Principle 5

The first four principles in JSI’s framework have focused on what justice professionals should understand and do when responding to substance use disorders (SUDs). SUD is a chronic medical condition. It is treatable, and recovery is possible. Accountability and recovery can coexist. Justice-system responses should be guided by evidence about what works. Principle 5 addresses another factor that can influence those responses: substance use disorder stigma.

Consider, even evidence-based practices can be undermined by the assumptions we bring to them. The words used to describe someone, assumptions made about their motivation, and attitudes toward treatment and recovery can influence decisions throughout the justice system. They affect whether someone is viewed and treated as a person or simply as a problem. They affect access to treatment, acceptance of medications for opioid use disorder (MOUD), responses to renewed substance use, and expectations about whether recovery is possible.

Overcoming stigma is not simply about changing language or attitude. It can affect what decisions are made and, ultimately, the outcomes those decisions produce.

Stigma Begins with Assumptions

Historically, SUDs have been associated with ideas about character, morality, and personal weakness.^[1] Those attitudes have not disappeared simply because medical science has advanced.^[2]

Even today an individual who continues to use illicit substances despite serious consequences is often described as unmotivated, manipulative, noncompliant, or unwilling to change.^[3] Someone who returns to substance use after a period of recovery may be viewed as having thrown away an opportunity.^[4] A person receiving an MOUD, such as Methadone, may be regarded as substituting one drug for another.^[5]

That skepticism may be understandable. Justice professionals often encounter individuals with SUD after repeated arrests, unsuccessful treatment attempts, broken promises, and harm to families and communities.^[6]

But skepticism can become prejudice when those experiences shape judgments about an individual’s willingness or ability to change. Those judgments can stigmatize the individual.

Language Can Shape Perception

Words do more than describe behavior. They influence how we think about the person. Consider the difference between describing someone as an “addict” and describing that person as an “individual with a substance use disorder.” One defines the individual by the condition. The other identifies a person who has a condition.

The distinction may appear minor, but research has found that terminology can influence attitudes.^[7] Studies comparing terms such as “substance abuser” with “person with a substance use disorder” have found that stigmatizing terminology can lead people to favor more punitive responses.^[8] That has particular significance in the justice system.

Words appear in police reports, court files, treatment reports, supervision records, hearings, team meetings, and conversations with participants. Terms such as “dirty urine,” “clean,” “addict,” “drug abuser,” or “habit” may carry judgments that are unnecessary to describe what actually occurred.^[9]

The same information can be communicated in language that describes what occurred without characterizing the individual. A drug test is positive or negative. A person is receiving medication for OUD. An individual returned to substance use. A participant did not attend a required appointment. Those descriptions identify the relevant facts without adding a label.

How Substance Use Disorder Stigma Affects Justice Decisions

If renewed substance use is automatically interpreted as proof that someone does not care about recovery, a sanction may follow without considering whether treatment should also be reassessed. If someone receiving MOUD is viewed as “still using,” access to an effective medication may be restricted. If a person with SUD is assumed to be dishonest because of the diagnosis, information that would be evaluated objectively for another individual may be discounted.

This does not mean justice professionals should ignore dishonesty, manipulation, violations, criminal behavior, or risks to public safety. An SUD diagnosis does not establish that every behavior is caused by the disorder, nor does it prevent individuals from being held responsible for their actions. Decisions should be based on evidence about the individual and the behavior, not assumptions attached to a diagnosis.

That distinction is consistent with the evidence-based approach discussed in Principle 4. Justice professionals should ask what happened, what the available information establishes, what risks are present, and what response is most likely to achieve the intended objective.

Principle 4 emphasized that justice system responses should be guided by evidence rather than tradition or intuition. The same standard should apply when decisions involve individuals with SUD. If research tells us that SUD is treatable, that recovery is possible, that treatment should be individualized, or that medications are effective, those conclusions should not be displaced by beliefs about character, motivation, or what recovery is supposed to look like.

Stigma Can Become a Barrier to Treatment

Stigma can also affect whether people seek and remain engaged in treatment. Admitting to a substance use problem can carry consequences. Individuals may fear judgment from family members, employers, treatment providers, or the justice system. They may worry that acknowledging continued use will be interpreted as failure rather than information that could help determine what should happen next.

In the justice system, those concerns can be magnified because disclosure may occur in an environment where liberty, supervision conditions, family relationships, employment, or other significant interests are at stake.

That creates a practical challenge. Justice professionals need accurate information to make good decisions, yet an environment in which people expect humiliation or automatic punishment can discourage honest communication.

Reducing stigma does not mean eliminating consequences. It means creating an environment in which individuals can be held accountable without being defined by their worst behavior or discouraged from acknowledging when they need help.

MOUD Shows the Consequences of Stigma

Few areas demonstrate the consequences of stigma more clearly than MOUD. The belief that someone receiving an prescribed opioid medication is merely replacing one addiction with another can affect whether individuals are permitted to begin or continue medication while involved with courts, treatment programs, correctional facilities, or community supervision.

