Impact of Substance Use Terminology on MSW Students: A Randomized Vignette Study

Abstract

Purpose

Despite recognizing substance use-related stigma as a potential primary obstacle to treatment engagement, there is limited evidence investigating the nuanced intersection of stigma with master's level social work (MSW) education. Method We randomly assigned 322 MSW students to read one of two vignettes differing only in terminology describing a character's substance use condition (“substance use disorder” vs. “substance abuser”). Two Likert scales measured attitudes toward punishment and personal comfort. Results Students exposed to less stigmatizing language perceived lower social threat in individuals with SUD, with no significant difference in punitive attitudes. Discussion Findings reveal that language used by future social workers affects attitudes toward substance use. Terms like “substance use disorder” reduce perceptions of social threat, highlighting the need to educate MSW students on stigma-reducing language. This may foster more empathetic, professional practice. Further research should explore additional methods for reducing stigmatizing attitudes in social work education.

Keywords

MSW students stigma substance use social work education

Get full access to this article

View all access options for this article.

References

Akoglu

(2018). User’s guide to correlation coefficients. Turkish Journal of Emergency Medicine, 18(3), 91–93. https://doi.org/10.1016/j.tjem.2018.08.001

Ali

M. M.

Teich

J. L.

Mutter

(2017). Reasons for not seeking substance use disorder treatment: Variations by health insurance coverage. The Journal of Behavioral Health Services & Research, 44(1), 63–74. https://doi.org/10.1007/s11414-016-9538-3

Ashford

R. D.

Brown

A. M.

Canode

McDaniel

Curtis

(2019). A mixed-methods exploration of the role and impact of stigma and advocacy on substance use disorder recovery. Alcoholism Treatment Quarterly, 37(4), 462–480. https://doi.org/10.1080/07347324.2019.1585216

Ashford

R. D.

Brown

Curtis

(2019). Expanding language choices to reduce stigma: A Delphi study of positive and negative terms in substance use and recovery. Health Education, 119(1), 51–62. https://doi.org/10.1108/HE-03-2018-0017

Babor

T. F.

Hall

(2007). Standardizing terminology in addiction science: To achieve the impossible dream. Addiction, 102(7), 1015–1018. https://doi.org/10.1111/j.1360-0443.2007.01845.x

Benz

M. B.

Cabrera

K. B.

Kline

Bishop

L. S.

Palm Reed

(2021). Fear of stigma mediates the relationship between internalized stigma and treatment-seeking among individuals with substance use problems. Substance Use & Misuse, 56(6), 808–818. https://doi.org/10.1080/10826084.2021.1899224

Blanco

Iza

Rodríguez-Fernández

J. M.

Baca-García

Wang

Olfson

(2015). Probability and predictors of treatment-seeking for substance use disorders in the US. Drug and Alcohol Dependence, 149, 136–144. https://doi.org/10.1016/j.drugalcdep.2015.01.031

Botticelli

M. P.

Koh

H. K.

(2016). Changing the language of addiction. JAMA, 316(13), 1361–1362. https://doi.org/10.1001/jama.2016.11874

Brezing

Marcovitz

(2016). Stigma and persons with substance use disorders. In Parekh

Childs

E. W.

(Eds.), Stigma and prejudice (pp. 113–132). Springer International Publishing.

10.

Carpenter

(2002). Mental health recovery paradigm: Implications for social work. Health & Social Work, 27(2), 86–94. https://doi.org/10.1093/hsw/27.2.86

11.

Chung

Monroe

G. S.

(2003). Exploring social desirability bias. Journal of Business Ethics, 44(4), 291–302. https://doi.org/10.1023/A:1023648703356

12.

Clary

Bennett

Bui

Tan

Carter-Black

(2023). Simulation-based learning to foster critical dialogues and enhance cultural competency with MSW students. Journal of Social Work Education, 59(4), 977–990. https://doi.org/10.1080/10437797.2022.2033661

13.

