Reduce Stigma - Revision history

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 * '''Public stigma''' is the collective public’s prejudice and discrimination toward a specific group of individuals — in this case, individuals who use drugs or those with substance use problems. These negative perceptions cause emotional and behavioral reactivity.
-* '''Structural stigma.''' These are policies or institutional actions, which intentionally or unintentionally, restrict the opportunities of those who use drugs or those with substance use disorder and mental health conditions. This could include discriminatory behaviors or negative perceptions held by institutional representatives, such as those in criminal justice systems or healthcare settings. This includes both public and private sector polices that restrict opportunities of those with drug dependence. <ref>Corrigan P. W. “How stigma interferes with mental health care,” American Psychologist. 2004;59(7):614–625.</ref>
+* '''Structural stigma.''' These are policies or institutional actions, which intentionally or unintentionally, restrict the opportunities of those who use drugs or those with substance use disorder and mental health conditions. This could include discriminatory behaviors or negative perceptions held by institutional representatives, such as those in criminal justice systems or healthcare settings. This includes both public and private sector polices that restrict opportunities of those with drug dependence. <ref>Corrigan P. W. “How stigma interferes with mental health care,” American Psychologist. 2004;59(7):614–625.</ref> Power dynamics between the individual and the authority can also contribute to discriminatory behaviors within the medical, legal, and social services systems.
 * '''Multiple stigma''' may be referred to as “double stigma.” This is prevalent among those who have co-occurring challenges, such as mental illness, substance use disorder, homelessness, and poverty.
 '''Stigma Around Treatment.''' Some treatment centers are centered on profit, rather than service to patients. This has led to a degree of stigma associated with seeking treatment. Thus, it has become necessary to increase the quality of information about treatment centers for people seeking treatment, as well as for people who provide patient referrals.
 '''Stigma Specific to People who are Pregnant'''
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 *Past trauma and stigma impact reaching out for supports.
-Other areas of stigma for pregnant people with SUDs include those seeking MAT/MAR and those with HIV or other infectious diseases. Educating providers and communities about pregnancy and substance use can assist with reducing harm and facilitate pregnant people getting access to care and services. <ref>https://www.astho.org/globalassets/brief/stigma-reinforces-barriers-to-care-for-pregnant-and-postpartum-women-with-substance-use-disorders.pdf</ref>
+Other areas of stigma for pregnant people with SUDs include those seeking MAT/MAR and those with HIV or other infectious diseases. Educating providers and communities about pregnancy and substance use can assist with reducing harm and facilitate pregnant people getting access to care and services. <ref>https://www.astho.org/globalassets/brief/stigma-reinforces-barriers-to-care-for-pregnant-and-postpartum-women-with-substance-use-disorders.pdf</ref> Gender, race, and ethnicity also impact stigma during pregnancy.
 = Relevant Research =

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	The recovery community has been instrumental in advancing the reduction of stigma, so understanding the definition of recovery is a useful foundation for understanding stigma. SAMHSA’s working definition of recovery states that recovery is “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” <ref>https://www.samhsa.gov/sites/default/files/programs_campaigns/02._webcast_3_resources.pdf</ref> When a person with substance use disorder reaches out for help, he or she is often met with judgment or unhelpful responses, often resulting from stigma. SAMHSA lists health, home, purpose, and community as essential dimensions of support for a life in recovery, so it is important to reduce stigma barriers across all of these domains. Persons with mental health and substance use problems are exposed to an array of stigma components that interact to endanger their behavioral health, including stereotypes, prejudice, and discrimination. <ref>Corrigan P. W. “How stigma interferes with mental health care,” American Psychologist. 2004;59(7):614–625.</ref> Many examples of stigma are not overt, but are more subtle. Stigma comes in the form of language choice, pity, disdain, silence, or rejection.		The recovery community has been instrumental in advancing the reduction of stigma, so understanding the definition of recovery is a useful foundation for understanding stigma. SAMHSA’s working definition of recovery states that recovery is, “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” <ref>https://www.samhsa.gov/sites/default/files/programs_campaigns/02._webcast_3_resources.pdf</ref> When a person with substance use disorder reaches out for help, he or she is often met with judgment or unhelpful responses, often resulting from stigma. SAMHSA lists health, home, purpose, and community as essential dimensions of support for a life in recovery, so it is important to reduce stigma barriers across all of these domains. Persons with mental health and substance use problems are exposed to an array of stigma components that interact to endanger their behavioral health, including stereotypes, prejudice, and discrimination. <ref>Corrigan P. W. “How stigma interferes with mental health care,” American Psychologist. 2004;59(7):614–625.</ref> Many examples of stigma are not overt, but are more subtle. Stigma comes in the form of language choice, pity, disdain, silence, or rejection.

