Stigma from healthcare professionals and care-limiting behaviors in individuals with substance use disorders: a mixed-methods study

TL;DR

Healthcare professionals' stigma toward people with substance use disorders leads to patients avoiding or stopping treatment, worsening health outcomes.

Contribution

First robust quantitative metrics on how healthcare stigma directly causes treatment disengagement in individuals with substance use disorders.

Findings

Nearly half of patients with substance use disorders avoided or stopped treatment due to healthcare stigma.

Internalized stigma strongly predicted non-disclosure, treatment avoidance, and treatment discontinuation.

Qualitative analysis revealed themes like 'Institutional Stigma' and 'Cost of Disclosure' shaping patients' experiences.

Abstract

Stigmatization of individuals with substance use disorders (SUDs) by healthcare professionals (HCPs) is a recognized problem, but its direct impact on patient treatment choices has not been systematically quantified. We aimed to provide first robust, quantitative metrics of non-disclosure, treatment avoidance, and treatment discontinuation for any medical treatment directly attributable to HCP stigma and to explore the lived experiences underpinning these behaviors.

We conducted a prospective mixed-methods study with 119 adult inpatients with SUDs at a German university hospital (2021–2024). A self-developed questionnaire assessed stigma-related behaviors and their association with self-stigmatization. Qualitative data were analyzed using reflexive thematic analysis (RTA). A person with lived experiences contributed to writing up the manuscript.

49.6% (95% CI 40.3–58.9; n = 59/119) reported non-disclosure of substance use, 36.1% (95% CI 27.5–45.5; n = 43/119) avoided necessary medical treatment, and 29.4% (95% CI 21.4–38.5; n = 35/119) discontinued treatment due to stigma. Internalized stigma significantly predicted all three outcomes (aORs 1.055–1.075, p ≤ .001). RTA identified “Institutional Stigma” (addiction as a “moral failing”), “Barriers to Care” (obstacles to respectful treatment), and “Cost of Disclosure” (negative consequences such as hostility after revealing substance use).

Stigma from HCPs is a quantifiable contributor of treatment disengagement, representing a direct threat to patient safety and a major contributor to the SUD treatment gap. These findings underscore the urgent need for evidence-based interventions, including training HCPs across all specialties in non-stigmatizing communication, to improve healthcare engagement for this vulnerable population and narrow the substantial treatment gap.

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