Researchers, interventionists, and clinicians are increasingly recognizing the importance of structural stigma in elevating the risk of mental illnesses (MIs) and substance use disorders (SUDs) as well as in undermining MI/SUD treatment and recovery. Yet, the pathways linking structural-level stigma with these MI/SUD-related outcomes remains unclear. In this paper, we review scholarship on structural MI/SUD stigma and pathways that may link this structural stigma with MI/SUD-related outcomes. We introduce a conceptual framework that describes how structural-level stigma influences the MI/SUD treatment cascade via (a) interpersonal- and individual-level stigma mechanisms and (b) mediating processes among people with MI/SUD (i.e., access to resources, psychological responses, behavioral responses, social isolation). We consider the role of intersecting stigmas and discuss implications for future research, interventions, and clinical practice.

Earnshaw, V. A., Mousavi, M., Qiu, X., & Fox, A. B. (2025). Mental illness and substance use disorder stigma: Mapping pathways between structures and individuals to accelerate research and intervention. Annual Review of Clinical Psychology, 21, 85-111.