Reducing substance use stigma in healthcare settings has never been more urgent. Yet a major new scoping review finds that most training programmes designed to shift attitudes among healthcare professionals still default to lectures and handouts. More effective, immersive approaches remain rare. The review analysed 108 peer-reviewed studies and concludes that the field carries genuine momentum, but also serious gaps.

The review was published in the Journal of Substance Use and Addiction Treatment in 2026. It came from a national workgroup of researchers across the United States, operating under the Clinical Trials Network. Their goal was practical: to map what delivery strategies have actually been used, so future research can build on what works and drop what does not.

The Scale of the Problem

Substance use disorders rank among the most stigmatised medical conditions in the world. In the United States, over one million overdose deaths have been recorded since 1999. In 2024, only one in five people who needed treatment for a substance use disorder actually received it. Researchers link that gap directly to the stigmatising attitudes and practices embedded in health systems.

People seeking help regularly meet dismissive language, discriminatory policies, and a culture that frames addiction as a character flaw. The consequences are concrete: reduced access to care, worse treatment outcomes, and higher rates of dropping out of treatment altogether. Stigma also carries measurable mental and physical health consequences for those on the receiving end.

This is not simply a matter of bedside manner. It is a structural problem that demands a structural response.

What the Research Looked At

Cioffi and colleagues searched three major academic databases. They included studies published from 2000 onwards, all conducted in the United States. The 108 studies that met the criteria covered physicians, nurses, pharmacists, social workers, and students across multiple disciplines and healthcare settings.

Rather than evaluating whether programmes worked, the team focused on how they were delivered. They used a structured taxonomy, the Expert Recommendations for Implementing Change (ERIC) framework, to categorise each strategy. They also added new categories the original taxonomy had not anticipated, including different forms of consumer contact.

Reducing Substance Use Stigma in Healthcare: What Programmes Actually Do

The findings are striking in their consistency. Three in every four studies, specifically 74%, relied on educational meetings as the core delivery method. Around 39% distributed written or digital training materials. These are familiar formats. They are relatively cheap to run. They are also, based on the broader evidence base, not the most powerful tools available.

Far fewer studies used interactive approaches. Only 27% incorporated simulation exercises. Just 25% used small group learning. A mere 6% involved participants practising new skills between sessions.

The figures for consumer contact are similarly low. Community contact with people who have lived experience of substance use disorders featured in 18% of studies. Live personal stories appeared in 17%. Pre-recorded accounts reached only 8%.

That matters because contact and reflection tend to change attitudes in ways that lectures rarely do. Sitting with someone’s story, in person or on screen, works differently in the brain than reading a handout. Mental health research has shown this repeatedly. Substance use disorder stigma reduction research is catching up to the same conclusion.

Most Programmes Showed Promise, But the Science Needs Strengthening

About 73% of studies reported reductions in stigmatising attitudes after their intervention. That is encouraging. But the authors urge caution in reading too much into it.

Most studies used a single group, measuring attitudes before and after with no comparison group. Sample sizes were often small. Long-term follow-up was rare. Very few studies checked whether attitude shifts actually changed clinical behaviour.

Just six of the 108 studies used a randomised controlled trial design. Only five produced the improvements they set out to achieve. That is not a failure of individual researchers. It reflects where the field sits right now: early, exploratory, and in need of more rigorous tools to move forward.

Where Training Happens and Where It Does Not

Most substance use disorder stigma reduction programmes run inside academic settings. Medical schools, nursing programmes, pharmacy courses, and continuing education events make up the majority of the evidence base. Sixty-three of the 108 studies focused on students or trainees rather than practising clinicians.

That is a reasonable starting point. Training professionals before they enter clinical settings means attitudes have less time to harden. But it also means the field has largely overlooked primary care, community health centres, emergency departments, and outpatient services. Those are the places where people with substance use disorders most often encounter stigma when they try to access help.

The authors name this explicitly as a priority for future research. The evidence base needs to follow people into the settings that matter most.

The Missing Ingredient: Why Implementation Science Matters

One of the more valuable contributions this review makes is applying an implementation science framework to substance use disorder stigma reduction. Implementation science does not just ask whether something works. It asks how to make something work reliably, in different contexts, and at scale.

The researchers found that implementation strategies across the 108 studies skewed heavily towards education. Far less attention went to ongoing consultation, interactive technical assistance, or the kind of organisational change that tends to stick: revising clinical roles, changing team structures, or embedding stigma reduction into supervision and feedback systems.

Some studies did move into this territory. A handful used what the researchers call “support clinicians” strategies, sharing real-time data, reminding clinicians to apply new skills, or building learning communities. A small number went further still, tackling infrastructure: mandates, records systems, and team redesign. These approaches are rare. The review’s authors argue they are also some of the most promising.

The Gap Around Lived Experience

One finding deserves particular attention. Consumer contact, meaning direct engagement with people who have lived or living experience of substance use disorders, appeared in a minority of studies. More telling, the ERIC taxonomy did not even include it as a strategy. The research team had to add the category themselves.

The standard implementation science framework had simply not accounted for it. That tells you something about whose knowledge has historically shaped this field.

Bringing lived experience into training is not tokenism. Mental health research consistently finds it among the more effective approaches to attitude change. Hearing someone describe their own experience with addiction and their encounters with health services does something that a lecture cannot replicate. The review found examples of this being done well. They remain the exception.

What the Field Needs to Do Next

The authors set out clear priorities. Studies need randomised designs, validated outcome measures, and long-term follow-up. The review recommends two instruments for standardising measurement: the Substance Use Stigma Mechanisms Scale and the Opening Minds Scale for Health Care Providers. Wider adoption of both would make it easier to compare results across studies and build a cumulative evidence base.

Researchers also need to be more precise about what they are testing. Many of the 108 studies described their interventions broadly, without spelling out which components drove any changes they observed. Disentangling what was delivered from how it was delivered is essential groundwork.

People with lived and living experience of substance use disorders need a seat at the table when programmes are designed, tested, and refined. That applies to research design, not just delivery.

Conclusion

This review captures a field at an early but important stage. Reducing substance use stigma in healthcare is achievable. The evidence from 73% of reviewed studies says so. But the tools being used are often too blunt, the settings too narrow, and the science not yet strong enough to drive the scale of change that people with substance use disorders need.

The work ahead involves building on what exists, testing it with more rigour, and taking it into the clinical settings where stigma does the most damage.

Reference: Cioffi, C.C. et al. (2026). A scoping review of implementation strategies to reduce stigma toward people who use substances in healthcare settings. Journal of Substance Use and Addiction Treatment. https://doi.org/10.1016/j.josat.2026.210005

Source: dbrecoveryresources