	Studies have shown that people with substance use disorder experience labeling, shame, and rejection from family members, friends, teachers, co-workers, supervisors, and health care professionals. This stigma can get in the way of the support that people need -- especially those in early recovery. Stigma also persists around individuals who chose particular paths of recovery, and also for those who do not choose recovery. Outside stigma can become internalized, leading people to embody and adopt inaccurate beliefs about themselves due to their exposure to external stigmatizing forces. <ref> https://attcnetwork.org</ref> Individual factors, such as beliefs, play a large role in an individual’s decision about whether to seek treatment. According to ''Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health'' “stigma has created an added burden of shame that has made people with substance use disorders less likely to come forward and seek support.” <ref>https://addiction.surgeongeneral.gov/sites/default/files/surgeon-generals-report.pdf (Facing Addiction in America)</ref> Research shows that the vast majority of people do not seek treatment because of attitudinal or belief barriers, such as lack of perceived need, concerns about stigma, and doubts about efficacy.		Studies have shown that people who use substances and those with substance use disorder experience labeling, shame, and rejection from family members, friends, teachers, co-workers, supervisors, and health care professionals. This stigma can get in the way of the support that people need -- especially those in early recovery. Stigma also persists around individuals who chose particular paths of recovery, and also for those who do not choose treatment or recovery. Outside stigma can become internalized, leading people to embody and adopt inaccurate beliefs about themselves due to their exposure to external stigmatizing forces. <ref> https://attcnetwork.org</ref> Individual factors, such as beliefs, play a large role in an individual’s decision about whether to seek treatment. According to ''Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health'' “stigma has created an added burden of shame that has made people with substance use disorders less likely to come forward and seek support.” <ref>https://addiction.surgeongeneral.gov/sites/default/files/surgeon-generals-report.pdf (Facing Addiction in America)</ref> Research shows that the vast majority of people do not seek treatment because of attitudinal or belief barriers, such as lack of perceived need, concerns about stigma, and doubts about efficacy.

	'''Types of Stigma.''' There are five different types of stigma, and each has an impact at both personal and social levels. Understanding and having awareness of the following types of stigma can help to break down barriers and reinvent the field of substance use and the ~~road~~ to recovery.		'''Types of Stigma.''' There are five different types of stigma and each has an impact at both personal and social levels. Understanding and having awareness of the following types of stigma can help to break down barriers and reinvent the field of substance use and the potential roads to recovery.

	* '''Self-Stigma.''' Shame, evaluative thoughts, and stigma prevent users from seeking prevention services, testing, and treatment. Stigma also limits employment, school enrollment, housing, and access to social and safety net services. <ref>Luoma, J. B., Kohlenberg, B. S., Hayes, S. C., Bunting, K., & Rye, A. K. (2008). Reducing self-stigma in substance abuse through acceptance and commitment therapy: Model, manual development, and pilot outcomes. Addiction Research & Theory, 16(2), 149–165. https://doi.org/10.1080/16066350701850295</ref>		* '''Self-Stigma.''' Shame, evaluative thoughts, and stigma prevent substance users from seeking prevention services, testing, and treatment. Stigma also limits employment, school enrollment, housing, and access to social and safety net services. <ref>Luoma, J. B., Kohlenberg, B. S., Hayes, S. C., Bunting, K., & Rye, A. K. (2008). Reducing self-stigma in substance abuse through acceptance and commitment therapy: Model, manual development, and pilot outcomes. Addiction Research & Theory, 16(2), 149–165. https://doi.org/10.1080/16066350701850295</ref>

	* '''Courtesy stigma.''' This is “stigma by association” and involves public disapproval for people associating with a stigmatized group. One example is society blaming the family for an individual's substance use ~~disorder~~ or mental health condition. This may have a negative impact as people may distance themselves to avoid stigma.		* '''Courtesy stigma.''' This is “stigma by association” and involves public disapproval for people associating with a stigmatized group. One example is society blaming the family for an individual's substance use or mental health condition. This may have a negative impact as people may distance themselves to avoid stigma.

	* '''Public stigma''' is the collective public’s prejudice and discrimination toward a specific group of individuals — in this case, individuals with substance use problems. These negative perceptions cause emotional and behavioral reactivity.		* '''Public stigma''' is the collective public’s prejudice and discrimination toward a specific group of individuals — in this case, individuals who use drugs or those with substance use problems. These negative perceptions cause emotional and behavioral reactivity.

