Stigma of Addiction
How Societal Judgment and Self-Perception Create Barriers to Recovery from Addiction
Stigma of Addiction
Society often views addiction as a series of poor personal choices, yet research indicates that approximately 50% of addiction risk is genetic, suggesting that our current system of blame is scientifically misplaced. Substance use disorder is a major public health crisis. In the United States, 48.7 million people aged 12 or older had a substance use disorder in 2022. Early intervention and treatment are critical steps in supporting recovery; however, a major barrier to seeking assistance is stigma (Earnshaw, 2020).
Journey with me, if you will, into the definition of stigma: a mark of disgrace, stereotype, or negative attitude attached to a person or group based on characteristics such as mental illness, disability, or social status. Stigma leads to prejudice, discrimination, and social exclusion, often causing shame, reduced opportunities, and barriers to seeking treatment.
I beg the question: if you experienced an unrelenting addiction, how would you want to be treated?
Stigma shapes how people with addiction are treated. Unfortunately, individuals are often referred to by demeaning terms such as “junkie,” “addict,” or “crackhead,” which dehumanize them.
Stigma is further compounded by systemic racism. Because of fear of judgment, individuals often conceal their substance use from healthcare providers, leading to missed opportunities to diagnose or treat related conditions such as HIV or hepatitis. Despite substance use disorder (SUD) being recognized as a medical condition, many healthcare professionals still hold negative attitudes toward individuals with addiction, which can result in poorer treatment outcomes.
Studies show that some professionals are less likely to provide evidence-based care, such as medication-assisted treatment for opioid addiction, because they believe patients are “manipulative” or “unmotivated” (Cazalis et al., 2023). Addiction is often viewed more negatively than other mental illnesses, with many people unwilling to work with, associate with, or welcome someone with a drug addiction into their family.
Research demonstrates that stigma damages the health and well-being of individuals with substance use disorders and interferes with the quality of care they receive. Although substance use disorders are chronic and treatable medical conditions, people with these disorders continue to face discrimination and stigma—a set of negative attitudes and stereotypes that impact their health and well-being in numerous ways. This stigma also affects people who use drugs but may not meet the criteria for a substance use disorder.
There are safe, effective, and lifesaving tools available to help individuals struggling with substance use. However, stigma is often one of the primary reasons people avoid seeking care.
Research shows that the language people use can contribute to stigma and discrimination against individuals with substance use disorders, including discrimination by healthcare professionals. Addiction is a health condition that can improve with medical treatment. However, for much of history, addiction was incorrectly viewed by medical professionals and society as a character flaw. This misunderstanding has contributed to bias among healthcare providers, some of whom may provide inadequate treatment—or no treatment at all—to people with substance use disorders.
Changing medical language is a good start, but changing mindsets takes time. We can help by becoming more mindful of the way we speak about addiction.
Structural stigma is embedded in policies, laws, and institutions that marginalize individuals struggling with addiction. The stigma surrounding addiction has significant consequences. Treating drug use as a criminal act rather than a public health issue marginalizes individuals and disproportionately affects Black and brown communities through punitive policies and systemic inequities.
Landlords and employers may exclude individuals based on addiction history, creating barriers to employment and housing. These exclusions are often rooted in fears of relapse, concerns about reliability, and perceived safety risks or property damage. While active drug use is not legally protected, laws such as the Americans with Disabilities Act (ADA) often protect individuals in recovery, making discrimination against rehabilitated individuals illegal in many circumstances.
Health insurance companies frequently limit coverage for substance use treatment, often treating addiction differently from other chronic illnesses. These stigmatizing attitudes are rooted in the false belief that addiction reflects a character weakness rather than a disease. Research indicates that individuals with substance use disorders are less likely to receive the same quality of care as those with other severe medical conditions, making stigma one of the greatest barriers to overcoming the addiction crisis. Insurance providers often view comprehensive substance use treatment, particularly long-term residential rehabilitation, as high-cost care and may limit coverage to reduce financial liability.
Individuals with substance use disorders often experience deep shame, believing they are “fundamentally flawed,” which lowers self-esteem and increases stress. Many experience the “why try” effect: when individuals feel despised or believe they are beyond help, they may decide there is no point in seeking treatment. This can lead to increased substance use and reduced treatment adherence.
