The Dual Role of Media in Addiction: Shaping Narratives, Reinforcing Stigma, and Influencing Policy Outcomes

There is a vast history of addiction in America, which was first explored in 1875 in a study by Levinstein, who outlined morphine addiction and was the first to classify it as a distinct disorder rather than a moral failing.¹ Although this classification made great strides toward the treatment of addiction as a medical issue, stigmatization and the racialization of drugs continued. In the 19th century, the racialized framing of cocaine use as a threat posed by black men, infamously labeled the “negro menace,” played a central role in accelerating the criminalization of cocaine in the post–Civil War South. At the same time, Jim Crow segregation laws imposed by southern states entrenched the foundations of racially driven drug policy in the United States. This framework was later reinforced through intense racialized propaganda surrounding opium dens, which specifically targeted Chinese immigrant communities.² Subsequently, the Harrison Narcotics Tax Act of 1914 was passed, which required the taxation and registration of opium and coca derivatives, marking a turning point by effectively criminalizing substance use. The Act defined opioid use disorder not as a medical condition but as a criminal issue and prohibited physicians from treating it, leading to the imprisonment of many clinicians who attempted to provide care. This legislation ushered in an era in which addiction was framed as a moral failing, casting individuals with substance use disorders as threats to society and promoting total abstinence as the only acceptable solution.²

The political declaration of drug use as “public enemy number one” under President Richard Nixon in the 1970s was amplified by news outlets that framed addiction as a criminal issue. This narrative gained traction during the Reagan administration, when Nancy Reagan’s “Just Say No” campaign—heavily promoted through television and schools—encouraged simplistic understandings of substance use as a matter of willpower. Such portrayals bolstered punitive measures such as mandatory minimum sentencing, which disproportionately targeted communities of color.³

The media’s role in the “crack epidemic” further reinforced this divide. Highly racialized portrayals of black communities emphasized crime, while later coverage of predominantly white opioid-using populations often emphasized victimhood, family impact, and treatment needs. This selective empathy revealed biases in how addiction is framed and whose suffering is recognized.⁴

Toward Humanization: Celebrity, Memoir, and Film

By the 2000s, a shift was underway. The highly publicized struggles of celebrities such as Amy Winehouse reframed addiction as a tragedy, albeit one still tinged with voyeurism. Winehouse’s song “Rehab” and her death from alcohol poisoning underscored both the personal devastation of addiction and systemic failures of care.⁵

Memoirs and their adaptations also played a role in reshaping cultural narratives. David Sheff’s Beautiful Boy and Nic Sheff’s Tweak, later adapted into a film starring Steve Carell and Timothée Chalamet, portrayed addiction as a family illness marked by relapse and resilience. In interviews, Chalamet emphasized the importance of breaking the association between addiction and moral failure while acknowledging how culture sometimes romanticizes substance use.^6,7 These portrayals created more space for empathy while still reflecting the tensions inherent in media representation.

Contemporary Media and Structural Context

During the COVID-19 pandemic, reporting further highlighted the intersection between addiction and structural vulnerability. Articles in The Guardian, for example, emphasized how lockdowns and reduced access to treatment exacerbated opioid use and overdose risk, giving voice to individuals navigating these challenges.⁸ Such coverage contrasts sharply with the stigmatizing headlines of the 1980s, reflecting a slow but notable cultural shift toward understanding addiction as a public health issue.

At the same time, neuroscience-based framing has become increasingly common in media coverage. Stories that highlight addiction as a “brain disease” can generate sympathy by reducing blame, but this biological reductionism risks obscuring the social and environmental conditions—poverty, trauma, housing instability—that shape substance use patterns. It also privileges pharmacologic solutions while downplaying community-based and psychosocial interventions.⁹

Additionally, even different approaches to harm reduction face controversy. For example, the passing of Oregon’s landmark ballot initiative Measure 110 removed criminal penalties for possession of small amounts of hard drugs and was aimed at shifting policy toward harm reduction and treatment rather than incarceration. It also directed significant funding to services such as naloxone distribution, housing support, and voluntary treatment, with the hope that lowering stigma would increase help seeking and improve public health outcomes. However, after more than 3 years of implementation, overdose deaths in Oregon continued to rise at rates surpassing the national average. As a result, political and public sentiment shifted sharply; polling later showed a majority of voters wanted parts of Measure 110 repealed. State lawmakers and the governor moved to recriminalize drug possession and return to approaches that use the criminal-legal system to compel treatment.¹⁰ The multifaceted representation of addiction and harm reduction in various media forms, ranging from sensationalized news coverage to film and television portrayals, reflects broader social, political, and economic forces, complicating how addiction is understood and addressed in both public discourse and policy.

