By: Madeline Beasley Peacock, Ph.D. and Robert Baillieu, M.D., M.P.H. | SAMHSA
Substance Use Disorders (SUDs) are chronic disorders of the brain with a risk of recurrence but from which people can, and do, recover. Like other medical conditions, some people are more susceptible to developing a SUD than others. According to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey on Drug Use and Health, only about 25 percent of people who had used alcohol and illicit drugs within the past year met the criteria for a SUD diagnosis.(1) For this subgroup of people, the brain disease model underscores the brain changes that happen with SUDs and that drive a person to continue using substances despite all the negative consequences and harms that follow.
For countless generations, however, people with SUDs have been subjected to a false social belief, or stigma, that their use of substances and its consequences were a result of their moral failings or lack of willpower. This stigma impacts their lives – resulting, for some, in loss of child custody, loss of employment, and incarceration rather than treatment.
The impact of stigma extends far beyond these direct consequences. Research shows that stigma creates barriers to seeking treatment, with many individuals avoiding help due to fear of judgment or discrimination. Health care settings, which should be safe spaces for seeking help, can sometimes perpetuate these harmful attitudes. Studies have found that even experienced health care practitioners may hold unconscious biases that affect the quality of care they provide to individuals who have SUDs.
Moreover, internalized stigma – when individuals begin to believe these negative stereotypes about themselves – can lead to decreased self-esteem, increased isolation, and reduced hope for recovery. This creates a devastating cycle where stigma itself becomes a barrier to healing and recovery.
Fortunately, individuals who have histories of a SUD are now protected from job discrimination by the Americans with Disabilities Act of 1990. However, judgmental attitudes – even sometimes harbored by the practitioners who can otherwise provide effective SUD treatment – and other forms of discrimination still occur. This is despite the reality that their SUD is the result of long-term, neurobiological brain changes often complicated by genetic predispositions, impacts of early childhood adverse experiences, and other environmental factors.
Breaking Down Stigma
One way to break down the stigma impacting people is to understand SUD as a brain disease. This can help reduce stigma in several crucial ways:
- It shifts the narrative from personal blame to medical understanding, recognizing that SUDs involve biological changes and are not a matter of willpower.
- It places SUDs in the same category as other chronic medical conditions that benefit from ongoing management and support.
- It emphasizes the importance of evidence-based treatment approaches rather than punishment or moral judgment.
- It supports the role of all health care practitioners in screening for and treating SUDs, rather than viewing people who have SUDs as having primarily legal or moral issues.
Recent research(2) has shown that when health care providers receive education about the neurobiology of addiction, their attitudes toward patients who have SUDs improve significantly. This scientific understanding helps replace stigmatizing beliefs with empathy and evidence-based approaches to treatment. However, addressing stigma requires a multi-faceted approach beyond just education about the brain disease model.
One of the most powerful tools in reducing stigma is direct interaction with people in recovery. Through peer support programs and recovery storytelling, health care providers, community members, and policymakers gain firsthand exposure to the human reality of SUDs. These personal connections challenge stereotypes and misconceptions, replacing them with understanding and empathy.
Health care organizations play an important role in dismantling stigma by instituting operational changes. By implementing comprehensive stigma awareness training for all staff members, organizations can create environments where individuals feel safe seeking treatment. This transformation goes beyond surface-level changes – it requires a fundamental shift in culture that prioritizes equitable treatment and dignity for all patients. Many health care systems have found success by integrating addiction treatment into primary care settings, making it as routine as managing diabetes or hypertension.
The media wields significant influence in shaping public perceptions of SUDs, and thoughtful public education campaigns can help challenge longstanding misconceptions. Success stories of recovery, particularly those highlighting the diverse backgrounds of people affected by SUDs, help demonstrate that addiction touches all communities, and that recovery is possible for everyone.
Systemic change also requires robust policy support. When insurance coverage for SUD treatment expands, more people can access the care they need. Strong legal protections against discrimination in employment and housing provide essential stability for individuals in recovery. Harm reduction programs save lives and provide crucial points of contact for individuals who might otherwise avoid health care settings entirely. Sustained funding for research helps improve treatment approaches, while parity laws ensure that individuals seeking treatment for SUDs receive the same level of care as those with other medical conditions.
Health care professionals benefit from ongoing education that goes beyond understanding addiction’s neurobiology. Training in cultural competency helps providers recognize and respect the diverse experiences of their patients. Trauma-informed care approaches acknowledge the complex relationships between trauma and substance use, while skills in motivational interviewing enable more effective patient interactions. Education about implicit bias helps providers recognize and address their own prejudices, and training in person-first, recovery-oriented language ensures that communication supports rather than undermines recovery. Community engagement initiatives also play a vital role in reducing stigma. When local organizations, religious institutions, and community leaders come together to support recovery efforts, the partnership creates a network of understanding and support. Educational programs in schools can help prevent stigma from taking root in younger generations by promoting understanding and empathy from an early age.
Finally, workplace programs that support employees in recovery and that provide education about SUDs help reduce stigma in professional settings. When organizations create policies that treat SUDs as health conditions rather than moral failings, it enables employees to seek help without fear of discrimination.
A Chronic Condition — Not a Choice
No one chooses to develop an SUD, and they can happen to anyone. While people may struggle to manage them, help is available.
For more information and resources on SUD Treatment Month, visit the SUD Treatment Month Toolkit.
To learn how to get support for mental health, drug, or alcohol issues, visit FindSupport.gov. If you are ready to locate a treatment facility or provider, you can go directly to FindTreatment.gov or call 800-662-HELP (4357). If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat at 988lifeline.org.
Treatment works. Recovery is possible.
1. Substance Abuse and Mental Health Services Administration. (2024). Key substance use and mental health indicators in the United States: Results from the 2023 National Survey on Drug Use and Health (HHS Publication No. PEP24-07-021, NSDUH Series H-59). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
2. The Centers for Disease Control and Prevention. 2024. The Addiction Medicine Primer: An Overview of Treatment of Substance Use Disorders
