Substance use, stigma, and coping in treatment: A qualitative study of participant perspectives

This study explores experiences of stigma in substance use treatment, coping strategies, and the contexts in which individuals feel stigmatized due to current or past substance use. Semi-structured interviews were conducted with 55 individuals enrolled in substance use treatment programs within two distinct geographical areas of the U.S., Northeast and Southeast. Data were collected from February to October 2023. Themes were organized by the Health Stigma and Discrimination Framework. Five themes were identified: 1.) Interpersonal drivers of stigma participants described feeling stigmatized by treatment staff, healthcare practitioners, and family; 2.) Substance- and method-specific stigmatization: participants reported feeling greater stigma from the use of criminalized substances and substances used intravenously, compared to non-criminalized substances and non-injection use methods; 3.) Coping approaches: participants identified active (e.g., prayer, meditation, exercise) and avoidant (e.g., laughing it off) strategies to manage stigmatizing experiences; 4.) Rejection of stereotypes: participants described empathetic views of people who use substances, even as they acknowledged that treatment environments often reinforce stigmatizing practices; 5.) Recovery-oriented care: participants felt less stigmatized and more comfortable with treatment providers with lived experience. Data for this study did not indicate differences by study site. Recommendations include prioritizing providers with lived experience, training healthcare workers in culturally responsive care, and integrating coping strategies and harm reduction into treatment to reduce stigma.