Addiction Stigma and Its Impact on Treatment: How The OAD Clinic Approaches Person-Centred Care

By Luciana D'Agnone BA, MSc | Director & Editorial Lead - Last reviewed: 10 July 2026

Stigma remains one of the most persistent and most damaging barriers to addiction treatment.¹ Despite decades of evidence supporting that substance use disorders are medical conditions with biological, psychological, and social roots, the perception of addiction as a moral failing continues to delay help-seeking, reduce engagement with treatment, and contribute to poorer outcomes for people who need care most.

At The OAD Clinic, dismantling that stigma is built into the foundations of how we work. This article explores what the latest international research tells us about addiction stigma, and how those findings are reflected in our clinical approach.

What the Research Tells Us About Addiction Stigma

A 2024 paper published in Frontiers in Psychiatry ‘Stigma toward substance use disorders: a multinational perspective and call for action’ (2024) provides one of the most comprehensive recent examinations of how stigma operates in addiction care. The research, led by Dr El Hayek and colleagues across multiple countries identifies stigma as a systemic problem with consequences at every level: individual, clinical, societal, and structural.

Where stigma comes from

Dr El Hayek's findings identifies several distinct sources of stigma that affect people with substance use disorders:

• Social stigma - the negative attitudes held by society at large, often rooted in the framing of addiction as a lifestyle choice

• Family stigma - shame or blame directed at the individual by those closest to them, which can undermine recovery relationships

• Institutional stigma - embedded in healthcare systems, criminal justice, and policy frameworks that treat addiction as a criminal or moral issue rather than a health one

• Self-stigma - the internalisation of these negative perceptions by the person themself, which is often among the most damaging to treatment engagement

• Media stigma - sensationalised or judgemental portrayals that reinforce public misconceptions and reduce support for evidence-based policy

The clinical consequences of stigma

The research makes clear that stigma has direct clinical consequences:

• People delay or avoid looking for help, often for years, due to fear of judgement

• Once in treatment, stigma reduces engagement and increases drop-out rates

• Healthcare professionals who hold stigmatising attitudes provide lower quality care and are less likely to recommend evidence-based treatments

• Self-stigma contributes to hopelessness, isolation, reduced motivation for recovery, and poorer mental health outcomes

The OAD

Practice

At The OAD Clinic, we recognise that many patients arrive having already experienced stigma - from services, from family, or from within themselves. Our initial assessment process is designed to be explicitly non-judgmental, and we train all clinical staff in the use of person-first language and trauma-informed communication from the outset.

Why Language Matters: Person-First Approaches at The OAD Clinic

One of the most immediately actionable recommendations in the research is the routine adoption of destigmatising, person-first language. For example, saying 'person with a substance use disorder' rather than 'addict' or 'abuser', for example. This shift is not merely cosmetic. Research consistently shows that the language used by clinicians affects how patients perceive themselves, how willing they are to engage in treatment, and how healthcare professionals themselves make clinical decisions.

Dr El Hayek emphasises that this language shift is foundational, not supplementary:

"The first priority should be creating a non-judgmental and stigma-free therapeutic environment through the use of destigmatising language and a trauma-informed approach. These foundations can significantly improve trust and engagement."

At The OAD Clinic, person-first language is embedded in our documentation, our clinical training, and our patient-facing communications. We understand that for many patients, the language they encounter when first accessing treatment shapes whether they feel safe enough to continue. To read about one of our patients' struggle with stigma, please read Hugh's testimonial.

Trauma-Informed Care and the Link Between Addiction and Mental Health

The research highlights a critical and often underacknowledged dimension of substance use disorders: the high prevalence of co-occurring trauma and mental health difficulties. Many people who develop problematic substance use do so in the context of adverse experiences: abuse, neglect, loss, or chronic psychological distress, that have never been adequately addressed.

Treating substance use in isolation from these underlying experiences is, at best, incomplete. At worst, it repeats the pattern of fragmented care that has historically failed the public.

The case for integrated care models

Dr El Hayek's position on this is unambiguous:

"I believe addiction treatment should move toward more integrated models that address both substance use disorders and co-occurring mental health conditions. Many patients present with complex psychological and social needs, and separating these conditions often creates barriers to effective care."

