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Special Issue "Substance Use, Stigma and Social Harm"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Mental Health".

Deadline for manuscript submissions: 30 November 2023 | Viewed by 3946

Special Issue Editors

Department of Sociology, Durham University, Durham DH1 3HN, UK
Interests: social and health inequalities; lived experiences of people who use illicit drugs; marginalisation and stigma
Department of Social Work Education and Community Wellbeing, Faculty of Health and the Life Sciences, Northumbria University, Newcastle NE7 7XA, UK
Interests: addiction psychology; treatment; motivational interviewing; mental illness; counseling
Department of Sociology, Durham University, Durham DH1 3LE, UK
Interests: drug use and addiction; structural violence and illness; psychoanalysis; ethnography; mental health

Special Issue Information

Dear Colleagues,

This Special Issue of the International Journal of Environmental Research and Public Health (IJERPH) brings together new interdisciplinary analyses of the impacts of substance use, stigma and social harm on health and social inequalities during a time of global upheaval. This arises partly out of the WHO’s agenda for social justice in which they advocate that everyone should have the same opportunities to lead a healthy life. However, we are witnessing a worrying escalation in drug-related deaths in the UK and globally (4,561 deaths related to drug poisoning) [1]. We know that drug use has increased for frequent users during and after the global pandemic, and the number of drug-related offences increased by 30% between April and June 2020 in the UK [1]. These increases and subsequent increases in the need and demand for services have also aligned with a public and political hardening of attitudes and stigmatisation towards people who use drugs (PWUD) [2,3], cuts to public services as a result of ‘austerity economics’, and an increase in a criminal justice response to drug use as a means of reducing social harm [4].

There is an urgent need for insights into the health and social harms arising from stigma which is weaponised against vulnerable groups [5] who use drugs, as well as critical engagement with systems of power and privilege that reproduce social harm. The focus here on social harm, as an analytical framework, presents an opportunity to develop an understanding of how socially mediated injury and public and private stigma overlaps with social and health inequalities and criminalisation at a time where the global ‘cost of living crisis’, food and energy poverty, and the aftermath of the global pandemic are acutely impacting the most vulnerable and marginalised in society [6].

Furthermore, we call for a fundamental reorientation in public health, social care, and criminal justice systems which can add to, rather than mitigate, social harm towards vulnerable groups who use drugs. In doing so, we invite scholars to creatively and critically rethink how drug use could be framed, navigated, and addressed in these systems to better support people who use drugs and reduce the harms that are generated via everyday stigmatisation. This involves moving attention ‘upstream’ to structural and contextual factors that can shape drug use and critically engaging with toxic individualising rhetoric that presents drug use as a ‘problem of the person’ [3,7]. We ask scholars and readers to engage in debate that addresses the questions: ‘Why does stigma persist?’ and ‘whose interests does stigmatisation serve?’ when public health and criminal justice systems engage with PWUD. In doing so, we turn attention to how and why stigma is weaponised against PWUD and how this generates unfair and unjust health and social harms impacting marginalised and minoritised communities the most.

This Special Issue shines a light on the lives and voices of communities of people who have past or present experience of using drugs, as well as the practitioners who provide support services. In doing so, we are particularly interested in power imbalances and intersectional oppressions reproduced by structural inequalities and experienced by these people.

We are also hopeful of (radical) change and encourage scholars, practitioners, and readers to develop creative and pragmatic solutions and recommendations that address the problem of stigma and social harm impacting the lives of people who use drugs both within and across public health and criminal justice systems. As such, we invite scholars to address the following questions:

  • How and why is stigma weaponised against people who use drugs?
  • What social and health harms arise from stigma connected to drug use? We are particularly interested in a focus on mental health.
  • How is stigma variously experienced by PWUD from within and across different stages of the criminal justice system, social care, and public health services?
  • How is stigma identified, negotiated, resisted, or refused by people who use drugs at different stages of the life course and across different intersections of identity?
  • How does the stigmatisation of people who use drugs impact on a person’s sense of inclusion in society?
  • Does stigma harm people who use drugs equally, or is this unevenly experienced?
  • How can we imagine criminal justice systems and public health differently so that they operate to reduce social harm experienced by PWUD?

Presenting original and distinctive research, this Special Issue will showcase a range of research designs and will have broad appeal to an international audience given the scope of involvement and focus on public health, criminology, sociology, social psychology, psychology, and social work. New research papers, reviews and case reports are invited to be submitted to this issue. Other manuscript types also accepted include methodological papers, position papers, brief reports, and commentaries.


