Toward an actionable model to investigate and mitigate racialized substance use stigma facing Black people who use drugs

Black Americans face lower access to substance use treatment and overdose prevention, poorer outcomes for those who do access treatment, and higher rates of substance use-related morbidity and mortality than the general U.S. population. Heretofore separate areas of prior research have (1) demonstrated the negative effects of anti-Black racial stigma on substance use, mental health, and addiction treatment outcomes among Black people and (2) identified substance use stigma as a barrier to psychological well-being, treatment-seeking, and positive recovery outcomes among people who use(d) drugs. Yet health science has largely neglected the intersection of racial stigma and substance use stigma as a driver of health inequities, preventing assessment and intervention of substance use stigma among Black individuals and allowing disparities to persist. In response to these gaps, this commentary introduces a model of racialized substance use stigma that characterizes how the intersection of these stigmas across multiple social-ecological levels impacts health and treatment outcomes among Black people who use(d) drugs. Using previous multilevel frameworks of substance use stigma as a guide, the commentary presents data from a set of community-engaged qualitative studies with Black stakeholders and men who use(d) drugs to provide initial evidence and analysis of the proposed model of racialized substance use stigma. The goal is to spur a critically needed area of research and intervention to mitigate racial disparities driven by substance use stigma in the U.S.