	* '''Structural stigma.''' These are policies or institutional actions, which intentionally or unintentionally, restrict the opportunities of those with substance use disorder and mental health conditions. This could include discriminatory behaviors or negative perceptions held by institutional representatives, such as those in criminal justice systems or healthcare settings. This includes both public and private sector polices that restrict opportunities of those with drug dependence. <ref>Corrigan P. W. “How stigma interferes with mental health care,” American Psychologist. 2004;59(7):614–625.</ref>		* '''Structural stigma.''' These are policies or institutional actions, which intentionally or unintentionally, restrict the opportunities of those who use drugs or those with substance use disorder and mental health conditions. This could include discriminatory behaviors or negative perceptions held by institutional representatives, such as those in criminal justice systems or healthcare settings. This includes both public and private sector polices that restrict opportunities of those with drug dependence. <ref>Corrigan P. W. “How stigma interferes with mental health care,” American Psychologist. 2004;59(7):614–625.</ref>

	* '''Multiple stigma''' may be referred to as “double stigma.” This is prevalent among those who have co-occurring challenges, such as mental illness, substance use disorder, homelessness, and poverty.		* '''Multiple stigma''' may be referred to as “double stigma.” This is prevalent among those who have co-occurring challenges, such as mental illness, substance use disorder, homelessness, and poverty.

	'''Stigma Around Treatment.''' Some treatment centers are ~~focused~~ on profit than service to patients. This has led to a degree of stigma associated with seeking treatment. Thus, it has become necessary to increase the quality of information about treatment centers for people seeking treatment, as well as for people who provide patient referrals~~. Education about the following help to identify the most positive treatment centers:~~		'''Stigma Around Treatment.''' Some treatment centers are centered on profit, rather than service to patients. This has led to a degree of stigma associated with seeking treatment. Thus, it has become necessary to increase the quality of information about treatment centers for people seeking treatment, as well as for people who provide patient referrals.

	*Lack of Outcomes Data. The measure of substance use disorder treatment effectiveness may be more nuanced than presented by the treatment center's website. For example, if a center says it has a 90% success rate, that most likely refers to the following conditions:
	**A reduction in the frequency of substance use during drug rehab treatment.
	**A reduction in the amount of the substance being used during drug rehab treatment.
	**Successful sobriety for a relative period of time (i.e. self-reported sobriety among patients between 3 and 6 months after treatment).
	*Unbranded Drug Rehab Websites. Some facilities have created unbranded websites to attract additional web traffic. These websites often appear like an independent source verifying that one center may be better than another, when in reality that website was created by another center.
	*Drug Rehab Centers. Some claim to be experts at everything.
	*Patient Brokering. This illegal practice occurs when "body brokers" make money by recruiting people for unethical and unscrupulous treatment facilities.
	*Rampant Urinalysis Testing and Lab Abuse. Some recovery homes homes around the country make money by recruiting people for the intensive outpatient programs (IOPs) that take place at drug rehabilitation centers. These centers charge millions of dollars in fees to insurance companies for drug urinalysis performed on patients in IOPs.

	'''Stigma Reduction Strategies'''		'''Stigma Reduction Strategies'''
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	Those speaking and writing about mental health and substance use should strongly consider the language they use. People-first language or person-centric language can influence whether the material produced is stigmatizing. The new edition of the Associated Press style book recommends people-first phrasing with the goal of separating the person from the disease. The Addiction Technology Transfer Center (ATTC) has specific suggestions for stigma-reducing language: <ref>https://attcnetwork.org/centers/central-east-attc/product/anti-stigma-toolkit-guide-reducing-addiction-related-stigma</ref>		Those speaking and writing about mental health and substance use should strongly consider the language they use. People-first language or person-centric language can influence whether the material produced is stigmatizing. The new edition of the Associated Press style book recommends people-first phrasing with the goal of separating the person from the disease. The Addiction Technology Transfer Center (ATTC) has specific suggestions for stigma-reducing language: <ref>https://attcnetwork.org/centers/central-east-attc/product/anti-stigma-toolkit-guide-reducing-addiction-related-stigma</ref>
	* Call it what it is: substance use disorder (or alcohol use disorder, cocaine use disorder, etc.) or substance dependence (or alcohol dependence, drug dependence, etc.).		* Call it what it is: substance use disorder (or alcohol use disorder, cocaine use disorder, etc.) or substance dependence (or alcohol dependence, drug dependence, etc.).
	* Use "people first" language and refer to people with substance use disorder~~, people with drug dependence, people with addiction~~.		* Use "people first" language and refer to people who use drugs, people with substance use disorder.
	* Avoid negative terms, like addict, junkie, wino, boozer, drug fiend, and bum.		* Avoid negative terms, like addict, junkie, wino, boozer, drug fiend, clean, and bum.

