• Although substance use disorders are chronic and treatable medical conditions, studies show people with these disorders still face discrimination and stigma (a set of negative attitudes and stereotypes) that can impact their health and well-being in numerous ways. This stigma also affects people who use drugs who do not have a substance use disorder.
• There are safe, effective, and lifesaving tools available to help people struggling with substance use. However, stigma often factors into the reasons why people who need help do not seek care.
• Research shows the language we use contributes to stigma and discrimination against people with substance use disorders, including by healthcare professionals.

Stigma is a social phenomenon that involves negative attitudes (prejudices) or beliefs (stereotypes) about others typically (but not always) based on defining characteristics such as sexuality or health conditions (e.g., HIV, mental illness, or substance use) that are perceived to be contagious, dangerous, or incurable. It is relational in nature as occurring in the context of power. Goffman defined stigma as “an attribute that is deeply discrediting” that reduces the individual “from a whole and usual person to a tainted, discounted one.” Stigma and the process of stigmatization consists of identifying and labeling a “difference,” linking a labeled person to undesirable characteristics, and separating “them” from “us”; thus, the stigmatized group (“them”) subsequently experiences discrimination and loss of status in the context of social, economic and political power. For example:

• Health-related stigma happens when people have or are associated with a specific health condition perceived as undesirable. As a result of this stigma, they may avoid seeking screening or treatment or are treated differently or poorly by others because of it.
• Health-related discrimination is discrimination based on a health condition, disease, or another health-related issue. It may occur in the workplace, health care, education, housing, and other settings.

There are multiple types of health-related stigma, including:

• Internalized stigma: The individual believes they are bad or at fault for having a health condition
• Enacted stigma: The individual experiences discrimination from others because they are known or believed to have a health condition
• Anticipated stigma: The individual expects or fears future discrimination due to the health condition
• Associated stigma: Others, such as family members or healthcare workers, experience discrimination because of their proximity to those with a health condition.
• Perceived stigma: An individual’s perceptions about how stigmatized groups are treated due to a health condition.

Stigma exists at multiple levels:

• Individual level: A person’s cognitive, affective, and behavioral responses to facing or experiencing stigma, including concealment and disclosure, internalization, and stigma consciousness
• Interpersonal level: Discrimination as expressed by one person toward another, manifesting in ways such as lack of respect, devaluation, and dehumanization
• Structural level: Societal-level conditions, cultural norms, and institutional policies that constrain the opportunities, resources, and well-being of the stigmatized

Stigma’s Impact on Health

Research shows that health-related stigma for any condition is not just a social problem. It can have detrimental impacts on how health care is sought, accessed, and delivered, and slow scientific progress. Stigma is also associated with poor health outcomes and reduced service utilization. For example, stigma related to conditions like HIV, tuberculosis, epilepsy, and substance use, increases the likelihood that the individual will develop a related mental disorder like depression or anxiety. In addition, research shows that stigma reduces quality of life and makes individuals less likely to seek out needed care.

Language and Stigma

The language we use to talk about health plays a crucial role in shaping opinions and beliefs about a disease or condition, and the people affected. Scientific and medical terminology typically used by the research community may inadvertently create or perpetuate stereotypes about diseases or drive fear and “othering.”

The stigma against people with substance use disorders is a set of negative attitudes and stereotypes that can create barriers to treatment and make these conditions worse. Although substance use disorders are chronic, treatable medical conditions, studies show people who have them often face stigma and discrimination in part because others do not understand these disorders or how they can be effectively treated.

Many people do not know that a substance use disorder is the result of changes in the brain that make drug use compulsive (difficult or impossible to stop without adequate support). Some people with severe substance use disorders may become aggressive, lie, or steal to support their drug problem or during withdrawal. These behaviors may alienate them even further from family, friends, and society and reinforce certain negative stereotypes around substance use. Importantly, the compulsive behaviors and brain changes in substance use disorders are not necessarily permanent. People can and do recover, especially with the help of treatment.

There are many reasons why a person may be more susceptible to substance use disorders, including genetic and social factors that may be beyond their control. Still, many people see addiction as a personal or moral failure. As a result, people may feel fear and anger toward someone with a substance use disorder, even if they are a friend or family member. For many, it can be hard to see – and help – the individual behind the illness.

