For healthcare professionals
From awareness to action
Knowing that stigma exists changes very little on its own. These are the points in a routine consultation where a different approach is possible.
Three stages
What this looks like in practice
Nothing here requires extra clinic time. Most of it is about sequence: listening before concluding, and describing before labelling.
Before the consultation
Steps
- Reflect on your own assumptions about substance use, including where they came from
- Recognise that unconscious bias is normal, and that recognising it is what allows it to be managed
- Prepare to raise substance use as a routine health question rather than a confrontation
- Remember that substance use can be influenced by trauma, mental health, environment, socioeconomic circumstances and social networks
During the consultation
Steps
- Use person-first language, out loud and in the notes
- Ask open, respectful questions and allow the answer to be incomplete
- Listen before forming a plan; the function of someone's substance use matters clinically
- Explain why you are asking sensitive questions and what will happen to the information
- Protect privacy and confidentiality, including who can overhear
- Treat substance use as a health issue alongside the person's other health needs
- Involve the person in decisions about their care, including realistic options short of stopping
After the consultation
Steps
- Signpost to appropriate local and national support, with enough detail to be usable
- Make referrals where appropriate, and say what will happen next
- Remove barriers you can control: flexible appointments, fewer hoops, clearer routes back in
- Reflect on whether assumptions shaped the interaction, the documentation or the plan
- Support continuity of care — the same information, the same welcome, next time
Organisational change
Individual practice is not the whole answer
Where barriers are structural, they cannot be solved consultation by consultation.
Review the pathway, not just the appointment
Look at referral criteria, discharge-for-non-attendance rules, ID requirements, opening hours and abstinence conditions. Ask which of them would exclude your most unstably housed patient.
Make stigma a standing agenda item
Include language, access and complaints patterns in audit, induction and team learning rather than relying on one-off training.
Involve people with lived experience
UK strategy and standards for alcohol and drug treatment emphasise involving people who use services in how those services are designed and reviewed.
Offer harm reduction unconditionally
Naloxone, injecting equipment, wound care, testing and vaccination should not depend on a person being ready to stop.
References & further reading
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 ↗
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.
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.