	Regarding stigma specifically associated with Medicated Assisted Treatment/Recovery (MAT/MAR), the National Alliance for Medication Assisted Recovery recommends the following: <ref>https://namarecovery.org/</ref>		Regarding stigma specifically associated with Medicated Assisted Treatment/Recovery (MAT/MAR), the National Alliance for Medication Assisted Recovery recommends the following: <ref>https://namarecovery.org/</ref>
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	*Create a unified voice to reach the public on all issues of concern to MAT/MAR patients.		*Create a unified voice to reach the public on all issues of concern to MAT/MAR patients.

	'''Stigma Specific to Pregnant ~~People~~'''		'''Stigma Specific to People who are Pregnant'''

	Reducing stigma and perception surrounding pregnancy and substance use will increase access to care. Pregnant people ~~with SUD~~ may face feelings of shame and guilt compounding their challenges with childcare, social service involvement, and access to care. These difficulties are amplified by stigma. It should be noted that pregnant people with an SUD are not one uniform group. Some are actively using substance, others are in recovery, and others my be engaged in harm reduction, such as ~~medicated assisted treatment~~/~~recovery~~ (MAT/MAR). Nonetheless, as a sub-population, they face similar hardships around stigma.		Reducing stigma and perception surrounding pregnancy and substance use will increase access to care. Pregnant people may face feelings of shame and guilt compounding their challenges with childcare, social service involvement, and access to care. These difficulties are amplified by stigma. It should be noted that pregnant people with a SUD are not one uniform group. Some are actively using substance, others are in recovery, and others my be engaged in harm reduction, such as Medicated Assisted Treatment/Recovery (MAT/MAR). Nonetheless, as a sub-population, they face similar hardships around stigma.

	Women have different experiences with SUD, both biologically as well as culturally, as they are seen as caregivers and mothers. Barriers and challenges include: <ref>https://infantcrier.mi-aimh.org/perinatal-substance-use-an-update-and-reflection-on-the-importance-of-relationship/#respond</ref>		Women in particular have different experiences with SUD, both biologically as well as culturally, as they are seen as caregivers and mothers. Barriers and challenges include: <ref>https://infantcrier.mi-aimh.org/perinatal-substance-use-an-update-and-reflection-on-the-importance-of-relationship/#respond</ref>

	*Women are at highest risk for developing SUDs during reproductive years.		*Women are at highest risk for developing SUDs during reproductive years.

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	The term “stigma” is used to represent the complex of attitudes, beliefs, behaviors, and structures which interact at different levels of society (i.e., individuals, groups, organizations, systems) and which manifest in prejudicial attitudes about and discriminatory practices against people with mental and substance use disorders. Attention to stigmatizing structures of society, such as laws and regulations, enables examination of discriminatory policies and practices which can appear to endorse negative social norms and deepen self-stigma. <ref>"Ending Discrimination Against People with Mental and Substance use Disorders: The Evidence for Stigma Change" at https://www.ncbi.nlm.nih.gov/books/NBK384923/</ref>		The term “stigma” is used to represent the complex of attitudes, beliefs, behaviors, and structures which interact at different levels of society (i.e., individuals, groups, organizations, systems) and which manifest in prejudicial attitudes about and discriminatory practices against people who use drugs and people with mental health and substance use disorders. Attention to stigmatizing structures of society, such as laws and regulations, enables examination of discriminatory policies and practices, which can appear to endorse negative social norms and deepen self-stigma. <ref>"Ending Discrimination Against People with Mental and Substance use Disorders: The Evidence for Stigma Change" at https://www.ncbi.nlm.nih.gov/books/NBK384923/</ref>

