Stigma Toward Substance Dependence: Causes, Consequences, and Potential Interventions

Abstract

Substance dependence is a prevalent and urgent public health problem. In 2021, 60 million Americans reported abusing alcohol within the month prior to being surveyed, and nearly 20 million Americans reported using illegal drugs (e.g., heroin) or prescription drugs (e.g., opioids) for nonmedical reasons in the year before. Drug-involved overdose rates have been steadily increasing over the past 20 years. This increase has been primarily driven by opioid and stimulant use. Despite its prevalence, drug dependence is one of the most stigmatized health conditions. Stigma has myriad negative consequences for its targets, including limiting their access to employment and housing, disrupting interpersonal relationships, harming physical and mental health, and reducing help-seeking. However, because research on stigma toward people with substance use disorders (SUDs) is relatively sparse compared with research on stigma toward other mental illnesses, the field lacks a comprehensive understanding of the causes and consequences of SUD stigma. Moreover, it remains unclear how, if at all, these factors differ from other types of mental illness stigma. The goal of this review is to take stock of the literature on SUD stigma, providing a clear set of foundational principles and a blueprint for future research and translational activity.

The Heterogeneous Nature of Substance Use and Substance Use Disorders: Implications for Characterizing Substance-Related Stigma

“…PSYCHOLOGICAL SCIENCE Krendl and Perry's (2023) article is an informative summary of research into stigma toward substance use disorders (SUDs). Of particular importance is their emphasis on key dimensions of perceptions of both SUDs and individuals suffering from them, a processoriented approach that generates useful proposals for strategies to reduce stigma.…”

Stigma Related to Substance Use and Addiction: The Long Journey Ahead—Commentary on Krendl and Perry (2023)

“…Despite the enormous suffering and impairment resulting from substance use-including staggering costs to individuals, families, communities, and economies as well as huge fatality rates from overdoses-and despite the continuing stigma around the entire topic (Barry et al, 2014;Yang et al, 2017), the literature on stigma related specifically to substance use is far smaller than that for mental disorders (e.g., mood disorders, schizophrenia). Krendl and Perry (2023) admit that they had to go directly to research on mental illness stigma in several instances because of the dearth of studies specifically focusing on substance-related stigma. 1 As a result, especially as the opioid crisis continues to wreak havoc and death and as debates about the moral versus medical nature of substance use proliferate, there is an urgent need to understand why stigma remains so high (Schomerus et al, 2022), both in the United States and worldwide (Mascayano et al, 2015).…”

“…Without sufficient data, it is similarly mistaken to believe that a uniform level of denigration and stigmatization exists with respect to the use and abuse of prescription medications, legalized substances such as alcohol or nicotine, or illicit drugs (e.g., cocaine, most psychedelics, or street opioids), all of which may be included in blanket terms such as "drug addiction" in national surveys. Despite a dearth of relevant literature, as Krendl and Perry (2023) highlight, we do know that variables such as the legality of the substances that are ingested, the perceived danger to society linked to the target individual, and the desire for treatment on the part of the substance-abusing individual are all crucial. In general, use of illicit substances predicts greater stigma and perceived danger, whereas commitment to treatment predicts lowered stigma.…”

“…In short, it is incredibly frustrating to attempt to find viable data on (a) relapse rates and (b) long-term treatment success figures for individuals who have experienced substance use disorders. Krendl and Perry (2023) cited Miller (2023) to the effect that 75% of people with addictions fully recover-but that source had no supporting data. I note as well that despite the clear benefits of medical interventions designed mainly to reduce harm (e.g., methadone, buprenorphine, recovery naloxone for overdoses), stigma toward such interventions remains high and access is often poor (McCradden et al, 2019).…”

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Krendl and Perry (2023) have made a monumental contribution to research on the origins of, mechanisms underlying, and potential interventions for the longstanding and pernicious stigmatization of individuals with substance use disorders. The ongoing crisis related to substance use, which can lead to physical and mental impairment and even death, remains one of the core public-health issues of our era.

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