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New Study on Stigmatizing Imagery for Substance Use Disorders Released

A new Addiction Policy Forum-led study explores stigmatizing and non-stigmatizing imagery for substance use disorders (SUD) and criminal justice contact.

The qualitative study of people with lived experience with SUD identified stigmatizing images of substance use and criminal justice settings, along with alternative images to utilize. Researchers found that certain images were identified by individuals as not only stigmatizing but triggering, making individuals reactive and think of using again (i.e., relapse).

The results are published in the latest edition of the journal Health & Justice.

“Stigma is a major barrier to treatment and recovery for individuals with SUD, with intersecting stigma experiences for those who are also justice-involved,” explained Jessica Hulsey, the study’s lead author and the Executive Director of the Addiction Policy Forum. “Much of the imagery currently used to depict addiction in the news, social media, television and in publications can be both triggering and stigmatizing for those in recovery from SUD. We hope the findings can be helpful in informing the selection of less harmful imagery to represent substance use disorders.”

Individuals with a substance use disorder frequently experience stigma, which includes prejudice, stereotypes, and discriminatory treatment. The effects of stigma can hamper treatment, recovery, and reintegration outcomes.

Images of people using substances and paraphernalia (needles, syringes, spoons, or lighters) were identified as both stigmatizing and triggering, with participants reporting that the images brought up urges or cravings to use substances. Powders, crystals, marijuana, pills, alcohol containers or servings, or cigarettes/vapes were also not recommended.

Individuals in recovery participating in the study recommended using conceptual image options, such as molecular symbols of the SUD type, definitions of the type of substance from the dictionary, and typography options. One individual explained that conceptual imagery “keeps it scientific. It keeps it fact-based.”

To depict treatment services, study participants endorsed photos of hand-holding, and individuals in a circle to illustrate group therapy or mutual aid support groups. One individual in recovery shared: “I love the hand holding, because I think it communicates if you're talking about patient services treatment it communicates what we actually do to help people get to where they need to be is that's very embracing.”

Images identified by study participants as stigmatizing and/or triggering are included in the journal article, but not in public-facing materials to prevent harm and unintended consequences for patients accessing the content. Researchers conducted a qualitative study following Rapid Qualitative Inquiry (RQI) methods with people with lived experience with different types of SUD. A total of 46 images were used alongside an interview guide to elicit participant feedback and discussion.

Support for the study was provided by the National Institute on Drug Abuse (NIDA) Justice Community Opioid Innovation Network (JCOIN), part of the NIH HEAL Initiative®. Other authors of the study Kayla Zawislak of Addiction Policy Forum, Ginnie Sawyer-Morris, and Valerie Earnshaw at the University of Delaware.


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