What you can do
WHAT YOU CAN DO
Now that you understand why there is so much stigma around substance use disorders and how it affects pregnant women and new mothers, what can you do to make a difference? Use the tool below to reflect on your own beliefs and then discover steps you can take to change the conversation around SUDs in your organization and community.
TAKE A CLOSER LOOK AT YOUR OWN BELIEFS
Even with our best intentions and efforts to be accepting of others, we may have implicit and unconscious bias about SUDs. It’s important to take a closer look at your own beliefs and compare them with evidence-based recommendations by trusted organizations.
Read each statement below and indicate whether you strongly agree, agree, somewhat agree, somewhat disagree, disagree, or strongly disagree. Then take a closer look.
Note: Your answers will be completely anonymous and will not be saved. This tool is intended to help you self-reflect and evolve, not place judgment on any of your attitudes or beliefs.
Click the circles below to move between questions.
It’s important to stop and assess your own beliefs and find out if they’re based on up-to-date evidence and recommendations from professional organizations that you trust.
It Takes a Village
1 in 9 pregnancies in the U.S. is exposed to alcohol. Stigma can prevent people who need extra support to remain alcohol-free during pregnancy from getting help. Listen to one mother’s plea for people to extend grace to parents whose children have been impacted by prenatal alcohol exposure.
CHANGE THE CONVERSATION
It can be difficult to know how to respond to our colleagues and community members when they use stigmatizing language or when they talk about addiction or substance use disorders in a way that perpetuates misinformation, blame, and shame.
Use the tips below to change the conversation around substance use and create a cultural shift in your organization or community.
By changing the conversation around substance use disorder, we are helping to change the beliefs and behaviors of others which can help reduce substance use disorder stigma and its effects on pregnant women and their babies.
KEEP LEARNING
WEBSITES
The Words Matter: Help End Stigma in Our State (Stigma Free West Virginia)
https://stigmafreewv.org/
Shaming the Sick: Addiction and Stigma (American Addiction Centers)
https://drugabuse.com/addiction/stigma/
The Stigma of Addiction (DrugRehab.com, Advanced Recovery Systems)
https://www.drugrehab.com/addiction/stigma/
Shattering Stigma: A National Strategy Addressing Addiction Stigma (Shatterproof)
https://www.shatterproof.org/shattering-stigma
Lift the Label (Colorado Office of Behavioral Health)
https://liftthelabel.org/
Stamp Out Stigma (Association for Behavioral Health and Wellness)
https://www.stampoutstigma.com/
SBIRT: Screening, Brief Intervention, and Referral to Treatment (SBIRT) | SAMHSA
Planning and Implementing Screening and Brief Intervention for Risky Alcohol Use (cdc.gov)
Motivational Interviewing: USING MOTIVATIONAL INTERVIEWING IN - Advisory 35 (samhsa.gov)
Motivational Interviewing to Help Your Patients Seek Treatment | Opioids | CDC
Substance Use and Mental Health Treatment Locator: To find treatment facilities confidentially, 24/7, please call 1-800-662-4357 (HELP) or go to: Home - FindTreatment.gov
March of Dimes CARES Framework- Others may use the framework, with a copyright notice - © March of Dimes Inc. 2023, and a note or acknowledgment that it is used with permission of March of Dimes
Hear Her Campaign: HEAR HER Campaign | CDC
CMQCC Tool Kit: Mother & Baby Substance Exposure Initiative Toolkit | California Maternal Quality Care Collaborative (cmqcc.org)
Marijuana Use: Pregnancy | Health Effects | Marijuana | CDC
What You Should Know About Using Cannabis, Including CBD, When Pregnant or Breastfeeding | FDA
Marijuana and Pregnancy | ACOG
Benefits of keeping mom and baby together: A Mother-Centered Approach to Treating Neonatal Abstinence Syndrome (nichq.org)
