Reframe: Substance Use

An online library of resources to help you reduce substance use stigma through a health equity lens.
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Gathered by Reframe Health and Justice. Made possible with support from the Center for Disease Control Foundation.

Health equity is a proactive process of creating and enforcing practices, policies, values, and action that produce fair and equitable health access, opportunities, treatment and outcomes for all. Health equity requires a commitment to naming and confronting inequities , shifting power, equitable distribution of resources to address historical and contemporary causes of inequities, accountability and targeted, intersectional approaches designed to materially improve the lives of marginalized people. We practice health equity to achieve health justice.

Adapted from the definition of racial equity put forth by the Center for Urban and Racial Equity (CURE).

How we chose resources

Pills from ZeroStigma.Art
Generated by DALL-E.

We chose resources based on three factors:

If they had a racial, gender, and economic equity focus

If they had the potential to reduce stigma related to drug use and people who use drugs

If they were broad, scalable, or multi-dimensional

A few of these resources meet the above criteria but do not use what the harm reduction field considers best language practice. We encourage readers to connect with what works for you. Should you wish to submit a resource for inclusion in this library, please contact us.

Research & Articles

These resources explore data surrounding drug user health inequities and provide empirically-backed themes and solutions.

Narcan from ZeroStigma.Art
Illustrated by Lindsey Morano.

Stigma and substance use disorders: an international phenomenon

A global review of published information on stigma associated with substance use and abuse.

Health Equity Focus

Describes the impacts of stigma, explains the need for public education and targeted information.

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At the Expense of a Life: Race, Class, and the Meaning of Buprenorphine in Pharmaceuticalized "Care"

Analyzes differences in buprenorphine treatment utilization by race, ethnicity, and socioeconomic status.

Health Equity Focus

Gathers and examines the different experiences of office-based Buprenorphine treatment by race and class; advocates for culturally inclusive shifts in Buprenorphine treatment practice.

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Double stigma and help-seeking barriers among Blacks with a behavioral health disorder

We love this summary from the article: “There is considerable evidence that racial stigma and stigma due to mental illness or addiction are each independently a barrier to help-seeking for Black adults. This study examines empirically the "double stigma" of discrimination, marginalization, and exclusion due both to a behavioral health disorder and to race among Black adults.”

Health Equity Focus

The results demonstrate the combined impact of racism and substance use disorder stigma on treatment and social service access in Black communities.

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Communication Strategies to Counter Stigma and Improve Mental Illness and Substance Use Disorder Policy

Promotes stigma reduction activities that thoughtfully combine the use of personal narratives and data on structural barriers.

Health Equity Focus

Examines the role of stigma in policy preferences, provides evidence for the utility of certain communication strategies, highlights the roles of structural barriers and involvement of people with lived experience.

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Advancing Health Equity Through Cross-Cutting Approaches To Health-Related Stigma

A global body of research which puts forth that efforts to reduce disease-related stigma need to prioritize cross-cutting systemic issues rather than focusing on individual conditions.

Health Equity Focus

Uplifts that people may be navigating multiple stigmatized conditions/ identities at once, advocates for breaking down disease silos and finding core drivers + approaches, includes a historical account of the progression of stigma theory.

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Race and addiction: How Bias and Stigma Affect Treatment Access and Outcomes

We love this description from the article: “Equitable access to substance use disorder treatment in the US requires meaningful policy changes as well as a shift in clinical practice. Here, experts discuss the progress being made to address the role of systemic racism and trauma as contributors to treatment disparities.”

Health Equity Focus

Points to health disparities within racialized communities and unequal substance use treatment access, includes data by racial category, advocates for addressing access and equity gaps among communities of color.

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Videos & Podcasts

These video resources offer multiple learning formats to engage audiences in stigma reduction and health equity

Self-care from ZeroStigma.Art
Illustrated by Eje.

Bringing Racial Equity Strategies to Recovery Support Services

One hour-long presentation recording from C4Innovations discussing racism within treatment and recovery spaces, barriers to chance, and what authentic inclusion looks like.

Health Equity Focus

Uses a social justice perspective to analyze power distribution and social aspects of racism.

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EQUIP Substance Use Stigma

Diverse narratives from patients and providers discussing the impacts of stigma and how to address personal and institutional bias.

Health Equity Focus

Incorporate double or overlapping stigma narratives of class, race, and substance use.

