Perceived stigma and its role in substance use disorder treatment completion
Published in: The American Journal of Drug and Alcohol Abuse
Published online: July 31, 2025
Kelsey Isman¹, Salvatore Giorgi¹, Jennifer D. Ellis², Andrew S. Huhn², Tingting Liu¹, and Brenda Curtis¹
¹Technology and Translational Research Unit, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA; ²Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
ABSTRACT
Background: Perceived Substance Use Disorder (SUD) stigma, defined as the awareness of negative societal attitudes toward individuals with SUDs, may discourage treatment-seeking and completion. Unlike self-stigma (negative beliefs about oneself), perceived stigma reflects individuals’ perceptions of stigma from the public. While self-stigma has been widely studied, research on perceived stigma’s role in shaping treatment outcomes remains limited.
Objectives: This study aimed to examine whether higher perceived stigma at treatment intake predicts premature treatment discontinuation and hypothesized that greater perceived stigma would be associated with increased rates of premature treatment discontinuation.
Methods: A total of 7,591 participants (70.2% male) from 75 SUD treatment facilities across the United States completed surveys at treatment intake and early in treatment. Perceived stigma was assessed using the Perceived Stigma of Addiction Scale (PSAS). Treatment completion, defined as standard discharge (recommended duration of care), served as the primary outcome. Mixed-effects models evaluated the relationship between perceived stigma and treatment discontinuation while adjusting for demographic, SUD, and mental health-related covariates.
Results: Higher perceived stigma significantly predicted an increased likelihood of premature discontinuation (adjusted odds ratio [AOR] = 0.97, 95% CI [0.95, 0.99], p < .001). For each one-unit increase in PSAS score, the odds of treatment completion decreased by 3%. This relationship persisted across all models, even after accounting for covariates.
Conclusion: These findings underscore the importance of addressing perceived stigma at treatment intake and its role in predicting treatment retention. Routine screening for stigma and implementing stigma-reduction interventions during care may contribute to better treatment outcomes for individuals with SUDs.
INTRODUCTION
Substance use disorders (SUD) are a public health crisis, impacting approximately 48.5 million individuals aged 12 and older in the United States (U.S.) in 2023 (1). Despite the availability of evidence-based treatments, fewer than 25% of these individuals access care, contributing to over 100 thousand annual drug overdose mortalities (2) and substantial societal costs exceeding one trillion dollars (3).
Despite this, most people do not seek treatment (1). Further, oftentimes, those who enter treatment do not complete it; some treatment sites have premature discontinuation rates of over 70% (4). While there are many reasons people with SUDs may not seek treatment (4), stigma (defined within the context of mental health and SUD as “negative attitudes and/or negative behaviors toward individuals with mental illness”) (5, 6) is a prominent one (7). In fact, SUDs are one of the most stigmatized health conditions (8).
Not only does stigma discourage seeking care (7) but it is also associated with negative consequences at all stages of treatment. Stigma is associated with a decline in help seeking behaviors and access to care (9–13), a decrease in quality and approach of care patients receive from healthcare providers (14) and an increase in cravings (15). Furthermore, stigma can affect sub-populations receiving treatment for SUD differently. For example, high levels of stigma have been reported in participants receiving supervised withdrawal treatment such as detoxification (16) and in people who use heroin (17).
