End the stigma: Substance use disorder a medical issue, not a moral one, advocates say

“It just took a grip on me that I still can’t even fathom,” said Beth Hoekstra of her experience with opioids.

Opioid deaths

Editor's note: This is the third installment in a series about the opioid epidemic across the region. Watch for the fourth story in this series next Wednesday.

WORTHINGTON — Largely considered to be the worst drug epidemic in U.S. history, the opioid crisis has been linked to the rising number of overdoses since the 1990s. While harm prevention and overdose treatment have become essential in combating the impact of opioids, education on stigma and substance use also has a role to play, advocates say.

“Stigma is a very naturally-occurring component of culture. However it's important for us to unlearn it where and when we can,” said Allie Carey, director of programs with the Steve Rummler Hope Network, an organization that focuses on helping those with chronic pain and substance use disorder, during a forum on the opioid crisis earlier this year in Worthington. “With that in mind, there’s this shift now that’s very important, in defining substance use disorder as a medical condition and concern, rather than a moral one ... that's a big thing when we talk about opioid overdose prevention."

A class of drugs including heroin, pain medications such as oxycodone and hydrocodone, and synthetic opioids like fentanyl, opioids can be addictive and deadly, as well as a medication for pain treatment. Opioids interact with receptors in nerve cells in the body and the brain, reducing feelings of pain.

However, due to their highly addictive nature, the use of prescription opioids for pain management can result in a significant mental or physical dependence on opioids, the same as illegal substances like heroin or fentanyl.


This type of reliance on opioids is known as opioid use disorder, a form of substance use disorder characterized by chronic use of opioids that causes clinically significant distress or impairment.

In 2020, an estimated 2.7 million people ages 12 or older reported having an OUD. With the diagnosis of OUD including the inability to cut back on or control opioid use — or a significant impact on the ability to function in the day-to-day — OUD is a medical condition that can affect anyone.

For Beth Hoekstra, director of operations at a Worthington residential recovery house, her story of opioid use began with a series of seven surgeries in the span of two years, and an opioid prescription to help manage the pain she was in.

“I had never really heard of opioids, I’d never had anything like that until I had these surgeries, and then it was like ‘bam!’,'” said Hoekstra, now in her ninth year of sobriety. “It just took a grip on me that I still can’t even fathom.”

A former social worker in Nobles County, Hoekstra’s idea of addiction and substance use was largely formed around stereotypes back then, she admitted — and it was heavily impacted by stigma. Substance use disorder was something thought to affect people under bridges, faceless strangers with a syringe or a bottle.

“Being a social worker, you would think that there would be this compassion, this empathy for people that are having problems, but no. And I definitely couldn't see myself as being someone in that position,” Hoekstra said. “The stigma I had associated with addiction — and huge denial I had — really stopped me from getting help.”

She remembers being amazed, early on, at the amount of opioids doctors prescribed, and found herself “hooked” gradually as her surgeries progressed, getting worse and worse throughout time. Eventually, getting access to opioids became “a full-time job,” Hoekstra recalled. She would “doctor shop,” going around to different clinics in order to get a prescription filled, traveling as far as Faribault and Rochester’s Mayo Clinic.

“It absolutely consumed my entire life. I felt like I would do anything to get them … I think about how easy it was at that time,” Hoekstra said, “And it’s scary to me now. The fact that I didn’t overdose, it’s honestly amazing … But I was in such denial of my own addiction, just because it was medication.”


For Hoekstra, her self-described rock bottom came after stealing medication from people’s homes. Her family performed an intervention, read her letters, and offered up bottom lines. She was charged with a felony. It was humbling, she said, to be serving time in jail in the same county where she had once been a social worker.

After attending inpatient treatment, Hoekstra entered the local drug court program, an experience that “saved her life,” by putting her in an environment of strong accountability, where she couldn’t deny her reality of substance use.

“I had a lot of shame and guilt and it took me a long time to get over that, and I was definitely ashamed of some of the things I did to get opioids,” Hoekstra said. “I think when you're living in rural areas, (addiction) is hidden a lot more because there is that stigma and everyone talks when you live in a small community.

"There’s this shame that if you reach out, you’re just the guy with the problem and everyone is going to know," she added. "Reaching out is going to hurt me and make me look like a bad person. That denial, not wanting to be that person, was my biggest hurdle.”

It’s why she feels education on both OUD and the stigmatization of substance use needs to be part of addressing the opioid overdose crisis.

“Nobody’s exempt … going through this, it obviously opened my eyes to the reality that addiction does not discriminate,” Hoekstra said. “I think there are probably a lot more people that are living normal lives that are addicted to prescription medications, but because of the stigma associated with addiction, they don't ever reach out for help … But you’re not alone. It happens to anyone and it doesn't make you a bad person. That’s the biggest lesson I learned.”

Hoekstra now works at Project Morning Star, a sober living house in rural Worthington, a staying place for people working to recover from substance use disorder. She describes it as a place of support and accountability, transitional living to help people set themselves up for success and reintegration.

“A lot of the people employed at sober homes, we’ve been through addiction ourselves, and unless you’ve been through it, you have no understanding of how intense it is — how much you feel you need it — once you become addicted to a substance. I get that, though,” she said. “To go through it is the best way to help someone else because you know what they’re going through.”


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Emma McNamee joined The Globe team in October 2021 as a reporter covering Crime & Courts, Politics, and the City beats. Born and raised in Duluth, Minn., McNamee left her hometown to attend school in Chicago at Columbia College. She graduated in 2021 with a degree in Multimedia Journalism, with a concentration in News & Feature Writing and a minor in Creative Writing.
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