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Treating substance use disorder: Stigma and bias

Individuals are diagnosed with substance use disorder (SUD) when they begin to use an uncontrolled amount of a substance despite harmful consequences. Often, people reach a point when they continue to use the substance despite knowing that it will cause problems in all aspects of their life, from personal well-being to social and professional perspectives. 

The stigma surrounding SUD implies that people suffering from SUD have “low motivation” or “weak willpower.” However, that is not true. People with SUD experience changes in brain structure and function, causing them to have intense cravings and changes in personality. Research has shown changes in the brain relating to decision-making, learning, memory, and behavioral control.

 In addition, studies have found that SUD is often strongly associated with poor socioeconomic conditions and multiple health risks. While the relationship between socioeconomic status, ethnicity, health, and drug use is complex and multifaceted, it still holds that marginalized groups experience higher levels of adversity that perpetuate healthcare disparities. Socioeconomic factors shape various risk behaviors and the health of drug users and affect the availability of resources and access to social welfare systems. 

While a greater understanding of how social determinants shape the health of drug users is essential, physician willingness to work with the population also plays a significant role in the effective treatment of SUD.

Many studies have shown that physicians are not eager to work with patients suffering from SUD. Moreover, willingness to treat is lower when physicians believe addiction is a choice or within the control of patients and when physicians believe that they would not personally misuse substances or experience addiction. 

Furthermore, burnout also influences physician attitudes. Approximately 70 percent of physicians reported experiencing negative emotions when working with patients suffering from SUD, while 19 percent mentioned experiencing burnout specifically. Furthermore, physicians working with SUD patients had high burnout scores, and consequently, those experiencing burnout reported more recent medical errors and scored lower on instruments measuring empathy. Ultimately, this results in reduced patient satisfaction with medical care and adherence to treatment plans, often advancing the severity of the disorder. 

As a physician, it is crucial, and an ethical responsibility, to avoid biases and practice an open mindset to allow for sensitivity in patient care. Dwelling on personal prejudice and societal stigma is harmful to the psyches of both patients and physicians.  

Acknowledging and actively correcting stigma in daily interactions, both in clinical and non-clinical settings, is an important place to start. For example, the phrase “person with substance use disorder” is a better alternative to slang words with negative connotations like “abuser,” “addict,” and “junkie.” By being proactive, we can work to decrease the stigmatization in healthcare surrounding SUD.


~ Saathvika Diviti `25

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