A new national study from Columbia University Mailman School of Public Health, with colleagues at the University of Miami Miller School of Medicine, University of Chicago, National Opinion Research Center, and Emory University finds that stigma toward patients with substance use disorders (SUD) remains widespread among U.S. healthcare providers—and varies significantly across types of substances. The findings are published in the journal Addiction .
The study is the first national analysis to compare provider stigma across opioid (OUD), stimulant, and alcohol use disorders (AUD) with other chronic but often-stigmatized conditions like depression, HIV, and Type II diabetes. Researchers also assessed how stigma influences whether providers screen for SUD, offer referrals, or deliver treatment.
“While we've made progress in expanding access to evidence-based SUD treatment, stigma remains a profound barrier—often embedded in the clinical encounter itself,” said Carrigan Parish, DMD, PhD, assistant professor in the Department of Sociomedical Sciences at Columbia Mailman School of Public Health. “Our findings show that many providers still feel uncomfortable treating patients with substance use disorders and that hesitancy leads directly to missed opportunities for care. In particular, emergency departments often serve as the first—and sometimes only—point of care for people with substance use disorders. We need to leverage those moments, not miss them.”
The study, conducted from October 2020 to October 2022, surveyed 1,081 primary care providers (PCPs), 600 emergency medicine providers (EMPs), and 627 dentists using a nationally representative random sample licensed from the American Medical and Dental Associations. Participants rated their agreement with 11 standardized stigma statements and reported their screening, referral, and treatment practices for six conditions: three SUDs (opioids, stimulants, alcohol) and three comparison medical conditions (Type II diabetes, depression, HIV).
Key findings:
“Overall, providers were less likely to feel they could effectively help patients with stimulant or opioid use disorders. In fact, 22 percent of providers said, ‘there is little I can do to help patients like this’—a response we almost never saw for other conditions,” said Daniel Feaster, PhD and professor of Biostatistics and one of the lead investigators at University of Miami.
“This isn’t just a matter of attitude—it’s about access. If a provider doubts treatment efficacy or holds stigmatizing beliefs, they’re less likely to screen or refer a patient. That becomes a system failure.”
The study also highlighted key institutional barriers that may reinforce stigma, including:
Senior author Lisa R. Metsch, professor of Sociomedical Sciences at Columbia Mailman School and Dean of the School of General Studies at Columbia University added, “We heard over and over that providers feel unequipped or unsupported to treat SUD—despite being on the frontlines. That’s especially true in primary care settings, where time pressures and limited resources are a daily challenge.” Metsch also added, “Notably, the majority of health providers agreed that insurance plans should cover patients with SUD at the same degree as they cover patients with other health conditions.”
Dentists, although typically less involved in treating SUD, are well-positioned to recognize oral signs of substance use and refer patients to appropriate care—but they, too, face gaps in training and systemic support.
“Going forward, we should strive to be more cognizant of the many treatment and provider roles we have distinguished in this study. By unpacking all the variations, we can start to build smarter interventions—tailored by specialty, setting, and substance,” said Parish.
Other co-authors are Viviana E. Horigian, University of Miami Miller School of Medicine; Harold A. Pollack, University of Chicago School of Social Work; Xiaoming Wang and Petra Jacobs, National Institute of Drug Abuse; Christina Drymon and Elizabeth Allen, National Opinion Research Center; Carlos del Rio, Emory University School of Medicine; and Margaret R. Pereyra and Lauren Gooden, Columbia Mailman School.
The study was supported by the National Institute on Drug Abuse Treatment Clinical Trials Network, grant 5UG1DA013720-23.
Columbia University Mailman School of Public Health
Founded in 1922, the Columbia University Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Columbia Mailman School is the third largest recipient of NIH grants among schools of public health. Its nearly 300 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change and health, and public health preparedness. It is a leader in public health education with more than 1,300 graduate students from 55 nations pursuing a variety of master’s and doctoral degree programs. The Columbia Mailman School is also home to numerous world-renowned research centers, including ICAP and the Center for Infection and Immunity. For more information, please visit www.mailman.columbia.edu .
Addiction
Healthcare provider stigma toward patients with substance use disorders