Overview
Ableism is bias or discrimination against people who are labeled or self-identify as having a disability.
History and Etymology
Commentary
Ableism is a complex concept because “disability” is a complex concept. Our norms surrounding the expectations we place on ourselves and others are constantly evolving.
Decades ago, the expectation in American workplaces was that people would work 12 hours a day, every day of the week- children included. If someone was suffering from unresolved health issues or trauma as a result of serving in a war and couldn’t work along those expectations, they might be considered disabled. In 2026, expecting someone to work more than 40 hours a week and forsake their weekends to make ends meet is considered unreasonable, and children aren’t expected to work at all when public education is available. Of course, that doesn’t mean people aren’t working unreasonable amounts to survive, but our norms are constantly evolving.
Because the concept of disability has always been fluid and varied, ableism too is a moving target to define. In the context of addiction and recovery, the forms ableism comes in depends on the model of addiction and health being applied in a particular situation.
For instance, reducing substance use disorders to issues of morality, willpower, and/or denial is a form of ableism. It ignores the measurable changes to the brain and body that occur after long-term substance use. It also ignores findings like the increased chance of someone developing a substance use disorder if they were born to parents who struggled with substance use. Most adults who develop alcohol use disorder report having their first drink between 13 to 17, so it seems a little bizarre that a pattern which was developed before someone had a mature adult brain, and was expected to have been protected by adult guardians, is reduced to a moral and willpower issue.
Often, I’ve heard people express the sentiment, “so what if you’re sober? that’s just the baseline everyone is at who was able to control their substance use.” This is ableist since it very explicitly erases the effort it can take to work against the combination of biological predisposition, intergenerational trauma, socioeconomic barriers, and physiological changes that are real parts of one’s lived experiences. We wouldn’t tell someone who survived cancer, “so what? The baseline expectation for a person in our society is that you don’t have cancer.” At least, I hope not.
Medical Interference
In its most extreme forms, the ableism goes beyond social stigma and directly interferes with recovery and medical treatment. In the early half of the 20th century, American physicians largely had written off substance use disorders as untreatable, or at least, not worth attempting to treat. There was a turning point around the debut of Alcoholics Anonymous (AA) and the “Disease Like Any Other” campaigns pushed for by advocates like Marty Mann, which argued that substance use disorders were really a disease that followed patterns we could manage. The Minnesota Model emerged as a rehabilitation model that incorporated medical supervision with therapy, counseling, and peer support through groups like AA. Still, no disease can truly be said to be like any other, any more than people themselves can be reduced to stereotypes.
Those with SUD who take medication are often accused of substituting one dependency for another, even if to address something like Major Depressive Disorder (MDD) that co-occurs with SUD. Medication for Opioid Use Disorder (MOUD) involves taking methadone or buprenorphine, which are especially likely to be stigmatized as continued drug dependence. Patients with substance use disorders who visit clinics for other health issues will always have to be conscious of the stigma around drug-seeking behavior when approaching treatment providers, particularly for medical professionals who haven’t had specialized training in SUD. In fact, studies have shown that just changing the term “substance abuse” to “substance use disorder” results in physicians treating patients with less intent to punish them, which shows how easily suggestible everyone, including experts, can be to social stigma.
Reasonable Accommodations
In my experience, the vast majority of people with SUD have no idea that there are reasonable accommodations they can request from their workplace in support of recovery. There’s a major misconception that reasonable accommodations for substance use disorders involves tolerating illicit use in the workplace, when in reality these accommodations apply before a positive drug screen or after a recovery program has been initiated. It’s actually somewhat shocking to me that treatment centers and facilities do not provide any kind of standard pamphlet describing these accommodations, especially when they certainly have the time to do sound bowls, equine therapy, and hour-long playlist-sharing sessions.
Adjusting shift hours to accommodate morning/evening clinic visits for MOUD, eliminating erratic shifts that disrupt the sleep cycles needed for healing, modifying break schedules to practice stress-reduction exercises or call a sponsor are all within scope of reasonable accommodations for the workday. Job-protected leave to attend a rehabilitation program or seek short-term stabilization following a relapse are included too. Some people who work in environments with frequent exposure to triggers or substances can request reassignment to other tasks or departments, at least in early recovery. In other words, these protections exist so that a relapse isn’t automatically a cause to be fired and can be seen as part of a chronic disease.
Even if you were completely aware of these accommodations, there are plenty of other systemic manifestations of ableism against substance use disorders that can trip you.
One of them may have occurred to you while reading the above paragraph: “if someone experiences a relapse and seeks treatment, they’re protected, but between those two points, isn’t someone considered an active user who is eligible for termination or eviction?” Yes, that’s a current loophole in the law. Someone who relapses on Saturday, arranges a rehab stay starting Tuesday due to bed availability limitations, but fails a drug test at work on Monday can be fired on the spot. In comparison, if someone with epilepsy has a seizure at work rather than failing a drug test, that wouldn’t be protected justification to fire them even if the productivity loss to the employer was exactly the same.
Under Section 14(c) of the Fair Labor Standards Act, workers with disabilities can be paid below the federal minimum wage.
Government programs like Supplemental Security Income (SSI) effectively penalize individuals with disabilities for marrying, since the combined assets can put them over the eligibility limits for healthcare and income for survival. Many couples with disabilities are not able to live together or get married without significant risks to their wellbeing.
Many laws, like public intoxication, mean that any individual experiencing a relapse who leaves private view to enter the public space can be criminally institutionalized at the sole discretion of law enforcement, despite no damage to property or life.
