Healthcare Awareness – Tarrant County Physician Online

Beating the Stigma: The Challenges in Treating Substance Use Disorders

President’s Paragraph

By Cheryl Hurd, MD, TCMS President

This article was originally published in the May/June 2026 issue of Tarrant County Physician.

By the time you all read this article, I hope you will have had a chance to listen to some of Tarrant County Medical Minute’s many interesting podcast episodes. I recently had the privilege of being invited as a guest on the podcast (you can find my episode here), which TCMS launched in 2025. It was fun, and I also found it to be an opportunity to continue to highlight mental health and advocacy. As I’ve mentioned before, mental health is marginalized and stigmatized but so essential to overall health. I appreciated the opportunity to talk about this on the podcast, fulfilling one of my promises to speak openly about mental health issues.

So, today we are going to talk about an even more stigmatized mental health issue—substance use disorders. They are far more common than many of us realize. According to the Substance Abuse and Mental Health Services Administration in their National Survey on Drug Use and Health in 2023–24, nearly 48 million Americans age 12 and older, or about one in six people, meet criteria for a substance use disorder in any given year.¹

Texas mirrors this national statistic. Alcohol use disorder accounts for the largest proportion, followed by drug use disorders involving marijuana, stimulants, opioids and more. State‑level estimates from the National Survey on Drug Use and Health indicate that roughly one out of seven Texans meets criteria for a substance use disorder each year.² While this is slightly lower than the national average, it still represents millions of people across our state whose health, relationships, and economic stability are affected. In a state as large and diverse as Texas, the collective impact of these conditions is substantial: it affects healthcare utilization, workforce participation, public safety, and even community well-being.

For physicians, this data shows what is already evident in clinical practice. Substance use disorders frequently coexist with chronic medical conditions, complicating diagnoses and treatments while increasing the risk of poor health outcomes. For legislators and policymakers, the numbers highlight the scope of the issue and the importance of continuous investment in prevention, early identification, evidence‑based treatment, and long‑term recovery support. And for the general public, the message is both sobering and illuminating: substance use disorders are common, treatable medical conditions, not moral failures or character flaws.

Substance use disorders do not exist in isolation. National data consistently demonstrates high rates of co‑occurring mental illness as well.¹ This overlap reinforces the need for integrated approaches to care that address the whole person rather than fragmented systems that separate “mental health” from “substance use.” The stigma surrounding substance use disorders mirrors the stigma that has historically marginalized mental health conditions—just as depression and anxiety were once dismissed as weaknesses rather than illnesses, substance use disorders continue to be judged rather than treated.

Stigma remains one of the most powerful barriers to care. It delays seeking help, discourages honest conversations between patients and physicians, and shapes policies that emphasize punishment over treatment. When individuals fear judgment, they are less likely to disclose substance use concerns, less likely to engage in treatment, and less likely to experience recovery. This is true no matter what walk of life you stem from, no matter what profession you are in. Reducing stigma is thus a clinical, ethical, and public health imperative.

Texas‑specific health data further illustrates the downstream effects of untreated substance use disorders, including alcohol‑related hospitalizations, drug‑related overdoses, and preventable deaths.² Even when prevalence rates are slightly lower than national averages, the absolute number of affected individuals places significant strain on healthcare systems and communities. These outcomes are not inevitable; evidence‑based prevention strategies, timely access to treatment, and sustained recovery supports have been shown to reduce morbidity, mortality, and costs.³ The key is that these initiatives have to be adequately funded and broadly accessible.

It is essential to treat substance use disorders as seriously and compassionately as other chronic illnesses. This includes speaking openly about prevalence, acknowledging the role of stigma, and advocating for systems of care that are based on scientific evidence rather than outdated assumptions. If one in six Americans—and one in seven Texans—are affected, then nearly every family, workplace, and community has a stake in how we respond. As physicians, policy advocates, and community leaders, we have both the opportunity and the responsibility to lead with data, compassion, and transparency. By reframing substance use disorders as the common, treatable health conditions they are, we can achieve these goals of reducing stigma, improving access to care, and improving the health and well-being of the populations we serve.

For physicians, the message should be clear: substance use disorders are common and addressing them as part of routine medical care should be best practice. Screening and brief, non-judgmental conversations about substance use should be normalized in our clinical settings. How we ask and how we respond do matter. Framing substance use disorders as treatable medical conditions like the evidence shows will increase patient disclosures, increase their engagement in treatment, and ultimately lead to their trust in us. We must lead the shift from judgment to treatment by insisting that substance use disorders are met with evidenced based care, equitable insurance coverage, and our compassion—not silence or shame.