Cohen

(1988). The effect size. In Statistical power analysis for the behavioral sciences (pp. 77–83). Routledge.

14.

Cohen

Feinn

Arias

Kranzler

H. R.

(2007). Alcohol treatment utilization: Findings from the national epidemiologic survey on alcohol and related conditions. Drug and Alcohol Dependence, 86(2-3), 214–221. https://doi.org/10.1016/j.drugalcdep.2006.06.008

15.

Corrigan

P. W.

Druss

B. G.

Perlick

D. A.

(2014). The impact of mental illness stigma on seeking and participating in mental health care. Psychological Science in the Public Interest, 15(2), 37–70. https://doi.org/10.1177/1529100614531398

16.

Corrigan

P. W.

Kerr

Knudsen

(2005). The stigma of mental illness: Explanatory models and methods for change. Psychology, 11(3), 179–190. https://doi.org/10.1016/j.appsy.2005.07.001

17.

Corrigan

P. W.

Schomerus

Shuman

Kraus

Perlick

Harnish

Kulesza

Kane-Willis

Qin

Smelson

(2017). Developing a research agenda for understanding the stigma of addictions part I: Lessons from the mental health stigma literature. The American Journal on Addictions, 26(1), 59–66. https://doi.org/10.1111/ajad.12458

18.

Corrigan

P. W.

Watson

A. C.

Miller

F. E.

(2006). Blame, shame, and contamination: The impact of mental illness and drug dependence stigma on family members. Journal of Family Psychology, 20(2), 239–246. https://doi.org/10.1037/0893-3200.20.2.239

19.

Council on Social Work Education. (2021). Practitioner education in substance use and misuse: Competency-based resources. https://cswe.org/getdoc/fc32c12a-5fee-4e23-a352-9a9176fb5856/Practitioner-Education-in-Substance-Use-and-Misuse.aspx.

20.

Crapanzano

Vath

R. J.

Fisher

(2014). Reducing stigma towards substance users through an educational intervention: Harder than it looks. Academic Psychiatry, 38(4), 420–425. https://doi.org/10.1007/s40596-014-0067-1

21.

Earnshaw

V. A.

(2020). Stigma and substance use disorders: A clinical, research, and advocacy agenda. American Psychologist, 75(9), 1300–1311. https://doi.org/10.1037/amp0000744

22.

Estreet

Archibald

Tirmazi

M. T.

Goodman

Cudjoe

(2017). Exploring social work student education: The effect of a harm reduction curriculum on student knowledge and attitudes regarding opioid use disorders. Substance Abuse, 38(4), 369–375. https://doi.org/10.1080/08897077.2017.1341447

23.

Farhoudian

Razaghi

Hooshyari

Noroozi

Pilevari

Mokri

Mohammadi

M. R.

Malekinejad

(2022). Barriers and facilitators to substance use disorder treatment: An overview of systematic reviews. Substance Abuse: Research and Treatment, 16, 1–11. https://doi.org/10.1177/11782218221118462

24.

Goffman

(1963). Embarrassment and social organization. In Smelser

N. J.

Smelser

W. T.

(Eds.), Personality and social systems (pp. 541–548). John Wiley & Sons, Inc.

25.

Goodyear

Haass-Koffler

C. L.

Chavanne

(2018). Opioid use and stigma: The role of gender, language and precipitating events. Drug and Alcohol Dependence, 185, 339–346. https://doi.org/10.1016/j.drugalcdep.2017.12.037

26.

Hatzenbuehler

M. L.

Link

B. G.

(2014). Introduction to the special issue on structural stigma and health. Social Science & Medicine, 103, 1–6. https://doi.org/10.1016/j.socscimed.2013.12.017

27.

Heather

(2017). Q: Is addiction a brain disease or a moral failing? A: Neither. Neuroethics, 10(1), 115–124. https://doi.org/10.1007/s12152-016-9289-0

28.

