In the world of addiction, “stigma” often gets cast as the ultimate villain—the big bad wolf of public health narratives. It’s the term we throw around when we talk about shame, isolation, and the barriers people face when seeking treatment.
The problem with the term stigma is that it’s broad and elusive, seeming to apply everywhere and yet often failing to target the specific barriers that actually obstruct access. While “stop the stigma” is a powerful and resonant slogan, it rarely captures the nuanced, targeted actions that are genuinely required to dismantle these obstacles.
Understood as a negative social judgment of a person, group, or behavior, the addiction fields over-reliance on the term as the universal “bad guy,” inadvertently dilutes our ability to solution around the resulting harms.
Framing stigma as a blanket issue creates four serious problems. Let’s break it down:
Stigma Isn’t One Thing
From a social norm or social control perspective, stigma around substance use can function as a form of social signaling, guiding people away from behaviors perceived as harmful. Social disapproval of behaviors like smoking cigarettes or showing up to work intoxicated can reinforce social limits that help to discourage risky behaviors. In this way, stigma acts as a preventative deterrent, supporting shared social contracts that may prevent harm to oneself or others.
Negative social judgements also have the potential to act as “sticks” that prompt positive action. Often, behavior change around substance use happens through a mix of carrots and sticks—positive and negative reinforcements that drive treatment seeking. The negative pressures of stigma, such as disapproval from family members, can create a sense of urgency that nudges people toward behavior change. A boundary set by a loved one or an ultimatum from an employer can serve to nudge someone toward seeking help.
However, the potential benefits of stigma end here. While “sticks” can sometimes prompt treatment initiation, lasting change relies on positive internal motivation and a sense of self-worth. Research shows that initial motivation to enter treatment isn’t a strong predictor of someone’s long-term success. Basically, what got you into rehab may not be the same thing that helps you find success on the other side of rehab. Positive social reinforcements, like peer supports during service receipt, ultimately transform external pressures into the lasting internal drive that sustains recovery.
Not All Stigma Arguments Are Good Ones
Yes, it’s true—not all stigma is bad, a factually true statement often highlighted by the well-known psychologist Dr. Keith Humphreys of Stanford University. But let’s not get ahead of ourselves. In theory, stigma as a construct can offer some functional benefits. In practice, however, it is nearly impossible to control negative social judgement. Stigmatized beliefs are applied so indiscriminately that, ultimately, the net impact of stigma does far more harm than good.
We can’t ignore that stigma has greatly contributed to a cultural climate where incarceration has become the first line of defense against substance use, especially within communities of color where unequal application is the rule, not the exception. These racial disparities reflect a realization of the shift from disapproving thoughts to punitive action. Instead of motivating change, stigma isolates those who need treatment, creating barriers to seeking help and blocking essential resources like employment or housing for those in recovery.
Additionally, for stigma to achieve its true protective potential, it would need to be applied fairly across all substances. Currently, stigma is inconsistently applied—opioids, for instance, are heavily stigmatized, while alcohol and tobacco are socially accepted or even glamorized. This imbalance sends a confusing message, creating a hierarchy of “acceptable” versus “unacceptable” substances rather than conveying a unified understanding of health risks.
Addressing Harm with Blame
One of the most complex challenges: substance use often harms not only the person using but also those around them, creating a difficult dynamic where the person using alcohol and other drugs may be both causing harm and suffering from it. Navigating this complexity requires a shift from stigmatizing individuals to addressing specific behaviors and the broader conditions that drive substance use. This distinction between behavior-based stigma and person-based stigma is crucial: while the former may serve a preventive purpose, the latter almost always obstructs pathways to recovery.
Addressing harm without blame begins with recognizing that individuals with substance use challenges deserve resources, compassion, and effective treatment. By focusing blame on actions rather than labeling people, we encourage treatment-seeking while making space for both accountability and reconciliation. For example, addressing substance use within families can involve identifying and discussing the impact of specific behaviors rather than condemning the individual. This approach creates a space where both those experiencing substance use and those affected by it can openly address harm, allowing for reconciliation and support. It ensures that the harms faced by both parties are acknowledged, without one being being minimized or excluded at the expense of the other.
Get Specific or Get Nowhere
The broad concept of stigma tends to shut down discussion rather than clarify it. When we say ‘stop the stigma,’ we leave the problem too undefined to address specific actions that would make a difference. By identifying the specific attitudes, stereotypes, and policies that perpetuate harm, we move away from vague slogans and toward targeted actions, allowing us to dismantle barriers and create tangible paths toward recovery.
It’s time to name the specific thoughts, practices, and systems that perpetuate harm. When we break stigma down into specific problems, we can begin to create targeted solutions and measure the changes we want to see. This refined approach allows us to pinpoint what is harmful, retain any elements of value, and clear a path that leads towards improved patient outcomes.
Conclusion
In theory, stigma might serve as a well-timed deterrent against risky substance use behaviors. In reality, however, it’s far from precise. Once set in motion, stigma is nearly impossible to control—it seeps into policies, systems, and personal judgments, harming those most in need of support. Even within discussions internal to the field, the term ‘stigma’ often serves as a conversation-ender or a metaphorical mic drop, keeping conversations at a surface level. The vague threat implied by stigma makes the actual harms resulting from negative social judgements around substance use hard to study, measure or address effectively. It prevents us from separating the truly harmful aspects from those that might serve a protective purpose.
It’s time to see the big bad wolf of stigma for what it is: a hollow, overused villain that distracts us from the real work of addressing specific, actionable barriers to recovery. Relying too heavily on such a broad concept creates missed opportunities for meaningful solutions that address the complexities of substance use. Measurable change will begin when we stop talking about stigma and start dismantling the barriers to care.
Recovery Review 