  1. Office for National Statistics. Drug misuse in England and Wales: year ending March 2020. Available online: https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/articles/
     (accessed on 16 November 2022).
  2. Wacquant, L. Urban Outcasts: A Comparitive Sociology of Advanced Marginality; Polity Press: Cambridge, UK, 2008.
  3. Addison, M. Framing Stigma as an Avoidable Social Harm that Widens Inequality. Sociol. Rev. 2023.
  4. HM Government. From harm to hope: A 10-year drugs plan to cut crime and save lives. Available online: https://www.gov.uk/government/publications/from-harm-to-hope-a-10-year-drugs-plan-to-cut-crime-and-save-lives (accessed on 16 November 2022).
  5. Scambler, G. Heaping blame on shame: 'Weaponising stigma' for neoliberal times. Sociol. Rev. 201866, 766–782.
  6. Pemberton, S.; Pantazis, C.; Hillyard, P. Poverty and social harm: Challenging discourses of risk, resilience and choice. Poverty and Social Exclusion in the UK: Volume 2 - The Dimensions of Disadvantage, 1st ed.; Polity Press: Cambridge, UK, 2017.
  7. Drugs, Identity and Stigma, 1st ed.; Addison, M.; McGovern, W.; McGovern, R., Eds.; Palgrave Macmillan: London, UK, 2022.

Dr. Michelle Addison
Dr. William McGovern
Dr. Jesse Proudfoot
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.


  • stigma
  • social harm
  • health and social inequality
  • public health and social care
  • criminal justice

Published Papers (2 papers)

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Exploratory Factor Analysis of a French Adapted Version of the Substance Abuse Attitude Survey among Medical Students in Belgium
Int. J. Environ. Res. Public Health 2023, 20(7), 5356; https://doi.org/10.3390/ijerph20075356 - 31 Mar 2023
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To evaluate the impact of a new Substance Use Disorder (SUD) education program on medical students’ attitudes, we selected the Substance Abuse Attitude Survey (SAAS) questionnaire, which we adapted to our curriculum and cultural context. To validate this adapted version, we conducted an [...] Read more.
To evaluate the impact of a new Substance Use Disorder (SUD) education program on medical students’ attitudes, we selected the Substance Abuse Attitude Survey (SAAS) questionnaire, which we adapted to our curriculum and cultural context. To validate this adapted version, we conducted an exploratory factor analysis following the administration of our 29-item bSAAS questionnaire to 657 medical students in Belgium (response rate: 71.1%). Twenty-three items correlated to three factors; namely, “Stereotypes and moralism”, “Treatment optimism” and “Specialized treatment” were retained (70% of total variance explained, Cronbach’s alpha = 0.80) and constituted the new questionnaire called beSAAS. The factor “Specialized treatment” stood out from previous studies, which could be explained by our target population and the impact of the formal, informal and hidden curricula in medical education. This study was able to highlight certain factors influencing stereotypical representations such as age, gender, origin, personal or professional experience with substance use. Our study allowed us to retain the beSAAS as a good questionnaire to evaluate SUD stigma and highlighted interesting findings to improve SUD training in medicine. Further studies are needed to complete its validity and reliability. Full article
(This article belongs to the Special Issue Substance Use, Stigma and Social Harm)
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Should I Stay or Should I Go? A Qualitative Exploration of Stigma and Other Factors Influencing Opioid Agonist Treatment Journeys
Int. J. Environ. Res. Public Health 2023, 20(2), 1526; https://doi.org/10.3390/ijerph20021526 - 14 Jan 2023
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(1) The harm-reduction benefits of opioid agonist treatment (OAT) are well-established; however, the UK government’s emphasis on “recovery” may be contributing to a high proportion of people leaving treatment and low retention rates. We wanted to develop a rich and nuanced understanding of [...] Read more.
(1) The harm-reduction benefits of opioid agonist treatment (OAT) are well-established; however, the UK government’s emphasis on “recovery” may be contributing to a high proportion of people leaving treatment and low retention rates. We wanted to develop a rich and nuanced understanding of the factors that might influence the treatment journeys of people who use OAT. (2) We explored factors at each level of the socioecological system and considered the ways these interact to influence treatment journeys in OAT. We carried out semi-structured interviews with people who use OAT (n = 12) and service providers (n = 13) and analysed data using reflexive thematic analysis. (3) We developed three themes representing participant perceptions of treatment journeys in OAT. These were: (1) The System is Broken; (2) Power Struggles; and (3) Filling the Void. (4) Conclusions: The data suggest that prioritisation of treatment retention is important to preserve the harm-reduction benefits of OAT. Stigma is a systemic issue which presents multiple barriers to people who use OAT living fulfilling lives. There is an urgent need to develop targeted interventions to address stigma towards people who use OAT. Full article
(This article belongs to the Special Issue Substance Use, Stigma and Social Harm)
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Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Authors: Joanne McGrath, Monique Lhussier, Steve Crossley, Natalie Forster
Affiliation: Northumbria University, UK; Durham University, UK
Abstract: Child removal is a common experience of women with experience of severe and multiple disadvantage but professional involvement often tapers off with little ongoing support for mothers. This article aims to explore women’s narratives of child removal within life stories of multiple exclusion homelessness and examines how stigma, power and State surveillance manifested in their experiences. Data drawn from qualitative interviews with 18 mothers conducted in north-east of England are explored within the wider context of lifetimes of multiple exclusion and stigma. All participants had experienced the removal of their children through the family courts. Women described the immediate mental health impact following child removal, which frequently precipitated a crisis event deepening cumulative trauma and enduring problems. Drawing on women’s accounts we seek to illuminate their experiences of child removal and enhance our understanding of how stigma plays out in statutory settings. In particular family court proceedings are perceived by the mothers as punitive and heavily prejudiced. The removal of their children is frequently a highly traumatic experience, adding to mistrust of statutory services and ultimately leading to further social exclusion.
Keywords: multiple disadvantage; stigma, mothers; child removal