Commonly used terms referring to people with addiction often reflect the misconception that their drug use and related behaviors are a choice, rather than a compulsion, and that they are to blame for their medical condition. Studies show that terms like “junkie” and “addict” feed negative biases and dehumanize people. Research shows that language can even sway clinicians’ attitudes. In one study, clinicians rated a person described as a “substance abuser” as more worthy of blame and punishment than someone described as “having a substance use disorder.”

Treating drug use as a criminal activity may also contribute to the stereotype of people who use drugs as being dangerous and a risk to society. It can further marginalize disadvantaged groups. For example, in the United States, punitive policies disproportionately affect Black people and communities of color, who are more likely to be arrested for illegal drug use. Black people were nearly four times more likely to be arrested for cannabis possession than white people in 2018, even though the two groups use the drug at similar rates.

• People who need care may not seek it. People with substance use disorders may face mistreatment, stereotyping, and negative bias from society, including in healthcare settings. These challenges may lead them to avoid seeking medical help. In fact, in 2020, about 12% of people who felt they needed substance use treatment but did not receive it in the past year said they did not seek treatment because they feared attracting negative attitudes from their communities.
• People fear disclosing their substance use. If a person conceals their substance use in a medical setting due to fear of bias or mistreatment, they may miss important opportunities for care. For example, clinicians may not know to offer information about how drugs may interact with their prescribed medications or may not screen them for conditions related to substance use, like HIV, hepatitis, and mental illness. Pregnant women especially may avoid talking about substance use, feeling shame and fearing social disapproval or loss of parental rights.
• People receive a poorer quality of care. Some health professionals also have bias toward people with addiction and may fail to provide evidence-based care as a result. A national survey of primary care providers in 2019 showed that while they generally understood opioid use disorder is a treatable condition, most also had stigmatizing attitudes against it, which affected the care they provided.
  
  Racial disparities and other kinds of discrimination add an extra barrier to care for many people in health care settings. For example, 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.
• People have reduced access to health programs. Medications for opioid use disorder, including methadone, buprenorphine, and naltrexone, are safe and effective treatments that help people recover. Yet because they must be taken regularly, and because methadone and buprenorphine can produce euphoria (a “high”) in people without opioid use disorder, these medicines are often mistakenly seen as mere substitutes for illegal drugs and carry a similar stigma.
  
  Similarly, syringe services programs, also known as needle exchanges, help link people to addiction treatment and help prevent health risks associated with using drugs, including HIV, hepatitis, and endocarditis. Yet some people shy away from these programs, fearing stigma from police, friends, family, and healthcare professionals. However, many cities and towns have been slow to implement these and other harm-reduction programs, due in part to stigma-related policy and funding challenges. and the misconception that they promote illicit drug use.

• People may increase their substance use. People with substance use disorders may already feel guilt and may blame themselves for their illness. They may have self-stigma, or adopt negative attitudes towards themselves around their substance use. These feelings of shame and isolation may in turn reinforce drug-seeking behavior.

Every person in our society can play a role in reducing stigma and discrimination against people with substance use disorders—from health professionals and addiction researchers to the general public and those directly affected by drug and alcohol problems.

• Understand substance use disorders as chronic, treatable medical conditions. To eliminate the stigma surrounding substance use disorders, we need to see these disorders for what they are: chronic, treatable medical conditions. People with substance use disorders deserve compassion and respect—not blame for their illness. Learn more about substance use disorders.
  
  The medical community can also better train health professionals on how to treat patients with substance use disorders. This begins with ensuring clinicians approach these disorders as treatable, chronic health conditions and use appropriate language.The NIDAMED website includes evidence-based screening tools, treatment resources, and continuing education for providers and providers-in-training.
• Replace stigmatizing language. An important step toward eliminating stigma is replacing stigmatizing language with preferred, empowering language that doesn’t equate people with their condition or have negative connotations. However, people experiencing substance use disorders or in recovery may choose to describe themselves and their own disorder with terms that work best for them, especially in certain contexts such as recovery support groups. NIDA has developed Words Matter: Preferred Language for Talking About Addiction, a guide for the general public on non-stigmatizing language.
  
