BEYOND LABELS

DO YOUR PART TO REDUCE STIGMA AROUND SUBSTANCE USE DISORDER AND PREGNANCY

Stigma related to substance use disorder (SUD) affects pregnant women by creating social isolation and barriers to treatment.

 

Pregnant women who use or misuse tobacco, alcohol, opioids, and other substances often experience stigma at multiple levels. People with substance use disorder are more stigmatized because their illness is seen as a result of their own behavior.

 

Additionally, pregnant women have to cope with self-stigma and feelings of guilt or shame about the related risks of substance use to the health of their baby.

STORIES OF SUBSTANCE USE STIGMA

 

 

 

See me for who I am. I am not a label.
I am not my substance use disorder. I am me.

 

 

Watch the video to hear stories about women impacted by stigma.

How Attitudes and Beliefs affect Access to Care

Societal beliefs frame SUD as a personal flaw or failure.

 

This framing may influence how healthcare professionals perceive and treat pregnant women with SUD, sometimes using language that makes pregnant women feel blamed or shamed.

Fear and judgment of this stigma (blame and shame) cause pregnant women with SUD to be less likely to seek help and stick with treatment.

Lack of or delayed prenatal  care and treatment for SUD put the developing baby and pregnant mom at a greater risk for negative health outcomes.

Societal beliefs frame SUD as a personal flaw or failure.

 

This framing may influence how healthcare professionals perceive and treat pregnant women with SUD, sometimes using language that makes pregnant women feel blamed or shamed.

Fear and judgment of this stigma (blame and shame) cause pregnant women with SUD to be less likely to seek help and stick with treatment.

Lack of or delayed prenatal  care and treatment for SUD put the developing baby and pregnant mom at a greater risk for negative health outcomes.

Source: (White, 2009).

Source: (White, 2009).

UNDERSTANDING THE PROBLEM

 

THE EFFECTS OF SUBSTANCE USE-RELATED STIGMA

 

 

What is addiction, really? It is a sign, a signal, a symptom of distress. It is a language that tells us about a plight that must be understood. 

- Alice Miller

 

  • Why is there so much stigma around substance use disorder?

    A survey (2014) of 709 Americans by Johns Hopkins University looked at stigma toward people with substance use disorders:

    said they would not work with someone with an SUD.

    said employers should have the right to deny employment to someone with an SUD.

    said people with SUDs should not be granted the same health insurance benefits as other individuals.

    • Pregnancy adds an additional layer of stigma to substance use disorders.

      Some people, including health professionals, may be inclined to blame mothers of children born with conditions, such as Neonatal Abstinence Syndrome or Fetal Alcohol Syndrome. However, it is often this shame that keeps women from receiving the treatment they need to address substance use disorders.

  • How does stigma toward women who have a substance use disorder prevent them from getting healthcare and treatment?

    • Fear of Disclosure to Providers

      Many women with SUDs fear the legal and criminal consequences for them and their baby – like ending up in jail or having their babies taken away from them – if they disclose their substance use to their provider, so they skip appointments and avoid prenatal care.

      According to the Guttmacher Institute (2020):

      23 states, as well as the District of Columbia, consider substance use during pregnancy to be child abuse under civil child-welfare statutes.

      25 states, as well as the District of Columbia, require healthcare professionals to report suspected prenatal substance use.

      8 states require healthcare professionals to test women for prenatal drug exposure if they suspect substance use.

    • Fear of Losing Social Network

      Also, many pregnant women with substance use disorders don’t tell their family or friends they are dealing with addiction because they’re worried about disappointing or embarrassing them.  They often isolate themselves, negatively affect both their mental and physical health (White, 2009).

  • How does substance use-related stigma toward pregnant women affect babies?

    Because stigma is a substantial barrier to care, it has serious implications for the health of pregnant women with substance use disorders and their babies.

    Exposure to substances during pregnancy can cause serious problems for newborns. Depending on the substance (e.g. opioids, alcohol, tobacco), infants may experience a range of health challenges such as

    • premature birth,

    • low birthweight,

    • breathing problems,

    • feeding problems,

    • vision or hearing problems,

    • abnormal facial features, and

    • longer-term developmental problems.

    Pregnant women, themselves, are also at risk for health problems, including complications during pregnancy and labor and delivery (Lamy et al, 2015), as well as the risk for maternal overdose depending on the substance.

