Based on the most recent statistics from the 2024 National Survey on Drug Use and Health, 48.4 million Americans (16.8%) aged 12 and older were diagnosed with a substance use disorder (SUD) in the past year. This includes both alcohol and drug use disorders (9.7% and 9.8%, respectively).1
Of the individuals with SUD, 1 in 5, or 19% received treatment for substance use, and only 2.5% of those with alcohol use disorder received evidence-based treatment with medication for alcohol use disorder in the past year.1,2 For comparison-sake, think of this through the lens of say diabetes, inclusive of prediabetes; of the 11.6% and 38% of the U.S. population with this diagnosis, respectively,3 imagine a world where only 1 in 5 of these individuals sought treatment. While reasons for not receiving treatment for SUDs are multi-layered and complex, from equity to access, stigma continues to be the driving force.
Stigma
Stigma is the proverbial elephant in the room and can be defined as the act of stereotyping, labeling and discrimination occurring in the context of social structures or power differentials;4 it may be experienced, anticipated, or internalized, and captures the experiences of both those living with the condition and those outside it.5 It has been well documented that decades-long stigma and antiquated approaches in addiction care lead to worse outcomes of affected individuals, their families, healthcare providers, and even extending toward research, policy, and society.6–9
Words
The words we use as a society and healthcare community around SUD are often stigmatizing themselves.9 When the DSM-5 was published in 2013, much of the archaic diagnostic verbiage was removed, such as “substance abuse,” and “dependence,” consolidating it into substance use disorder, which helps medicalize the condition, and not frame it as a choice or moral failing (even the diagnostic criteria of “legal problems,” was removed).
From social media to mainstream television and news outlets, the omnipresence of stigmatizing words describing addictive disorders continues to perpetuate the epidemic. With the advent of artificial intelligence (AI)-based large language models, such as ChatGPT, it will be even more relevant to be as cognizant as possible in the language we use around SUDs since stigmatizing words from medical records and published media may influence their responses.10
Moving Beyond Stigma
How can stigma, therefore, be overcome? Though herculean it may sound, changing the way we talk to people with SUD or at-risk use, and using non-stigmatizing, accurate language can move mountains. Creating an empathic, trusting environment, using person-centered and -first language goes a long way.
Through education, dialogue and media platforms, it all starts with human connection and interaction. If we each commit to changing the words we use, we change the stories we tell — and ultimately, the way our society treats those affected by addiction. When teaching, I often get asked by medical students what they can do to help shift the pendulum of stigma in addiction care. My answer remains the same, always: “Lead by example.”
