Race, Stigma, and Addiction

  • Sonia Mendoza
  • Alexandrea E. Hatcher
  • Helena HansenEmail author


Racialized attitudes toward addiction have shaped medical and institutional responses in the United States since the nineteenth century. This racialization has been made salient by the recent rise in opioid abuse and dependence among whites, which has precipitated unprecedented efforts at caring for individuals with opioid use disorder. Such a response was not mounted in an attempt to treat Native American communities, which have similar rates of opioid overdose mortality as whites, nor was it mobilized in response to past and current drug epidemics in African American communities. Treatment and policy innovations have primarily targeted white communities, under the assumption that medicalization of addiction treatment will reduce stigma in treatment. In this chapter, the authors argue that stratified medicalization furthers racial inequalities in addiction treatment while also failing to reduce treatment stigma even among white Americans. Racialization of opioid use disorder has led to disparate policy and clinical responses, and it has led to criminalization of addiction among nonwhites and medicalization of addiction among whites, thereby deeply influencing and differentiating the experiences of stigma among these groups.


Racialized drug stigma Opioid use disorder 


  1. 1.
    Alexander M. The new Jim Crow: mass incarceration in the age of colorblindness. New York: The New Press; 2010.Google Scholar
  2. 2.
    Andrews CM, D’Aunno TA, Pollack HA, Friedmann PD. Adoption of evidence-based clinical innovations: the case of buprenorphine use by opioid treatment programs. Med Care Res Rev. 2014;71(1):43–60. Epub 18 Sep 2013.CrossRefPubMedGoogle Scholar
  3. 3.
    Barnett AI, Hall W, Fry CL, Dilkes-Frayne E, Carter A. Drug and alcohol treatment providers’ views about the disease model of addiction and its impact on clinical practice: a systematic review. Drug Alcohol Rev. 2018;37(6):697–720. Epub 2017 Dec 14.CrossRefGoogle Scholar
  4. 4.
    Barry DT, Irwin KS, Jones ES, Becker WC, Tetrault JM, Sullivan LE, Hansen H, O'Connor PG, Schottenfeld RS, Fiellin DA. Opioids, chronic pain, and addiction in primary care. J Pain. 2010;11(12):1442–50. Epub 2 Jun 2010.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Broz D, Ouellet LJ. Racial and ethnic changes in heroin injection in the United States: implications for the HIV/AIDS epidemic. Drug Alcohol Depend. 2008;94(1–3):221–33. Scholar
  6. 6.
    Campbell ND. Discovering addiction. : The science and politics of substance abuse research. Michigan: University of Michigan Press; 2007. Scholar
  7. 7.
    Casadonte PP, Kolodner GF, Horton T, McMurphy SM. Community treatment programs take up buprenorphine. Sci Pract Perspect. 2004;2(2):24–9.CrossRefGoogle Scholar
  8. 8.
    Centers for Disease Control (CDC). Vital signs: overdoses of prescription opioid pain relievers—United States, 1999–2008. Morb Mortal Wkly Rep. 2011;60:1487–92.Google Scholar
  9. 9.
    Centers for Disease Control (CDC). Overdose deaths involving opioids, cocaine, and psychostimulants — United States, 2015–2016. Morb Mortal Wkly Rep. 2018;67(12):349–58. Scholar
  10. 10.
    Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The changing face of heroin use in the United States: a retrospective analysis of the past 50 years. JAMA Psychiat. 2014;71(7):821–6. Scholar
  11. 11.
    Corrigan PW, Shapiro JR. Measuring the impact of programs that challenge the public stigma of mental illness. Clin Psychol Rev. 2010;30(8):907–22.CrossRefGoogle Scholar
