Addressing Stigma

Stigma is one of the leading barriers to people seeking treatment for their addiction. Furthermore, research has pointed to healthcare worker stigma as a contributing factor to patients with substance use disorder discharging against medical advice.  Healthcare settings have a unique opportunity to shift myths and inaccurate perceptions of substance use disorders. Creating an inclusive and welcoming culture within your hospital is not a one-time event; multiple trainings that include people living with substance use disorders coupled with one-on-one feedback and processing will be essential to creating sustained change.  

While addressing individual employees’ potentially inaccurate beliefs about substance use disorder is important, it is just as important to address stigma that may be embedded in ED policies, procedures, forms, and practices. As your hospital addresses stigma, don’t be surprised if you see improved patient disclosure and treatment engagement as it relates to their substance use disorder.  

Key Takeaways for the ED 

1. Implement pre– and post– evaluations to demonstrate value of stigma elimination training to leadership and measure changes in attitudes.
2. Normalize real–time feedback within department to promote a culture of person–first language. 
3. Include stigma elimination training in orientation and ongoing training cadence.  
4. Seek out opportunities to invite people with lived experience to contribute to anti-stigma curricula or messaging. While facts and statistics are an important component of changing beliefs and behaviors, it is generally stories and experiences that change hearts and minds.  
5. Consider how to engage the patient perspective, especially those with substance use disorders, on advisory boards established within your hospital. 
6. Stigma and internal biases are sneaky. As your team reviews protocols for substance use patients, ask yourself if the same standard would apply to another chronic health condition, like heart disease or diabetes.  

Resources to Get You Started 

A practical guide to get you started on formalizing anti-stigma efforts in your ED

Model Stigma Elimination Trainings developed by Mountain Area Health Education Center (MAHEC) and UNC Health Care.

Examples of Person-First Language for Patients with Substance Use Disorder

Stop the Stigma: Language Guide for Providers developed by the NC Department of Health and Human Services, Injury and Violence Prevention Branch.

UNC Health Care has developed a stigma elimination training by Kara Schaal, BSN, RN, CEN. Hospitals and health systems will be able to use this training for their own emergency department or other health system staff. For more information, please contact Kara at kara.schaal@unchealth.unc.edu .

MAHEC is providing health equity and inclusion training to share best practices in applying a structural competency lens to Medication Assisted Treatment (MAT)/ Medication for Opioid Use Disorder (MOUD) developed by a team of faculty, researchers and education providers. For more information or to schedule a training please email Elizabeth.flemming@mahec.net.

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