Substance-Specific Stigma and the Gatekeeping Role of Social Distance in Recovery Support Provision

Background: Community integration for individuals with substance use disorders (SUDs) depends on the willingness of social network members to provide aid, yet the mechanisms driving this support remain poorly understood. This study evaluates how substance type and relational proximity influence willingness to help, isolating the relative impact of social distance, recovery optimism, and individual normative assets. Methods: In an 8 × 2 randomized factorial vignette experiment (N = 239), participants read a scenario describing a cousin or childhood friend going through a “rough patch.” Conditions manipulated substance type (seven specific SUD histories vs. a no-substance control) and relational proximity (extended kin vs. non-kin friend). Four OLS regression models (overall, instrumental, informational, and emotional support) were estimated with robust standard errors and Benjamini–Hochberg false discovery rate (FDR) adjustments. Results: Social distance was the strongest and most consistent correlate of support across all four outcomes, surviving FDR correction in every model (b = −0.20 to −0.40). While several substance contrasts reached raw significance in the positive direction, none survived correction. Relational proximity produced no statistically significant kinship advantage, though estimates were consistently positive. Among individual-level predictors, recovery optimism, religiosity, and willingness to disclose the relationship with the individual described were positively associated with support provision. Conclusions: Social distance, rather than public stigma or substance-specific risk, was the primary barrier to support provision. Interventions seeking to mobilize community recovery support should prioritize reducing desired social distance within existing relationships rather than focusing exclusively on substance-specific anti-stigma campaigns.