Reducing the Stigma of Addiction

The U.S. has experienced a devastating rise in drug overdose deaths in recent years. Between 1999 and 2020, more than 800,000 Americans died from drug overdoses, and escalating rates of drug addiction have contributed to recent decreases in U.S. life expectancy.

Health care providers at Johns Hopkins Medicine can offer hope to patients living with substance use disorder and their loved ones. Reducing the stigma around addiction is an important step. We hope that you will join us in our campaign to reduce stigma and help ensure that all patients feel welcome and cared for in our health system.

What is stigma of addiction?

A major barrier to overcoming the challenges of addiction and overdose in the community we serve is stigma. “Stigma” is a word that comes from Latin and Greek, and originally meant a burn, tattoo or other mark inflicted on another person to signify their disgrace.

Today, stigma means labeling, stereotyping and discrimination. One example is using disparaging or judgmental terms to refer to addiction, people with substance use disorder, or treatments for the disease.

What causes stigma of addiction?

A large body of research indicates that stigma is persistent, pervasive, and rooted in the belief that addiction is a personal choice reflecting a lack of willpower and a moral failing. Rates of stigma are extremely high both in the general public and within professions whose members interact with people with addiction, including the health care professions. Research demonstrates that stigma damages the health and well-being of people with substance use disorder and interferes with the quality of care they receive in clinical settings.

Stigma toward people with substance use disorder can be seen at all levels of care within health care settings. Any effort to address the drug overdose crisis must include action to reduce stigma.

How do we stop stigma of addiction?

Use words that can reduce addiction stigma.

There is an urgent need to combat stigma surrounding addiction. Recognizing the enormous challenge that stigma poses to our communities, including patients with substance use disorder, Johns Hopkins Medicine is committed to dismantling stigma within our health system as a key part of our strategy for tackling the addiction and overdose crisis.

One way to start is by revising the words and terms we use when discussing substance use disorder and the people affected by it.

Research indicates that use of “person-first” language is essential for stigma reduction, focusing on the person and not his or her condition. Research has shown that use of terms such as “substance abuser” is more likely to worsen stigma than use of person-first language such as “a person with a substance use disorder.”

The alternatives to the stigmatizing language are consistent with the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

Words to Use and Not Use

Recognize that treatment works

Clinicians and other caregivers make a meaningful difference in their patients’ lives. While many may not yet know how to help patients with substance use disorders, the most important thing to remember is treatments can work. Patients can recover and live happy, fulfilling lives.

For opioid use disorder, FDA-approved medications — methadone, buprenorphine, and extended-release naltrexone — can cut the risk of overdose death in half. However, they are underused in part due to the stigma and misunderstanding about their role in treatment.

Medications to treat opioid use disorder save lives

Opioid use disorder (OUD) is a chronic brain disease caused by the effects of prolonged opioid use on brain structure and function. These brain changes — and the resulting addiction — can be treated with life-saving medications, but those medications are not available to most of the people who need them.

Methadone, buprenorphine, and extended-release naltrexone are safe and highly effective medications that are already approved by the U.S. Food and Drug Administration (FDA) to treat OUD. In all treatment settings studied, medication-based therapy is shown to be effective.

By alleviating withdrawal symptoms and reducing opioid cravings, medications make people with OUD less likely to return to drug use and risk fatal overdose.

These medications also help people restore their functionality, improve their quality of life and reintegrate into their families and communities.

They can save lives, but the majority of people with OUD in the United States receive no treatment at all. Confronting the major barriers to the use of medications to treat OUD is critical to addressing the opioid crisis. Withholding or failing to have available all classes of FDA-approved medications for the treatment of OUD in any care setting is denying appropriate medical treatment.