# 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.

## Key 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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