Aims To conduct a systematic review of the literature investigating the relationship between stigma experienced by individuals who use drugs. Methods We conducted an online literature search and identified articles related to stigma among individuals who use drugs. Studies evaluating associations between stigma and socio-demographic variables and if applicable clinical and substance use variables are presented. In addition, recommendations for future research are provided. Results We identified 26 articles describing 28 studies evaluating stigma. The majorities of studies were published in the last 11 years and conducted in the U.S. Samples were relatively diverse: 41.7% of all participants who provided data identified as racial/ethnic minorities. The vast majority of the relationships between stigma and socio-demographic characteristics were included in only one or very few studies, which limits conclusions. The relationship between stigma and psychological well-being is the only consistent finding reported in the literature. Specifically, results suggest that stigma has a detrimental effect on psychological well-being among individuals who use drugs. Conclusions While this literature is expanding at a rapid pace, this review indicates several areas for future research and needed improvements in research methodology in this area. Specifically, lack of comprehensive description of sample characteristics, lack of construct identification and proper definition, a dearth of longitudinal studies and limited research describing relationships between stigma and substance use behavior are a few areas identified for further research.

In Part II paper (American Journal of Addictions, Vol 26, pages 67-74, this issue), we address how this literature informs a research program meant to develop and evaluate and stigma strategies (eg, education, contact, and protest). Both papers end with recommendations for next steps to jumpstart the addiction stigma portfolio. Here in Part I, we offer one possible list of key research issues for studies attempting to describe or explain addiction stigma. (Am J Addict 2017;26:59-66).

Sexual minorities have higher rates of depression and anxiety than their heterosexual counterparts. This elevated risk of psychological distress has generally been hypothesized to be a result of the effects of discrimination including internalized negative beliefs about sexual minorities. However, little research has examined the role of various types of coping in mediating between internalized homophobia and mental health. We tested the direct relationship between internalized homophobia and psychological distress and evaluated general and sexual minority-specific coping strategies as potential mediators using structural equation modeling. Data are from a national sample of 1,099 young adult sexual minority women who were on average 20.86 (SD= 2.12) years old, participating in a study on mental health and substance use. The model demonstrated acceptable fit, χ2 (83) = 402.9, p <.001, CFI=.94, TLI=.92, SRMR= .07, and RMSEA=.06, accounting for 73% of variance in psychological distress. Greater use of maladaptive coping and less use of sexual minority-specific coping were associated with higher psychological distress. Although maladaptive coping mediated the relationship between internalized homophobia and psychological distress, sexual minority-specific coping did not. Our findings support previous studies that have demonstrated the impact of internalized homophobia on psychological distress as well as the role of coping as a protective/risk factor in this relationship.

Veterans underutilize mental health services. We investigated the association between treatment seeking stigma and utilization of mental health services in a sample of 812 young adult veterans. Higher perceived public stigma of treatment seeking was significantly related to lower treatment utilization. Although many veterans were concerned about negative perceptions if they were to seek treatment, a much smaller number of them endorsed that they would judge a fellow veteran negatively in similar situation. Targeting perceived public stigma of treatment seeking, through perceived norms interventions, might help in narrowing the gap between the need and receipt of help among veterans.

The paper ends with recommendations for next steps in addiction stigma research. (Am J Addict 2017;26:67-74).