Effects of Stigmatizing Language on Trainees’ Clinical Decision-Making in Substance Use Disorders: A Randomized Controlled Trial

Substance use disorder (SUD) continues to be one of the most stigmatized and under-treated conditions in the United States. Stigmatizing language used by healthcare workers can transmit bias to others within healthcare, including medical trainees. This study investigates how stigmatizing language and undergraduate medical education (UME) curricula may influence trainees’ clinical decision-making for patients with SUD.

Medical students from three Chicago-area medical schools were randomized to review either a stigmatizing or neutral version of a clinical scenario describing a patient experiencing opioid withdrawal. Participants (a) selected treatment plans for the fictional patient using two multiple-choice questions, (b) completed the Medical Condition Regard Scale (MCRS) to assess their attitudes, and (c) reported prior SUD experiences, both curricular and personal. Statistical analyses explored whether treatment decisions were influenced by attitudes, addiction medicine curricula, and exposure to the stigmatizing vignette.

Among the 366 medical students who completed this study, exposure to stigmatizing language (n = 191) led to clinical decision-making that would be less effective in treating opioid withdrawal for the fictional patient (p = 0.027; η2 = 0.013). Exposure to more SUD education during UME was correlated with more effective clinical decision-making for opioid withdrawal (β = 0.181; R² = 0.033; p < 0.001) but was not correlated with attitudes toward patients with SUD (p = 0.231).

Stigmatizing language influences clinical decision-making when treating patients with SUD. Improving SUD education within UME may be an effective strategy for mitigating this effect within medical trainees.