Breaking Down Stigma: What It Means for Addiction

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SASI measures stigma and attitudes related to substance use. It includes perceptions of those with SUDs and aims to hold the nation accountable while tracking progress in eliminating stigma.

Jen Slusser-Macternan, Director of Outreach and Talent Development
Summary by: Jen Slusser-MacTernan, Director of Outreach and Talent Development CLAS Committee Facilitator

The Shatterproof Addiction Stigma Index (SASI) report, done in collaboration with The Hartford in 2021, provides important insights and learnings about the impacts of stigma, which I will summarize here. I do encourage you to review the included document – just 16 pages.

The SASI is like a measuring stick. It helps us see how much stigma there is around addiction. Unfortunately, despite decades of public education, 75.2% of the public do not believe that a person with a SUD is experiencing a chronic medical illness. Suffice it to say, this inevitably impacts every level of participation in prevention and treatment, resulting in preventable community impact, including addiction-related-deaths.

According to the report, in 2020, a staggering 93,000 people died from overdoses, marking the highest number in history. The opioid crisis has exacted a devastating toll on communities across the United States. Over 20 million American adults still suffer from addiction, highlighting the urgent need for comprehensive treatment and support. The COVID-19 pandemic exacerbated the crisis by increasing economic instability, social isolation, and limiting access to treatment and recovery services. Furthermore, structural racism and health inequities disproportionately affect marginalized communities, leading to higher substance use rates and overdose incidents.

SUD stigma perpetuates preventable deaths by discouraging individuals from seeking treatment due to a fear of judgment and rejection. There is an evidenced general reluctance to associate with someone with SUD, which affects personal relationships and community integration. Shame further compounds the problem, perpetuating long-term health challenges for those with SUDs.

Discriminatory views against people with SUDs vary significantly and are compounded for marginalized communities. Further barriers must be overcome across race, age, gender, sexual orientation, faith, and socioeconomic traits, and the systems built up around them. Resulting prejudice and social exclusion lead to ongoing harm, eroding an individual’s self-worth and fear of failure – which negatively impacts the chance they will seek help.

“The intersection of racism, discrimination, and substance use in the United States is well documented, and stigma further disadvantages populations who have the least access to care and support. For years, Black communities have borne the brunt of discriminatory policies like mandatory sentencing laws, severe discrepancies in sentencing times depending on the type of substance used, and the categorization of nonviolent drug offenses as federal violations. Today, nearly 80% of people in federal prison and almost 60% of people in state prison for drug offenses are Black or Latino/a. Approximately half of federal drug cases are brought against Latino/a people, even though this group makes up just 17% of the U.S. population”. – pg. 9, Shatterproof Addiction Stigma Index

Policy changes across systems and institutions is an ongoing challenge – seeking restorative over punitive responses to SUD related problems. Continuing to challenge discriminatory practices at all levels is essential.

There is much work to be done, and stakeholders must continue to elevate this issue at the National and local levels. SASI measures stigma and attitudes related to substance use. It includes perceptions of those with SUDs and aims to hold the nation accountable while tracking progress in eliminating stigma. This report is a monumental step with insights to learn from and take corrective action around. It is critical that we continue to address addiction as a chronic, treatable disease until that has been normalized and accepted. By addressing SUD stigma collectively, continuing to generate the best evidence-based resources we can (as data continues to improve), and addressing it from schools to society as a whole, we can improve access to treatment and support for those affected by addiction.

I encourage you to explore several helpful resources that Shatterproof has produced:
A Movement to End Addiction Stigma

Addiction Language Guide

Our Plan to Fight Stigma