Kelly

J. F.

Greene

M. C.

Abry

(2021). A US national randomized study to guide how best to reduce stigma when describing drug-related impairment in practice and policy. Addiction, 116(7), 1757–1767. https://doi.org/10.1111/add.15333

29.

Kelly

J. F.

Wakeman

S. E.

Saitz

(2015). Stop talking ‘dirty’: Clinicians, language, and quality of care for the leading cause of preventable death in the United States. The American Journal of Medicine, 128(1), 8–9. https://doi.org/10.1016/j.amjmed.2014.07.043

30.

Kelly

J. F.

Westerhoff

C. M.

(2010). Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms. International Journal of Drug Policy, 21(3), 202–207. https://doi.org/10.1016/j.drugpo.2009.10.010

31.

Keselman

H. J.

Othman

A. R.

Wilcox

R. R.

Fradette

(2004). The new and improved two-sample t test. Psychological Science, 15(1), 47–51. https://doi.org/10.1111/j.0963-7214.2004.01501008.x

32.

Kloss

J. D.

Lisman

S. A.

(2003). Clinician attributions and disease model perspectives of mentally ill, chemically addicted patients: A preliminary investigation. Substance Use and Misuse, 38(14), 2097–2107. https://doi.org/10.1081/JA-120025127

33.

Kourgiantakis

Sewell

K. M.

McNeil

Lee

Logan

Kuehl

McCormick

Adamson

Kirvan

(2022). Social work education and training in mental health, addictions, and suicide: A scoping review. Journal of Social Work Education, 58(1), 123–148. https://doi.org/10.1080/10437797.2020.1773363

34.

Kulesza

Larimer

M. E.

Rao

(2013). Substance use related stigma: What we know and the way forward. Journal of Addictive Behaviors, Therapy & Rehabilitation, 2(2), Article 782. https://doi.org/10.4172/2324-9005.1000106

35.

Lee

C. A.

Bonar

E. E.

Ilgen

M. A.

(2024). Impact of social determinants of health and individual characteristics on substance use disorder treatment utilization among emerging adults aged 18-25. Addiction Research and Theory, 33(1), 65–71. https://doi.org/10.1080/16066359.2024.2314049

36.

Link

B. G.

Phelan

(2014). Stigma power. Social Science and Medicine, 103(1), 24–32. https://doi.org/10.1016/j.socscimed.2013.07.035

37.

Luoma

J. B.

(2010). Substance use stigma as a barrier to treatment and recovery. In Bankole

R. A.

(Ed.), Addiction medicine: Science and practice (pp. 1195–1216). Springer New York.

38.

Mackert

Mabry

Hubbard

Grahovac

Holleran Steiker

(2014). Perceptions of substance abuse on college campuses: Proximity to the problem, stigma, and health promotion. Journal of Social Work Practice in the Addictions, 14(3), 273–285. https://doi.org/10.1080/1533256X.2014.936247

39.

Major

O’Brien

L. T.

(2005). The social psychology of stigma. Annual Review of Psychology, 56(1), 393–421. https://doi.org/10.1146/annurev.psych.56.091103.070137

40.

Martinelli

T. F.

Meerkerk

G.-J.

Nagelhout

G. E.

Brouwers

E. P. M.

Weeghel

J. v.

Rabbers

Mheen

D. v. d.

(2020). Language and stigmatization of individuals with mental health problems or substance addiction in the Netherlands: An experimental vignette study. Health & Social Care in the Community, 28(5), 1504–1513. https://doi.org/10.1111/hsc.12973

41.

National Association of Social Workers (NASW). (2021). The provision of behavioral health services by recent master of social work graduates. NASW. https://www.socialworkers.org/News/Research-Data/Workforce .

42.

O’Shay-Wallace

(2020). “We weren’t raised that way”: Using stigma management communication theory to understand how families manage the stigma of substance abuse. Health Communication, 35(4), 465–474. https://doi.org/10.1080/10410236.2019.1567443

43.