  Choosing appropriate language is of particular concern for health professionals. NIDA has developed the guide Words Matter - Terms to Use and Avoid When Talking About Addiction for health professionals and trainees. NIDA has also developed Your Words Matter – Language Showing Compassion and Care for Women, Infants, Families, and Communities Impacted by Substance Use Disorder, a guide for clinicians on discussing substance use with pregnant patients and mothers.
• Address systemic discrimination. Systemic racism, sexism, and other forms of discrimination lead to multiple layers of stigma for many people with addiction. Just the stress of feeling discriminated against can increase the likelihood that someone will use substances. NIDA conducts and supports research to better understand stigma’s impact on marginalized groups, and on interventions that promote equitable, effective treatment and services. NIDA also funds research on the effects of alternative ways of regulating and decriminalizing drugs in countries that already have these policies.

Addiction can happen to anyone

One in 7 Americans reports experiencing a substance use disorder. There is not one single driving factor that leads to addiction. Some people may use drugs to help cope with stress, trauma, or to help with mental health issues. Some may even develop opioid use disorder after misusing opioids they are prescribed by doctors. In any case, using drugs over time makes it easier to become addicted.

Drug use and effects on the brain

When people take drugs, the brain is flooded with chemicals that take over the brain’s reward system and cause them to repeat behaviors that feel good but aren’t healthy.

The brain adapts to continued drug use by developing a tolerance, which means it takes more of a drug to feel the same result.

Not only does this lessen the brain’s ability to resist temptation, but it can also affect the amount of pleasure a person receives from normal, healthy activities like enjoying food or the company of others.

Addiction is a treatable disease

Addiction is a disease, not a character flaw. People suffering from SUDs have trouble controlling their drug use even though they know drugs are harmful.

Overcoming a SUD is not as simple as resisting the temptation to take drugs through willpower alone. Recovery may involve medication to help with cravings and withdrawal as well as different forms of therapy. It may even require checking into a rehabilitation facility. Recovery can be challenging, but it is possible.

Recovery options

There are safe and effective ways to recover from SUDs. Finding the right treatment option can be the key to a successful recovery journey.

Medications for opioid use disorder (MOUD)

Opioid use disorder may require medication as the first course of treatment. Medications for opioid use disorder (MOUD) can help with cravings and withdrawal symptoms. MOUD is effective in helping people overcome addiction, stay in recovery longer, and prevent reoccurrence of use.

MOUD medications approved by the Food and Drug Administration (FDA):

• Methadone
• Buprenorphine
• Naltrexone

Taking these medications during treatment doesn’t mean taking the easy way out; it means finding something that works best for that individual.

Medication-assisted treatment (MAT)

Treatment that combines medicine with counseling or other behavioral therapy is called medication-assisted treatment (MAT). MAT can be an effective way to overcome addiction to opioids. Behavioral therapy can be equally important as it helps people change their attitudes and behaviors related to drug use, helps prevent relapse, and keeps people in recovery longer.

Additional Treatment Options

• Twelve-step facilitation therapy is an individual active engagement strategy designed to encourage people to accept drug addiction as a chronic, progressive disease and prepare them to begin a 12-step mutual support program.
• Outpatient counseling can help people understand addiction, their triggers, and their reasons for using drugs. This form of treatment can be done at a doctor’s office or via telehealth appointment.
• Inpatient rehabilitation at a full-time facility provides a supportive environment to help people recover without distractions or temptations.

Relapsing is not a sign of failure

Reoccurrence of use may happen to people who use drugs and can happen even years after not taking the substance. More than anything, reoccurrence of use may be a sign that more treatment or a different method is needed. A routine review of one’s treatment plan may be necessary to determine if another method could be more effective.

Signs of overdose

Recognizing the signs of opioid overdose can save a life. Here are some things to look for:

• Small, constricted “pinpoint pupils”
• Falling asleep or losing consciousness
• Slow, weak, or no breathing
• Choking or gurgling sounds
• Limp body
• Cold and/or clammy skin
• Discolored skin (especially in lips and nails)

What to do if you think someone is overdosing

It may be hard to tell whether a person is high or experiencing an overdose. If you aren’t sure, treat it like an overdose—you could save a life.

• Call 911 Immediately.*

• Administer naloxone, if available. **

• Try to keep the person awake and breathing.

• Lay the person on their side to prevent choking.

• Stay with the person until emergency assistance arrives.

*Most states have laws that may protect a person who is overdosing or the person who called for help from legal trouble.

**Naloxone is a life-saving medication that can reverse the effects of opioid overdose and save lives. It is available in all 50 states and can be purchased from a local pharmacy without a prescription in most states.