The barriers to achieving this, as the research acknowledges, are real: workforce shortages, service fragmentation, funding constraints, and the ongoing stigma that affects both addiction and mental health services. But the direction of travel is clear, and it reflects what The OAD Clinic has long seen in practice.

The OAD

Practice

The OAD Clinic's clinical model is built around the recognition that addiction does not exist in isolation. Our assessments routinely explore trauma history, mental health, and social circumstances, and our treatment planning reflects the full picture of a patient's needs, not just their substance use.

Harm Reduction, Motivational Interviewing, and Meeting Patients Where They Are

Central to both the research and The OAD Clinic's practice is the principle that recovery is not linear, and that treatment engagement must be supported even when abstinence is not an immediate goal. This is where harm reduction and motivational interviewing become essential tools.

Central to both the research and The OAD Clinic's practice is the principle that recovery is not linear, and that treatment engagement must be supported even when abstinence is not an immediate goal. This is where harm reduction and motivational interviewing become essential tools.

Motivational interviewing is a structured, collaborative conversation approach that draws out a patient's own motivation for change rather than confronting or directing them. This method has strong evidence behind it for improving engagement in addiction treatment. It is particularly effective in early-stage engagement, when ambivalence about change within the cycle of change is high and stigma-related barriers to treatment are most acute.

Harm reduction approaches, meanwhile, acknowledge that for some patients at some points in their recovery journey, reducing risk is a more realistic and clinically appropriate goal than immediate cessation. Far from enabling continued use, harm reduction has consistently been shown to maintain contact with services, reduce overdose risk, and provide a pathway toward longer-term recovery.

Peer support as a counter to self-stigma

The research also identifies peer support, which can be described as a connection with others who have lived experience of substance use and recovery, as a particularly powerful mechanism for addressing self-stigma. Hearing from someone who has been in the same position and found a way through can shift the internal narrative in ways that clinical intervention alone often cannot.

How The OAD Clinic Puts Anti-Stigma Practice Into Action

The interventions advocated by the research, namely destigmatising language, trauma-informed care, motivational interviewing, harm reduction, integrated mental health support, and peer connection, reflect the evidence base that The OAD Clinic’s clinical approach is built on.

This means in practice:

• Every patient is assessed as a whole person: their mental health history, trauma background, social circumstances, and personal goals are part of the clinical picture from day one

• Our language, documentation, and communication are grounded in person-first principles. We do not use stigmatising terminology in clinical or patient-facing materials

• Harm reduction is offered as a legitimate and valued approach, not a second-best alternative to abstinence

• Our clinical team are trained in motivational interviewing and use it as a foundation for all patient conversations about change and the cycle of change

• Where patients present with co-occurring mental health conditions, this is addressed as part of integrated care, not referred elsewhere and separated

Key Takeaways

• Stigma is a clinically significant barrier to addiction treatment. It delays help-seeking, reduces engagement, and worsens outcomes

• Person-first language and trauma-informed communication are the most immediate and impactful changes any clinical setting can make

• Addiction and mental health should be treated together. Fragmented services increase barriers to effective care

• Harm reduction and motivational interviewing are evidence-based tools that support engagement at every stage of recovery

• Self-stigma (ie. the internalisation of shame) is often the hardest barrier to address and requires active clinical attention

Frequently Asked Questions

What is stigma in addiction treatment and why does it matter?

Stigma in addiction treatment refers to the negative attitudes, beliefs, and behaviours directed at people with substance use disorders: by society, families, healthcare professionals, or the individuals themselves. It matters because it is one of the most significant barriers to people accessing and remaining in treatment. Research shows that stigma delays help-seeking by years, reduces treatment engagement, and contributes to worse clinical and social outcomes.

What is person-first language and why does The OAD Clinic use it?

Person-first language puts the individual before their diagnosis. For example, 'person with a substance use disorder' rather than 'addict'. The OAD Clinic uses person-first language across all clinical and patient-facing communications because research demonstrates that language shapes both how patients perceive themselves and how clinicians make decisions about their care. It is a concrete, immediately implementable way of reducing the harm caused by stigma.

What is trauma-informed care in addiction treatment?

Trauma-informed care is an approach that recognises the high prevalence of trauma: abuse, neglect, adverse childhood experiences and loss, among people with substance use disorders, and integrates this understanding into every aspect of clinical practice. Rather than asking 'what is wrong with you?', a trauma-informed approach asks 'what happened to you?'. At The OAD Clinic, trauma-informed principles underpin our assessment process, our therapeutic relationships, and our treatment planning.