  12. 12.
    Cummings JR, Wen H, Ko M, Druss BG. Race/ethnicity and geographic access to medicaid substance use disorder treatment facilities in the United States. JAMA Psychiat. 2014;71(2):190–6. Scholar
  13. 13.
    Delgado R, Stefancic J. Critical race theory: an introduction. New York: NYU Press; 2017.Google Scholar
  14. 14.
    Dick AW, Pacula RL, Gordon AJ, Sorbero M, Burns RM, Leslie D, Stein BD. Growth in buprenorphine waivers for physicians increased potential access to opioid agonist treatment, 2002-11. Health Aff (Millwood). 2015;34(6):1028–34. Scholar
  15. 15.
    Duncan LG, Mendoza S, Hansen H. Buprenorphine maintenance for opioid dependence in public sector healthcare: benefits and barriers. J Addict Med Ther Sci. 2015;1(1):031–6.Google Scholar
  16. 16.
    Fiellin DA. The first three years of buprenorphine in the United States: experience to date and future directions. J Addict Med. 2007;1(2):62–7. Scholar
  17. 17.
    Gone JP, Trimble JE. American Indian and Alaska native mental health: diverse perspectives on enduring disparities. Annu Rev Clin Psychol. 2012;8:131–60. Scholar
  18. 18.
    Gryczynski J, Jaffe JH, Schwartz RP, Dusek KA, Gugsa N, Monroe CL, et al. Patient perspectives on choosing buprenorphine over methadone in an urban, equal-access system. Am J Addict. 2013;22(3):285–91. Scholar
  19. 19.
    Hansen HB, Skinner ME. From white bullets to black markets and greened medicine: the neuroeconomics and neuroracial politics of opioid pharmaceuticals. Ann Anthropol Pract. 2012;36:167–87.CrossRefGoogle Scholar
  20. 20.
    Hansen HB, Siegel CE, Case BG, Bertollo DN, DiRocco D, Galanter M. Variation in use of buprenorphine and methadone treatment by racial, ethnic, and income characteristics of residential social areas in New York City. J Behav Health Serv Res. 2013;40(3):367–77. Scholar
  21. 21.
    Hansen H, Netherland J. Is the prescription opioid epidemic a white problem? Am J Public Health. 2016;106(12):2127–9.CrossRefGoogle Scholar
  22. 22.
    Hansen H, Siegel C, Wanderling J, DiRocco D. Buprenorphine and methadone treatment for opioid dependence by income, ethnicity and race of neighborhoods in New York City. Drug Alcohol Depend. 2016;164:14–21.CrossRefGoogle Scholar
  23. 23.
    Harris S. To be free and normal: addiction, governance, and the therapeutics of buprenorphine. Med Anthropol Q. 2015;29:512–30.CrossRefGoogle Scholar
  24. 24.
    Hatzenbuehler ML, Phelan JC, Link BG. Stigma as a fundamental cause of population health inequalities. Am J Public Health. 2013;103(5):813–21. Epub 14 Mar 2013.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Herzberg D. Happy pills in America: from Miltown to Prozac. Baltimore: Johns Hopkins University Press; 2009.Google Scholar
  26. 26.
    Heygi, N. (2017). Cherokee Nation Sues Wal-Mart, CVS, Walgreens over tribal opioid crisis. Retrieved from
  27. 27.
    Hughes PH, Barker NW, Crawford GA, Jaffe JH. The natural history of a heroin epidemic. Am J Public Health. 1972;62(7):995–1001.CrossRefGoogle Scholar
  28. 28.
    Kaye K. De-medicalizing addiction: toward biocultural understandings. Crit Perspect Addict. 2012;14:27–51.CrossRefGoogle Scholar
  29. 29.
    Kissin W, McLeod C, Sonnefeld J, Stanton A. Experiences of a national sample of qualified addiction specialists who have and have not prescribed buprenorphine for opioid dependence. J Addict Dis. 2006;25(4):91–103.CrossRefGoogle Scholar
  30. 30.
