service organizations in the United States and elsewhere have used this knowledge to establish campaigns to combat the stigma of M/SU illnesses, usually through the use of one or more of the following strategies: (1) educating the public about M/SU illnesses; (2) creating opportunities for the public to have contact with individuals with these illnesses; (3) protesting against erroneous, stereotyped portrayal of these individuals by the media21; and (4) pursuing legal action to guarantee rights to health care, housing, employment, and other justice-related concerns (Corrigan and Penn, 1999; Smith, 2002). These initiatives include those of SAMHSA’s Resource Center to Address Discrimination and Stigma (SAMHSA, 2000); SAMHSA’s National Addiction Technology Transfer Centers Network initiative to develop and disseminate a training module on stigma for treatment providers, and to collect and distribute research-based information on fighting the stigma of drug and alcohol dependence (Woll, 2001); Faces & Voices of Recovery, a national recovery advocacy campaign and organization that promotes public policies and actions to end discrimination against individuals with substance-use illnesses22; the National Alliance for the Mentally Ill’s (NAMI) “In Our Own Voices” and “StigmaBusters” initiatives; the National Institute of Mental Health’s (NIMH) Outreach Partnership Program (NIMH, 2005); and the efforts of many other consumer and advocacy organizations, such as the National Mental Health Association and the National Council on Alcoholism and Drug Dependence, that fight stigma by using a combination of the above strategies. Some consumers report that becoming involved in these initiatives helps them cope with the adverse effects of stigma and develop feelings of self-empowerment and self-enhancement (Wahl, 1999).
The committee applauds and supports the continuation of these campaigns. However, national, state, and local initiatives to eliminate stigma and discrimination often are targeted at changing the attitudes of society at large. Research has shown that public attitudes are not the sole determinant of behaviors; behaviors are also influenced by a number of personal and situational features present in the interactions of stigmatized individuals with others. Thus, to combat the effects of stigma on patient-centered care, additional actions are required of (1) health care organizations and clinicians providing treatment services; (2) insurance plans that shape patient–provider relationships; and (3) public policy makers and quality oversight organizations, who are able to address other situational conditions that