  • How can we ensure that pregnant women with substance use disorders get the care they need?

    1. Create safe, caring, and supportive environments and relationships that are free from stigma (Stone, 2015).

    2. Eliminate blaming and shaming pregnant women with substance use disorders, as this only drives them away from the care and support they need (Thigpen et al., 2014; Krans et al., 2015)

    3. Inform women with SUD that help is available and encourage them to seek treatment (FindTreatment.gov).

KNOW THE FACTS

 

 

What we see in the media, what we’re taught by our families and in school, and what we’ve learned in our jobs all shape our thoughts and beliefs about pregnant women with substance use disorder.  However, these thoughts and beliefs might not be based on the most current facts.

 

Click on the tiles below to find the answers to these questions.

 

 

 

QUESTION

 

Should pregnant women using opioids or other substances stop using them immediately?

ANSWER: No. Going “cold turkey” from opioid use—even when medically supervised—is not currently recommended. Doing this is associated with higher rates of relapse for the mother and worse outcomes for the baby. Maintaining the stability of the patient is the recommended course of treatment for both the mother and baby.

Source: SAMHSA, 2018

 

 

 

QUESTION

 

 What are success rates for SUD treatment compared to other health conditions?

ANSWER: Success rates for SUD treatment are similar to success rates for certain other health conditions. For example, SUD treatment has the same success rate as the treatment of asthma or diabetes. In addition, people with substance use disorders, in particular, are as likely to adhere to treatment as people with other chronic medical conditions, such as hypertension or diabetes.

Source: National Institute on Drug Abuse, 2018

 

 

 

QUESTION

 

Can women receive medication-assisted treatment (MAT), such as methadone or buprenorphine, while pregnant?

ANSWER: Safe and effective interventions exist for pregnant women, including MAT. MAT helps control symptoms, such as cravings, which helps the mother regain control over decisions and rebuild a more stable life and social environment. Use of these interventions can result in healthy outcomes for both the mother and baby.

Source: SAMHSA, 2018

 

 

 

QUESTION

 

Should women who smoke breastfeed their baby?

ANSWER: While mothers are encouraged to quit smoking while breastfeeding, the benefits of breast milk outweigh any potential risks of smoking. The CDC suggests not smoking while breastfeeding the baby and making sure the home is smoke free.

Source: CDC, 2019

WHAT YOU CAN DO

 

Now that you understand why there is so much stigma around substance use disorders and how it affects pregnant women and new mothers, what can you do to make a difference? Use the tool below to reflect on your own beliefs and then discover steps you can take to change the conversation around SUDs in your organization and community.

 

TAKE A CLOSER LOOK AT YOUR OWN BELIEFS

 

Even with our best intentions and efforts to be accepting of others, we may have implicit and unconscious bias about SUDs. It’s important to take a closer look at your own beliefs and compare them with evidence-based recommendations by trusted organizations.

 

Read each statement below and indicate whether you strongly agree, agree, somewhat agree, somewhat disagree, disagree, or strongly disagree. Then take a closer look.

 

Note: Your answers will be completely anonymous and will not be saved. This tool is intended to help you self-reflect and evolve, not place judgment on any of your attitudes or beliefs.

 

Click the circles below to move between questions.

It’s important to stop and assess your own beliefs and find out if they’re based on up-to-date evidence and recommendations from professional organizations that you trust.

It Takes a Village

1 in 9 pregnancies in the U.S. is exposed to alcohol. Stigma can prevent people who need extra support to remain alcohol-free during pregnancy from getting help. Listen to one mother’s plea for people to extend grace to parents whose children have been impacted by prenatal alcohol exposure.

Understand the Power of Words

 

 

"If you think of it like that, you think of the person first and not I'm an addict but a person with addiction like a person with an affliction, [I] think that will help with the stigma."

Source: Beyond Labels Substance Use Stigma Video Stories

 

Can the words and labels we use make a difference in the way we treat people or affect their health?

 

Read about two studies that explore the question of whether using “substance abuser” as compared with “having a substance use disorder” has an effect on healthcare professionals’ or the public’s judgments about a person.

 

Change the conversation

 

It can be difficult to know how to respond to our colleagues and community members when they use stigmatizing language or when they talk about addiction or substance use disorders in a way that perpetuates misinformation, blame, and shame.

 

Use the tips below to change the conversation around substance use and create a cultural shift in your organization or community.

