Best Practice of the Month
Ensuring That the Message Doesn’t Get Lost: Avoiding Stigma

There are many barriers to substance use disorder treatment: Only 10% of the estimated 21.6 million people age 12 and older who needed substance use treatment in 2019 received treatment. Of these barriers, stigma involves patterns of communication and may dissuade people from seeking treatment. Stigmatization can lead people to hide their substance use or not seek treatment out of fears about, for example, how people around them might think of them, how seeking treatment might negatively affect their employment, and how their substance use disorder may put them at risk of losing custody of their children.

Stigmatizing thoughts and actions are not limited to the general public; healthcare providers’ thoughts and actions may send stigmatizing messages, whether they realize it or not. Stigma can diminish the effectiveness of substance use disorder (SUD) treatment efforts by, e.g., making providers unwilling to treat patients for addiction or motivating them to not raise the topic with patients out of an overcorrecting effort to avoid stigmatizing patients. Because of stigma, providers may not use screening tools to identify patients who would benefit from preventive services or who need brief interventions, referrals to treatment, or evidence-based care.

What is Stigma?

Stigma is a degrading and debasing attitude of the society that discredits a person or a group because of an attribute… Stigma destroys a person’s dignity; marginalizes affected individuals; violates basic human rights; markedly diminishes the chances of a stigmatized person of achieving full potential; and seriously hampers pursuit of happiness and contentment.

—2015 International Conference on Stigma (Howard University, Washington, DC)

Stigma related to substance use falsely equates it with moral weakness or character flaws, resulting in discrimination and unfair treatment of the stigmatized person. Stigma is conveyed through language, attitudes, and actions.

Strategies for Reducing Stigma

Many strategies can be used to educate family members, caregivers, practitioners, and the public to increase their understanding of SUD as a chronic brain disorder affecting millions of people. For example, consortia often use town hall meetings, community forums, and other types of community meetings to share information with specific audiences, such as family members or the community-at-large. In addition to public education efforts, there are some concrete steps your program can take to help reduce stigma: provide correct information to counter misinformation; replace punitive practices with evidence-based prevention and treatment services; and counter stigmatizing language with neutral, accurate language.

Provide correct information to counter misinformation.

People who are unaware of the complex factors leading to substance use may react with frustration when they witness the confounding behaviors of people who use drugs, which can lead to blaming. When you encounter this kind of reaction, acknowledge the feelings, but counter the stigmatized response with accurate information based on available science:

  • Social and environmental factors—including community, social setting, access to health care, education, and economic stability—are linked to resilience and risk related to addiction.
  • Genetics make up about half of a person’s addiction risk. Negative experiences, especially early in life, make the expression of that genetic risk more likely.
  • A person’s addiction may have evolved from drug use that was originally an adaptive coping strategy in the face of, for example, childhood neglect, physical or sexual abuse, witnessing of violence, incidents in military service, accidents, or disaster.
  • The brain’s reward circuitry drives the desire for pleasure, balanced the prefrontal cortex’s work weighing goals and decision-making. An underlying vulnerability to addiction and the brain’s adapting to repeated drug exposure disrupt both the reward and decision-making pathways. This disruption can interfere with the ability of people with SUD to use reasoned judgment to deal with their addiction.
  • Altered brain function, combined with the intense physical and emotional misery of withdrawal, can make it difficult for the person with addiction to make healthy choices toward treatment, even when faced with negative consequences.

When providing stigma-reducing education:

  • Share information about brain science and the science of addiction. The National Institute on Drug Abuse (NIDA) website provides an abundance of information on the science of SUD and how drugs affect the brain. People better understanding that SUD is a chronic health condition that impacts the brain reduces SUD-associated stigma.
  • Highlight successful programs and interventions rooted in science and evidence. Invite speakers with expertise in evidence-based prevention, harm reduction, treatment, and recovery practices. Sample topics include school-based programs, permanent drug disposal programs, medications for opioid use disorder, syringe exchange programs, naloxone to reverse overdoses, and peer-based recovery support services.
  • Ensure the event is culturally responsive. It is vital that community outreach and educational events are culturally appropriate to the audience. Knowledge of your community’s demographics will help you decide how best to move forward in a culturally responsive manner, as will a solid understanding of Culturally and Linguistically Appropriate Services standards. These standards establish a framework to assist organizations that are striving to serve diverse communities in a competent manner.

