The Incidence and Disparities in Use of Stigmatizing Language in Clinical Notes for Patients With Substance Use Disorder

Scott G Weiner, Ying-Chih Lo, Aleta D Carroll, Li Zhou, Ashley Ngo, David B Hathaway, Claudia P Rodriguez, Sarah E Wakeman
Peer-Reviewed Article
January 2023


Patients with substance use disorder were likely to have at least one medical note containing stigmatizing language.


The drug-related overdose crisis in the U.S. continues to increase at historic levels. Combatting stigma of people with substance use disorder (SUD) is important to increase political and public support for dedicating resources and improving policy to address SUD. Addressing stigma is also essential to ensure that providers identify and treat SUD more effectively. This study analyzed over 500,000 medical notes of patients with SUD across a one-year period at a major health care system operating in Massachusetts and New Hampshire to determine the incidence of stigmatizing language for patients with SUD and explore if there were associated disparities based on demographic characteristics.


The study found that 61% of patients with SUD had at least one medical note containing stigmatizing language, such as “alcoholic” or “user.” Patients with Medicaid had disproportionately higher rates of stigmatizing language in their medical notes compared to patients with commercial insurance (70% compared to 57%). Black patients had disproportionately higher percentages than white patients, but not in the adjusted analysis. The study had several other findings, including that nurses were less likely than other providers to use stigmatizing language in medical notes and office visits were less likely to be associated with use of stigmatizing language than hospital encounters.


These findings suggest that hospital-based providers need education about stigma of people with SUD.

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