    Larance B, Carragher N, Mattick RP, Lintzeris N, Ali R, Degenhardt L. A latent class analysis of self-reported clinical indicators of psychosocial stability and adherence among opioid substitution therapy patients: do stable patients receive more unsupervised doses? Drug Alcohol Depend. 2014;142:46–55. Epub 2 Jun 2014.CrossRefPubMedGoogle Scholar
  31. 31.
    Link BG, Phelan J. Conceptualizing stigma. Annu Rev Sociol. 2001;27:363–85. Scholar
  32. 32.
    Magura S, Lee SJ, Salsitz EA, Kolodny A, Whitley SD, Taubes T, Seewald R, Joseph H, Kayman DJ, Fong C, Marsch LA, Rosenblum A. Outcomes of buprenorphine maintenance in office-based practice. J Addict Dis. 2007;26(2):13–23.CrossRefGoogle Scholar
  33. 33.
    McGinty EE, Goldman HH, Pescosolido B, Barry CL. Portraying mental illness and drug addiction as treatable health conditions: effects of a randomized experiment on stigma and discrimination. Soc Sci Med. 2015;126:73–85. Epub 5 Dec 2014.CrossRefPubMedGoogle Scholar
  34. 34.
    McGinty E, Pescosolido B, Kennedy-Hendricks A, Barry CL. Communication strategies to counter stigma and improve mental illness and substance use disorder policy. Psychiatr Serv. 2018;69(2):136–46. Epub 2 Oct 2017.CrossRefPubMedGoogle Scholar
  35. 35.
    McLellan AT, Lewis DC, O’Brien CP, Kleber HD. Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. JAMA. 2000;284(13):1689–95.CrossRefGoogle Scholar
  36. 36.
    Mennis J, Stahler GJ. Racial and ethnic disparities in outpatient substance use disorder treatment episode completion for different substances. J Subst Abus Treat. 2016;63:25–33.CrossRefGoogle Scholar
  37. 37.
    Merrill JO, Rhodes LA, Deyo RA, Marlatt GA, Bradley KA. Mutual mistrust in the medical care of drug users. J Gen Intern Med. 2002;17:327–33.PubMedPubMedCentralGoogle Scholar
  38. 38.
    Netherland J, Hansen H. White opioids: pharmaceutical race and the war on drugs that wasn’t. BioSocieties. 2017;12(2):217–38.CrossRefGoogle Scholar
  39. 39.
    Omi M, Winant H, editors. Racial formation in the United States: from the 1960s to the 1990s. 2nd ed. New York: Routledge; 1994.Google Scholar
  40. 40.
    Rice WS, Logie CH, Napoles TM, Walcott M, Batchelder AW, Kempf MC, Wingood GM, Konkle-Parker DJ, Turan B, Wilson TE, Johnson MO, Weiser SD, Turan JM. Perceptions of intersectional stigma among diverse women living with HIV in the United States. Soc Sci Med. 2018;208:9–17. Scholar
  41. 41.
    Roman PM, Ducharme LJ, Knudsen HK. Patterns of organization and management in private and public substance abuse treatment programs. J Subst Abus Treat. 2006;31(3):235–43. Epub 14 Aug 2006.CrossRefGoogle Scholar
  42. 42.
    Stanton A, McLeod C, Luckey B, Kissin WB, Sonnefeld LJ. Presentation: SAMHSA/CSAT evaluation of the buprenorphine waiver program: expanding treatment of opioid dependence: initial physician and patient experiences with the adoption of buprenorphine. Substance Abuse Mental Health Ser Admin. 2006.Google Scholar
  43. 43.
    Williams IL. The intersection of structurally traumatized communities and substance use treatment: dominant discourses and hidden themes. J Ethn Subst Abuse. 2016;15(2):95–126.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Sonia Mendoza
    • 1
    • 2
  • Alexandrea E. Hatcher
    • 3
  • Helena Hansen
    • 2
    Email author
  1. 1.Mailman School of Public Health, Sociomedical Sciences DepartmentColumbia UniversityNew YorkUSA
  2. 2.New York University, Departments of Anthropology and PsychiatryNew YorkUSA
  3. 3.Drug Policy AllianceNew YorkUSA

Personalised recommendations