Substance use disorders are often treated as a moral and criminal issue, rather than a health concern [18,31]. This is especially true of illegal substances, which are perceived more negatively than legal substances [18,32,33]. Using particular substances (e.g. heroin) has not only been deemed deserving of social disapproval and moral condemnation, but society has also defined such behaviors as crimes. Criminalization of substance-using behaviors exacerbates stigma and produces exclusionary processes that deepen the marginalization of people who use illegal substances [33]. Therefore, the social processes and institutions that are created to control substance use may, in actuality, contribute to its continuance [34].