Replace punitive practices with evidence-based prevention and treatment services.

People with diabetes are not dismissed from medical care if they fail to manage their blood sugar properly. Yet people with substance use disorder are sometimes prevented from entering treatment, or are dismissed from treatment, for drug-using behaviors. There is no therapeutic benefit to this. Refusing treatment or discharging patients who continue to use substances is associated with harm to the patient and, in the case of opioids, death from overdose. Replace any punitive practices in your program with evidence-based, life-altering, life-sustaining services:

  • Treatment with medication and psychosocial services, such as cognitive behavioral therapy, can help people achieve recovery from addition and substantially reduces their risk of death from overdose.
  • Training in self-regulation, social skills, and stress resilience can help people avoid substance use or recover from addiction.
  • Social supports—such as recovery groups, case management, transportation assistance, health education, and linkages to stable housing, legal assistance, and food assistance—can also help people prevent or address substance use disorder.

Counter stigmatizing language with neutral, accurate language.

Research shows that stigmatizing language shapes people’s perceptions of themselves and others. When discussing substance use disorder, use person-centered, nonjudgmental language consistent with how you discuss other medical conditions.

  • Use person-first language, such as person who uses drugs, person with substance use disorder. Terms like junkie, addict, or drug user should never be used.
  • Avoid describing a person as clean or dirty based on their toxicology results. People test positive or negative.
  • Do not say that someone who is not able to maintain abstinence has failed treatment. The person has had an episode of drug use.


Non-stigmatizing language


Always use accurate and non-stigmatizing language. It is vitally important to ensure all participants use accurate and non-stigmatizing language during the event. This includes all promotional materials. Modeling the use of correct terms for your community when talking about SUD can go a long way in reducing stigma related to drug use, thereby reducing barriers to treatment and recovery.

Nothing about us without us. Inviting people who use drugs, people in recovery from SUD, and/or family members and allies who have been touched by SUD to tell their personal story brings a face and a voice to this public health crisis. It is helpful to offer participants some form of messaging training to help them craft their stories for maximum impact.


  1. Words Matter – Terms to Use and Avoid When Talking about Addiction (web page from the National Institute on Drug Abuse [NIDA])
  2. Stigma and the Toll of Addiction (article by Nora D. Volkow, M.D., NIDA director)
  3. Drugs, Brain and Behavior: The Science of Addiction (plain-language overview from NIDA; free copies can be ordered here)
  4. Key Substance Use and Mental Health Indicators in the United States: Results from the 2019 National Survey on Drug Use and Health (report from the Substance Abuse and Mental Health Services Administration)
  5. Neuroscience of Addiction: Relevance to Prevention and Treatment (article by Dr. Volkow and Maureen Boyle, PhD, NIDA chief quality and science officer)
  6. How States Handle Drug Use During Pregnancy (report on state treatment of pregnant women with substance use disorder)
  7. Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change (2016) (resource for communities engaged in stigma elimination activities)
  8. Stigma, Prejudice and Discrimination Against People with Mental Illness (resource from the American Psychiatric Association)  

Related Organizations

  1. Recovery Research Institute (provides a repository for all relevant research related to the role language plays in discriminatory obstacles to wellness—including the Addictionary, a glossary of behavioral health terms with stigma alerts, where appropriate)
  2. Faces & Voices of Recovery (organizes and mobilizes people impacted by SUD into recovery community organizations that promote human rights and access to resources through stigma-eliminating advocacy and education)
  3. Addiction Policy Forum (a nationwide, nonprofit organization dedicated to eliminating addiction as a major health problem, with particular expertise translating and communicating to the general public the complex science associated with substance use prevention, treatment, and recovery)
  4. The Recovery Advocacy Project (a national network advocating for positive policy change, committed to giving people in recovery, their family members, and supporters of recovery the grassroots organizing tools to think and act locally)