Frame substance use disorder as a medical condition.

Professional organizations—such as the American Society of Addiction Medicine and the National Institute on Drug Abuse—support framing substance use disorder as a treatable chronic medical condition, similar to treating heart disease or diabetes.

Use “person first” language.

Person-first language puts the person before the diagnosis. It emphasizes the person, not their medical condition or disability. Rearranging words is a powerful way to not let the diagnosis define the person.

Avoid blaming the individual.

Making a person with substance use disorder feel that they’re weak-willed can perpetuate self-stigma and make them less likely to seek healthcare treatment and social support from family and friends.

Emphasize that  substance use disorder can affect anyone.

Organizations such as the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics encourage universal screening of all women for opioid use disorder to avoid any assumptions or bias about who might be at risk.

By changing the conversation around substance use disorder, we are helping to change the beliefs and behaviors of others which can help reduce substance use disorder stigma and its effects on pregnant women and their babies.

KEEP LEARNING

  • RESOURCES

    WEBSITES

    The Words Matter: Help End Stigma in Our State (Stigma Free West Virginia) https://stigmafreewv.org/

    Shaming the Sick: Addiction and Stigma (American Addiction Centers) https://drugabuse.com/addiction/stigma/

    The Stigma of Addiction (DrugRehab.com, Advanced Recovery Systems) https://www.drugrehab.com/addiction/stigma/

    Shattering Stigma: A National Strategy Addressing Addiction Stigma (Shatterproof) https://www.shatterproof.org/shattering-stigma

    Lift the Label (Colorado Office of Behavioral Health) https://liftthelabel.org/

    Stamp Out Stigma (Association for Behavioral Health and Wellness) https://www.stampoutstigma.com/

    WEBINAR

    The Power of Perceptions and Understanding: Changing How We Deliver Treatment and Recovery Services. This four-part webcast series educates healthcare professionals about the importance of using approaches that are free of discriminatory attitudes and behaviors in treating individuals with substance use disorders (SUDs) and related conditions, as well as patients living their lives in recovery. https://www.samhsa.gov/power-perceptions-understanding

    COURSES

    Stigma and OUD [Opioid Use Disorder]. This course from the Providers Clinical Support System (PCSS) is led by Nurse Practitioner Vanessa Loukas, a PCCS clinical expert. She discusses the issue of stigma in treating patients with opioid use disorder—from the patients to the providers who treat them. https://pcssnow.org/education-training/training-courses/stigma-and-oud/

    TOOLS AND TOOLKITS

    Anti-Stigma Toolkit (Addiction Technology Transfer Center Network, Substance Abuse and Mental Health Services Administration) This toolkit is a guide to provide the addiction treatment and recovering community with practical information and tools to enhance their capacity to engage in effective stigma reduction efforts. https://attcnetwork.org/sites/default/files/2019-04/Anti-Stigma%20Toolkit.pdf

    Addictionary (Recovery Research Institute) This website enhances recovery through science. Tools include an “addictionary,” news, and resources about recovery. https://www.recoveryanswers.org/addiction-ary/

    Understanding Drug-Related Stigma: Tools for Better Practice and Social Change. Curriculum Outline for Trainers (The Harm Reduction Coalition) This half-day training gives participants a distinct set of knowledge and skills to help them understand and address drug-related stigma. https://harmreduction.org/wp-content/uploads/2012/02/stigma-facilitators.pdf

    Stigma-reducing language (Shatterproof) This tool helps reduce stigmatizing language. https://www.shatterproof.org/about-addiction/stigma/stigma-reducing-language

    FindTreatment.gov (Substance Abuse and Mental Health Services Administration) SAMHSA collects information on thousands of state-licensed providers who specialize in treatment substance use disorders, addiction, and mental illness. https://findtreatment.gov./

    Words Matter: How Language Choice Can Reduce Stigma. (SAMHSA) Developed by the Center for the Application of Prevention Technologies (CAPT) This training resource examines the role of language in perpetuating SUD stigma, offers tips to assess how and when we may be using stigmatizing language, and steps to ensure that we use language that is positive, productive, and inclusive. https://facesandvoicesofrecovery.org/wp-content/uploads/2019/06/Words-Matter-How-Language-Choice-Can-Reduce-Stigma.pdf