That is not simply a disagreement over terminology. It can become a barrier to evidence-based care.

Justice professionals do not need to decide which medication is appropriate for a particular individual. That is a clinical determination. But they should recognize when assumptions about medication, rather than medical evidence, are influencing justice-system decisions.

The same principle applies beyond MOUD. If the justice system expects its practices to be guided by evidence, attitudes about treatment should change when the evidence changes.

Respect and Accountability Are Not Opposites

Some judges and other justice professionals may assume that reducing stigma requires lowering expectations or weakening accountability. It changes how accountability is imposed, not whether it is imposed.

A judge can enforce a court order while treating the individual before the court with dignity. A supervision professional can address a violation without labeling the individual a failure. A treatment court can impose a consequence while making clear what behavior led to it and what the participant can do differently. Law enforcement can protect public safety while recognizing that a person experiencing a substance use disorder is more than the conduct that brought the officer to the scene.

People are more likely to hear difficult messages when they believe they have been treated fairly and with dignity.^[10]Accountability focused on behavior also gives individuals something concrete to change. Labels do not.

• “You failed to attend treatment as ordered” identifies behavior.
• “You are an addict who does not care about treatment” assigns an identity and a motive.

Only one of those statements tells the individual what needs to change.

Changing Language Is Only the Beginning

Replacing stigmatizing terminology is important, but changing vocabulary without changing attitudes accomplishes little. Justice organizations should examine their policies and practices as well as their words.

Are individuals receiving MOUD treated differently from people receiving medication for other chronic conditions? Is renewed substance use automatically treated as proof that treatment has failed? Are people with SUD assumed to be less credible because of their diagnosis? Do court forms, policies, reports, and training materials use outdated terminology? Do professionals speak differently about participants when those individuals are not in the room?

This self-examination is important as stigma is often most influential when people do not recognize that it is affecting their decisions.

Language and Attitudes Matter

The justice system cannot eliminate the consequences of substance use disorder. Nor should it ignore criminal behavior, risk, harm to victims, or violations of lawful orders. But it can decide whether its responses are shaped by evidence or stereotypes. People with SUD should be held responsible for their behavior when responsibility is appropriate. They should also be treated as people capable of change.

The language justice professionals use communicates expectations. Their attitudes can influence treatment access, engagement, and recovery. Their decisions can reinforce stigma or help remove unnecessary barriers to change.

The first four principles tell us that SUD should be understood through science, that recovery is possible, that accountability can promote public safety, and that justice practices should be guided by evidence. Principle 5 adds another requirement: the language and attitudes justice professionals bring to those decisions matter.

But reducing stigma and removing barriers are not enough. Recovery also requires support. Treatment, stable relationships, housing, employment, peer support, and continuity of care can all influence whether an individual is able to sustain change. The justice system does not provide all of those supports, but its decisions can help connect individuals to them or make them more difficult to access.

That leads to the sixth and final principle in JSI’s framework: Support. Recovery is strengthened when the justice system helps create the conditions in which change can last.

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^[1] Nora D. Volkow & Carlos Blanco, Substance Use Disorders: A Comprehensive Update of Classification, Epidemiology, Neurobiology, Clinical Aspects, Treatment and Prevention, 22 World Psychiatry 203, 203–29 (2023).

^[2] Id.

^[3] L.C. van Boekel et al., Stigma Among Health Professionals Towards Patients with Substance Use Disorders and Its Consequences for Healthcare Delivery: Systematic Review, 131 Drug & Alcohol Dependence 23, 23–35 (2013).

^[4] Id.

^[5] Nat’l Acads. of Scis., Eng’g & Med., Medications for Opioid Use Disorder Save Lives 12, 89–90 (Alan I. Leshner & Michelle Mancher eds., 2019).

^[6] Faye S. Taxman & David Soule, What Works in Residential Reentry Centers, 38 Crim. Just. & Behav. 103, 103–20 (2011).

^[7] John F. Kelly & Cassandra M. Westerhoff, Does It Matter How We Refer to Individuals with Substance-Related Conditions? A Randomized Study of Two Commonly Used Terms, 21 Int’l J. Drug Pol’y 202, 202–07 (2010).

^[8] Id.; Kelly, Sarah J. Dow & Cara Westerhoff, Does Our Choice of Substance-Related Terms Influence Perceptions of Treatment Need? An Empirical Investigation with Two Commonly Used Terms, 40 J. Drug Issues 805, 805–18 (2010).

^[9] Nat’l Inst. on Drug Abuse, Words Matter: Preferred Language for Talking About Addiction, Nat’l Insts. of Health,NIDA, Words Matter (last visited Aug. 21, 2026).

^[10] Brian MacKenzie, The Judge Is the Key Component: The Importance of Procedural Fairness in Drug-Treatment Courts, published as an AJA White Paper in Court Review, Volume 52, Issue 1 (2016),