Does The OAD Clinic offer harm reduction support?

Yes. The OAD Clinic recognises harm reduction as a valid, evidence-based approach to addiction treatment. For patients where immediate abstinence is not the goal, reducing risk (ie. overdose risk, health harms, social harms) is a clinically meaningful and worthwhile outcome. Harm reduction also maintains contact with services, which creates the conditions for longer-term recovery work. 

How does The OAD Clinic support patients with co-occurring mental health conditions?

Many people with substance use disorders also experience mental health difficulties, often rooted in the same underlying trauma or adversity. The OAD Clinic approaches these as interconnected rather than separate conditions. Our assessments explore mental health history and current presentation, and treatment planning reflects the full complexity of a patient's needs. Where specialist input is required, we coordinate rather than simply redirect, maintaining the person at the centre of their care.

How does stigma affect help-seeking for addiction?

Stigma - both external (from others) and internal (self-stigma) - is one of the most commonly cited reasons people delay or avoid looking for treatment for substance use disorders. Fear of judgement, shame, concerns about confidentiality, and prior negative experiences with services all contribute. Addressing this requires both systemic changes (language, policy, training) and individual-level support, which is why The OAD Clinic embeds anti-stigma practice at every point of contact.

About the Research

This article draws on findings from the following peer-reviewed publication:

El Hayek, S., Foad, W., de Filippis, R., Ghosh, A., Koukach, N., Mahgoub Mohammed Khier, A., Pant, S.B., Padilla, V., Ramalho, R., Tolba, H. and Shalbafan, M. (2024): "Stigma toward substance use disorders: a multinational perspective and call for action", Front Psychiatry, vol. 15:1295818. DOI: 10.3389/fpsyt.2024.1295818

About Dr El Hayek

Dr El Hayek is a psychiatrist and researcher specialising in addiction medicine, with a particular focus on stigma, substance use disorders, and integrated mental healthcare. He is the lead author of Stigma toward substance use disorders: a multinational perspective and call for action, published in Frontiers in Psychiatry (2024), which draws on research across multiple countries to examine how stigma operates at individual, clinical, and systemic levels in addiction treatment. Read Dr El Hayek's full profile at The OAD Clinic.

Expert Q&A: Dr El Hayek on Stigma and Addiction Treatment

This Q&A draws on findings from: Dr Samer El Hayek et al. (2024): “Stigma toward substance use disorders: a multinational perspective and call for action”, Front Psychiatry, vol. 15:1295818. DOI: 10.3389/fpsyt.2024.1295818

Question: For clinics operating in regions with shifting poly-substance use, what initial steps or adjustments could be integrated into a clinician’s daily routine so they can adapt patient care plans in real time?

"In clinical settings, I believe the first priority should be creating a non-judgmental and stigma-free therapeutic environment through the use of destigmatising language and a trauma-informed approach. These foundations can significantly improve trust and engagement. Motivational interviewing and harm-reduction strategies are also essential, as they support patient-centred care and help individuals remain connected with treatment, even when recovery is not linear."

Dr El Hayek

Question: Should addiction services move toward fully integrated mental health and addiction treatment models?

"I believe addiction treatment should move toward more integrated models that address both substance use disorders and co-occurring mental health conditions. Many patients present with complex psychological and social needs, and separating these conditions often creates barriers to effective care. Key challenges include availability of trained multidisciplinary teams, service fragmentation, funding limitations, and the ongoing stigma surrounding addiction and mental health."

Dr El Hayek

About the Author

This article was written and reviewed by Luciana D'Agnone BA, MSc, Director and Editorial Lead at The OAD Clinic. Luciana oversees all clinical content published on the The OAD Clinic website, ensuring it reflects current evidence, clinical experience, and a commitment to person-centred addiction care.

1. El Hayek, S., Foad, W., de Filippis, R., Ghosh, A., Koukach, N., Mahgoub Mohammed Khier, A., Pant, S.B., Padilla, V., Ramalho, R., Tolba, H. and Shalbafan, M. (2024): "Stigma toward substance use disorders: a multinational perspective and call for action", Front Psychiatry, vol. 15:1295818. DOI: 10.3389/fpsyt.2024.1295818