3 Neuropsychopharmacology, Choosing appropriate language to reduce the stigma around mental illness and substance use disorders (accessed September 2023): nature.com.

4 American Society of Addiction Medicine, Definition of addiction (accessed September 2023): asam.org.

5 National Institute on Drug Abuse, Drugs, brains, and behavior: The science of addiction – Drugs and the brain (accessed September 2023): nida.nih.gov.

6 Substance Abuse and Mental Health Services Administration, Risk and protective factors (accessed September 2023): samhsa.gov.

7 Substance Abuse and Mental Health Services Administration, Highlights for the 2021 National Survey on Drug Use and Health (accessed September 2023): samhsa.gov.

8 National Institute on Aging, How to help someone you know who drinks too much (accessed September 2023): nia.nih.gov.

9 National Institute on Drug Abuse, Drugs, brains, and behavior: The science of addiction – Treatment and recovery (accessed September 2023): nida.nih.gov.

Used with permission from CredibleMind, author: Jacquelyn Buffo.