In most cultures and societies there is control or the attempt to control substance use. The supply and use of substances is controlled by a variety of means including the law and taxation; religious strictures, social norms and mores, and by social taboo and stigmatisation.

The stigmatisation of people who use drugs and people who have a substance problem is complex.

Stigma takes different forms –

A person with a substance use problem may stigmatise themselves or internalise the stigmatising view that others have of them.

They may be stigmatised by the state, the society, the community, the family they come from. They may experience stigma when they engage with services, or in public settings.

Stigma may be ‘contagious’. People who have a drug problem may find that their family or their community bear stigma related to their problem drug use. The services they use, including drug treatment services may be stigmatised.

Stigma may extend to people who have had a drug problem but now identify as being in recovery. It may even extend to people who do not have a drug problem but are perceived as likely to develop a drug problem.

Stigma may impact on some people every day; others, for example people in abstinent recovery, may only experience stigma if and when their status is made known.Broadly, none of this is contested. However, there is dispute regarding effective means of challenging and reducing stigma – or even agreeing that this is a desirable aim. The issue chiefly rests in terms of what is being destigmatised. Is the aim to destigmatise people who use substances, people who are involved in problem substance use; people who are in recovery? This matters because, in addressing stigma in one group, stigma may be promoted for another group. For example, a message that celebrates a recovery journey as a journey away from a stigmatised status and that therefore people who have stopped using drugs should not be stigmatised, actually promotes stigmatising views of people with a drug problem. This is why ‘visible recovery’ does not necessarily destigmatise people with a drug problem.

It has been suggested that ‘stigma does not kill people’. However, this is contested as people’s internalised stigma result in feelings of a lack of self-worth and inhibit their engagement with help and support from others, including services. Engagement in treatment is the most significant service provision in protecting people from overdose deaths.