Social Science and Human Research Bulletin

Stigma is widely recognized as a barrier to accessing addiction treatment, yet how internal and external forms of stigma jointly constrain treatment access within community-based rehabilitation settings in Tanzania remains underexplored. This study examined the impact of stigma on access to addiction treatment services in Iringa Municipality, using Iringa Sober House as a case study, guided by two objectives: to examine the impact of internal stigma on treatment access, and to examine the impact of external stigma on treatment access. A qualitative case study design was adopted, drawing on semi-structured interviews, documentary review and focus group discussions with thirty purposively selected participants, comprising fifteen residents, five family members, eight healthcare providers and support staff, and two community leaders. Data were analyzed thematically. Findings showed that internal stigma operated through shame, guilt and self-blame that inhibited disclosure, delayed help-seeking and reduced motivation to sustain treatment. External stigma operated through social rejection, fear of public labelling, institutional barriers within the health system, and continued stigmatization that disrupted recovery and reintegration after discharge. The study concludes that stigma functions as a multi-dimensional barrier constraining access to addiction treatment at every stage, from initial recognition of need to sustained recovery, and that interventions addressing only internal or only external stigma are unlikely to be sufficient without coordinated action across family, community, healthcare and policy domains.

stigma; addiction treatment; substance use disorders; internal stigma; external stigma; Tanzania

1. Ahmed, S., Abdulrahman, Y., & Okafor, E. (2017). Community perceptions and barriers to substance use treatment in Kenya and Nigeria. African Journal of Drug and Alcohol Studies, 16(2), 45-60.
2. Becker, H. S. (1963). Outsiders: Studies in the sociology of deviance. Free Press.
3. Boyd, S. (2015). Gendered stigma and women with substance use disorders. Substance Use & Misuse, 50(8-9), 1020-1026.
4. Corrigan, P. W., Druss, B. G., & Perlick, D. A. (2014). The impact of mental illness stigma on seeking and participating in mental health care. Psychological Science in the Public Interest, 15(2), 37-70.
5. Creswell, J. W., & Poth, C. N. (2018). Qualitative inquiry and research design: Choosing among five approaches (4th ed.). Sage.
6. Drug Control and Enforcement Authority. (2019). Annual drug control report 2019. Government of Tanzania.
7. Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Prentice-Hall.
8. Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual Review of Sociology, 27, 363-385.
9. Livingston, J. D., Milne, T., Fang, M. L., & Amari, E. (2012). The effectiveness of interventions for reducing stigma related to substance use disorders: A systematic review. Addiction, 107(1), 39-50.
10. Luoma, J. B., Twohig, M. P., Waltz, T., Hayes, S. C., Roget, N., Padilla, M., & Fisher, G. (2007). An investigation of stigma in individuals receiving treatment for substance use disorders. Addictive Behaviours, 32(7), 1331-1346.
11. Mushi, D., Nyamhanga, T., & Frumence, G. (2020). Community perspectives on substance use disorders and stigma in Tanzania. BMC Public Health, 20, Article 1451.
12. Myers, B., Govender, R., & Nel, E. (2018). Stigma and discrimination in treatment and recovery among substance users in South Africa. International Journal of Drug Policy, 55, 1-7.
13. Nyamhanga, T., & Frumence, G. (2017). Stigma and barriers to substance abuse treatment in Tanzania. BMC Public Health, 17, Article 763.
14. United Nations Office on Drugs and Crime. (2023). World drug report 2023. United Nations.
15. van Boekel, L. C., Brouwers, E. P. M., van Weeghel, J., & Garretsen, H. F. L. (2013). Stigma among health professionals toward patients with substance use disorders and its consequences. Drug and Alcohol Dependence, 131(1-2), 23-35.