What I Shared About the Stigma Around Mental Health and Substance Abuse
As part of a public health awareness campaign produced by Williamson County Television, I was asked to speak to one of the most persistent barriers in mental health and addiction care: stigma. Why does it exist, and what does it cost the people who need help most?
The video above is my direct answer to that question. What I want to expand on here is the clinical reality that sits underneath it, because stigma is not just a social inconvenience. It is a public health crisis with a body count.
Why Is There So Much Stigma Around Mental Health and Substance Abuse?
Stigma around mental health and substance use disorder does not come from nowhere. It comes from decades of cultural messaging that treated addiction as a moral failure and mental illness as a character weakness. It comes from systems that criminalized substance use rather than treating it as a health issue. It comes from communities, including faith communities, where struggle is expected to be private and strength is expected to be performed.
Research published in Frontiers in Psychiatry in 2024 identified stigma as one of the most significant barriers to treatment for people with substance use disorders, noting that it operates at multiple levels simultaneously: societal stigma from the broader culture, self-stigma internalized by the person struggling, family stigma, and even stigma from within healthcare settings. Each layer compounds the others. A person who has already absorbed the cultural message that their struggle is shameful encounters that same message in the doctor's office, in their family's reaction, and in their own internal narrative, and the result is a wall of shame that can feel impossible to climb over alone.
The result is a cultural environment in which the people who most need help are also the people most likely to feel shame about needing it. And shame, clinically speaking, is one of the most powerful barriers to help-seeking that exists. It operates below the level of rational decision-making. A person can know, intellectually, that therapy would help them, and still not make the call because the shame of being someone who needs it feels too high a cost.
What the Data Actually Shows About Who Is Affected
The scale of this problem is significant and consistently underestimated.
The 2024 National Survey on Drug Use and Health, conducted by SAMHSA and released in 2025, found that among the 61.5 million adults with any mental illness, only 52.1% received any mental health treatment in the past year. That means nearly half of adults with a diagnosed mental health condition are not receiving treatment. Stigma is one of the most consistently cited reasons why.
The numbers are even more stark for substance use. The same survey found that the majority of people with substance use disorders do not receive treatment in any given year — and the gap between those who need help and those who receive it has remained stubbornly persistent despite decades of awareness campaigns.
These are not numbers about other people. They are numbers about the people in our communities, our families, our congregations. The high-achieving professional who is quietly managing alcohol use as a way to decompress from a career that demands everything. The caregiver whose grief has nowhere to go and who has found a way to make the numbness more bearable. The faith leader who is carrying the weight of an entire community and cannot admit to a single person that they are not okay.
How Stigma Operates Differently in the Communities I Serve
In my practice I work primarily with high-achieving professionals, Black women, and faith leaders — populations where the stigma around mental health and addiction tends to be particularly acute. The expectation of strength, composure, and self-sufficiency runs deep in these communities. Needing help, especially help for something as stigmatized as addiction or serious mental illness, can feel like a fundamental failure of identity.
This is connected to what researcher Cheryl Woods-Giscombé identified as theSuperwoman Schema — the cultural mandate that many Black women internalize to present strength at all times, suppress emotions, and resist vulnerability.
For women carrying this pattern, reaching out for support around mental health or substance use is not just difficult. It can feel like a betrayal of who they are supposed to be.
What I want people in these communities to understand is that the stigma they feel is not evidence that something is wrong with them. It is evidence that they absorbed the messaging their environment gave them. And that messaging can be unlearned.
What Does Stigma Actually Cost?
Stigma costs lives. That is not hyperbole. It is the clinical and public health reality.
When stigma prevents someone from seeking treatment for a substance use disorder, the condition progresses. What might have been addressed with early intervention becomes significantly harder to treat after years of delay. When stigma prevents someone from seeking mental health support, untreated depression, anxiety, and trauma compound over time, affecting physical health, relationships, work performance, and every dimension of quality of life.
A 2024 multinational study published in Frontiers in Psychiatry found that stigma toward substance use disorders operates across society, individuals, families, and healthcare professionals alike — making it one of the most pervasive and difficult barriers to dismantle because it is reinforced from multiple directions simultaneously.
The people who pay the highest price for this stigma are not the ones who perpetuate it. They are the ones trying to survive it while quietly falling apart in rooms where no one is asking the right questions.
What Actually Changes Stigma
Conversations like this one. Public health campaigns that name mental health and substance use disorder as real, treatable health conditions — not moral failures, not weaknesses, not private shameful things. Clinicians who talk openly about the realities of the populations they serve. And individuals who are willing, when the time is right and the context is safe, to share their own experiences.
I joined this campaign because I believe that every honest public conversation about mental health makes it slightly more possible for someone who has been suffering in silence to finally ask for help. Not because awareness alone solves the problem (it does not) but because it shifts the cultural permission around help-seeking in ways that accumulate over time.
If you are carrying something you have not been able to name out loud, whether that is a relationship with substances that has become something harder to manage, or a mental health struggle that you have been white-knuckling through alone, that is worth bringing somewhere safe. You do not have to have hit a visible bottom to deserve support. And needing help is not a character flaw. It is a human reality.
Explore further:
If what I described resonates, my work on trauma recovery and emotional healing addresses many of the underlying experiences that intersect with substance use. For the high-achieving professionals and Black women navigating the particular weight of performing strength while struggling privately, my posts on the Superwoman Schema and identity, faith, and purpose speak directly to that experience. Schedule a consultation