“We, as a culture, have not fully acknowledged how much help is needed. The only real shame is on us for not being willing to speak openly. For continuing to deny that mental health is related to our overall health. We need to start talking, and we need to start now.”
– OPRAH WINFREY

References:

Blaire Bryant, Naomi Freel, and Emily Steckler, “SAMHSA Releases New 2024 Data on Rates of Mental Illness and Substance Use Disorder in the US,” National Association of Counties, July 28, 2025, https://www.naco.org/news/samhsa-releases-new-2024-data-rates-mental-illness-and-substance-use-disorder-us.
“Substance Use Disorder Statistics,” Drug Policy Facts, accessed May 4, 2026, https://www.drugpolicyfacts.org/node/4476.
Johanna Bellon et al., “Association of Outpatient Behavioral Health Treatment With Medical and Pharmacy Costs in the First 27 Months Following a New Behavioral Health Diagnosis in the US,” JAMA Network Open 5, no. 12 (2022): e2244644, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2799220.
Substance Abuse and Mental Health Services Administration, “National Survey on Drug Use and Health (NSDUH): 2023 National Releases,” SAMHSA, accessed April 1, 2026, https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health/national-releases/2023.
Substance Abuse and Mental Health Services Administration, “State Estimates of Mental Health and Substance Use,” accessed April 1, 2026, https://nsduhweb.rti.org/respweb/estimates.html.
Li-Tzy Wu, He Zhu, and Udi E. Ghitza, “Multicomorbidity of Chronic Diseases and Substance Use Disorders and Their Association with Hospitalization: Results from Electronic Health Records Data,” Drug and Alcohol Dependence 192 (2018): 316–23, https://doi.org/10.1016/j.drugalcdep.2018.08.013.
Lauren R. Ray et al., “Combined Pharmacotherapy and Cognitive Behavioral Therapy for Adults With Alcohol or Substance Use Disorders: A Systematic Review and Meta-analysis,” JAMA Network Open 3, no. 6 (2020): e208279, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767358.

Mental Health in Medicine: A Call to Lead

President’s Paragraph

By Cheryl Hurd, MD, TCMS President

This article was originally published in the January/February 2026 issue of Tarrant County Physician.

Hello everyone, my name is Cheryl Hurd, and it is my honor and privilege to serve as the 2026 TCMS president. I am a psychiatrist who has been in active practice for nearly twenty-five years, but I have also been a medical educator for the majority of that time. (I am also an English Lit major, so the “President’s Paragraph” is likely to become much longer than a paragraph. . . .) I want to thank the many presidents before me who have written articles and stories that have amused, enlightened, and inspired me. I admire the passion (and compassion) as well as the courage of my predecessors. I can only hope to aspire to the same level of dedication to my theme as they did to theirs.

My mission has always been to provide the highest quality and evidenced-based care to patients while training the next generation of physicians in best practices. Easy buzzwords to write, but they’re sincere nonetheless. As a psychiatrist, mental health is at the forefront of my mind. Mental health has long been marginalized, treated as secondary to physical illness, and burdened by stigma. Yet the evidence is clear: Mental health is inseparable from overall health, and its neglect undermines our patients, our communities, and ourselves.

I have chosen to make mental health advocacy the defining theme of my tenure. This is not just a matter of professional responsibility; it is a moral imperative. TCMS should be among those leading the way in ensuring that mental health is recognized as a cornerstone of care in this county and throughout the great state of Texas.

Millions of people struggle with depression, anxiety, trauma, and substance misuse; this includes us as physicians. Suicide remains a leading cause of death among young people, and burnout continues to erode the well-being of healthcare professionals. We still lose as many as 400 attending physicians to suicide a year.¹ Residents and medical students are facing the same challenges. These realities are not just statistics—they are the lived experiences of our patients, colleagues, families, and ourselves.

The pandemic further exposed the fragility of our mental health infrastructure. The sequelae of the pandemic included an explosion in mental health disorders across our country. Demand for services surged, yet access remained uneven despite the adoption of telepsychiatry. Rural communities, marginalized populations, and children bore disproportionate burdens. I was president of the medical staff at JPS from the beginning through the height of the pandemic, and I saw firsthand the devastation that was wrought on the physical and mental well-being of the healthcare workforce. My most important service as medical staff president during that time was to bolster our physicians and other providers, provide resources, give updates, and instill hope when despair seemed to overwhelm us. The infrastructure could not meet the demands, and it often still doesn’t.

