top of page

2021 North Dakota Stigma Survey: Findings on Attitudes, Levels of Stigma and Support of Key Policies

Updated: Jun 15, 2022

Study shows North Dakota has made progress in addressing the stigma around addiction

Bismarck, ND, October 25, 2021 -- North Dakota’s Recovery Reinvented Initiative in the Office of the Governor, the University of Delaware, and the Addiction Policy Forum conducted a statewide survey to better understand the prevalence of substance use disorder (SUD) stigma in North Dakota.

The study found that stigma across the state has improved over the last three years, with 74% of North Dakota residents reporting that addiction is a health condition. Data collected from a previous 2018 survey on attitudes and beliefs around addiction among North Dakota residents showed that 63% of respondents agreed that addiction is a disease and needs to be treated as a health condition.

"To truly move the needle with ending stigma, we need to be able to make data-driven decisions," First Lady Kathryn Burgum said. "The results from the North Dakota Addressing Addiction survey will help us share knowledge to communities on addiction, promote evidence-based interventions and identify partnership opportunities with communities and stakeholders.”

“The fact that three out of four of the respondents to the 2021 survey understood that addiction is a health condition is great news,” says Dr. Valerie Earnshaw, Associate Professor and Faculty Scholar in the Department of Human Development and Family Sciences at the University of Delaware. “It suggests that efforts aimed at increasing knowledge and reducing stigma in North Dakota may be paying off.”

Public health responses to addiction are preferred over criminal justice penalties

Nearly half of respondents (46%) support laws that protect people with addiction from criminal charges for drug crimes if they seek medical help, while 22% indicated that all people who use drugs illegally should be arrested and prosecuted. Three out of four (74%) support making Naloxone (lifesaving opioid reversal medication) available to friends and family members of people with opioid use disorder, and 69% of respondents support increasing government spending on addiction treatment.

Stereotypes and discrimination are low throughout the state

Stereotypes, or the inaccurate beliefs about people in recovery as a group, were relatively low among all survey respondents. Only 4% of respondents agreed that people in recovery are dangerous, 8% indicated they cannot be trusted, 9% do not make good decisions, and 19% selected individuals in recovery are to blame for their own problems.

Low levels of discrimination were found in social contact categories. The majority of respondents expressed willingness to work with someone in recovery (88%), have someone in recovery as a neighbor (87%), and willingness to introduce someone in recovery to their friends (87%). Thirty-one percent of the respondents felt comfortable having someone in recovery as a caretaker of their children (31%), rent a room in their home (34%), or have an individual in recovery marry into their immediate family (46%).

Higher levels of prejudice towards individuals with substance use disorders remain in the state

Prejudice, the feelings or emotions experienced in response to interacting with someone in recovery, were relatively split. The majority of respondents felt extremely or moderately supportive (88%) and compassionate (78%) when interacting with someone in recovery, while 50% of respondents reported feeling relaxed around someone in recovery. However, almost half of the respondents expressed feeling extremely to slightly anxious (49%) and nervous (48%) about interacting with an individual in recovery.

Lived experience and professional expertise are key factors in lower levels of stigma

Participants who have a loved one impacted by addiction, are in recovery themselves, or are professionals in the addiction field show significantly lower rates of stigmatizing feelings, thoughts and behaviors. Overall, impacted respondents endorsed 36% of stereotypes, 47% of prejudice, and 32% of discrimination items. In comparison, non-impacted respondents endorsed 46% of stereotypes, 57% of prejudice, and 45% of discrimination survey items.

“Stigma hurts patients and families. It can prevent people from asking for help and accessing evidence-based treatment,” says Jessica Hulsey, Executive Director of Addiction Policy Forum. “North Dakota is using science to tackle the stigma around addiction and its working,” says Jessica Hulsey, Executive Director of Addiction Policy Forum.

Research has found that individuals who experience stigma due to a SUD are more likely to continue engaging in substance use, and manifest greater delayed treatment access and higher rates of dropout. The three major domains of stigma include 1) stereotypes, the inaccurate beliefs or thoughts about a particular group of people; 2) prejudice, negative feelings or emotions towards a particular group; and 3) discrimination intent that includes negative or unjust treatment of a particular group.

The full survey report, “2021 North Dakota Stigma Survey: Findings on Attitudes, Levels of Stigma and Support of Key Policies to Address Addiction,” is available on the Recovery Reinvented website:


Recovery Reinvented is an ongoing series of innovative practices and initiatives to eliminate the shame and stigma of addiction in North Dakota. The initiative united North Dakotans to find solutions to help people in our state affected by the disease of addiction with proven prevention, treatment and recovery approaches.

Addiction Policy Forum works to combat the deadly consequences of addiction and help patients, families, and communities affected by the disease. The nationwide nonprofit organization is dedicated to eliminating addiction as a major health problem by helping patients, families, and communities affected by the disease, translating the science around addiction, expanding access to evidence-based prevention and treatment, and ending the stigma around addiction.

University of Delaware. Led by Dr. Valerie Earnshaw, University of Delaware Associate Professor and Faculty Scholar in the Department of Human Development and Family Sciences, the Earnshaw Lab aims to understand and intervene in associations between stigma and health inequities.


bottom of page