Children and adolescents are particularly vulnerable to the distorting portrayal of addiction in the media due to their neurological development as well as the growing accessibility to media through social platforms and websites. Adolescents are more focused on identity and image and have weaker executive control, which limits their ability to distinguish media portrayals from reality and makes them more likely to model behaviors they see in media and marketing. This developmental vulnerability increases the influence of media portrayals on attitudes and behaviors related to substance use.¹¹

Due to the lack of limitations on what is spread through social media and the emerging significance of social media in everyday lives, the initiation of drug use due to media consumption is far more likely than it once was through journalism. Social media is dominated by user-generated and algorithmically marketed content, not fact-checked journalism; teens who regularly see posts about e-cigarettes or cannabis on social feeds are significantly more likely to start using those substances over the following year.¹²

Clinical Implications: Media in the Therapy Room

Media depictions are not abstractions for patients—they can directly shape behavior and identity. A 22-year-old college student presented with escalating alcohol use that he initially modeled after the comedic personas of Will Ferrell. Binge drinking, framed as humorous imitation, evolved into a defining part of his social identity and contributed to academic and legal problems. In treatment, he was initially reluctant to discuss his substance use until his psychiatrist connected with him through these media references. Later, his recovery was influenced by listening to Dax Shepard’s Armchair Expert podcast. Shepard’s candid reflections on relapse and sobriety provided a counter-narrative, helping the patient reframe addiction not as failure but as an ongoing process of change. This case underscores how media can reinforce harmful norms yet also serve as a therapeutic resource.

The influence of a specific case of media portrayal leading to onset and supporting recovery from substance use disorder has been limited yet is slowly emerging. In a study by Davis et al,¹² exposure to substance-related media content was associated with increased alcohol use via perceived alcohol norms. In terms of recovery, it was found that the use of social media for recovery support is becoming increasingly common.¹³ While the majority of these studies are longitudinal, case studies are becoming more common and serve as an example of the benefits of media in opioid use disorder recovery.

Evidence-based approaches to integrating discussions of media influence into clinical care remain limited, though the topic is increasingly recognized as important. While interventions addressing substance use often focus on cognitive-behavioral strategies and motivational interviewing, few studies have explicitly examined structured ways to review patients’ media exposure. Some emerging work in digital literacy and media-based health interventions suggests that guided reflection on social media and media portrayals can enhance insight and support behavior change in adolescents and young adults, particularly in the context of alcohol or vaping prevention.¹⁴ However, there is a clear gap in research examining systematic, clinical protocols for discussing media influence with patients in the context of substance use disorders. Developing and evaluating such approaches could offer clinicians a novel avenue for enhancing recovery-oriented care and promoting more informed, conscious engagement with media content.

Media, Policy, and Public Health

The stakes of media framing extend beyond individual patients to the level of policy. Research has shown that public support for punitive versus health-oriented approaches to addiction depends heavily on how the issue is covered.¹⁵ Sensationalist reporting fosters fear and punishment, while stories that emphasize lived experience and treatment effectiveness increase support for evidence-based policy. Collaborations between public health professionals and journalists are beginning to address this.

Guidelines promoting person-first language, inclusion of recovery narratives, and accurate descriptions of treatment options are now in circulation, with evidence that such practices reduce stigma in reporting.⁹ Exposure to narratives grounded in lived experience also appears to shift attitudes among health care professionals: for example, Avery et al demonstrated that resident physicians’ biases toward individuals with substance use disorders decreased after engaging with an online training module that incorporated recovery and lived-experience stories.¹⁶ These efforts suggest that the media’s influence, though double-edged, can be steered toward promoting health equity.

Conclusion

The media has always been central to how societies understand addiction. From the punitive framings of the War on Drugs to more humanizing narratives in recent decades, it remains a powerful force that can either entrench stigma or foster compassion. Clinicians should recognize the role of media in shaping patients’ identities and leverage constructive narratives in treatment. Policymakers and public health advocates must continue engaging with the media to ensure coverage that emphasizes evidence, equity, and humanity.

Ultimately, the stories we tell about addiction matter. They determine not only cultural imagination but also clinical practice and political will. Harnessing media’s potential while resisting its stigmatizing currents is essential to building a more just and health-oriented response to addiction.

Article Information

Published Online: July 7, 2026. https://doi.org/10.4088/PCC.25br04119
© 2026 Physicians Postgraduate Press, Inc.
Prim Care Companion CNS Disord 2026;28(4):25br04119
Submitted: October 27, 2025; accepted February 2, 2026.
To Cite: Nadelmann E. The dual role of media in addiction: shaping narratives, reinforcing stigma, and influencing policy outcomes. Prim Care Companion CNS Disord 2026;28(4):25br04119.
Author Affiliation: Vanderbilt University, Nashville, Tennessee.
Corresponding Author: Ellie Nadelmann, BS, Vanderbilt University, Nashville, Tennessee ([email protected]).
Financial Disclosure: None.
Funding/Support: None.

Clinical Points

• Clinicians can review patients’ media exposure to identify influences on substance use and recovery.
• Recovery narratives can be used to reframe addiction as treatable and reduce shame in patients. Exposure to empathetic media can reduce clinician bias and improve patient-centered care.