Variations in Healthcare Provider Stigma Toward Substance Use Disorders by Condition and Provider Type

A comprehensive national study conducted by Columbia University's Mailman School of Public Health, in collaboration with the University of Miami Miller School of Medicine, University of Chicago, National Opinion Research Center, and Emory University, reveals that stigma toward patients with substance use disorders (SUD) remains widespread among healthcare providers in the United States. The research highlights significant disparities in attitudes depending on the type of substance involved and the healthcare provider's specialty.

Published in the journal Addiction, the study is the first of its kind to compare stigma levels across various SUDs — including opioid use disorder (OUD), stimulant, and alcohol use disorders — against other chronic conditions like depression, HIV, and Type II diabetes. It also examined how these attitudes influence clinical practices such as screening, referral, and treatment for SUD.

Lead researcher Carrigan Parish, DMD, Ph.D., emphasized that despite advances in expanding access to evidence-based treatments, stigma remains a major barrier embedded within clinical interactions. Many providers feel uncomfortable managing patients with SUDs, leading to missed opportunities for care, especially in emergency departments where initial contacts often occur.

The study, conducted between October 2020 and October 2022, surveyed 1,081 primary care providers, 600 emergency medicine providers, and 627 dentists, all selected through a nationally representative sampling of licensed practitioners. Participants responded to standardized stigma statements and reported their practices concerning six conditions: three SUDs (opioids, stimulants, alcohol) and three comparison medical conditions (Type II diabetes, depression, HIV).

Key findings include:

• The highest stigma scores were associated with stimulant use disorders (36.3 points), followed by OUD (35.6 points), and alcohol use disorder (32 points).
• In contrast, stigma levels were lower for depression (26.2), HIV (25.8), and diabetes (23.2). Providers expressed more compassion and reported more active treatment efforts in these areas.
• Over 30% of providers preferred not to work with patients with OUD or stimulant use disorders, compared to just 2% for diabetes and 9% for HIV and depression.
• Emergency physicians showed the highest stigma but were also the most likely to provide treatment, with 28.4% offering drug use treatment and 27.2% prescribing medications for OUD. Conversely, primary care physicians were less active in these roles.
• Dentists exhibited the lowest stigma across all conditions, likely due to less direct involvement in SUD treatment and viewing it as outside their scope.
• Attitudes did not significantly vary by provider race, age, gender, geographic region, or rural location, indicating that stigmatizing beliefs are pervasive across the healthcare workforce.

Daniel Feaster, Ph.D., a biostatistics professor involved in the study, noted that many providers feel powerless in helping patients with stimulant or opioid use disorders — with 22% stating there is little they can do. This reflects a systemic issue, where doubts about treatment efficacy and stigmatizing attitudes hinder proper screening and referral processes.

The research also identified barriers such as limited time, insufficient training, lack of referral resources, discomfort in discussing SUD, legal concerns, and lack of privacy. Columbia's Lisa R. Metsch highlighted that healthcare providers often feel ill-equipped and unsupported in managing SUDs, particularly in primary care settings where time and resources are limited.

Importantly, most providers agree that insurance coverage for SUD should match that of other health conditions. While dentists are less involved in treatment, they are positioned to identify oral signs of substance use and facilitate appropriate referrals, despite facing their own training and systemic gaps.

Carrigan Parish emphasized the importance of understanding the diverse roles of healthcare providers in addressing SUD stigma and developing tailored interventions based on specific settings and substances. This approach could help mitigate stigma and improve patient access to effective treatment.

For more information, consult the article in Addiction (2025) with DOI: 10.1111/add.70122. Source: Columbia University's Mailman School of Public Health.

Learn more about the journal Addiction.