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Rural Health Information Hub


Rural communities are taking different approaches to addressing the stigma associated with substance use disorder (SUD) and behavioral health care. In small rural communities where there is little anonymity, people with an SUD may not seek treatment due to the stigma associated with asking for help and receiving health services. Some rural SUD programs are integrating behavioral health services into primary care settings, which allows patients to receive behavioral health screenings and referrals during their regularly scheduled primary care visits. If the behavioral health and primary care services function in a co-location model, patients can also receive behavioral health services at their primary care location, instead of traveling to a separate location.

The criminalization of substance use also contributes to stigma for those with SUD. Some rural communities are addressing stigma by educating community members about the causes of SUD and enacting Good Samaritan protections at the local level. These protections may help to reduce concerns about the legal implications of calling for emergency medical services or helping someone who is overdosing. Further, rural programs are conducting cultural sensitivity trainings and providing technical assistance to healthcare providers to help them support people with SUDs.

The Rural Community Action Guide suggests four action steps to help address SUD-related stigma in rural communities:

  1. Understand the portfolio of SUD research to mitigate stigma and support evidence-based treatment.
  2. Educate the community about the science of SUDs by disseminating resources and educational materials.
  3. Create and implement a tailored marketing plan to reduce stigma. Understand the stigma concerns, the best way to reach the community, and create a campaign to address stigma.
  4. Disseminate positive recovery stories to support the recovery community.

Resources to Learn More

The Effectiveness of Interventions for Reducing Stigma Related to Substance Use Disorders: A Systematic Review
Outlines studies exploring how to reduce substance use disorder-related stigma. Includes information about reducing self-stigma and social stigma.
Authors: Livingston, J., Milne, T., Lan Fang, M., & Amari, E.
Citation: Addiction, 107(1), 39-50
Date: 1/2012

Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change
Analysis of how stigma relates to SUDs, including effective communication regarding stigma, approaches to reducing stigma, and recommendations.
Organization: National Academies of Sciences, Engineering, and Medicine
Date: 2016

Rural Community Action Guide: Building Stronger, Healthy, Drug-Free Rural Communities
Review of the impact of addiction in rural communities, prevention, treatment, and recovery. Contains a section by Addiction Policy Forum on "Moving Beyond Stigma in Rural Communities."
Organization: The Office of National Drug Control Policy
Date: 2020