Substance use disorder (SUD) is one of the most stigmatized health conditions. Individuals with SUDs are subject to harsh moral judgment and frequent discrimination. These effects can prevent people who are seeking treatment or those in recovery from accessing the necessary care and support to achieve or sustain recovery. This can also lead many individuals to hide their SUD history or recovery status which can present additional barriers to obtaining needed recovery support.
A 2019 study published in the Journal of Substance Abuse Treatment and led by Drs. Valerie Earnshaw, Brandon Bergman, and John Kelly sought to gain insights into the comfort levels of individuals in recovery in disclosing their SUD history/recovery status and whether, when, and to whom to share such information. Data was analyzed from the National Recovery Study (NRS), a study conducted by the Recovery Research Institute, which includes a nationally representative sample of American adults who self-identified as being in recovery or having “resolved alcohol or drug use problems.” The study found that disclosure comfort was primarily affected by three variables: length of recovery, closeness of relationships, and primary drug.
According to the study, patients early in recovery had low to moderate levels of disclosure comfort, which increased slightly over the first five years of recovery. Disclosure comfort continued to rise gradually over the next 40 years, but remained at a moderate level. The researchers surmised that the relationship of disclosure comfort to the passage of time may be due to the fact that a person will naturally become more accustomed to talking about their history over the years. This phenomenon could also reflect a person’s changing attitude about their experience over time.
The closeness of the relationship also made a significant difference in disclosure comfort, the study found. Approximately 50% of participants reported that they were completely comfortable disclosing their recovery journey to family whereas approximately 50% reported that they were not at all comfortable disclosing it to the media. Nearly 50% reported being completely comfortable with sharing this information with friends and approximately 30% with coworkers; roughly 40% reported were not at all comfortable disclosing it to first-time acquaintances and in public settings. The researchers noted that this may reflect a difference in how patients expect others to respond to them. Patients may expect their friends and family to respond more positively, with more support, while those sharing their experience in a more public setting or with acquaintances may risk more stigma.
“This study shows that many people in recovery from substance use disorders aren’t comfortable with disclosure, even years into recovery," shared Dr. Valerie Earnshaw from the University of Delaware. "This makes sense given that disclosure can be risky - it can either lead to positive, supportive reactions that benefit recovery or negative, stigmatizing reactions that harm recovery. Tools that help people in recovery decide whether, when, and how to disclose as well as build disclosure skills may help them feel more comfortable with disclosure.”
The type of substance matters, too, though apparently not as much as the passage of time and closeness of relationship. Survey participants whose primary drug had been an opioid were the least comfortable, while those who used cannabis, alcohol, or other drugs had higher levels of comfort. The variance among these groups was not very pronounced. The researchers noted that “further research should be conducted to better understand nuances of stigma and disclosure comfort associated with different types of drugs and substances.”
Other factors affected disclosure comfort, though not as much as the three primary factors. These included age (older participants were more comfortable with disclosure) and abstinence (those who abstained fully from the substance were more comfortable with disclosure).
Through this study, researchers developed a disclosure intervention to assist individuals in SUD treatment with making disclosure decisions and building skills to disclose. The one-hour intervention, Disclosing Recovery: A Decision Aid and Toolkit, was pilot-tested among 50 people receiving SUD treatment to determine its acceptability, feasibility, and preliminary impact. Results from the pilot showed that the intervention was viewed by participants as acceptable and feasible, influenced disclosure rates, and enhanced relationship closeness among participants.
In 2023, Dr. Earnshaw received funding from the National Institute on Drug Abuse (NIDA) to further test the Disclosing Recovery intervention and whether it leads to improved treatment- and recovery-related outcomes long-term.
"We are very grateful for the support from the National Institute on Drug Abuse and thrilled for the opportunity to work with the Addiction Policy Form to test this disclosure tool," added Dr. Earnshaw.