Substance Use Disorders (SUDs) have rapidly increased in the United States, leading to skyrocketing numbers of overdose deaths. How bad is it? Take a look at Figure 1 from the Centers for Disease Control. It shows that since 2010, the number of deaths per 100,000 people from overdoses has tripled!

Figure 1: Overdose deaths in the United States per 100,000 population. Source: Centers for Disease Control. Used under fair use: Commentary.

Why are so many dying when effective treatments are available and they’re not that expensive? They’re dying because substance abuse sufferers are reluctant to admit they have a problem that requires intervention, and they are reluctant to seek out treatment even when they recognize they have a problem.

A major reason people with SUDs don’t seek treatment is the stigma associated with coming out as “an addict.” Stigma is a major barrier to treatment and it’s the major reason the terms “addict” and “alcoholic” are being dropped in favor of less judgmental terms, such as people dealing with substance use problems.

A recent meta study of the scientific literature on stigma and substance abuse recovery published in Psychological Science in the Public Interest found there were many negative outcomes associated with stigma, including:

• limiting access to employment
• limiting access to housing
• disrupting interpersonal relationships
• harming physical health
• harming mental health
• reducing help-seeking

The researchers found that the stigma of self-identification as a substance abuser “leads to social psychological and behavioral consequences, such as secrecy, withdrawal from social relationships and roles, and downgrading of life goals and aspirations, all of which are self-sabotaging.” As we have seen, the stress these life changes cause is often displaced with self-damaging compulsive behavior, resulting in a downward spiral of substance abuse.

One of the results researchers found was how thin the literature is: 

[B]ecause 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.

In a fascinating section on ways to reduce stigma, the authors cite legislation and court cases as having a big impact. When people are not discriminated against in employment and housing, stigma diminishes. The stigma of homosexuality in the United States has markedly decreased with Supreme Court decisions and legislation that protects people who identify as homosexual.

Researchers found that “the reduction of structural treatment barriers, such as inadequate insurance coverage and lack of access to evidence-based interventions,” would help more people with SUDs connect with treatment. Recognizing that we are all hard-wired for substance abuse would go a long way toward relieving the stigma of seeking care.

Written by Steve O’Keefe. First published December 26, 2023.

Sources:

“Addiction stigma discourages many people from seeking treatment,” NewsMedical Network, December 2015.

“Substance-Use Stigma Impedes Treatment in Various Ways, Scientists Say,” Psychological Science in the Public Interest, December 2023.

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