    Respect to Connect: Undoing Stigma. (National Harm Reduction Coalition) This fact sheet shows the difference between liberation and stigma and states the principles of harm reduction. https://harmreduction.org/issues/harm-reduction-basics/undoing-stigma-facts/

    Stamp Out Stigma. (National Organization on Fetal Alcohol Syndrome). This campaign aims to end discrimination of birth mothers of children with FASD and individuals and families living with the disorders. https://nofas.org/stigma/

    ARTICLES

    “Abusing Addiction”: Our Language Still Isn’t Good Enough. Ashford, R.D., Brown, A.M, & Curtis, B. (2019). Alcohol Treatment Quarterly, 37(2): 257-272. https://pubmed.ncbi.nlm.nih.gov/31551647/

    Stigma, Discrimination, Treatment Effectiveness, and Policy: Public Views about Drug Addiction and Mental Illness. Barry, C.L., McGinty, E.E., Pescosolido, B.A., & Goldman, H.H. (2014). Psychiatric Services, 65(10), 1269-1272. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4285770/

    Stigma and Social Support in Pharmaceutical Opioid Treatment Populations: A Scoping Review. Cooper, S., & Nielsen, S. (2017). International Journal of Mental Health and Addiction, 15, 452-469. https://link.springer.com/article/10.1007%2Fs11469-016-9719-6

    Stigma and the Public Health Agenda for the Opioid Crisis in America. Corrigan, P.W., & Nieweglowski, K. (2018). International Journal of Drug Policy, 59, 44-49. https://pubmed.ncbi.nlm.nih.gov/29986271/

    Social Stigma Towards Persons with Prescription Opioid Use Disorder: Associations with Public Support for Punitive and Public Health-Oriented Policies. Kennedy-Hendricks, A., Barry, C.L., Gollust, S.E., Ensminger, M.E., Chisolm, M.S., & McGinty, E.E. (2017). Psychiatric Services, 68(5), 462-469. https://pubmed.ncbi.nlm.nih.gov/28045350/

    Effects of Competing Narratives on Public Perceptions of Opioid Pain Reliever Addiction during Pregnancy. Kennedy-Hendricks, A., McGinty, E.E., & Barry, C.L. (2016). Journal of Health Politics, Policy and Law, 41(5), 873-916. https://pubmed.ncbi.nlm.nih.gov/27256811/

    The Effectiveness of Interventions for Reducing Stigma Related to Substance Use Disorders: A Systematic Review. Livingston, J.D., Milne, T., Fang, M.L., & Amari, E. (2012). Addiction, 107(1), 39-50. https://pubmed.ncbi.nlm.nih.gov/21815959/

    Portraying Mental Illness and Drug Addiction as Treatable Health Conditions: Effects of a Randomized Experiment on Stigma and Discrimination. McGinty, E.E., Goldman, H.H., Pescosolido, B., & Barry, C.L. (2014). Social Science & Medicine, 126, 73-85. https://pubmed.ncbi.nlm.nih.gov/25528557/

    Stigma at Every Turn: Health Services Experiences among People Who Inject Drugs. Paquette, C.E., Syvertsen, J.L., & Pollini, R.A. (2018). International Journal of Drug Policy, 57, 104-110. https://pubmed.ncbi.nlm.nih.gov/29715589/

    Stigma as a dominant discourse in fetal alcohol spectrum disorder. Choate, P. and Badry, D. (2019). Advances in Dual Diagnosis, Vol. 12 No. 1/2, pp. 36-52.  https://www.emerald.com/insight/content/doi/10.1108/ADD-05-2018-0005/full/html

    Addressing the public health concerns of Fetal Alcohol Spectrum Disorder: Impact of stigma and health literacy. Corrigan PW, Shah BB, Lara JL, Mitchell KT, Simmes D, Jones KL. Drug Alcohol Depend. 2018 Apr 1;185:266-270. PMID: 29477086. https://pubmed.ncbi.nlm.nih.gov/29477086/

    The Public Stigma of Birth Mothers of Children with Fetal Alcohol Spectrum Disorders. Corrigan PW, Lara JL, Shah BB, Mitchell KT, Simmes D, Jones KL. Alcohol Clin Exp Res. 2017 Jun;41(6):1166-1173. doi: 10.1111/acer.13381. Epub 2017 Apr 24. PMID: 28370022. https://pubmed.ncbi.nlm.nih.gov/28370022/