	Stigma often creates barriers that prevent individuals from attaining treatment and other critical services. This lack of understanding impacts many people in society, especially those who are experiencing SUD and to those who are in early recovery. Reducing stigma and increasing understanding of substance use disorder improves the chance that people with SUD will find the assistance and support they need. Addressing stigma requires education and breaking down barriers. This is performed by changing attitudes, perceptions, and language that is used around substance use. Recent research showed that substance use is more stigmatized than obesity and smoking. <ref>"Substance use more stigmatized than smoking and obesity," Journal of Substance Use: Vol 18, No 4. (n.d.). Retrieved from https://www.tandfonline.com/doi/abs/10.3109/14659891.2012.661516</ref> To break down the barrier of stigma we need to provide education that substance use disorder is a chronic ~~Illness~~ and that the approach for treatment should be the same as heart disease, diabetes, asthma, cancer or other illnesses.		Stigma often creates barriers that prevent individuals from attaining harm reduction supports, treatment, and other critical services. This lack of understanding impacts many people in society, especially those who are experiencing SUD and those who are in early recovery. Reducing stigma and increasing understanding of drug use and substance use disorder improves the chance that people with SUD will find the assistance and support they need, if they want it. Addressing stigma requires education and breaking down barriers. This is performed by changing attitudes, perceptions, and language that is used around substance use. Recent research showed that substance use is more stigmatized than obesity and smoking. <ref>"Substance use more stigmatized than smoking and obesity," Journal of Substance Use: Vol 18, No 4. (n.d.). Retrieved from https://www.tandfonline.com/doi/abs/10.3109/14659891.2012.661516</ref> To break down the barrier of stigma we need to provide education that substance use disorder is a chronic illness and that the approach for treatment should be voluntary and the same as heart disease, diabetes, asthma, cancer or other illnesses.

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	The term “stigma” is used to represent the complex of attitudes, beliefs, behaviors, and structures which interact at different levels of society (i.e., individuals, groups, organizations, systems) and which manifest in prejudicial attitudes about and discriminatory practices against people with mental and substance use disorders. Attention to stigmatizing structures of society, such as laws and regulations, enables examination of discriminatory policies and practices which can appear to endorse negative social norms and deepen self-stigma. <ref>"Ending Discrimination Against People with Mental and Substance use Disorders: The Evidence for Stigma Change" at https://www.ncbi.nlm.nih.gov/books/NBK384923/</ref>		The term “stigma” is used to represent the complex of attitudes, beliefs, behaviors, and structures which interact at different levels of society (i.e., individuals, groups, organizations, systems) and which manifest in prejudicial attitudes about and discriminatory practices against people with mental and substance use disorders. Attention to stigmatizing structures of society, such as laws and regulations, enables examination of discriminatory policies and practices which can appear to endorse negative social norms and deepen self-stigma. <ref>"Ending Discrimination Against People with Mental and Substance use Disorders: The Evidence for Stigma Change" at https://www.ncbi.nlm.nih.gov/books/NBK384923/</ref>

	Stigma often creates barriers ~~for those who need~~ treatment and other critical services ~~from reaching out for assistance~~. This lack of understanding impacts many people in society, especially those who ~~suffering from~~ SUD and to those who are in early recovery. Reducing stigma and increasing understanding of substance use disorder improves the chance that people with SUD will find the assistance and support they need. Addressing stigma requires education and breaking down barriers. This is performed by changing attitudes, perceptions, and language that is used around ~~SUD~~. Recent research showed that substance use is more stigmatized than obesity and smoking. <ref>"Substance use more stigmatized than smoking and obesity," Journal of Substance Use: Vol 18, No 4. (n.d.). Retrieved from https://www.tandfonline.com/doi/abs/10.3109/14659891.2012.661516</ref> To break down the barrier of stigma we need to provide education that ~~SUD~~ is a chronic Illness and that the approach for treatment should be the same as heart disease, diabetes, asthma, cancer or other illnesses.		Stigma often creates barriers that prevent individuals from attaining treatment and other critical services. This lack of understanding impacts many people in society, especially those who are experiencing SUD and to those who are in early recovery. Reducing stigma and increasing understanding of substance use disorder improves the chance that people with SUD will find the assistance and support they need. Addressing stigma requires education and breaking down barriers. This is performed by changing attitudes, perceptions, and language that is used around substance use. Recent research showed that substance use is more stigmatized than obesity and smoking. <ref>"Substance use more stigmatized than smoking and obesity," Journal of Substance Use: Vol 18, No 4. (n.d.). Retrieved from https://www.tandfonline.com/doi/abs/10.3109/14659891.2012.661516</ref> To break down the barrier of stigma we need to provide education that substance use disorder is a chronic Illness and that the approach for treatment should be the same as heart disease, diabetes, asthma, cancer or other illnesses.