In a cultural and social sense, the stigma around substance use disorders is intense. Ableism suffers from the same social patterns as racism and sexism; the few who manage to “overcome” their barriers are elevated as proof that the systems people live in don’t need to change. Instead, others with disadvantages simply need to live up to the standards of the elevated examples. To illustrate the absurdity of this, imagine that someone paralyzed from the waist down manages to climb up a flight of stairs with their upper body alone because the elevators in their building aren’t working. It would be barbaric to celebrate this as a norm anyone should live up to while discarding plans to make buildings more accessible to those in wheelchairs. Similarly, there are people with substance use disorders who go into spontaneous remission without any treatment whatsoever, and there are people who recover because communities like AA provide a network of resources that align with their religious beliefs. It would be barbaric to assume this means we have proven paths for recovery within our current system and simply need to coerce individuals into the treatment process.
Media
Our media is pretty hostile toward substance use disorders too. I have a lot of affection for Thor from God of War: Ragnarok as a much more nuanced depiction of alcoholism than we usually get. Thor’s drinking, and attempts to abstain, is directly related not just to his own childhood growing up, but the ongoing dynamics between his family and a changing world that’s increasingly difficult to navigate with the patterns he knew before. The story paints a portrait of him as a genocidal drunken barbarian well before we encounter him, which is a clever use of the connection between mythology and reputation, but without absolving him of the atrocities he’s responsible for. The very first time we meet him, it’s through a classic patriarchal power move of fathers sending their sons ahead of a negotiation to size up the other side. Succession has a very similar scene to illustrate the relationship between Logan Roy and his son Kendall as an extension of himself. In both cases, the person we meet is borderline submissive and internally lost, clearly disengaged from the present moment while following the motions of a plan laid out by a patriarchal father.
The context we learn over time depicts someone who has been in a constant state of abuse and conflict his whole life, who drinks to avoid thinking about the consequences of the actions he feels obligated to carry out, and is the furthest thing from selfish at the point that we meet him. He’s in mourning over how replicating the parenting he got only led to the loss of his sons, in fear of what it would take to change for the sake of his living daughter and wife, in repressed guilt over the damage he’s caused that he can’t process without drinking, and in confusion through the manipulation of a father whose approval he desperately seeks as a foundation for securing his family’s future. It can’t be said that Thor didn’t take pleasure in his moments of brutality, but neither can it be said that he lives for the sake of a selfish agenda that necessitates brutality. His character is a foil to Kratos, who similarly had a brutal childhood that instilled a sense of brutality in him, but who rebelled against his family after feeling betrayed rather than rationalize that betrayal as necessary for the greater good. Whereas Kratos attempts to cast aside his humanity after he’s been tricked into killing his family, Thor is still mentally working out the sequence of events that led to him killing his son. Litigating the justifications that either character took in response to an impossible situation in some kind of morality play is a futile exercise. The narrative emphasizes that the only thing worth considering is the future: “Don’t you know what I’ve done? / Yes, but what will you do now?”
On the other hand, consider the Saw franchise, which has a Wikipedia page dedicated to the 24 “Drug Addicts” included across all their properties. The themes of Saw are generally that a deranged serial killer thinks he’s helping people appreciate the life they had by asking them to undergo a brutal torture to get it back. This explicitly runs with the narrative that addiction is the result of being ungrateful for everyday life and seeking greater pleasures selfishly at the expense of others, as well as their own best interests. In the case of addiction, Jigsaw seems to think addicts need more trauma in order to be grateful for their lives derailed by substance use.
Or consider Requiem for a Dream, which does treat addiction as a pattern that occurs across different social stratifications in different ways rather than a personal moral failing, but only through a parallel downward spiral. The takeaway isn’t just that addiction is a horrifying experience, but that it’s also an inescapable one that swallows an individual’s agency and identity.
Even Breaking Bad suffers a bit from this in order to be a morality play. Jesse is able to pull out of his struggles with addiction at various points in his life without demonstrating some kind of “truly bad” core and is depicted with a backstory that shows trauma and lack of support, but the show generally fails to do the same for characters who don’t have a middle-class white background. Partly, this is for the narrative tension that comes with casting a sense of enigmatic exoticism over both drugs and the drug trade, something that’s deeply embedded in the fabric of America’s imagination, but the end result is the same.
Capitalism
If we really want to dig into the root causes of these issues, we have to discuss capitalism. In a system designed around short-term profit-seeking at all costs, the concept of addiction is highly desirable to you. An addicted customer will sacrifice everything else past the point of their own expressed preferences in order to continue using your products. They will continually seek faster trades with larger volumes as their tolerance for the current volume builds. When the addiction leads to a destruction of one’s own life, perhaps to the point of breaking laws to maintain the usage patterns, the state comes along to institutionalize these individuals so that they can continue working with far fewer liberties and rights.
Logically, addiction is the ultimate goal of capitalism, and one that behavioral economists have historically overlooked with their emphasis on utility and rational choice.
Consider the absurdity of corporate and political leaders panicking about declining birth rates; what exactly is the social problem if people look at themselves and the world, and then decide that they don’t want to pursue parenthood in these conditions? The problem is that once everyone has been put as close to a track of addiction as possible, the only way to generate more capital is to have more labor that can be inserted into the tracks above. The systemic hostility to working-class families is papered over with propaganda about the happiness that’s just one more consumption away. The fundamental problem of modern advertising is convincing people they have an unmet need that only their product can satisfy.