Lesson 10: Introduction to Stigma and its Impact on the Delivery of Care

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The last three lessons of this course address the stigma associated with substance use, substance use and concurrent disorders, and interprofessional collaboration. This last section of the course considers the macro context in which substance use workers practice. The prevailing national document in Canadian substance use policy is Canada’s National Drug Strategy—called A Systems Approach to Substance Use in Canada: Recommendations for a National Treatment Strategy—which was developed in 2008.

Building on Activity 5 in Lesson 1, this lesson is intended to provide further understanding of the role that stigma has played in the development and treatment priorities for substance use and concurrent disorders, past and present. Such an understanding will lead to an appreciation of the current approaches taken, and the challenges and needs confronted by clinicians and clients/patients alike. A review of the initiatives for combating stigma will prepare participants to be advocates. At this time, it may be worth revisiting Activity 5 in Lesson 1.

In that activity we learned that: Prejudice + Discrimination = Stigma.

Negative attitudes (prejudice) and negative responses (discrimination) can make a person feel unwanted and shamed (stigmatized). Another way of understanding stigma and discrimination is that stigma is a negative stereotype, and discrimination is the behaviour that results from this negative stereotype.

People with substance use disorders, unlike many other health issues, often experience the impact of stigma (National Treatment Strategy, 2008). Stigma is compounded when people have a concurrent substance use disorder and mental health problem. The lived experience of stigma is a serious impediment to their wellbeing. Stigma and subsequent discriminatory behaviours result in the marginalization of people’s access to treatment services, and contribute to adverse outcomes as they enter and participate in treatment services (Room, 2005).

Following are two recommendations from the National Treatment Strategy for reducing stigma and discrimination related to problematic substance use:

  1. Develop, implement, and evaluate an evidence-based, comprehensive strategy that involves the specialized addiction treatment system, broader health and social service systems, people with substance use problems and others affected by substance use to increase awareness and understanding.
  2. Identify the range of potential partners and develop collaborative work plans with individuals and organizations already engaging in anti-stigma and anti-discrimination initiatives (e.g., the Mental Health Commission of Canada and the First Nations and Inuit Mental Wellness Advisory Committee).

In this lesson, we will broaden our perspectives on the insidiousness of stigma towards people with substance use and substance use disorders, and the impact of stigma on the accessibility to and experience of treatment. In the next lesson, we will consider the strategies for reducing stigma and consider how you can take a leadership role in advocacy in your workplaces and communities.


Lesson 10 addresses the following three topics:

  • The micro and macro context of stigma
  • The impact of substance use stigma on treatment accessibility
  • The impact of substance use stigma on treatment completion

Learning Outcomes

After you complete this lesson, you should be able to:

  • Examine your perception of attitudes and beliefs about persons engaged in substance use and their families, and consider how historical, political, personal, and societal forces may have contributed to our attitudes and beliefs.
  • Analyze the impact of health-related stigma on past, current, and future approaches to the prevention and treatment of substance use disorders and concurrent substance use and mental health problems.
  • Evaluate how historical, political, and societal forces have shaped past and current approaches to substance use prevention and treatment in North America.
  • Recognize how professionals’ attitudes and beliefs about substance use are perceived by substance users as stigmatizing and a barrier to accessing and completing substance use programs.


CAMH’s Mental Health and Addiction 101 Series Tutorial. (n. d.). Stigma. Retrieved from http://www.camhx.ca/education/online_courses_webinars/mha101/stigma/Stigma_.htm

ELs Global Medical News Network. (Producer). (2011, Apr 20). Addiction stigma still exists among physicians (interview with Dr. Nora Volkow) [Video file]. Retrieved from http://www.youtube.com/watch?v=OBHBpKrXug0.

National Treatment Strategy Working Group. (2008). A systems approach to substance use in Canada: Recommendations for a national treatment strategy. Ottawa, ON: National Framework for Action to Reduce the Harms Associated with Alcohol and Other Drugs and Substances in Canada.

Wax, R. (2012, Oct 10). Ruby Wax: What’s so funny about mental illness? [Video file]. Retrieved from http://www.youtube.com/watch?v=mbbMLOZjUYI.

Available Through TRU Library

Brener, L., von Hippel, W., von Hippel, C., Resnick, I., & Treloar, C. (2010). Perceptions of discriminatory treatment by staff as predictors of drug treatment completion: Utility of a mixed methods approach. Drug Alcohol Review, 29, 491–497.

Keyes, K., Hatzenbuehler, M., McLaughlin, K., Link, B, Olfson, M., Grant, B., & Hasin, D. (2010). Stigma and treatment for alcohol disorders in the United States. American Journal of Epidemiology, 172(12), 1364–1372.

Livingston, J., Milne, T., , M., & Amari, E. (2012). The effectiveness of interventions for reducing stigma related to substance use disorders: A systematic review. Addiction, 107(1), 39–50.

Radcliffe, P., & Stevens, A. (2008). Are drug treatment services only for “thieving junkie scumbags”? Drug users and the management of stigmatised identities. Social Science & Medicine, 67(7), 1065–1073.

Room, R. (2005). Stigma, social inequality and alcohol and drug use. Drug Alcohol Review, 24, 143–155.

Ross, C. , & Goldner, E. (2009). Stigma, negative attitudes and discrimination towards mental illness within the nursing profession: A review of the literature. Journal Psychiatric and Mental Health Nursing, 16(6), 558–567.

van Olphen, J., Eliason, M., Freudenberg, N., & Barnes, M. (2009) Nowhere to go: How stigma limits the options of female drug users after release from jail. Substance Abuse Treatment Prevention Policy, 4, 10.

Wechsberg, W., Luseno, W., & Ellerson, R. (2008). Reaching women substance abusers in diverse settings: Stigma and Access to Treatment 30 years later. Substance Use and Misuse, 43(8–9), 1277–1279.

Activity Checklist

Following is a checklist of the learning activities you will be completing in Lesson 10. You may find it useful for planning your work.

✔ Activity

☐ Activity 1: Stigma—The broader context

☐ Activity 2: Stigma and its impact on treatment accessibility

☐ Activity 3: Stigma and the treatment processes