Stigma Hits Harder: How Racism Shapes the Addiction Experience for Black Patients

Addiction affects people from all backgrounds, yet for many Black Americans, the journey to recovery carries additional burdens, stemming not just from substance use itself, but from the compounding weight of racism and stigma. These forces shape how patients seek help, how clinicians perceive them, and ultimately, whether they stay in treatment long enough to heal.

“Before I ever walked through the door, I already felt judged. I worried people would see me as a stereotype instead of a person who was hurting,” said one current BrightView patient. “I kept asking myself if I’d be taken seriously, or if they’d assume I was just another problem. That fear almost kept me from getting help at all.”

A Dual Burden: Substance Use and Stigma

Stigma in the context of substance use is already a powerful barrier; it leads individuals to delay seeking help and isolates them from support systems. When that stigma intersects with racial identity, the effects can multiply. Research shows that substance use stigma can be more pervasive and pernicious for Black people, creating unique barriers to treatment and recovery.

Black individuals who use drugs are more likely to face layered stigma: not just as people with substance use disorder, but also as members of a racial group that, historically and currently, faces discrimination and bias in healthcare and society at large.

Why It Starts Before Treatment

Greater stigma begins long before an individual enters treatment. In healthcare settings, Black patients have been documented to experience higher levels of perceived discrimination in both general health and behavioral health care.

“In a lot of Black families, addiction is something you don’t talk about. It’s hush-hush. People are ashamed to say they have a problem, and once they do, there’s often a label put on them. Some families will even shun you for it. That kind of stigma makes people afraid to speak up or ask for help at all.”
— Adrian Adams, Peer Recovery Specialist with the Virginia Harm Reduction Coalition

These experiences can shape how, and whether, someone engages with the medical system:

• Some Black patients report anticipatory fear of judgment or dismissal.
• Others describe feeling as if they must prove the legitimacy of their pain or symptoms to clinicians.

“A lot of Black patients come in guarded. They’re worried about being judged, dismissed, or not believed,” says Chrissy Richard, Nursing Director at BrightView. “Sometimes it’s not what’s said, it’s what they’ve experienced before. That hesitation shows up right away during intake, and it takes intentional effort to help that wall come down.”

Implicit bias among healthcare providers, meaning unconscious attitudes or stereotypes, also affects interactions, contributing to differential care experiences. Studies in general healthcare contexts have shown that these biases can influence clinical decision-making and communication.

Emergency Rooms and Immediate Care

Emergency departments, often the first point of contact during a crisis, present a unique challenge. Fast-paced environments can amplify reliance on snap judgments, which may be shaped by implicit bias. Research outside the addiction field has found that Black patients can be more likely to have negative experiences and mistrust in emergency care, even in psychiatric contexts.

“A lot of people worry that even coming to harm reduction services puts them on some kind of list — like they’re being watched or set up,” says Adrian Adams. “Especially in rural areas, there’s a fear that asking for help will bring police attention instead of support.”

In addiction care specifically, disparities in perceived treatment and support in urgent or crisis settings can discourage people from returning for consistent follow-up care.

“When I went to the ER, I was scared and desperate, but I didn’t feel seen. I felt rushed, questioned, and like I had to prove that my pain was real. That experience stayed with me. It made me hesitate to reach out again, even when I knew I needed help.”

Stigma Around MAT and Judgment

Medication-assisted treatment (MAT) is a cornerstone of effective recovery for many people with opioid or alcohol use disorders. Yet stigma attached to MAT persists in the broader culture, and Black patients may feel that stigma more acutely due to overlapping cultural narratives around self-reliance, weakness, or “drug swapping.”

“People say medication-assisted treatment is just trading one drug for another, but they don’t look at the science behind it,” says Chrissy Richard. “If someone is going to rely on something, shouldn’t it be regulated, researched, and proven to save lives? We don’t question medications for diabetes or heart disease; addiction shouldn’t be treated any differently.”

Nurse-led education and relationship-building can be key to reframing MAT as evidence-based care, not a lesser or “second-choice” treatment.

Completion, Retention, and Trust

“There’s so much mistrust built up from what people see in the news and what they’ve experienced themselves,” says Adams. “In Black and Brown communities, you can’t just offer services — you have to build real rapport first. That trust doesn’t come easy, and it doesn’t come fast.”

Black patients are statistically less likely to complete substance use treatment and more likely to be asked to leave programs prematurely than white patients. These disparities reflect more than individual choices; they highlight systemic and interpersonal barriers that influence retention — including culturally insensitive care, lack of representation, and communication gaps.

Chrissy notes that building trust is central to retention and recovery:

“Trust doesn’t start with paperwork or policies. It starts with simple things; a genuine greeting, a real conversation, meeting someone where they are,” says Richard. “When patients feel like you’re talking to them, not at them, they begin to open up. And once that wall comes down, that’s when real healing can start.”

Structural Barriers Beyond the Clinic Door

Racism isn’t only interpersonal, it’s structural. Black communities are disproportionately affected by social determinants of health rooted in systemic racism, such as:

• Barriers to quality healthcare access
• Economic and housing instability
• Unequal criminal justice impacts

These contribute to higher stress exposure and reluctance to seek care.

Toward Equitable Care

Addressing racism’s role in addiction care requires action at multiple levels:

1. Cultural Competency and Bias Awareness
Training clinicians to recognize and counteract implicit bias improves communication and rapport.

2. Building Trust Through Representation
A diverse workforce and representation within treatment teams can strengthen trust and engagement for patients who might otherwise feel misunderstood.

3. Centering Patient Voices
Listening to Black patients about their lived experiences, both inside and outside of treatment settings, is vital for shaping truly responsive care.

Conclusion

When stigma and racism intersect, they create a heavier burden for Black patients navigating addiction and recovery. But by understanding these forces, and centering dignity, respect, and evidence-based care, providers can work toward a system that supports healing for everyone.

Cover image provided by Adobe Stock.