Stigma education
Types of stigma
Stigma is not one thing. It operates inside a person, between people, and inside systems — and each form needs a different response.
Open each card
Seven forms of stigma
Select a card to see what it means, what it can look like, how it may affect people who use substances, and how it can be challenged.
Self-stigmaWhat it means
When a person takes in the negative beliefs that circulate about substance use and applies them to themselves.
What it can look like
- "I'm the problem" rather than "I'm dealing with a health problem"
- Feeling undeserving of healthcare, pain relief or kindness
- Hiding substance use from clinicians, family or employers
- Withdrawing from people who might have helped
How it may affect people
Self-stigma is associated with shame, lower self-belief and reduced help-seeking. It can delay contact with services for years, and can make someone leave treatment early when things get hard.
How it can be challenged
- Separate the person from the condition, including in how people are invited to talk about themselves
- Normalise substance use as a health issue that services deal with routinely
- Peer support and recovery communities, where the same experience is met without judgement
- Name returning to use as expected clinical information, not personal failure
Public / social stigmaWhat it means
The attitudes, stereotypes and reactions held across a community, workplace, media or family network.
What it can look like
- Jokes, headlines and storylines that treat substance use as a character flaw
- Assuming dishonesty, danger or unemployability
- Social distance — not wanting someone in a home, team or friendship group
- "Why don't they just stop?"
How it may affect people
Public stigma shapes what people expect before they ever reach a service, and can cost someone housing, work, friendships and family contact — the very things that support recovery.
How it can be challenged
- Challenge stereotyping language in everyday conversation, not just in clinical settings
- Share accurate information about dependence as a health condition
- Include people with lived experience in how services and campaigns are designed
- Avoid imagery and stories that exist only to shock
Structural / institutional stigmaWhat it means
Stigma built into rules, systems, funding, forms, policies and professional culture — often without anyone intending harm.
What it can look like
- Support that is only offered on condition of abstinence
- Narrow appointment systems that exclude people with unstable housing or work
- Records and coding that keep a historical label attached to a person indefinitely
- Services and training that are chronically under-resourced compared with other health needs
How it may affect people
Structural stigma can block access even when every individual involved is compassionate, because the barrier is in the process rather than the person.
How it can be challenged
- Review pathways for avoidable barriers: referral criteria, discharge rules, opening times, ID requirements
- Offer harm reduction without requiring abstinence first
- Involve people who use services in service design and audit
- Follow national standards and guidance on access, retention and continuity of care
Healthcare stigmaWhat it means
Stigma experienced in the settings a person turns to for help — general practice, pharmacy, emergency departments, wards, mental health and dental services.
What it can look like
- Substance use becoming the explanation for every symptom
- Being labelled as "drug-seeking" when reporting pain
- Shorter, cooler consultations, or a change of tone once substance use is mentioned
- Being spoken about rather than spoken with
How it may affect people
A systematic review of stigma among health professionals towards people with substance use disorders reported negative attitudes were common and were linked with poorer communication and less person-centred care (van Boekel et al., 2013).
How it can be challenged
- Ask about substance use routinely and neutrally, like any other health question
- Assess symptoms on clinical grounds first
- Use person-first language in conversation, handovers and notes
- Make it explicit that the person is welcome to come back
Anticipated stigmaWhat it means
Expecting to be judged, doubted or treated differently — whether or not it happens on the day.
What it can look like
- Rehearsing what to say, or deciding in advance not to mention substance use
- Bringing someone along as a witness
- Avoiding a particular service, pharmacy or clinician
- Presenting late, when a problem has become urgent
How it may affect people
Anticipated stigma can be as powerful as an actual negative experience: it changes behaviour before any interaction takes place, which is one reason people arrive later and sicker.
How it can be challenged
- Signal safety early — how information is used, who sees it and why questions are asked
- Publish plainly what a service will and won't do
- Consistency between staff members, so trust does not depend on who is on shift
- Offer self-referral and drop-in routes that don't require gatekeeping
Experienced (enacted) stigmaWhat it means
Discrimination or hostility that has actually happened to a person.
What it can look like
- Being refused care, or told a problem is self-inflicted
- Comments made within earshot
- Being searched, supervised or monitored differently to other patients
- Losing a tenancy, a job or contact with children
How it may affect people
One experience can shape years of behaviour. People commonly describe deciding never to return to a service after a single interaction, and passing that warning on to others.
How it can be challenged
- Make complaints and feedback genuinely easy and safe to use
- Act on patterns, not just individual incidents
- Repair openly when something has gone wrong
- Build stigma into team learning, audit and induction rather than one-off training
Courtesy / associative stigmaWhat it means
Stigma that extends to family, partners, children, friends, carers, peer workers and staff because of their connection to someone who uses substances.
What it can look like
- Parents blamed for a son or daughter's substance use
- Children treated differently at school
- Partners assumed to be using too
- Staff in substance use services treated as lower status than other clinicians
How it may affect people
Courtesy stigma isolates the people most likely to be providing day-to-day support, and can stop families asking for help of their own.
How it can be challenged
- Offer family and carer support in its own right, not only as an extension of the person's treatment
- Avoid blame framing in conversations with relatives
- Recognise peer and lived-experience roles as skilled work
- Be careful how families are described in notes and meetings
References & further reading
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.