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	Stigma often creates barriers for those who need treatment and other critical services from reaching out for assistance. This lack of understanding impacts many people in society, especially those who suffering from SUD and to those who are in early recovery. Reducing stigma and increasing understanding of substance use disorder improves the chance that people with SUD will find the assistance and support they need. Addressing stigma requires education and breaking down barriers. This is performed by changing attitudes, perceptions, and language that is used around SUD. Recent research showed that substance use is more stigmatized than obesity and smoking. <ref>"Substance use more stigmatized than smoking and obesity," Journal of Substance Use: Vol 18, No 4. (n.d.). Retrieved from https://www.tandfonline.com/doi/abs/10.3109/14659891.2012.661516</ref> To break down the barrier of stigma we need to provide education that SUD is a chronic Illness and that the approach for treatment should be the same as heart disease, diabetes, asthma, cancer or other illnesses.		Stigma often creates barriers for those who need treatment and other critical services from reaching out for assistance. This lack of understanding impacts many people in society, especially those who suffering from SUD and to those who are in early recovery. Reducing stigma and increasing understanding of substance use disorder improves the chance that people with SUD will find the assistance and support they need. Addressing stigma requires education and breaking down barriers. This is performed by changing attitudes, perceptions, and language that is used around SUD. Recent research showed that substance use is more stigmatized than obesity and smoking. <ref>"Substance use more stigmatized than smoking and obesity," Journal of Substance Use: Vol 18, No 4. (n.d.). Retrieved from https://www.tandfonline.com/doi/abs/10.3109/14659891.2012.661516</ref> To break down the barrier of stigma we need to provide education that SUD is a chronic Illness and that the approach for treatment should be the same as heart disease, diabetes, asthma, cancer or other illnesses.

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	The recovery community has been instrumental in advancing the reduction of stigma, so understanding the definition of recovery is a useful foundation for understanding stigma. SAMHSA’s working definition of recovery states that recovery is “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” <ref>https://www.samhsa.gov/sites/default/files/programs_campaigns/02._webcast_3_resources.pdf</ref> When a person with substance use disorder reaches out for help, he or she is often met with judgment or unhelpful responses, often resulting from stigma. SAMHSA lists health, home, purpose, and community as essential dimensions of support for a life in recovery, so it is important to reduce stigma barriers across all of these domains. Persons with mental health and substance use problems are exposed to an array of stigma components that interact to endanger their ~~mental~~ health, including stereotypes, prejudice, and discrimination. <ref>Corrigan P. W. “How stigma interferes with mental health care,” American Psychologist. 2004;59(7):614–625.</ref> Many examples of stigma are not overt, but are more subtle. Stigma comes in the form of language choice, pity, disdain, silence, or rejection.		The recovery community has been instrumental in advancing the reduction of stigma, so understanding the definition of recovery is a useful foundation for understanding stigma. SAMHSA’s working definition of recovery states that recovery is “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” <ref>https://www.samhsa.gov/sites/default/files/programs_campaigns/02._webcast_3_resources.pdf</ref> When a person with substance use disorder reaches out for help, he or she is often met with judgment or unhelpful responses, often resulting from stigma. SAMHSA lists health, home, purpose, and community as essential dimensions of support for a life in recovery, so it is important to reduce stigma barriers across all of these domains. Persons with mental health and substance use problems are exposed to an array of stigma components that interact to endanger their behavioral health, including stereotypes, prejudice, and discrimination. <ref>Corrigan P. W. “How stigma interferes with mental health care,” American Psychologist. 2004;59(7):614–625.</ref> Many examples of stigma are not overt, but are more subtle. Stigma comes in the form of language choice, pity, disdain, silence, or rejection.

	Studies have shown that people with substance use disorder experience labeling, shame, and rejection from family members, friends, teachers, co-workers, supervisors, and health care professionals. This stigma can get in the way of the support that people need -- especially those in early recovery. Outside stigma can become internalized, leading people to embody and adopt inaccurate beliefs about themselves due to their exposure to external stigmatizing forces. Individual factors, such as beliefs, play a large role in an individual’s decision about whether to seek treatment. According to ''Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health'' “stigma has created an added burden of shame that has made people with SUDs less likely to come forward and seek help.” <ref>https://addiction.surgeongeneral.gov/sites/default/files/surgeon-generals-report.pdf (Facing Addiction in America)</ref> Research shows that the vast majority of people do not seek treatment because of attitudinal or belief barriers, such as lack of perceived need, concerns about stigma, and doubts about efficacy.		Studies have shown that people with substance use disorder experience labeling, shame, and rejection from family members, friends, teachers, co-workers, supervisors, and health care professionals. This stigma can get in the way of the support that people need -- especially those in early recovery. Outside stigma can become internalized, leading people to embody and adopt inaccurate beliefs about themselves due to their exposure to external stigmatizing forces. <ref> https://attcnetwork.org</ref> Individual factors, such as beliefs, play a large role in an individual’s decision about whether to seek treatment. According to ''Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health'' “stigma has created an added burden of shame that has made people with SUDs less likely to come forward and seek help.” <ref>https://addiction.surgeongeneral.gov/sites/default/files/surgeon-generals-report.pdf (Facing Addiction in America)</ref> Research shows that the vast majority of people do not seek treatment because of attitudinal or belief barriers, such as lack of perceived need, concerns about stigma, and doubts about efficacy.