Plans of Safe Care:
Module 2_revised_a_SP (hhs.gov)
Plans of Safe Care | National Center on Substance Abuse and Child Welfare (NCSACW) (hhs.gov)
WEBINAR
The Power of Perceptions and Understanding: Changing How We Deliver Treatment and Recovery Services. This four-part webcast series educates healthcare professionals about the importance of using approaches that are free of discriminatory attitudes and behaviors in treating individuals with substance use disorders (SUDs) and related conditions, as well as patients living their lives in recovery. https://www.samhsa.gov/power-perceptions-understanding
COURSES
Stigma and OUD [Opioid Use Disorder]. This course from the Providers Clinical Support System (PCSS) is led by Nurse Practitioner Vanessa Loukas, a PCCS clinical expert. She discusses the issue of stigma in treating patients with opioid use disorder—from the patients to the providers who treat them. https://pcssnow.org/education-training/training-courses/stigma-and-oud/
TOOLS AND TOOLKITS
Anti-Stigma Toolkit (Addiction Technology Transfer Center Network, Substance Abuse and Mental Health Services Administration) This toolkit is a guide to provide the addiction treatment and recovering community with practical information and tools to enhance their capacity to engage in effective stigma reduction efforts. https://attcnetwork.org/sites/default/files/2019-04/Anti-Stigma%20Toolkit.pdf
Addictionary (Recovery Research Institute) This website enhances recovery through science. Tools include an “addictionary,” news, and resources about recovery. https://www.recoveryanswers.org/addiction-ary/
Understanding Drug-Related Stigma: Tools for Better Practice and Social Change. Curriculum Outline for Trainers (The Harm Reduction Coalition) This half-day training gives participants a distinct set of knowledge and skills to help them understand and address drug-related stigma. https://harmreduction.org/wp-content/uploads/2012/02/stigma-facilitators.pdf
Stigma-reducing language (Shatterproof) This tool helps reduce stigmatizing language. https://www.shatterproof.org/about-addiction/stigma/stigma-reducing-language
FindTreatment.gov (Substance Abuse and Mental Health Services Administration) SAMHSA collects information on thousands of state-licensed providers who specialize in treatment substance use disorders, addiction, and mental illness. https://findtreatment.gov./
Words Matter: How Language Choice Can Reduce Stigma. (SAMHSA) Developed by the Center for the Application of Prevention Technologies (CAPT) This training resource examines the role of language in perpetuating SUD stigma, offers tips to assess how and when we may be using stigmatizing language, and steps to ensure that we use language that is positive, productive, and inclusive. https://facesandvoicesofrecovery.org/wp-content/uploads/2019/06/Words-Matter-How-Language-Choice-Can-Reduce-Stigma.pdf
Respect to Connect: Undoing Stigma. (National Harm Reduction Coalition) This fact sheet shows the difference between liberation and stigma and states the principles of harm reduction. https://harmreduction.org/issues/harm-reduction-basics/undoing-stigma-facts/
Stamp Out Stigma. (National Organization on Fetal Alcohol Syndrome). This campaign aims to end discrimination of birth mothers of children with FASD and individuals and families living with the disorders. https://nofas.org/stigma/
ARTICLES
“Abusing Addiction”: Our Language Still Isn’t Good Enough. Ashford, R.D., Brown, A.M, & Curtis, B. (2019). Alcohol Treatment Quarterly, 37(2): 257-272. https://pubmed.ncbi.nlm.nih.gov/31551647/
Stigma, Discrimination, Treatment Effectiveness, and Policy: Public Views about Drug Addiction and Mental Illness. Barry, C.L., McGinty, E.E., Pescosolido, B.A., & Goldman, H.H. (2014). Psychiatric Services, 65(10), 1269-1272. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4285770/