Self-stigma is especially dangerous because it causes individuals to internalize negative societal stereotypes, severely damaging self-esteem, increasing anxiety and depression, and in some cases contributing to suicidal ideation. It becomes a major barrier to care by preventing individuals from seeking help due to shame. It also creates a “why try” effect that reduces motivation for recovery and encourages social withdrawal.
Proverbs 23:7 states, “As a man thinketh in his heart, so is he.” This verse suggests that a person’s inner thoughts, beliefs, and motivations shape their character and actions more than outward appearances. Deep-seated thoughts influence behavior and shape one’s sense of identity and reality.
Self-stigma is often considered more damaging than public stigma because it becomes internalized. Individuals begin to believe and agree with the negative stereotypes directed toward them, which can create a self-fulfilling prophecy. A self-fulfilling prophecy occurs when an initially false belief or expectation leads to behaviors that ultimately make the expectation come true. Our unconscious actions, shaped by what we expect to happen, can reinforce the very beliefs we fear.
While public stigma is something people encounter externally, self-stigma becomes something they live with daily, often leading to destructive outcomes.
Family members may also experience “courtesy stigma,” or stigma by association. This occurs when individuals experience prejudice, discrimination, or negative judgment simply because they are connected to someone who is stigmatized. As a result, families may feel shame and attempt to hide the problem, delaying treatment for their loved one.
Far too often, society stigmatizes behaviors and conditions viewed as different or outside accepted norms. The effects of substance use disorders are felt throughout the entire family system. Family context provides important insight into how substance use disorders develop, are maintained, and how recovery may be supported or hindered. Family systems theory and attachment theory provide valuable frameworks for understanding how substance use disorders affect families (Lander et al., 2013).
Research consistently shows that addiction is more highly stigmatized than many other health conditions. One study conducted by the Johns Hopkins Bloomberg School of Public Health found that drug addiction is viewed much more negatively than mental illness, and nearly three out of ten people believe recovery from drug addiction is impossible.
The more society associates shame with addiction, the less likely individuals will seek treatment and the less likely society will support meaningful change. We must address media bias and misinformation surrounding addiction while educating the public that addiction is a treatable medical condition.
Simple changes in language can help reduce harmful stigma surrounding substance use disorders. When discussing addiction, it is best to use neutral, person-first, and person-centered language. Instead of saying someone “is an addict,” we should say they “have a substance use disorder.”
In addition to promoting language changes, counselors can implement evidence-based approaches to help clients overcome stigma and shame. Cognitive Behavioral Therapy (CBT) can help clients identify and restructure distorted thoughts related to self-stigma. Cognitive reframing helps replace negative self-judgments with healthier and more realistic beliefs.
Motivational Interviewing (MI) is another valuable approach. This collaborative counseling method empowers clients by focusing on their autonomy, strengths, and inherent worth. Counselors can use MI to help clients identify personal reasons for change and build the self-efficacy necessary to overcome societal judgment.
Stigma provides the label—“unworthy,” “contaminated,” “broken”—while shame becomes the emotional consequence. Shame is often described as one of the most common emotional responses to stigmatized conditions such as addiction and mental illness.
Shame influences how individuals respond to stigma, often resulting in secrecy, isolation, dishonesty, or withdrawal from society.
Stigma hurts. Stigma damages. Stigma ruins lives. Stigma destroys potential.
Shame tells people they are broken, flawed, irreparable, and ultimately unlovable. Shame keeps individuals hidden in the shadows.
As a future counselor, this is the message I would offer clients experiencing stigma:
Once you begin to recognize your own worth, the voices and power you once gave to others begin to fade. Sometimes the bravest thing you can do is forgive yourself, release destructive self-narratives, and begin writing a new story for your life.
We are all part of a fallen humanity, but God’s mercies are new every morning. You are not defined by other people’s opinions of you. Pick up the pen and begin writing a new narrative.
References
Cazalis, A., Lambert, L., & Auriacombe, M. (2023). Stigmatization of people with addiction by health professionals: Current knowledge: A scoping review. Drug and Alcohol Dependence Reports, 9, 100196. https://doi.org/10.1016/j.dadr.2023.100196
Earnshaw, V. A. (2020). Stigma and substance use disorders: A clinical, research, and advocacy agenda. American Psychologist, 75(9), 1300–1311. https://doi.org/10.1037/amp0000744
Lander, L., Howsare, J., & Byrne, M. (2013). The impact of substance use disorders on families and children: From theory to practice. Social Work in Public Health, 28(3–4), 194–205. https://doi.org/10.1080/19371918.2013.759005
