Stigma and discrimination can be barriers to coordinated care. Stigma is usually based on stereotypes, assumptions or misconceptions, that discriminate, disparage, or devalue a person or a group of people [620, 621]. Stigma and discrimination are particularly evident in relation to both mental health and AOD use and can result in people being excluded from or denied health services [622]. Some people view those with AOD use conditions as being personally responsible for their problems and therefore less deserving of sympathy and treatment. Although some headway has been made in relation to societal attitudes toward other mental health conditions, some people continue to view people with AOD use disorders as immoral [623–626]; or potentially dangerous, violent, or manipulative [627, 628].
There is evidence that stigma and discrimination are commonly experienced across healthcare settings by people with co-occurring AOD and mental health conditions and are significant barriers to people accessing health services [622, 624]. Those who have experienced stigma or discrimination, or perceive that stigma exists, are less likely to access treatment services or seek help [624]. Unfortunately, these negative experiences can deter or delay future help-seeking [629].
Stigma and the attitudes of some providers can also impact the quality of healthcare provided, particularly among clinicians who believe people with co-occurring conditions are responsible for their own problems and are therefore less deserving of treatment than other people. For example, a person experiencing co-occurring conditions in need of a liver transplant may be perceived as less deserving than a person without co-occurring conditions [630]. These biases may also impact upon clinicians’ interactions with clients, insofar as clinicians with these attitudes may be more likely to patronise, scold or blame clients, provide opinion-based (as opposed to evidence-based) advice and care [631], or deny treatment altogether [624, 632].
Lack of practitioner knowledge, discriminatory workplace policies, practices, and structures may also intentionally or unintentionally deter people from seeking help [632, 633]. For example, workplace cultures that normalise stigmatising language or behaviours can impact whether clients are treated with dignity and respect [634].
As described in Chapter A3, Chapter B3 and Chapter B4, the language used when working with co-occurring conditions is vitally important; equally important is the use of respectful, person-centred, non-judgemental language when discussing clients with other healthcare providers, family members, or members of the public. Useful language guides developed by NADA and NUAA, in collaboration with people with lived experience, provide suggestions for non-stigmatising language, and examples of how such language can be utilised in clinical practice. More information about the Language Matters resource is available via NADA: https://nada.org.au/resources/language-matters/. There is preliminary evidence for organisational interventions aimed at reducing stigma among service providers [635, 636], which should include the identification of structural factors within workplaces and organisations that may contribute to the perpetuation of stigma, and consultation with the workforce [634, 637, 638].