Stigma and Social Support in Pharmaceutical Opioid Treatment Populations: A Scoping Review. Cooper, S., & Nielsen, S. (2017). International Journal of Mental Health and Addiction, 15, 452-469. https://link.springer.com/article/10.1007%2Fs11469-016-9719-6
Stigma and the Public Health Agenda for the Opioid Crisis in America. Corrigan, P.W., & Nieweglowski, K. (2018). International Journal of Drug Policy, 59, 44-49. https://pubmed.ncbi.nlm.nih.gov/29986271/
Social Stigma Towards Persons with Prescription Opioid Use Disorder: Associations with Public Support for Punitive and Public Health-Oriented Policies. Kennedy-Hendricks, A., Barry, C.L., Gollust, S.E., Ensminger, M.E., Chisolm, M.S., & McGinty, E.E. (2017). Psychiatric Services, 68(5), 462-469. https://pubmed.ncbi.nlm.nih.gov/28045350/
Effects of Competing Narratives on Public Perceptions of Opioid Pain Reliever Addiction during Pregnancy. Kennedy-Hendricks, A., McGinty, E.E., & Barry, C.L. (2016). Journal of Health Politics, Policy and Law, 41(5), 873-916. https://pubmed.ncbi.nlm.nih.gov/27256811/
The Effectiveness of Interventions for Reducing Stigma Related to Substance Use Disorders: A Systematic Review. Livingston, J.D., Milne, T., Fang, M.L., & Amari, E. (2012). Addiction, 107(1), 39-50. https://pubmed.ncbi.nlm.nih.gov/21815959/
Portraying Mental Illness and Drug Addiction as Treatable Health Conditions: Effects of a Randomized Experiment on Stigma and Discrimination. McGinty, E.E., Goldman, H.H., Pescosolido, B., & Barry, C.L. (2014). Social Science & Medicine, 126, 73-85. https://pubmed.ncbi.nlm.nih.gov/25528557/
Stigma at Every Turn: Health Services Experiences among People Who Inject Drugs. Paquette, C.E., Syvertsen, J.L., & Pollini, R.A. (2018). International Journal of Drug Policy, 57, 104-110. https://pubmed.ncbi.nlm.nih.gov/29715589/
Stigma as a dominant discourse in fetal alcohol spectrum disorder. Choate, P. and Badry, D. (2019). Advances in Dual Diagnosis, Vol. 12 No. 1/2, pp. 36-52. https://www.emerald.com/insight/content/doi/10.1108/ADD-05-2018-0005/full/html
Addressing the public health concerns of Fetal Alcohol Spectrum Disorder: Impact of stigma and health literacy. Corrigan PW, Shah BB, Lara JL, Mitchell KT, Simmes D, Jones KL. Drug Alcohol Depend. 2018 Apr 1;185:266-270. PMID: 29477086. https://pubmed.ncbi.nlm.nih.gov/29477086/
The Public Stigma of Birth Mothers of Children with Fetal Alcohol Spectrum Disorders. Corrigan PW, Lara JL, Shah BB, Mitchell KT, Simmes D, Jones KL. Alcohol Clin Exp Res. 2017 Jun;41(6):1166-1173. doi: 10.1111/acer.13381. Epub 2017 Apr 24. PMID: 28370022. https://pubmed.ncbi.nlm.nih.gov/28370022/
Ethical challenges in FASD prevention: Scientific uncertainty, stigma, and respect for women's autonomy. Zizzo N, Racine E. Can J Public Health. 2017 Nov 9;108(4):e414-e417. doi: 10.17269/cjph.108.6048. PMID: 29120314. https://pubmed.ncbi.nlm.nih.gov/29120314/
It’s a Shame! Stigma Against Fetal Alcohol Spectrum Disorder: Examining the Ethical Implications for Public Health Practices and Policies. Emily Bell, Gail Andrew, Nina Di Pietro, Albert E. Chudley, James N. Reynolds, Eric Racine, Public Health Ethics, Volume 9, Issue 1, April 2016, Pages 65–77. https://academic.oup.com/phe/article/9/1/65/2362433
Addiction Center. (2020). Illicit Drug Addiction and Abuse. https://www.addictioncenter.com/drugs/illicit-drugs/
Administration for Children and Families. (2020). Child Welfare Policy Manual. https://www.acf.hhs.gov/cwpm/public_html/programs/cb/laws_policies/laws/cwpm/policy_dsp_pf.jsp?id=2
American College of Obstetricians and Gynecologists (ACOG). (2017). Opioid use and opioid use disorder in pregnancy. Committee Opinion No. 711. Obstetrics and Gynecology, 130, e81–94. https://journals.lww.com/greenjournal/Fulltext/2017/08000/Committee_Opinion_No__711___Opioid_Use_and_Opioid.57.aspx
Anker, J.J. & Kushner, M.G. (2019). Co-occurring alcohol use disorder and anxiety. Alcohol Research, 40(1). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6927748/