So, I would like to focus on expanding equitable access to care for all; integrating mental health into primary care, schools, and workplaces; and leading a conversational shift that normalizes open discussions about mental health across our practices and communities. Through advocacy we can advance reforms that treat mental health with the same seriousness as physical illness, expand the workforce with training and support for all physicians (not just mandate PHQ-9 and GAD-7 questionnaires at every visit), strengthen school partnerships to provide early intervention, invest in community clinics, expand telehealth to close gaps in underserved areas, and promote research and innovation that drive evidence‑based solutions.

As physicians, we still carry unique credibility in shaping public discourse. When we speak openly about mental health—whether in clinical settings, community forums, policy debates, or even podcasts—we dismantle stigma and inspire change.

We must also look inward. Physician burnout and moral distress remain pressing concerns that negatively impact physician well-being. By prioritizing mental health within our own profession, we model resilience and compassion for the broader healthcare system. TMA, our state medical association, has developed many resources in service of our members for these very issues. Many county societies have done the same, as have we at TCMS. I encourage everyone to visit the Physician Wellness website and learn more about our efforts: https://www.tcam.org/physician-wellness.

I know that I am asking a lot of all of you, and it won’t be easy. There are many financial constraints and competing interests that limit the expansion of services. We have a workforce shortage that hinders access, and the stigma of mental illness persists (particularly when it is related to substance use disorders). Differences in healthcare policies and funding priorities can complicate efforts to expand mental health services, but collaboration can help bridge these divides. These challenges are not insurmountable. With advocacy, innovation, and determination, we can overcome them.

Mental health is about people. It is about the child struggling with anxiety, the veteran coping with trauma, the parent balancing stress, and the physician facing burnout. By focusing on mental health, we confirm that every individual’s well-being matters.

As president of our medical society, I call upon each of you—physicians, educators, researchers, and advocates—to join me in this work. Together, we can elevate mental health, ensuring that it is recognized as a fundamental component of healthiness and a shared responsibility of the medical community.

“What mental health needs is more sunlight, more candor, and more unashamed conversation.” —Glenn Close

References:

John Matheson, “Physician Suicide,” American College of Emergency Physicians https://www.acep.org/life-as-a-physician/wellness/wellness/wellness-week-articles/physician-suicide#:~:text=Each%20year%20in%20the%20U.S.,and%20alcohol%20and%20substance%20abuse;.

The Power of Palliative Care: A Physician’s Perspective

By Dr. Mo Rezaie

A Misunderstood Mission

One of the most significant misconceptions about palliative care is that it’s solely focused on end-of-life care. This couldn’t be further from the truth. Palliative medicine is a specialized area of medicine that focuses on improving the quality of life for people living with serious illnesses. By addressing physical, emotional, and spiritual needs, palliative care helps patients and their families navigate difficult times with grace and dignity.

Beyond Physical Symptoms

While palliative care can certainly help manage physical symptoms like pain and fatigue, it goes far beyond that. It’s about addressing the whole person, including their emotional, social, and spiritual well-being. This might involve counseling, support groups, or spiritual guidance.

The Importance of Early Palliative Care

Many people believe that palliative care is only for those in the final stages of life. However, palliative care can be beneficial at any stage of an illness. Early palliative care can help patients and their families make informed decisions about treatment options, manage symptoms effectively, and improve quality of life.

A Growing Need

Despite its many benefits, palliative care remains underutilized. There is a significant shortage of palliative care physicians, and many healthcare providers are not adequately trained to provide palliative care. This can lead to suboptimal care for patients with serious illnesses.

A Call to Action

To address this growing need, we must increase awareness of palliative care and encourage more healthcare providers to specialize in this field. By working together, we can ensure that all patients have access to the compassionate and effective care they deserve.

A Personal Perspective

As a palliative care physician, I have the privilege of witnessing firsthand the transformative power of this specialty. By focusing on the patient’s overall well-being, we can help them live their best lives, even in the face of serious illness.

Morvarid “Mo” Rezaie, DO, HMDC, FACOI is a Palliative Medicine physician at The Center for Cancer and Blood Disorders.