Published May 23, 2025
Written by Ngonyo Mungara
Stigma refers to the negative attitudes and beliefs society holds towards a group of people. It perpetuates negative stereotypes that lead to social isolation and discrimination. As a result, stigma can prevent people from seeking help, accessing healthcare, and receiving support.
Addressing stigma associated with substance use disorders was identified as a priority during a 2019 stakeholder meeting in Iowa to combat rural drug overdoses in the state.
Rachel Young, a professor at the University of Iowa’s School of Journalism and Mass Communication, co-authored two new studies: one exploring storytelling to confront stigma among people who use drugs, and another looking at the effectiveness of anti-stigma campaigns.
“After years of progress, we are in a moment where substance use stigma seems to be growing again even though we know how devastating and deadly that stigma can be,” she said.
Digital storytelling
One of Young’s studies examined digital storytelling, a participatory media process that guides individuals in creating brief videos about meaningful personal experiences. The study explored how digital storytelling, using a culture-centered approach, can be used to challenge narrative stigma towards people who use drugs and show the value of harm reduction efforts.
Harm reduction is a set of principles and practices to minimize harm associated with drug use, such as providing medications to reduce withdrawal symptoms or distributing life-saving medications to reverse opioid overdoses.
Young and her team, in collaboration with a local harm reduction organization, held workshops designed to support individuals in sharing their personal experiences with harm reduction. Fourteen storytellers shared their ideas and received feedback from their peers and facilitators on how to refine their stories.
Young became interested in digital storytelling after learning about the StoryCenter method during a workshop sponsored by the Obermann Center for Advanced Studies at the University of Iowa.
“I was so intrigued by how the method could unify and energize groups through storytelling, and how people found deeper meaning in their personal stories by refining narratives in a supportive space,” she said. “I knew I wanted to find ways to facilitate workshops for people who had stories to tell that could challenge official, top-down messaging about health.”
The study found that digital storytelling workshops provided a space for participants to challenge stigmatizing narratives, reclaim narrative control, and explore agency (e.g., making their own free choices). However, some participants felt their experiences with harm reduction could be misunderstood to an outside audience, which limits the potential of their stories being used for advocacy to reduce stigma.
As with all community-engaged projects, Young anticipated potential tensions among community members and researchers. “I found it was important to consider in advance how we would navigate those tensions when they arise and to constantly check in with ourselves as researchers about how we were maintaining our ethical commitments,” she said.
Her team made sure to emphasize to storytellers that they could change their minds and shape their stories differently throughout the process. Young’s colleague, Dr. Corinne Peek-Asa (former director of the UI IPRC), proposed doing a two-workshop sequence in the future. One could be focused on personal storytelling and another on advocacy storytelling, which uses personal stories to promote social change, raise awareness, and influence public opinion or policy.
For researchers interested in using digital storytelling in community-based health communication, Young recommends focusing on how the ethics of the method require listening to storytellers and challenging our own ideas of what a story should be. “There are so many theories about what makes a good story or an effective story, especially in health communication,” she said. “What makes digital storytelling meaningful and unique is that it’s up to the storyteller to decide.”
Anti-stigma campaigns
Anti-stigma campaigns often feature individuals who don’t fit the stereotype of the stigmatized condition. While this aims to challenge the stereotype that people with the stigmatized condition look a certain way, it can lead to the atypical person with that condition being seen as an exception.
Young said that it can be challenging to craft anti-stigma messaging. “Stigma is complex, and it’s reinforced by emotions, experiences, interactions, messages, and policies, which makes it very resistant to change. There are also lots of ways well-meaning health communication messages can backfire,” she said.
In another study, Young investigated the effectiveness of anti-stigma campaigns featuring individuals who don’t fit the stereotype of people who use drugs. The study aimed to see if these campaigns reduce stigma or if they reinforce it through a process known as subtyping. Subtyping is when people create a new, narrower category within an existing stereotype to accommodate individuals who do not fit the mold, thereby preserving the broader stereotype.
In two online experiments, Young and her team discovered that participants’ stigma towards people who use drugs in general worsened when they viewed images of individuals who did not fit the stereotypical drug user profile in a real-world anti-stigma campaign, especially when these individuals were perceived as less typical. This was the opposite effect intended by the campaign, which hoped to reduce stigma by showcasing individuals who didn’t fit the image of a “typical” person who uses drugs.
Researchers are still trying to determine what would be best to avoid subtyping. “Some research suggests that subtyping can be avoided by featuring people who are in a sort of sweet spot, relatable enough to the public but still recognizably a member of the stigmatized group,” she said. “At this point, though, there just hasn’t been enough research to know whether that strategy works well and especially how it works for different types of stigmatized conditions.”
Young recommends that public health organizations explore unintended effects of messages alongside intended ones. She said that thorough message testing with diverse audiences is essential, and leveraging the insights of people with stigmatized conditions can help avoid reinforcing negative beliefs.
“People experiencing stigma related to substance use are the experts in the specifics of stigma and its harms,” she said.
Focusing on these narratives can highlight the impacts of stigma and drive meaningful change. Young said, “The fullness of those personal narratives always challenges the demeaning and shallow stigma stories we hear repeated so often.”
Some resources:
Policy and Program Recommendations to Reduce Overdose Deaths in Rural Iowa
Drug overdose (UI IPRC Research and Action Practice Team)