    Ethical challenges in FASD prevention: Scientific uncertainty, stigma, and respect for women's autonomy. Zizzo N, Racine E. Can J Public Health. 2017 Nov 9;108(4):e414-e417. doi: 10.17269/cjph.108.6048. PMID: 29120314. https://pubmed.ncbi.nlm.nih.gov/29120314/

    It’s a Shame! Stigma Against Fetal Alcohol Spectrum Disorder: Examining the Ethical Implications for Public Health Practices and Policies. Emily Bell, Gail Andrew, Nina Di Pietro, Albert E. Chudley, James N. Reynolds, Eric Racine, Public Health Ethics, Volume 9, Issue 1, April 2016, Pages 65–77. https://academic.oup.com/phe/article/9/1/65/2362433

     

 

 

 

QUESTION

 

Should pregnant women using opioids or other substances stop using them immediately?

ANSWER: No. Going “cold turkey” from opioid use—even when medically supervised—is not currently recommended. Doing this is associated with higher rates of relapse for the mother and worse outcomes for the baby. Maintaining the stability of the patient is the recommended course of treatment for both the mother and baby.

Source: SAMHSA, 2018

 

 

 

QUESTION

 

 What are success rates for SUD treatment compared to other health conditions?

ANSWER: Success rates for SUD treatment are similar to success rates for certain other health conditions. For example, SUD treatment has the same success rate as the treatment of asthma or diabetes. In addition, people with substance use disorders, in particular, are as likely to adhere to treatment as people with other chronic medical conditions, such as hypertension or diabetes.

Source: National Institute on Drug Abuse, 2018

 

 

 

QUESTION

 

Can women receive medication-assisted treatment (MAT), such as methadone or buprenorphine, while pregnant?

ANSWER: Safe and effective interventions exist for pregnant women, including MAT. MAT helps control symptoms, such as cravings, which helps the mother regain control over decisions and rebuild a more stable life and social environment. Use of these interventions can result in healthy outcomes for both the mother and baby.

Source: SAMHSA, 2018

 

 

 

QUESTION

 

Should women who smoke breastfeed their baby?

ANSWER: While mothers are encouraged to quit smoking while breastfeeding, the benefits of breast milk outweigh any potential risks of smoking. The CDC suggests not smoking while breastfeeding the baby and making sure the home is smoke free.

Source: CDC, 2019

 

 

 

QUESTION

 

Should pregnant women using opioids or other substances stop using them immediately?

ANSWER: No. Going “cold turkey” from opioid use—even when medically supervised—is not currently recommended. Doing this is associated with higher rates of relapse for the mother and worse outcomes for the baby. Maintaining the stability of the patient is the recommended course of treatment for both the mother and baby.

Source: SAMHSA, 2018

 

 

 

QUESTION

 

 What are success rates for SUD treatment compared to other health conditions?

ANSWER: Success rates for SUD treatment are similar to success rates for certain other health conditions. For example, SUD treatment has the same success rate as the treatment of asthma or diabetes. In addition, people with substance use disorders, in particular, are as likely to adhere to treatment as people with other chronic medical conditions, such as hypertension or diabetes.

Source: National Institute on Drug Abuse, 2018

 

 

 

QUESTION

 

Can women receive medication-assisted treatment (MAT), such as methadone or buprenorphine, while pregnant?

ANSWER: Safe and effective interventions exist for pregnant women, including MAT. MAT helps control symptoms, such as cravings, which helps the mother regain control over decisions and rebuild a more stable life and social environment. Use of these interventions can result in healthy outcomes for both the mother and baby.

Source: SAMHSA, 2018

 

 

 

QUESTION

 

Should women who smoke breastfeed their baby?

ANSWER: While mothers are encouraged to quit smoking while breastfeeding, the benefits of breast milk outweigh any potential risks of smoking. The CDC suggests not smoking while breastfeeding the baby and making sure the home is smoke free.

Source: CDC, 2019

 

 

 

QUESTION

 

Should pregnant women using opioids or other substances stop using them immediately?

ANSWER: No. Going “cold turkey” from opioid use—even when medically supervised—is not currently recommended. Doing this is associated with higher rates of relapse for the mother and worse outcomes for the baby. Maintaining the stability of the patient is the recommended course of treatment for both the mother and baby.