Pescosolido

B. A.

Martin

J. K.

Long

Medina

Phelan

(1996). Public report on the MacArthur Mental Health Module, 1996 general social survey: Americans’ views of mental health and illness at century’s end—continuity and change (pp. 1–50). Indiana Consortium for Mental Health Services Research.

44.

Putney

Halmo

Collin

C.-R.

Abrego-Baltay

O’Brien

Thomas

K. A.

(2024). The perceived impact of substance use education on social work students’ knowledge, attitudes, and skills. Substance Use & Addiction Journal, 45(3), 446–452. https://doi.org/10.1177/29767342241229051

45.

Quinn

(2010). Institutional denial or minimization: Substance abuse training in social work education. Substance Abuse, 31(1), 8–11. https://doi.org/10.1080/08897070903442475

46.

Rundle

S. M.

Cunningham

J. A.

Hendershot

C. S.

(2021). Implications of addiction diagnosis and addiction beliefs for public stigma: A cross-national experimental study. Drug and Alcohol Review, 40(5), 842–846. https://doi.org/10.1111/dar.13244

47.

Russett

J. L.

Williams

(2015). An exploration of substance abuse course offerings for students in counseling and social work programs. Substance Abuse, 36(1), 51–58. https://doi.org/10.1080/08897077.2014.933153

48.

Salsberg

Quigley

Richwine

Sliwa

Acquaviva

Wyche

(2020). The social work profession: Findings from three years of surveys of new social workers. The George Washington University Health Workforce Institute for the Council on Social Work Education and National Association of Social Workers. https://www.socialworkers.org/LinkClick.aspx?fileticketp1_j2EXVNspY%3D&portalidp0.

49.

Schnyder

Panczak

Groth

Schultze-Lutter

(2017). Association between mental health-related stigma and active help-seeking: Systematic review and meta-analysis. The British Journal of Psychiatry, 210(4), 261–268. https://doi.org/10.1192/bjp.bp.116.189464

50.

Sedgwick

(2014). Spearman’s rank correlation coefficient. BMJ, 349, g7327. https://doi.org/10.1136/bmj.g7327

51.

Simon

Snow

Wakeman

(2020). Understanding why patients with substance use disorders leave the hospital against medical advice: A qualitative study. Substance Abuse, 41(4), 519–525. https://doi.org/10.1080/08897077.2019.1671942

52.

Smith

R. A.

Applegate

(2018). Mental health stigma and communication and their intersections with education. Communication Education, 67(3), 382–393. https://doi.org/10.1080/03634523.2018.1465988

53.

Smith

M. J. W.

Whitaker

Weismiller

(2006). Social workers in the substance abuse treatment field: A snapshot of service activities. Health & Social Work, 31(2), 109–115. https://doi.org/10.1093/hsw/31.2.109

54.

Stangl

A. L.

Earnshaw

V. A.

Logie

C. H.

van Brakel

Simbayi

Barré

Dovidio

(2019). The health stigma and discrimination framework: A global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Medicine, 17(1), Article 31. https://doi.org/10.1186/s12916-019-1271-3

55.

Stone

(2015). Pregnant women and substance use: Fear, stigma, and barriers to care. Health & Justice, 3(1), Article 2. https://doi.org/10.1186/s40352-015-0015-5

56.

Streiner

D. L.

(2003). Starting at the beginning: An introduction to coefficient alpha and internal consistency. Journal of Personality Assessment, 80(1), 99–103. https://doi.org/10.1207/S15327752JPA8001_18

57.

Stringer

K. L.

Baker

E. H.

(2018). Stigma as a barrier to substance abuse treatment among those with unmet need: An analysis of parenthood and marital status. Journal of Family Issues, 39(1), 3–27. https://doi.org/10.1177/0192513X15581659

58.