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Rethinking Race in Medicine

There are no biological differences in race, but the healthcare system has used race as an indicator of disease. This has contributed to institutional racism and poor healthcare experiences for BIPOC.

Health Equity Focus

Highlights medical practices that result in under or over treatment and delayed healthcare access among BIPOC. Points to current and future medical system re-evaluation and revision efforts to address institutional racism.

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#NIHHEAL: Overcoming Stigma to Start Buprenorphine During Hospitalization

This video discusses the role hospitals can play in providing SUD treatment, emphasizing the importance of patient-centered care via a narrative of one patient and doctor’s relationship.

Health Equity Focus

Stresses the need to redesign systems and for hospitals to address withdrawal symptoms and SUD along with physical conditions (to see patients as whole people).

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Campaigns

These resources provide tools and messaging to support health equity-informed anti-stigma campaigns.

Syringes from ZeroStigma.Art
Illustrated by Lindsey Morano.

Next Distro Anti-Stigma Library

We love this summary: “This page contains) some resources and further explanations as to how stigma has shaped drug usage and accessibility to safe supplies and rights."

Health Equity Focus

This page offers over a dozen resources that discuss addressing stigma and center or include equity. RHJ did not duplicate any of these resources on this page, so head to Next Distro’s anti-stigma page for more.

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Drug Policy Alliance on Race & the Drug War

This page contains information on the racialized history of the war on drugs and drug policy reform priorities that seek to address this history and its impacts.

Health Equity Focus

Video discusses the connection between drug policy reform and the Black Lives Matter movement.

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Anti-Stigma Toolkit: A Guide to Reducing Addiction-Related Stigma

Explains different types of stigma and how they manifest. Then, provides concrete tools and information on stigma reduction activities.

Health Equity Focus

None, but the worksheets and information can be adapted with a health equity-lens and tailored for different populations or purposes.

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King County Don’t Count Us Out

Seattle King County’s anti-stigma campaign and resource page.

Health Equity Focus

This is an example of an inclusive city-wide anti-stigma campaign that is geared towards a general audience. It doesn’t have a health equity focus, but uses diverse faces and images.

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Denver Public Health and Environment Anti-Stigma Campaign Project: Phase 1 Final Report

We like this summary from the report: "The Denver Department of Public Health & Environment (DDPHE) had three primary objectives for the Denver Anti-Stigma Campaign project. The first objective was to measure baselines of knowledge, attitudes, and beliefs that result in stigma associated with behavioral health conditions (i.e., substance use and mental health conditions) in Denver."

Health Equity Focus

Data shows the need to focus on people within specific demographics including race, gender identity, and housing status.

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Art

These designs offer easily-digestible visual aids to advance understandings of inequities and stigma.

Harm Reduction is Empathy from ZeroStigma.Art
Illustrated by Jamie Harary.

Zero Stigma Art

Part of undoing the stigma caused by the war on drugs is circulating evidence-based information and we need real images to help us communicate our messages. We envision a time when anyone can search for images and find options that reflect all kinds of experiences with drugs, pain, and diversity of people.‍ This online library contains free harm reduction illustrations that anyone can download and use.

Health Equity Focus

This library contains diverse, inclusive, and non-stigmatizing illustrations surrounding substance use and recovery. And they're free!

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Tree of Stigma & Tree of Liberation

This National Harm Reduction Coalition graphic is part of a stigma reduction activity that shows the effects of stigma as if it were part of a tree, and then juxtaposes it with what liberation can organically look like.

Health Equity Focus

The graphic and surrounding activity uses leaf, trunk, and root metaphors that are inclusive of overlapping stigmas.

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Health Dispartities in LGBTQ

We love this summary from the page: “This infographic highlights how LGBTQ+ individuals face health disparities linked to stigma and discrimination. Rates of mental health disorders, substance use disorders, and suicide are higher among LGBTQ populations. These disparities are exacerbated when people are unable to access care or are uncomfortable asking providers for the treatment they need.”

Health Equity Focus

Provides a visual representation of mental health and substance use data on LGBTQ+ youth, adults, and elders.

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Overdose Disparities are on the rise. What now?

This Centers for Disease Control and Prevention graphic depicts different hands holding a piece of the equity puzzle including “reduce criminalization” and “reduce stigma.”

Health Equity Focus

The graphic was created to address racial disparities in overdose deaths and substance use treatment access.

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