Ideas

September is National Recovery Month—a time to celebrate those on the path of recovery from substance use disorder (SUD), as well as the many service providers, families, friends, and communities who support them. Recovery looks different for everyone, and this month honors the many ways people define and pursue it.

SUD is now recognized as a health condition. Like other health conditions, treatment can be a powerful component of recovery. But for many, seeking treatment is accompanied by stigma. This stigma is so entrenched that some health providers hesitate to treat people with SUD—or even discriminate against them outright. Additionally, treatment is often siloed from the broader healthcare system, making it more challenging to navigate. Racism and criminalization also affect people who use drugs—a legacy of the War on Drugs, initiated by President Nixon in the 1970s. This policy dramatically increased criminal penalties for drug use and distribution with the explicit intent (as Nixon aide John Ehrlichman later admitted) of incarcerating large numbers of Black and Brown people. These punitive structures still exist today, leaving many people afraid to disclose their substance use for fear of punishment, job loss, or losing their children and rights.

In short, substance use disorder exists within systems of injustice—systems that restrict opportunities for treatment and recovery.

If you are someone who requests or collects data about substance use disorder, you have a role to play in addressing these injustices—starting with the questions you ask.

Racial Disparities in Overdose Deaths

There is encouraging news: after years of rising overdose deaths, the trend has begun to decline. But a closer look reveals racial inequities. According to recent Centers for Disease Control and Prevention data, overdose deaths among White people have decreased, while rates among Black people and Native Hawaiian or Other Pacific Islander people have risen. This suggests treatment access and effectiveness are not reaching all communities equally.

From Changing Individuals to Changing Systems

As we can see, there are system barriers, yet the metrics used to evaluate treatment programs tend to focus narrowly on individuals: How many people stayed in treatment? How many remained abstinent?

These metrics shape how results are interpreted and create a mental model of who—or what—needs to change. Research with titles like “Blacks Are Less Likely Than Whites to Complete Addiction Treatment” implies that disparities result from individual shortcomings, implicitly blaming people for “dropping out.” This framing reinforces stigma, a known barrier to recovery.

Asking Better Questions to Create System Accountability

This isn’t to say the data are wrong—but they are incomplete. Asking better questions can redirect our attention to the systemic barriers limiting recovery.
Here are examples of alternative questions and what they might reveal.

How many people have access to treatment?

Data collection:

• What is the ratio of providers to population? Are there geographic or racial disparities in provider availability?
• Are treatment services located in areas that are accessible and safe for patients?
• Do patients have to choose between keeping a job, maintaining housing, or going to treatment?

This data can identify where treatment access needs to be expanded.

How many providers practice in a way that is respectful and culturally relevant?

Data collection:

• Do patients trust their providers?
• Are there differences in trust and experience by race?

This data can guide training or practice improvements.

How many patients feel safe disclosing their substance use?

Data collection:

• Can patients disclose their substance use without fear of punishment by police, employers, or child welfare systems?
• How many patients disclosed and were not punished?

This data can inform policy change to ensure patient safety.

This reframing shifts our focus from individual compliance to system accountability. It encourages us to measure how well systems support—not hinder—recovery. We can then measure the extent to which there is progress in improving the way the system supports recovery. Instead of reporting that “X% dropped out of treatment,” we might report that “X% of providers deliver care that patients trust.”

Changing the narrative from blaming individuals for treatment “dropout” to analyzing how systems fail to support retention is key to designing better strategies and achieving improved health outcomes.

With this kind of data, we can still track treatment retention and completion, but now in the context of whether people had the resources, opportunities, and rights to pursue recovery free from discrimination.

Shifting to a systems perspective helps to shift mental models to acknowledge substance use disorder is not an individual failing—it is the product of systems that create and sustain barriers. If we truly want recovery for all, we must hold those systems accountable and work to change them.

It starts with asking different questions—questions that drive the data we collect toward justice and equity.

For more on this topic, see this webinar: Disparities in Opioid Deaths: Let’s Look at the System Not the Individual.

References

 https://nida.nih.gov/research-topics/stigma-discrimination Accessed 9/19/25
https://www.hopkinsmedicine.org/stigma-of-addiction#whatistigma Accessed 9/19/25
Zwick, J., Appleseth, H. & Arndt, S. Stigma: how it affects the substance use disorder patient. Subst Abuse Treat Prev Policy 15, 50 (2020). https://doi.org/10.1186/s13011-020-00288-0
Corrie L. Vilsaint, Lauren A. Hoffman, John F. Kelly, Perceived discrimination in addiction recovery: Assessing the prevalence, nature, and correlates using a novel measure in a U.S. National sample, Drug and Alcohol Dependence, Volume 206, 2020, 107667, ISSN 0376-8716, https://doi.org/10.1016/j.drugalcdep.2019.107667. (https://www.sciencedirect.com/science/article/pii/S0376871619304442)
https://harpers.org/archive/2016/04/legalize-it-all/ Accessed 9/19/25
Drug Overdose Deaths in the United States, 2003–2023 CDC Data Brief https://www.cdc.gov/nchs/products/databriefs/db522.htm#:~:text=For%20White%20non%2DHispanic%20(subsequently,with%20the%20rate%20increasing%2039.4%25 Accessed 9/19/25