Change the Narrative on Substance Use Disorder

Eliminate the stigma of addiction

January 6, 2025

Sandra Rivers, Co-Author & Founder, Authentic Trainings LLC

Tom O'Connor, Co-Author & Publisher

Topic

During 2024, over 45 million people in the U.S. had a substance use disorder.

New beginnings for 2025. To celebrate our New Year as a Vital Voyage Community, I have changed the title of our newsletter to "Substance Use Disorder." Our first 2025 Next Generation issue will explain why I changed the series name.

Substance Use Disorder (SUD) is a complex but treatable disease that affects brain function and behavior. While SUD is one of the U.S.'s most significant public health problems, unfortunately, the disease is still highly stigmatized, preventing many people from getting the help they need.

People with SUDs often suffer in isolation, are outcasts, and are even imprisoned. They suffer in shame, guilt, and embarrassment, terrified to find themselves in this situation. Belittling terms such as alcoholic, drunk, junkie, or crackhead perpetuate stigma and negatively affect a person's self-esteem, damage relationships, and prevent someone from getting access to the care they need.

In this post, we will describe how to change the narrative on substance use disorder. I am honored to have Sandra Rivers as my co-author.

Sandra Rivers, Co-Author, utilizes her 35+ years of experience working with SUDs and trauma treatment. As the founder of Authentic Trainings (www.authentictrainings.com/), Sandy has assembled an exceptional team of trainers with real-world clinical and training experience. She has decades of clinical experience in substance use disorder, sexual abuse, and trauma. Sandy develops customized training solutions to meet the growing needs of professionals in the fields of substance use disorder and mental health conditions. If you have any questions, please email Sandy at sandy@authentictrainings.com.

Additional Information For You

According to Sandy Rivers:

It is time to change the narrative on substance use disorder (SUD).

I have often wondered what it would be like if individuals in recovery from substance use disorders (SUDs) were genuinely welcomed in their communities.

Until 2023, the national average of opioid overdose deaths was 100,000 per year. Since then, the national average has declined, while New York State's numbers have increased. These statistics might sound like we are winning the war. But the number of methamphetamine and cocaine overdoses increased during the same period. Many of them are attributed to fentanyl contamination.

In 2021, over 100,000 people in the U.S. died from an opioid overdose. While that number has declined slightly over the years, it's alarming that this stark reality has never made the news.

Our culture perpetuates the belief that opioid use disorder is a choice. Individuals who misuse opioids are responsible for their circumstances and deserve the consequences.

It's time for that narrative to change.

The old narrative ignores the role of chronic pain or trauma in the development of SUD, particularly for those prescribed pain medications that initially aimed to ease their suffering. Even these individuals, many of whom sought relief through medical channels, are caught up in the pervasive stigma surrounding SUD.

In many cases, doctors, wary of the potential for dependence, stop prescribing these medications. Patients whose pain tolerance has diminished due to regular opioid use are then left with untreated pain. It is no surprise that some of these individuals turn to illicit substances like heroin or street opioids for relief.

How long could anyone endure relentless, unmanageable pain? Many who find themselves in this position face a life-altering injury, illness, or condition that introduces daily suffering. When these individuals seek illegal drugs, they are often treated as criminals, ostracized, and stigmatized.

The old narrative also disregards the complex drivers of substance use disorder. It disregards unresolved trauma, family dysfunction, and criminal justice. It disregards the role Big Pharma played in creating the SUD crisis we face.

The old narrative imposes a stigma that's hard to overcome, making successful treatment difficult and sometimes impossible.

Society's response frequently involves punishment rather than addressing the root causes of SUD.

Why do we persist in punishing people instead of improving treatment and outcomes? Why do family members, employers, and friends still perceive substance use disorder as a moral failing, believing those affected are inherently inferior?

Despite the staggering toll of over one million lives lost to opioid overdoses, the media coverage remains sparse. Compare this to the Vietnam War, when nightly news reports tracked casualty numbers daily, reminding the public of the ongoing crisis. Imagine if opioid-related deaths were similarly reported in every community.

Substance use disorder awareness through widespread education could help dismantle the misconception of SUD as a moral issue, reframing it instead as a complex condition—a medical disease with measurable brain changes. A psychological coping mechanism often rooted in trauma. A societal problem that drives people into isolation.

Until now, the narrative has focused on treating the individual. Those involved in SUD treatment and care often feel the family is the problem, and they discourage including family members in the treatment process.

In my 30+ years of working with substance use disorder, I have rarely seen someone not return to their family of origin. When we accept this, we may be compelled to consider SUD treatment from a family and societal perspective.

The impact of SUD on families is a missing link. Family members often feel overwhelmed, which may inadvertently hinder recovery. However, with proper education, they can become vital allies, supporting treatment engagement and long-term recovery.

Although we offer medical treatment for SUD, the stigma persists. This stigma often pushes individuals into isolated recovery efforts, limiting their support networks to others with SUD.