Source: SAMHSA, 2018

 

 

 

ANSWER: Success rates for SUD treatment are similar to success rates for certain other health conditions. For example, SUD treatment has the same success rate as the treatment of asthma or diabetes. In addition, people with substance use disorders, in particular, are as likely to adhere to treatment as people with other chronic medical conditions, such as hypertension or diabetes.

Source: National Institute on Drug Abuse, 2018

QUESTION

 

 What are success rates for SUD treatment compared to other health conditions?

 

 

 

QUESTION

 

Can women receive medication-assisted treatment (MAT), such as methadone or buprenorphine, while pregnant?

ANSWER: Safe and effective interventions exist for pregnant women, including MAT. MAT helps control symptoms, such as cravings, which helps the mother regain control over decisions and rebuild a more stable life and social environment. Use of these interventions can result in healthy outcomes for both the mother and baby.

Source: SAMHSA, 2018

 

 

 

ANSWER: While mothers are encouraged to quit smoking while breastfeeding, the benefits of breast milk outweigh any potential risks of smoking. The CDC suggests not smoking while breastfeeding the baby and making sure the home is smoke free.

Source: CDC, 2019

QUESTION

 

Should women who smoke breastfeed their baby?

 

 

 

QUESTION

 

Should pregnant women using opioids or other substances stop using them immediately?

ANSWER: No. Going “cold turkey” from opioid use—even when medically supervised—is not currently recommended. Doing this is associated with higher rates of relapse for the mother and worse outcomes for the baby. Maintaining the stability of the patient is the recommended course of treatment for both the mother and baby.

Source: SAMHSA, 2018

 

 

 

QUESTION

 

 What are success rates for SUD treatment compared to other health conditions?

ANSWER: Success rates for SUD treatment are similar to success rates for certain other health conditions. For example, SUD treatment has the same success rate as the treatment of asthma or diabetes. In addition, people with substance use disorders, in particular, are as likely to adhere to treatment as people with other chronic medical conditions, such as hypertension or diabetes.

Source: National Institute on Drug Abuse, 2018

 

 

 

QUESTION

 

Can women receive medication-assisted treatment (MAT), such as methadone or buprenorphine, while pregnant?

ANSWER: Safe and effective interventions exist for pregnant women, including MAT. MAT helps control symptoms, such as cravings, which helps the mother regain control over decisions and rebuild a more stable life and social environment. Use of these interventions can result in healthy outcomes for both the mother and baby.

Source: SAMHSA, 2018

 

 

 

QUESTION

 

Should women who smoke breastfeed their baby?

ANSWER: While mothers are encouraged to quit smoking while breastfeeding, the benefits of breast milk outweigh any potential risks of smoking. The CDC suggests not smoking while breastfeeding the baby and making sure the home is smoke free.

Source: CDC, 2019
  • WEBSITES

    The Words Matter: Help End Stigma in Our State (Stigma Free West Virginia) https://stigmafreewv.org/

    Shaming the Sick: Addiction and Stigma (American Addiction Centers) https://drugabuse.com/addiction/stigma/

    The Stigma of Addiction (DrugRehab.com, Advanced Recovery Systems) https://www.drugrehab.com/addiction/stigma/

    Shattering Stigma: A National Strategy Addressing Addiction Stigma (Shatterproof) https://www.shatterproof.org/shattering-stigma

    Lift the Label (Colorado Office of Behavioral Health) https://liftthelabel.org/

    Stamp Out Stigma (Association for Behavioral Health and Wellness) https://www.stampoutstigma.com/

    WEBINAR

    The Power of Perceptions and Understanding: Changing How We Deliver Treatment and Recovery Services. This four-part webcast series educates healthcare professionals about the importance of using approaches that are free of discriminatory attitudes and behaviors in treating individuals with substance use disorders (SUDs) and related conditions, as well as patients living their lives in recovery. https://www.samhsa.gov/power-perceptions-understanding

    COURSES

    Stigma and OUD [Opioid Use Disorder]. This course from the Providers Clinical Support System (PCSS) is led by Nurse Practitioner Vanessa Loukas, a PCCS clinical expert. She discusses the issue of stigma in treating patients with opioid use disorder—from the patients to the providers who treat them. https://pcssnow.org/education-training/training-courses/stigma-and-oud/

