Contents

Welcome: Stigma-Free Organisations

Understanding Stigma: What It Is and Why It Matters

Evidence‑Based Ways to Reduce Stigma (Overview)

Social Contact: The “Why” and the “How”

Education: Building Understanding Without Oversimplifying

Training: Turning Values Into Behaviour and Practice

Structural Interventions: Changing the game, not just the players

Multicomponent Approaches: Combining Actions for Greater Impact

The Implementation Pathway: Co‑Producing and Delivering Change

Avoiding Unintended Harms and Embedding Change

Wrapping up

Understanding Stigma: What It Is and Why It Matters

Stigma refers to negative attitudes, beliefs, and behaviours toward people based on characteristics society views as undesirable or disapproved. In substance use, stigma often becomes a set of assumptions - not about the person in front of us, but about a “type” of person we believe they represent.

Stigma isn’t evenly distributed

Substance use is highly stigmatised, but stigma varies by context. People may be judged differently depending on the substance, patterns of use, whether they are parents, whether they are involved in the criminal justice system, and whether they face other forms of stigma (e.g. poverty, homelessness, mental ill health).


This matters because stigma is not just interpersonal - it can become embedded in organisational routines and wider systems.

Types of stigma (and what we focus on)

There are multiple overlapping forms of stigma. This learning focuses on two that organisations can change:

Professional stigma

Stigmatising professional attitudes and behaviours that lead to poorer care, avoidance, disrespectful language, or withholding support.

Structural stigma

Organisational policies, procedures, norms or rules that systematically disadvantage people who use substances - including indirect effects from under‑resourcing.

Other forms are important, even if they’re not the main focus here:

  • Self‑stigma
    (internalised beliefs)

  • Public stigma
    (wider social attitudes)

  • Stigma by association
    (impact on families, friends and carers)

These forms interact: structural stigma legitimises public stigma, which shows up in professional stigma, repeated experiences of professional stigma can fuel self‑stigma, and ripple out to families.

The impact of stigma in practice:

Stigma can lead to:

Labels like “chaotic”, “non‑compliant”, “manipulative” becoming routine

Long waits or complex application processes that deter access

Eligibility rules that exclude people who are most in need

Power imbalances where lived experience is tokenised rather than genuinely influential

Stigma also shapes what gets funded, what gets prioritised, and how “deservingness” is judged. This can often be implicit, you won’t hear these decisions talked about in terms of who is “most deserving” sometimes it’s the lack of protest or resistance that leads stigmatised people to be de-prioritised.

Practical signs of stigma in organisations:

Delayed or avoided help seeking

Reduced trust and poorer engagement

Worse treatment experiences and outcomes

Burnout and stress for staff in stigmatising environments

Quick reflection

Where might stigma be “built into” your organisation - language, routines, policies, environments, or assumptions?

Next: Evidence‑Based Ways to Reduce Stigma (Overview)