What if recovery-friendly communities embraced these individuals and their families? These communities would be non-judgmental, supportive, and welcoming environments that reduce triggers and encourage recovery.

At the 2024 National Association for Alcoholism and Drug Abuse Counselors (NAADAC) Conference, Dr. David Best introduced the CHIME framework for facilitating recovery change:

C: Connectedness

H: Hope

I: Identity

M: Meaning

E: Empowerment

Dr. Best also outlined the concept of an Inclusive Recovery City (IRC), a model designed to make cities better for everyone by focusing on education, employment, events, training, recovery communities, and service provision. Recovery Dublin and BRIM are already implementing IRC principles.

Expanding this model could encourage innovative approaches to address the medical, social, and economic costs of SUD, from first-responder expenses to hospital and insurance costs. More importantly, it could save lives and alleviate the immeasurable emotional toll of these losses.

We are already beginning to see recovery-friendly communities with the addition of recovery centers. Unfortunately, they are typically limited to those in recovery and often exclude families. They fill a gap but need further expansion and connection with recovery-friendly organizations in the community. When someone in recovery feels safe, they also feel welcome to attend a community event, take an art class, or join an organization without feeling stigmatized.

Sandy Rivers added: At Authentic Trainings LLC, we are committed to improving the quality of care and combating stigma for individuals with SUD and their families. We train clinicians, peers, and other support personnel, with an emphasis on Motivational Interviewing for SUD. This evidence-based communication style has proven effective for SUD, mental health challenges, and family engagement.

Additionally, we encourage treatment centers to involve family members in the recovery process. We also provide critical training on embracing families to prepare staff to integrate families effectively into treatment and care.

We also address the social aspect of recovery through programs such as Creating Connections and Community, which integrate expressive arts, mindfulness, and rhythm. Presented at the 2024 NAADAC Conference, this program equips clinicians, peers, and family members with tools to foster deep, non-verbal connections. Feedback from the conference highlighted its value in creating transformative experiences.

Including Peer support in SUD recovery is another key component in developing recovery-friendly communities. Peers working in the community can support individuals in active use and serve as a bridge to recovery. Peers are critical bridges between the isolation of early recovery and full integration into the community.

If we genuinely want to address the opioid crisis, it is time to think beyond traditional approaches. By fostering recovery-friendly communities and empowering families, we can create a supportive framework that promotes healing, reduces stigma, and saves lives.

These steps are how we change the narrative on substance use disorder.

According to additional research at Johns Hopkins Medicine

(hopkinsmedicine.org), Substance abuse has a persistent, pervasive stigma attached to it, rooted in the belief that addiction is a personal choice reflecting a lack of willpower and moral failing. Rates of stigma are extremely high both in the general public and within professions whose members interact with people with addiction, including healthcare professionals. Research demonstrates that stigma damages the health and well-being of people with substance use disorder and interferes with the quality of care they receive in clinical settings.

Stigma toward people with substance use disorder can be seen at all levels of care within healthcare settings. Any effort to address the drug overdose crisis must include action to reduce stigma.

Your Call to Action

How Do We Stop Stigma Addiction?

Johns Hopkins Medicine recommended the following action steps:

Use words that can reduce stigma.

Words to Use and Not Use

Instead of these stigmatizing words and phrases, try these preferred alternatives:

Substance Abuse/Drug Abuse	Substance use
Drug Habit/Addiction	Substance Use Disorder
Abuser, Substance Abuser, Drug Abuser, Addict, Alcoholic, Drunk, Junkie, User	A person with a Substance Use Disorder
Addicted Baby	Babies exposed to opioids
Problem	Risky, unhealthy, or heavy use
Clean (person)	In recovery
Clean (or dirty) toxicology results	Negative (or positive) toxicology results
Substitution Therapy, Replacement Therapy, Medication-assisted treatment	Medication for opioid or alcohol use disorder

Recognize that treatment works. Clinicians and other caregivers make a meaningful difference in their patients' lives. While many may not know how to help patients with substance use disorders, the most important thing to remember is that treatments can work. Patients can recover and live happy, fulfilling lives.

Medications to treat opioid use disorder save lives. Opioid use disorder (OUD) is a chronic brain disease caused by the effects of prolonged use on brain structure and function. These brain changes – and the resulting ones – can be treated with life-saving medications, but those medications are not available to most of the people who need them.

Action Steps I Have Taken:

Become an Expert. Seek out expert information and construct a list of reliable information on substance use addiction, recovery, and treatment. Dive into public health studies and medical research.

Spread the Message. Social media is a simple, powerful tool. Use platforms like LinkedIn and Facebook, build a substance use disorder website, create and publish a weekly newsletter, and write and publish your personal story about addiction, recovery, and treatment.

Be an Advocate. Share your expertise and experience directly with the substance use disorder professional addiction, recovery, and treatment community, individuals, and families afflicted with substance use disorder.

Banish Your Bias. I had unintended biases and inaccurate assumptions that contributed to stigma by using words like substance abuse, drug abuse, alcoholic, drunk, junkie, user, and addict.