    TOOLS AND TOOLKITS

    Anti-Stigma Toolkit (Addiction Technology Transfer Center Network, Substance Abuse and Mental Health Services Administration) This toolkit is a guide to provide the addiction treatment and recovering community with practical information and tools to enhance their capacity to engage in effective stigma reduction efforts. https://attcnetwork.org/sites/default/files/2019-04/Anti-Stigma%20Toolkit.pdf

    Addictionary (Recovery Research Institute) This website enhances recovery through science. Tools include an “addictionary,” news, and resources about recovery. https://www.recoveryanswers.org/addiction-ary/

    Understanding Drug-Related Stigma: Tools for Better Practice and Social Change. Curriculum Outline for Trainers (The Harm Reduction Coalition) This half-day training gives participants a distinct set of knowledge and skills to help them understand and address drug-related stigma. https://harmreduction.org/wp-content/uploads/2012/02/stigma-facilitators.pdf

    Stigma-reducing language (Shatterproof) This tool helps reduce stigmatizing language. https://www.shatterproof.org/about-addiction/stigma/stigma-reducing-language

    FindTreatment.gov (Substance Abuse and Mental Health Services Administration) SAMHSA collects information on thousands of state-licensed providers who specialize in treatment substance use disorders, addiction, and mental illness. https://findtreatment.gov./

    Words Matter: How Language Choice Can Reduce Stigma. (SAMHSA) Developed by the Center for the Application of Prevention Technologies (CAPT) This training resource examines the role of language in perpetuating SUD stigma, offers tips to assess how and when we may be using stigmatizing language, and steps to ensure that we use language that is positive, productive, and inclusive. https://facesandvoicesofrecovery.org/wp-content/uploads/2019/06/Words-Matter-How-Language-Choice-Can-Reduce-Stigma.pdf

    Respect to Connect: Undoing Stigma. (National Harm Reduction Coalition) This fact sheet shows the difference between liberation and stigma and states the principles of harm reduction. https://harmreduction.org/issues/harm-reduction-basics/undoing-stigma-facts/

    Stamp Out Stigma. (National Organization on Fetal Alcohol Syndrome). This campaign aims to end discrimination of birth mothers of children with FASD and individuals and families living with the disorders. https://nofas.org/stigma/

    ARTICLES

    “Abusing Addiction”: Our Language Still Isn’t Good Enough. Ashford, R.D., Brown, A.M, & Curtis, B. (2019). Alcohol Treatment Quarterly, 37(2): 257-272. https://pubmed.ncbi.nlm.nih.gov/31551647/

    Stigma, Discrimination, Treatment Effectiveness, and Policy: Public Views about Drug Addiction and Mental Illness. Barry, C.L., McGinty, E.E., Pescosolido, B.A., & Goldman, H.H. (2014). Psychiatric Services, 65(10), 1269-1272. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4285770/

    Stigma and Social Support in Pharmaceutical Opioid Treatment Populations: A Scoping Review. Cooper, S., & Nielsen, S. (2017). International Journal of Mental Health and Addiction, 15, 452-469. https://link.springer.com/article/10.1007%2Fs11469-016-9719-6

    Stigma and the Public Health Agenda for the Opioid Crisis in America. Corrigan, P.W., & Nieweglowski, K. (2018). International Journal of Drug Policy, 59, 44-49. https://pubmed.ncbi.nlm.nih.gov/29986271/

    Social Stigma Towards Persons with Prescription Opioid Use Disorder: Associations with Public Support for Punitive and Public Health-Oriented Policies. Kennedy-Hendricks, A., Barry, C.L., Gollust, S.E., Ensminger, M.E., Chisolm, M.S., & McGinty, E.E. (2017). Psychiatric Services, 68(5), 462-469. https://pubmed.ncbi.nlm.nih.gov/28045350/

    Effects of Competing Narratives on Public Perceptions of Opioid Pain Reliever Addiction during Pregnancy. Kennedy-Hendricks, A., McGinty, E.E., & Barry, C.L. (2016). Journal of Health Politics, Policy and Law, 41(5), 873-916. https://pubmed.ncbi.nlm.nih.gov/27256811/

    The Effectiveness of Interventions for Reducing Stigma Related to Substance Use Disorders: A Systematic Review. Livingston, J.D., Milne, T., Fang, M.L., & Amari, E. (2012). Addiction, 107(1), 39-50. https://pubmed.ncbi.nlm.nih.gov/21815959/