Barry, C.L., McGinty, E.E., Pescosolido, B.A., & Goldman, H.H. (2014). Stigma, discrimination, treatment effectiveness, and policy: Public views about drug addiction and mental illness. Psychiatric Services, 65(10), 1269–1272. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4285770/
Centers for Disease Control and Prevention. (2020). Breastfeeding: Tobacco and E-Cigarettes. https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/vaccinations-medications-drugs/tobacco-and-e-cigarettes.html
Child Welfare Information Gateway. (2019). About CAPTA: A Legislative History. https://www.childwelfare.gov/pubPDFs/about.pdf
Goodyear K, & Haass-Koffler, C.L. (2018.) Opioid use and stigma. The role of gender, language, and precipitating events. Drug and Alcohol Dependence, 185, 339‒346. https://pubmed.ncbi.nlm.nih.gov/29499554/
Guttmacher Institute. (2020). Substance Use During Pregnancy. https://www.guttmacher.org/state-policy/explore/substance-use-during-pregnancy
Healthline. (2020). What is an Addictive Personality? https://www.healthline.com/health/addictive-personality-traits
HelpGuide. (2020). Substance Abuse and Mental Health Issues. https://www.helpguide.org/articles/addictions/substance-abuse-and-mental-health.htm
Jones, M.J. & McCance-Katz, E.F. (2019). Co-occurring substance use and mental disorders among adults with opioid use disorder. Drug and Alcohol Dependence, 197(1), 78‒82. https://www.sciencedirect.com/science/article/abs/pii/S0376871618305209?via%3Dihub
Kelly, J.F. & Westerhoff, C.M. (2010). Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms. International Journal of Drug Policy, 21(3), 202‒207. https://pubmed.ncbi.nlm.nih.gov/20005692/
Krans, E.E., Cochran, G., & Bogen, D.L. (2015). Caring for opioid-dependent pregnant women: Prenatal and Postpartum Care Considerations. Clinical Obstetrics and Gynecology, 58(2), 370‒379. https://pubmed.ncbi.nlm.nih.gov/25775440/
Lamy, S., Laqueille, X., & Thibaut, F. (2015). Consequences of tobacco, cocaine, and cannabis consumption during pregnancy on the pregnancy itself, on the newborn, and on child eevelopment. Encephale, 41(Supple 1), S13-20. https://pubmed.ncbi.nlm.nih.gov/25439854/
Laudet, A.B. (2012). Rate and predictors of employment among formerly polysubstance dependent urban individuals in recovery. Journal of Addictive Diseases, 31(3), 288‒302. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3416052/
National Institute on Drug Abuse. (2020). Principles of Drug Addiction Treatment: A Research-Based Guide (3rd Ed.). https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-effective-drug-addiction-treatment
Stone, R. (2015). Pregnant women and substance use: Fear, stigma, and barriers to care. Health Justice, 3, 2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5151516/
Substance Abuse and Mental Health Services Administration. (2018). Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants. https://store.samhsa.gov/product/Clinical-Guidance-for-Treating-Pregnant-and-Parenting-Women-With-Opioid-Use-Disorder-and-Their-Infants/SMA18-5054
Substance Abuse and Mental Health Services Administration. (2020a). Medication and Counseling Treatment. https://www.samhsa.gov/medication-assisted-treatment/treatment
Substance Abuse and Mental Health Services Administration. (2020b). Recovery and Recovery Support. https://www.samhsa.gov/find-help/recovery
Thigpen, J.T. & Melton S.T. 2014. Neonatal Abstinence Syndrome: A challenge for medical providers, mothers, and society. Journal of Pediatric Pharmacology and Therapeutics,19(3), 144‒146. https://www.jppt.org/doi/abs/10.5863/1551-6776-19.3.144?journalCode=jppt
White, W. (2009). Long-term strategies to reduce the stigma attached to addiction, treatment, and recovery within the City of Philadelphia (with particular reference to medication-assisted treatment/recovery). Philadelphia: Department of Behavioral Health and Mental Retardation Services. http://www.williamwhitepapers.com/pr/2009Stigma%26methadone.pdf