Stigma and substance use

Stigma is the mechanism by which people who use drugs are often marginalised.

There is a growing consensus that stigma is not just a symptom of a problem, but is a significant component of the challenge we face in addressing problem drug use.

Recent discussion on stigma has focussed on the language people use and how people are portrayed in the media. There is a consensus that stigma causes harm and a general feeling that something should be done.

SDF has been working on this agenda for some time and is keen to further develop consensus and action that addresses this key issue.

Stigma impacts on all aspects of the lives of people with a substance use problem. Stigma affects people’s well-being and life chances and their ability to seek and get the help, support and treatment they need and deserve.

Stigma marginalises people with a substance use problem and makes them more vulnerable.  It makes them less likely to reach out for support when they need it.  Stigma limits lives and kills.

Stigma also impacts on the families, friends and the broader communities of people with a drug problem.  This impacts on the ability family members, friends and community members to support people with a substance use problem.

Stigma affects the level of investment in and the quality and effectiveness of specialist treatment and support services. Stigma affects the willingness and capacity of mainstream services to support and serve people with a substance problem

Stigma impairs Scotland’s ability to make a full and effective response to, and prevent, problem substance use.

Scottish Drugs Forum works to identify, challenge and reduce stigma and resolves to continue this work. Identifying, challenging and reducing stigma is a cross cutting theme of SDF’s work.

We work with colleagues and partners including people who have a substance use problem. Our aim is to empower others to identity, challenge and reduce stigma.

SDF has delivered anti-stigma training to hundreds of staff in frontline services and service commissioners. All of SDF’s training challenges stigma and the judgmental and prejudiced attitudes and behaviours stigma supports. This training equips people to change their own practice and identify and challenge stigma within their own and other organisations.

SDF undertakes proactive work with the media to promote informed public debate on key issues that challenges stigmatising prejudiced views.

SDF promotes informed debate in Parliament and in local councils, briefing elected members and as the secretary of the Scottish Parliament’s Cross Party Group on Drug and Alcohol Misuse.

SDF’s Addiction Worker Training Programme trains and supports people with personal experience of problem drug use to get work experience and jobs in drug and alcohol services and in the broader care field.  This ensures people who understand stigma and have addressed their own internalised stigma and can challenge others’ stigma are working with some of Scotland’s most vulnerable and stigmatised people.

Through direct representation and through peer research SDF ensures the voices and opinions of people with a substance use problem and people engaged by treatment and support services are heard.  This means that the otherwise marginalised opinions and experiences of this stigmatised group shape the design, management and evaluation of services working with people who have a substance use problem and in the development of policy responses to problem substance use.

SDF’s own research has identified and described the stigma borne by particular groups of people including older people with a drug problem.  This has led to more informed discussion and policy development as well as practical improvements in service delivery.

SDF is working to identify, challenge and reduce the stigma borne by groups affected by multiple stigma including women who use drugs, people engaged in transactional sex, people who have Hepatitis C and HIV and members of the LGBT+ community.

Is all this enough? No.

SDF commits to more explicitly challenging stigma and seeking active partnerships which effectively identify, challenge and reduce stigma.  Stigma will be a key cornerstone theme of SDF’s three year workplan.

We call on all stakeholders in the drugs field and beyond to work to prioritise and address this issue now – the effectiveness of Scotland’s response to problem substance use depends on reducing the stigma borne by some of the most vulnerable and marginalised people in Scotland.


David Liddell

CEO, Scottish Drugs Forum

September 2020