Substance Abuse and Mental Health Services Administration. (2012). SAMHSA’s working definition of recovery. U.S. Department of Health and Human Services. https://store.samhsa.gov/sites/default/files/d7/priv/pep12-recdef.pdf .

59.

Substance Abuse and Mental Health Services Administration. (2021). Substance use disorders recovery with a focus on employment and education (HHS Publication No. PEP21-PL-Guide-6). https://library.samhsa.gov/sites/default/files/pep21-pl-guide-6.pdf.

60.

Substance Abuse and Mental Health Services Administration. (2024). Key substance use and mental health indicators in the United States: Results from the 2023 National Survey on Drug Use and Health (HHS Publication No. PEP24-07-021, NSDUH Series H-59). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/report/2023-nsduh-annual-national-report.

61.

Tan

Campbell

Lindsey

(2023). Simulation-based learning in school social work education: Developing MSW competencies in a holistic, engaging, and experiential approach. Journal of Teaching in Social Work, 43(5), 600–617. https://doi.org/10.1080/08841233.2023.2263501

62.

Turan

J. M.

Elafros

M. A.

Logie

C. H.

Banik

Turan

Crockett

K. B.

Pescosolido

Murray

S. M.

(2019). Challenges and opportunities in examining and addressing intersectional stigma and health. BMC Medicine, 17(1), Article 7. https://doi.org/10.1186/s12916-018-1246-9

63.

U.S. Bureau of Labor Statistics. (2025). Occupational outlook handbook: Social workers. https://www.bls.gov/ooh/community-and-social-service/social-workers.html .

64.

U.S. Department of Health and Human Services. (2019). Addiction and substance misuse reports and publications. https://www.hhs.gov/surgeongeneral/reports-and-publications/addiction-and-substance-misuse/index.html.

65.

Van Boekel

L. C.

Brouwers

E. P. M.

van Weeghel

Garretsen

H. F. L.

(2013). Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: Systematic review. Drug and Alcohol Dependence, 131(1), 23–35. https://doi.org/10.1016/j.drugalcdep.2013.02.018

66.

Van Weeghel

van Zelst

Boertien

Hasson-Ohayon

(2019). Conceptualizations, assessments, and implications of personal recovery in mental illness: A scoping review of systematic reviews and meta-analyses. Psychiatric Rehabilitation Journal, 42(2), 169–181. https://doi.org/10.1037/prj0000356

67.

Werder

Curtis

Reynolds

Satterfield

(2022). Addressing bias and stigma in the language we use with persons with opioid use disorder: A narrative review. Journal of the American Psychiatric Nurses Association, 28(1), 9–22. https://doi.org/10.1177/10783903211050121

68.

White

W. L.

(2007). Addiction recovery: Its definition and conceptual boundaries. Journal of Substance Abuse Treatment, 33(3), 229–241. https://doi.org/10.1016/j.jsat.2007.04.015

69.

Wilkey

Lundgren

Amodeo

(2013). Addiction training in social work schools: A nationwide analysis. Journal of Social Work Practice in the Addictions, 13(2), 192–210. https://doi.org/10.1080/1533256X.2013.785872

70.

Witkiewitz

Montes

K. S.

Schwebel

F. J.

Tucker

J. A.

(2020). What is recovery? Alcohol Research: Current Reviews, 40(3), Article 01. https://doi.org/10.35946/arcr.v40.3.01

71.

Zellmann

K. T.

Madden

E. E.

Aguiniga

D. M.

(2014). Bachelor of social work students and mental health stigma: Understanding student attitudes. Journal of Social Work Education, 50(4), 660–677. https://doi.org/10.1080/10437797.2014.947900

72.

Zwick

Appleseth

Arndt

(2020). Stigma: How it affects the substance use disorder patient. Substance Abuse Treatment, Prevention, and Policy, 15(1), Article 50. https://doi.org/10.1186/s13011-020-00288-0