	'''Types of Stigma.''' There are five different types of stigma, and each has an impact at both personal and social levels. Understanding and having awareness of the following types of stigma can help to break down barriers and reinvent the road to recovery.		'''Types of Stigma.''' There are five different types of stigma, and each has an impact at both personal and social levels. Understanding and having awareness of the following types of stigma can help to break down barriers and reinvent the road to recovery.

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 *Participate in media interviews
 *Create a unified voice to reach the public on all issues of concern to MAT patients
 = Relevant Research =

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	The following organizations, associations, and agencies provide information on stigma, stigma prevention, or developing prevention campaigns. Some of the organizations that provide information on stigma may focus on mental health but also address substance abuse. Similarly, some of the resources on conducting prevention campaigns focus on substance use prevention rather than stigma prevention. However, the principles and processes employed by substance use prevention campaigns are applicable to stigma prevention campaigns:		The following organizations, associations, and agencies provide information on stigma, stigma prevention, or developing prevention campaigns. Some of the organizations that provide information on stigma may focus on mental health but also address substance abuse. Similarly, some of the resources on conducting prevention campaigns focus on substance use prevention rather than stigma prevention. However, the principles and processes employed by substance use prevention campaigns are applicable to stigma prevention campaigns:

	*'''SAMHSA''' seeks to provide substance use and mental health services to the people most in need and to translate research in these areas more effectively and more rapidly into the general health care system. Its Addiction Technology Transfer Center (ATTC) Network is a nationwide, multidisciplinary resource for professionals in the addictions treatment and recovery services field. The ATTC Network raises awareness of evidence-based and promising treatment and recovery practices. It builds skills to prepare the workforce to deliver state-of the-art substance use treatment and recovery services and to change practice by incorporating these new skills to improve outcomes. ATTC provides a resource titled "Anti-Stigma Toolkit: Guide to Reducing Addiction-Related Stigma." <ref>https://attcnetwork.org/centers/central-east-attc/product/anti-stigma-toolkit-guide-reducing-addiction-related-stigma</ref>		*'''SAMHSA''' seeks to provide substance use and mental health services to the people most in need and to translate research in these areas more effectively and more rapidly into the general health care system. Its Addiction Technology Transfer Center (ATTC) Network is a nationwide, multidisciplinary resource for professionals in the addictions treatment and recovery services field. The ATTC Network raises awareness of evidence-based and promising treatment and recovery practices. It builds skills to prepare the workforce to deliver state-of the-art substance use treatment and recovery services and to change practice by incorporating these new skills to improve outcomes. ATTC provides a resource titled "Anti-Stigma Toolkit: Guide to Reducing Addiction-Related Stigma." <ref>https://attcnetwork.org/centers/central-east-attc/product/anti-stigma-toolkit-guide-reducing-addiction-related-stigma</ref> It has also created a downloadable Powerpoint presentation titled, "Reducing Stigma in Pregnant & Parenting Women with Substance Use Disorder." <ref>https://www.ndsu.edu/fileadmin/centers/americanindianhealth/files/Maternal_Health_Learning_Collaborative_Session_2.pdf</ref>

	*'''SAFE Project''' ~~promotes the~~ No Shame Pledge ~~in the belief that there~~ is ~~'''''No Shame'''''~~ in ~~getting help or in talking~~ about ~~mental health~~ and ~~substance use. The '''''No Shame Pledge''''' supports the ability~~ to get help without judgement ~~and to acknowledge~~ commitment to saving lives by fighting ~~the~~ stigma~~. Join the no shame movement~~. <ref>https://www.safeproject.us/noshame-mental-health-addiction/~~?gad_source=1&gclid=Cj0KCQjwncWvBhD_ARIsAEb2HW81jVzdiu98jXEgsohnb6NwGV5qdffXSAIcfSDEbPIOmU8-HjSZeMoaAvKpEALw_wcB~~</ref>		*'''SAFE Project.''' The "No Shame Pledge" is a campaign created to end stigma and support others in speaking up about their own disorders and to get help without judgement. Participants receive a certificate in acknowledgement of their commitment to saving lives by fighting stigma. <ref>https://www.safeproject.us/noshame-mental-health-addiction/</ref>

