Stigma education
Understanding stigma
Stigma can be one of the biggest barriers between a person and the help they need. Understanding stigma is the first step towards changing it.
Definitions
What stigma actually is
Stigma is often used as a synonym for unkindness. It is more specific than that — and separating its parts makes it easier to change.
- Stereotype
- A belief held about a group — for example, that people who use drugs are dishonest. It is a thought, and it can be held without any personal hostility.
- Prejudice
- When the belief is accompanied by a reaction or feeling — irritation, mistrust, discomfort, fear.
- Discrimination
- When belief and feeling turn into behaviour: a refusal, a shorter consultation, a rejected application, a different tone of voice.
- Stigma
- The whole process. Sociological accounts describe stigma as labelling, stereotyping, separation, status loss and discrimination occurring together within a context of power (Link & Phelan, 2001) — which is why stigma is more than individual rudeness.
Substance use dependency is a health condition influenced by interacting biological, psychological, social and environmental factors. It is not a moral failure, and it is not explained by one characteristic of a person. Stigma persists partly because substance use is one of the few health conditions still widely treated as a choice about character.
Why it matters clinically
Stigma is a health risk, not just a hurt feeling
It delays help
People commonly describe waiting months or years before mentioning substance use to a clinician, because of what they expect to happen when they do.
It hides clinical information
Non-disclosure is a safety issue: interactions, withdrawal risk, overdose risk and infection can all be missed.
It removes support
Housing, work, family contact and friendships are protective. Stigma puts each of them at risk.
It looks like evidence
When stigma produces worse outcomes, those outcomes are then read as proof that the stereotype was right.
Keep going
Where to next
Types of stigma
Seven forms of stigma — self, public, structural, healthcare, anticipated, experienced and courtesy — and how each one can be challenged.
Learn moreStigma in healthcare
How stigma can shape communication, clinical decisions, pain management and whether someone comes back.
Learn morePersonality & gender
What research does and does not show about personality traits, gender and substance use — and why neither is destiny.
Learn moreReferences & further reading
Every major claim on these pages is drawn from UK guidance or peer-reviewed research. Where evidence is mixed or limited, we say so on the page rather than simplifying it.
Stigma research
Link, B.G. & Phelan, J.C. (2001). Conceptualizing Stigma. Annual Review of Sociology, 27, 363–385.
The labelling, stereotyping, separation, status loss and discrimination model of stigma used on this page.
van Boekel, L.C. et al. (2013). Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. Drug and Alcohol Dependence, 131(1–2), 23–35.
Systematic review of health professional attitudes and their effect on care.
Kelly, J.F. & Westerhoff, C.M. (2010). Does it matter how we refer to individuals with substance-related conditions? International Journal of Drug Policy, 21(3), 202–207.
Experimental evidence that the term used ("substance abuser" vs "person with a substance use disorder") changes judgements, including among clinicians.
Corrigan, P.W. et al. Work on self-stigma, public stigma and structural stigma in mental health and substance use.
Widely used framework distinguishing self, public and structural stigma and their different remedies.
Room, R. (2005). Stigma, social inequality and alcohol and drug use. Drug and Alcohol Review, 24(2), 143–155.
Discussion of why substance use attracts stigma differently from other health conditions.
UK guidance and policy
Drug misuse and dependence: UK guidelines on clinical management (the "Orange Book")
Department of Health and Social Care and devolved administrations, 2017. Treatment and prescribing practice for drug dependence in the UK.
Open source ↗NICE guidance on alcohol-use disorders and drug misuse
Includes CG115 (alcohol dependence and harmful drinking), CG100 (alcohol-related physical complications) and CG51 (psychosocial interventions for drug misuse).
Open source ↗Office for Health Improvement and Disparities — alcohol, drugs and tobacco collections
UK Government guidance, commissioning support and data on treatment and recovery in England.
Open source ↗Independent review of drugs (Dame Carol Black)
GOV.UK, 2020–2021. Examines treatment capacity, funding and system barriers in England.
Open source ↗Rights, respect and recovery: alcohol and drug treatment strategy
Scottish Government, 2018. Sets out a rights-based, stigma-aware approach to alcohol and drug support.
Open source ↗Medication Assisted Treatment (MAT) standards
Scottish Government / Public Health Scotland. Standards on same-day access, choice, harm reduction and retention in treatment.
Open source ↗Public Health Scotland — substance use and stigma resources
Population health information and work on reducing stigma in services.
Open source ↗NHS inform and NHS.uk
Public-facing health information and service finders for drug and alcohol support.
Open source ↗World Health Organization — alcohol, drugs and addictive behaviours
International guidance, including WHO/UNODC International Standards for the Treatment of Drug Use Disorders (2020).
Open source ↗
This website provides educational information and is not a substitute for individual medical assessment, diagnosis or treatment. Information should be interpreted alongside current clinical guidance and evidence.