    Portraying Mental Illness and Drug Addiction as Treatable Health Conditions: Effects of a Randomized Experiment on Stigma and Discrimination. McGinty, E.E., Goldman, H.H., Pescosolido, B., & Barry, C.L. (2014). Social Science & Medicine, 126, 73-85. https://pubmed.ncbi.nlm.nih.gov/25528557/

    Stigma at Every Turn: Health Services Experiences among People Who Inject Drugs. Paquette, C.E., Syvertsen, J.L., & Pollini, R.A. (2018). International Journal of Drug Policy, 57, 104-110. https://pubmed.ncbi.nlm.nih.gov/29715589/

    Stigma as a dominant discourse in fetal alcohol spectrum disorder. Choate, P. and Badry, D. (2019). Advances in Dual Diagnosis, Vol. 12 No. 1/2, pp. 36-52.  https://www.emerald.com/insight/content/doi/10.1108/ADD-05-2018-0005/full/html

    Addressing the public health concerns of Fetal Alcohol Spectrum Disorder: Impact of stigma and health literacy. Corrigan PW, Shah BB, Lara JL, Mitchell KT, Simmes D, Jones KL. Drug Alcohol Depend. 2018 Apr 1;185:266-270. PMID: 29477086. https://pubmed.ncbi.nlm.nih.gov/29477086/

    The Public Stigma of Birth Mothers of Children with Fetal Alcohol Spectrum Disorders. Corrigan PW, Lara JL, Shah BB, Mitchell KT, Simmes D, Jones KL. Alcohol Clin Exp Res. 2017 Jun;41(6):1166-1173. doi: 10.1111/acer.13381. Epub 2017 Apr 24. PMID: 28370022. https://pubmed.ncbi.nlm.nih.gov/28370022/

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  • Why is there so much stigma around substance use disorder?

    A survey (2014) of 709 Americans by Johns Hopkins University looked at stigma toward people with substance use disorders:

    said they would not work with someone with an SUD.

    said employers should have the right to deny employment to someone with an SUD.

    said people with SUDs should not be granted the same health insurance benefits as other individuals.

    • Pregnancy adds an additional layer of stigma to substance use disorders.

      Some people, including health professionals, may be inclined to blame mothers of children born with conditions, such as Neonatal Abstinence Syndrome or Fetal Alcohol Syndrome. However, it is often this shame that keeps women from receiving the treatment they need to address substance use disorders.

  • How does stigma toward women who have a substance use disorder prevent them from getting healthcare and treatment?

    • Fear of Disclosure to Providers

      Many women with SUDs fear the legal and criminal consequences for them and their baby – like ending up in jail or having their babies taken away from them – if they disclose their substance use to their provider, so they skip appointments and avoid prenatal care.

      According to the Guttmacher Institute (2020):

      23 states, as well as the District of Columbia, consider substance use during pregnancy to be child abuse under civil child-welfare statutes.

      25 states, as well as the District of Columbia, require healthcare professionals to report suspected prenatal substance use.

      8 states require healthcare professionals to test women for prenatal drug exposure if they suspect substance use.

    • Fear of Losing Social Network

      Also, many pregnant women with substance use disorders don’t tell their family or friends they are dealing with addiction because they’re worried about disappointing or embarrassing them.  They often isolate themselves, negatively affect both their mental and physical health (White, 2009).

  • How does substance use-related stigma toward pregnant women affect babies?

    Because stigma is a substantial barrier to care, it has serious implications for the health of pregnant women with substance use disorders and their babies.

    Exposure to substances during pregnancy can cause serious problems for newborns. Depending on the substance (e.g. opioids, alcohol, tobacco), infants may experience a range of health challenges such as

    • premature birth,

    • low birthweight,

    • breathing problems,

    • feeding problems,

    • vision or hearing problems,

    • abnormal facial features, and

    • longer-term developmental problems.

    Pregnant women, themselves, are also at risk for health problems, including complications during pregnancy and labor and delivery (Lamy et al, 2015), as well as the risk for maternal overdose depending on the substance.

  • How can we ensure that pregnant women with substance use disorders get the care they need?

    1. Create safe, caring, and supportive environments and relationships that are free from stigma (Stone, 2015).
    2. Eliminate blaming and shaming pregnant women with substance use disorders, as this only drives them away from the care and support they need (Thigpen et al., 2014; Krans et al., 2015)
    3. Inform women with SUD that help is available and encourage them to seek treatment (FindTreatment.gov).