	*'''National Institute on Drug Abuse (NIDA)''' has published “Words Matter - Preferred Language When Talking about Addiction." It provides a table of stigma-reducing language to act as a guide when talking about those with SUD and people in recovery. <ref>https://nida.nih.gov/nidamed-medical-health-professionals/health-professions-education/words-matter-terms-to-use-avoid-when-talking-about-addiction</ref>		*'''National Institute on Drug Abuse (NIDA)''' has published “Words Matter - Preferred Language When Talking about Addiction." It provides a table of stigma-reducing language to act as a guide when talking about those with SUD and people in recovery. <ref>https://nida.nih.gov/nidamed-medical-health-professionals/health-professions-education/words-matter-terms-to-use-avoid-when-talking-about-addiction</ref>

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Promising Practices

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	= Promising Practices =		= Promising Practices =

			'''Maryland.''' "Refocus: Look Again" is a public education campaign from the Anti-Stigma Project within On Our Own of Maryland. It is designed to challenge misconceptions and assumptions associated with mental health and substance use. Their goal is to foster change through awareness and dialogue about the real and damaging impact of stigma. <ref>https://refocuslookagain.org/</ref> An example iof their online content is an anti-stigma interview with Adina Weissman titled, "Medicated Assisted Treatment and Pregnancy." <ref>https://www.distortedperceptions.org/articles-main/2022/4/4/medicated-assisted-treatment-and-pregnancy-an-anti-stigma-interview-with-adina-weissman?fbclid=IwAR1rkj3LV5sbgU6TLPUwq7MVfesTfokhEbUHT2GTS85ko5SbDF-YzWXU-zU</ref> They also have an online pledge to challenge perceptions, to speak out, and to become an agent of change. <ref>https://www.distortedperceptions.org/take-the-pledge</ref>

	'''Massachusetts''' has developed a comprehensive anti-stigma campaign at the state level titled "State Without StigMA". <ref>https://www.mass.gov/state-without-stigma</ref> This resource defines stigma and provides information on how it contributes to the current epidemic. It includes personal stories of people who talk about their own experiences with stigma and how they overcame it to find help for themselves and others in a variety of settings.		'''Massachusetts''' has developed a comprehensive anti-stigma campaign at the state level titled "State Without StigMA". <ref>https://www.mass.gov/state-without-stigma</ref> This resource defines stigma and provides information on how it contributes to the current epidemic. It includes personal stories of people who talk about their own experiences with stigma and how they overcame it to find help for themselves and others in a variety of settings.

	= Sources =		= Sources =

BasilSavitsky: /* Available Tools and Resources */

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Available Tools and Resources

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	*'''The Centre for Addiction and Mental Health (CAMH) Addictions Program.''' CAMH is Canada’s largest mental health and addiction teaching hospital. CAMH combines clinical care, research, education, policy development, and health promotion to help transform the lives of people affected by mental health and substance use issues. <ref>https://www.camh.ca/en/driving-change/addressing-stigma</ref>		*'''The Centre for Addiction and Mental Health (CAMH) Addictions Program.''' CAMH is Canada’s largest mental health and addiction teaching hospital. CAMH combines clinical care, research, education, policy development, and health promotion to help transform the lives of people affected by mental health and substance use issues. <ref>https://www.camh.ca/en/driving-change/addressing-stigma</ref>

	'''The Addiction Center''' provides a list of proactive ways to reduce the stigma around SUD within communities. <ref>https://www.addictioncenter.com/community/raising-addiction-awareness/</ref>		*'''The Addiction Center''' provides a list of proactive ways to reduce the stigma around SUD within communities. <ref>https://www.addictioncenter.com/community/raising-addiction-awareness/</ref>

	*'''The Advertising Council''' produces, distributes, promotes, and evaluates public service communications programs. It provides information, resources, and assistance to community groups about public service campaigns. <ref>https://www.adcouncil.org</ref>		*'''The Advertising Council''' produces, distributes, promotes, and evaluates public service communications programs. It provides information, resources, and assistance to community groups about public service campaigns. <ref>https://www.adcouncil.org</ref>