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RCORP - Rural Center of Excellence on SUD Prevention


Overcoming SUD Stigma in Rural Communities

Stigma around substance use disorder

Substance use disorder (SUD) is highly stigmatized, and this stigma stands in the way of our progress in the opioid crisis.1 In rural communities, individuals with an SUD such as opioid use disorder (OUD) have less access to providers and resources. Stigma and a lack of anonymity are additional barriers to seeking care.2 Health care providers who have stigmatizing views may treat individuals with OUD differently or not offer certain services.3 Stigma stands in the way of patients’ and providers’ utilization of medications for opioid use disorder (MOUD).4

Stigma can negatively impact a person with SUD in many ways, including their mental and physical health, housing, work, and relationships.5 The pain and isolation from being stigmatized can also result in more drug taking.6


Research shows that stigmatizing beliefs around SUD can be reduced by bringing people into contact with a person with SUD and providing education about effective treatments and the potential for recovery.7 Bringing people in contact with those who have SUD and sharing information on the disease can shift attitudes and perceptions. Building awareness that SUD is a chronic, yet treatable condition can help promote hope among individuals with SUD, community members, and health care providers.8 Efforts to reduce and address specific types of stigma include:

  • Educational opportunities for health care providers and support structures such as clinical supervision.9 Education as well as contact have led to reduced discomfort, increased responsibility, and reduced stigmatizing attitudes toward people with SUD.10
  • Marketing campaigns to educate the public about SUD and treatment, developed and implemented collaboratively in communities.11
  • Churches supporting individuals and families impacted by the opioid crisis in rural areas, recognizing and attempting to diminish stigmatizing attitudes.12

Our approach

Visit the Community Conversations page to see how workshops in rural communities introduce biographical works of art as a way of humanizing those affected by SUD and dismantling the perceptions that lead to stigma. 


  • Gloria Baciewicz, MD, FAPA, FASAM, Senior Medical Director, Strong Recovery; Professor of Clinical Psychiatry, University of Rochester Medical Center (URMC); Co-PI, UR Medicine Recovery Center of Excellence
  • Lisham Ashrafioun, PhD, Assistant Professor of Psychiatry, URMC
  • Ken Sayres, Project Manager



[1] Tsai, A. C., Kiang, M. V., Barnett, M. L., Beletsky, L., Keyes, K. M., McGinty, E. E., Smith, L. R., Strathdee, S. A., Wakeman, S. E., & Venkataramani, A. S. (2019). Stigma as a fundamental hindrance to the United States opioid overdose crisis responsePLoS Medicine16(11), e1002969.

[3] Tsai et al. (2019).

[4] Bourne, D., Peterson, K., Anderson, J., Mackey, K., & Veazie, S. (2020). Barriers and facilitators to the use of medications for opioid use disorder: A rapid reviewJournal of General Internal Medicine35(12), 954–963.

[5] Livingston, J. D., Milne, T., Fang, M. L., & Amari, E. (2012). The effectiveness of interventions for reducing stigma related to substance use disorders: a systematic reviewAddiction107(1), 39–50.

[6] Volkow, N. D. (2020). Stigma and the toll of addiction. New England Journal of Medicine, 382(14), 1289-1290.

[7] National Academies of Sciences, Engineering, and Medicine. (2016). Ending discrimination against people with mental and substance use disorders: The evidence for stigma change. National Academies Press.

[8] Livingston et al. (2012).

[9] Howard, V., & Holmshaw, J. (2010). Inpatient staff perceptions in providing care to individuals with co-occurring mental health problems and illicit substance useJournal of Psychiatric and Mental Health Nursing17(10), 862–872.

[10] Silins, E., Conigrave, K. M., Rakvin, C., Dobbins, T., & Curry, K. (2007). The influence of structured education and clinical experience on the attitudes of medical students towards substance misusers. Drug and Alcohol Review, 26(2), 191-200.

[11] Lefebvre, R. C., Chandler, R. K., Helme, D. W., Kerner, R., Mann, S., Stein, M. D., Reynolds, J., Slater, M. D., Anakaraonye, A. R., Beard, D., Burrus, O., Frkovich, J., Hedrick, H., Lewis, N., & Rodgers, E. (2020). Health communication campaigns to drive demand for evidence-based practices and reduce stigma in the HEALing communities studyDrug and Alcohol Dependence217, 108338.

[12] Oak Ridge Associated Universities & Appalachian Regional Commission. (2017). Communicating about opioids in Appalachia: Challenges, opportunities, and best practices.


Updated June 2024