Health-related stigma is an individual’s experience of exclusion, rejection, and/or blame associated with a health condition.1,2 Stigma associated with opioid use disorder (OUD) and other substance use disorder (SUD) impacts the individual in several ways, including experienced discrimination from individuals and systems with whom the individual interacts, as well as negative self-evaluation and shame.3,4

“Intersecting stigma” is believed to occur when multiple stigmas are present, such as minority race/ethnicity, low socioeconomic status, or criminal involvement.5 For individuals with intersecting stigma, such as addiction and minority race/ethnicity, discrimination may be considerably more intense.6 Stigma can ultimately reduce the likelihood of seeking and engaging in treatment for SUD, posing a serious barrier to effective addiction care.7,8

The SMART Policy Network is committed to addressing stigma at all levels of society, including among individuals with SUDs, families, treatment systems, and the community.

Policy Brief

The Cost of Stigma

Substance Use Disorder (SUD), formerly known as addiction or substance abuse, is a treatable medical condition, but fewer than 1 in 10 Tennesseans with SUD receive treatment. Stigma can lead to a view of those with SUD as weak-willed, unmotivated, and unlikely to recover. However, the reality is that about 60% of people with SUD experience full remission. Treatment is also fiscally sound: every $1 spent on evidence-based treatment for SUD saves $12 in healthcare and criminal justice costs.

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August 2021


1 Weiss MG, Ramakrishna J. Stigma interventions and research for international health. The Lancet. 2006;367(9509):536-538.

2 Major B, O’brien LT. The social psychology of stigma. Annu Rev Psychol. 2005;56:393-421.

3 Van Boekel LC, Brouwers EP, Van Weeghel J, Garretsen HF. Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. Drug and alcohol dependence. 2013;131(1-2):23-35.

4 Can G, Tanrıverdi D. Social functioning and internalized stigma in individuals diagnosed with substance use disorder. Archives of Psychiatric Nursing. 2015;29(6):441-446.

5 Hargreaves J, Stangl A, Bond V, et al. P14. 14 Intersecting stigmas: a framework for data collection and analysis of stigmas faced by people living with hiv and key populations. BMJ Publishing Group Ltd; 2015.

6 Kulesza M, Matsuda M, Ramirez JJ, Werntz AJ, Teachman BA, Lindgren KP. Towards greater understanding of addiction stigma: Intersectionality with race/ethnicity and gender. Drug and alcohol dependence. 2016;169:85-91. doi: 10.1016/j.drugalcdep.2016.10.020.

7 Crapanzano KA, Hammarlund R, Ahmad B, Hunsinger N, Kullar R. The association between perceived stigma and substance use disorder treatment outcomes: a review. Substance abuse and rehabilitation. 2018;10:1-12. doi: 10.2147/SAR.S183252

8 Hammarlund R, Crapanzano KA, Luce L, Mulligan L, Ward KM. Review of the effects of self-stigma and perceived social stigma on the treatment-seeking decisions of individuals with drug- and alcohol-use disorders. Subst Abuse Rehabil. 2018;9:115-136. doi: 10.2147/sar.S183256.



Stigma SMART Team

Robert Pack
Robert Pack, PhD, MPH
Professor of Community and Behavioral Health, Associate Dean for Academic Affairs in the College of Public Health at East Tennessee State University, Director of the ETSU Addiction Science Center and Co-Director of the Opioids Research Consortium of Central Appalachia (the ORCCA)


Karen Derefinko
Karen Derefinko, PhD
Assistant Professor
Department of Preventative Medicine
UT Health Science Center College of Medicine


Jeremy Kourvelas
Jeremy Kourvelas
SMART Policy Network Graduate Research Assistant
UT Knoxville Master of Public Health student



Kelly Moore

Kelly Moore, PhD,
Assistant Professor
Department of Psychology
East Tennessee State University


Carole Myers
Carole Myers, PhD
Professor, UT Knoxville College of Nursing and
Associate Professor, UT Knoxville Department of Public Health


Davis Porcari
Davis J. Porcari
UT Knoxville Master of Public Health and Heath Policy Program student


Jennifer Tourville
Jennifer Tourville, DNP, CPNP
Director of Substance Misuse Outreach and Initiatives, UT System
Clinical Assistant Professor, UT Knoxville College of Nursing


Katie Cahill
Katie Cahill, PhD
Associate Director
Howard Baker Jr. Center for Public Policy
UT Knoxville