Substance use disorders (SUDs) are chronic brain disorders with a risk of relapse, but from which people can and do recover. Like other medical conditions, some people are more prone to developing 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 in the past year met criteria for a SUD diagnosis.1 For this subgroup of people, the brain disease model emphasizes the brain changes that occur with SUDs that lead a person to continue using substances despite all the negative consequences and harm that follow.
For countless generations, however, people with SUDs have been subjected to a false social belief, or stigma, that substance use and its consequences were the result of moral weaknesses or a lack of will. This stigma affects their lives—resulting, for some, in losing custody of children, losing jobs, and going to jail despite treatment.
The impact of stigma extends far beyond these immediate consequences. Research shows that stigma creates barriers to seeking treatment, with many people avoiding help due to fear of judgment or discrimination. Health care settings, which should be safe spaces to seek help, can sometimes perpetuate these harmful behaviors. Studies have found that even experienced healthcare professionals may have unconscious biases that affect the quality of care they provide to people who have SUD.
Additionally, internalized stigma – when individuals begin to believe these negative stereotypes about themselves – can lead to decreased self-esteem, increased isolation, and decreased hope for recovery. This creates a vicious cycle where stigma itself becomes a barrier to healing and recovery.
Fortunately, people with a history of SUD are now protected from employment discrimination by the Americans with Disabilities Act of 1990. However, judgmental attitudes—even sometimes by professionals 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 changes in the brain that are often complicated by genetic predispositions, the effects of adverse early childhood experiences, and other environmental factors.
Breaking the Stigma
One way to analyze the stigma that affects people is to understand SUD as a brain disease. This can help reduce stigma in several critical ways:
- It shifts the narrative from personal responsibility to medical understanding, recognizing that SUDs involve biological changes and are not a matter of will.
- 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 professionals in the screening and treatment of SUDs, rather than viewing individuals who have SUDs as having major legal or moral problems.
Recent research2 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 empathic and evidence-based approaches to treatment. However, addressing stigma requires a multifaceted approach beyond simple education about the brain disease model.
One of the most powerful tools for reducing stigma is direct interaction with people in recovery. Through peer support programs and recovery storytelling, health care providers, community members, and policy makers gain firsthand exposure to the human reality of SUDs. These personal connections challenge stereotypes and misconceptions, replacing them with understanding and empathy.
Healthcare organizations play an important role in eliminating stigma by enacting operational changes. By implementing comprehensive stigma awareness training for all staff, organizations can create environments where individuals feel safe seeking treatment. This transformation goes beyond superficial changes – it requires a fundamental shift in culture that prioritizes fair treatment and dignity for all patients. Many health care systems have found success integrating addiction treatment into primary care settings, making it as routine as managing diabetes or hypertension.
The media is a major influence in shaping public perceptions of SUDs, and thoughtful public education campaigns can help challenge long-held misconceptions. Recovery success stories, particularly those that highlight the diverse backgrounds of people affected by SUDs, help demonstrate that addiction touches all communities and that recovery is possible for all.
Systemic change also requires strong political support. When insurance coverage for SUD treatment is expanded, more people can access the care they need. Strong legal protections against employment and housing discrimination provide meaningful stability to people in recovery. Harm reduction programs save lives and provide critical points of contact for people who might otherwise avoid healthcare facilities altogether. Continued funding for research helps improve treatment approaches, while parity laws ensure that people seeking treatment for SUDs receive the same level of care as those with other medical conditions.
Healthcare professionals benefit from continuing education that goes beyond understanding the neurobiology of addiction. Cultural competency training helps providers recognize and respect the diverse experiences of their patients. Trauma-informed care approaches recognize the complex relationships between trauma and substance use, while motivational interviewing skills enable more effective interactions with patients. Implicit bias training helps providers recognize and address their own biases, and training in person-centered 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, faith-based 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 a young age.
Finally, workplace programs that support workers 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 empowers employees to seek help without fear of discrimination.
A chronic condition — No choice
No one chooses to develop an SUD and it can happen to anyone. While people may struggle to manage them, help is available.
For more information and resources about 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’re ready to locate a treatment facility or provider, you can jump right in 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 on 988lifeline.org.
The treatment works. Recovery is possible.
1. Substance Abuse and Mental Health Services Administration. (2024). Key indicators of substance use and mental health 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, Substance Abuse and Mental Health Services Administration Statistics and Quality.
2. The Centers for Disease Control and Prevention. 2024. The Addiction Medicine Primer: An Overview of the Treatment of Substance Use Disorders.