Title: Addiction as Moral Failure, Feast and Phoenix
Authors: Tammy Ayres; Stuart Taylor
Affiliation: University of Leicester; Open University
Abstract: This article will theoretically examine the stigmatisation of the ‘drug addict’. In the context of consumer capitalism drug addiction has become a moralistic metaphor for a failed life. Addicts have been stigmatised to create artificial monsters. They constitute matter out of place as their excessive consumption means they are ostracised and branded as failures. Providing a tripartite framework - of failure, feast, and phoenix – this article will illustrate addiction’s contradictory moral place, highlighting the contentious and contradictory practices of consumer capitalism, which at once act as cause, effect, and solution. It is in this context that the stigmatisation of addiction operates, despite the fact addicts - Jouisseaur Propres – constitutes a consumer par excellence solicited by the very system that seeks to punish, control and cure them (Žižek, 2014). Drawing on Girard’s (1986) generative scapegoat it will examine the hypocritical and contradictory portrayal of addiction, the social harm and stigmatisation arising from this portrayal and the systems of power and privilege (e.g. capitalism and its drug apartheid) that reproduce this social harm.

Title: The associated stigma of substance use during the perinatal period and the resulting outcomes for both the mother and child: A cross- cultural critical review
Authors: Sam Burton; Jo-Anne Puddephatt; Abi Rose; Sergio A. Silverio; Abigail Easter
Affiliation: School of Life Course & Population Sciences, King’s College London; Faculty of Health & Medicine, Lancaster University; School of Psychology, Liverpool John Moores University
Abstract: Background: The perinatal period is characterized by significant social and physiological changes, and a time when it is crucial to capture women’s healthcare needs and encourage positive health practices (1). Perinatal women who engage in substance use are of major public health concern, and globally, clinical and government guidelines advocate for pregnant women to ab-stain from substance use. However, evidence suggests moderate rates of alcohol and tobacco use persist. Methods: Adopting a critical review methodology we will provide a broad, informed narrative about perinatal substance us (2). Our aim is to develop new theorizing on the area. Results: 2.47 substance-use related perinatal deaths per 100,000 occur (3), 86% occurring after maternity care cessation (4). Social stigmatization suggests mothers who use alcohol are anti-thetical to the ‘motherhood ideal’, embody the ‘bad mother’ discourse, and are unfit to parent(5). Such stigma is embedded within healthcare services (6) leading women to adopt strategies to evade detection by avoiding treatment (7). Conclusion: Perinatal women face stigmatization for substance, and fear of disclosure and po-tential repercussions acts as a barrier to accessing healthcare. We argue this as indicative of wider societal harm incurred because of such stigma on perinatal substance use.

Title: Drug stigma, consumer culture, and corporate power in the US opioid crisis
Authors: Liviu Alexandrescu
Affiliation: Manchester Metropolitan University
Abstract: Recent theoretical efforts to rethink drug and dependency stigma have been increasingly considering the power dimension of the concept, to show how stigma formations flow top-down from governments and political stakeholders to the powerless and marginalised. These also attach themselves to the individual and collective identities of the substance-using subject. But they equally alter the multiple lives of the substance. In the US opioid crisis of the recent decades, big pharma companies could be seen lobbying the medical profession and harnessing their economic power to destigmatise opioid painkillers in their efforts to effectively ‘stigmatise’ pain, as part of their wider marketing strategies. This has been linked with rising opioid-related fatalities and spiralling addiction rates among some of the most vulnerable communities and groups. This theoretical paper locates the object-stigma of drugs between the cultural confines of ‘limbic capitalism’ (the drive to seek pleasure through consumption) and ‘palliative capitalism’ (the drive to pathologize and medicate ills attributed to the individual, but not the system). It argues that stigma should be viewed as a dynamic force which, under the guise of consumer culture, can be manipulated by corporate actors and business elites to shift meanings around pain, pleasure, addiction, in ways that are conducive to social harms.

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