Care management staff perspectives on stigma and barriers to substance use treatment experienced by latine adults who use substances.

Background: Stigma related to substance use or addiction contributes to health care inequality. Structural stigma - embedded in societal conditions, policies, practices, and cultural norms - has been less studied than interpersonal (e.g., provider bias) and individual level stigma processes. The perspectives of staff working with patients who navigate health care systems can help to identify substance use stigma at the structural and interpersonal levels. The study aimed to examine staff perceptions of structural and interpersonal stigma processes, their association with barriers to substance use disorder (SUD) care, the interplay between different levels of stigma, and their impacts at the individual level. Methods: Care management staff (n = 20, 75 % community health workers, CHWs) from a complex care management program were interviewed about the challenges Latine compared to non-Latine patients faced in accessing care for substance use treatment. Thematic analysis was used to analyze interview transcripts. The Structural Stigma framework was used to guide analysis. Results: Structural and interpersonal stigma processes as well as intersectional stigma were associated with barriers to SUD care. Latine patients were reported as being frequently affected by intersecting systems of oppression due to multiple stigmatized identities (e.g., persons with substance use and as immigrants) than non-Latine patients. Structural and interpersonal stigma processes were associated with self-stigma and hindered help-seeking behaviors. Conclusion: Care management staff offer unique perspectives into how stigma at multiple levels is experienced by patients and perpetuated. Stigma processes may discourage the initiation of needed substance use care among Latine persons experiencing oppression.