Developing a research agenda for understanding the stigma of addictions Part I: Lessons from the Mental Health Stigma Literature

Corrigan, Patrick W.; Schomerus, Georg; Shuman, Valery; Kraus, Dana; Perlick, Debbie; Harnish, Autumn; Kulesza, Magdalena; Kane-Willis, Kathleen; Qin, Sang; Smelson, David A.

doi:10.1111/ajad.12458

Cited by 102 publications

(116 citation statements)

References 53 publications

(57 reference statements)

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“…Confronting public stigma—stereotypes, prejudice and discrimination endorsed by the general population—is one of the greatest barriers to reversing the opioid epidemic and reducing the harm it causes to individuals, families and communities [1–3]. Historically, non‐medical drug dependence has been the most stigmatized of all psychiatric or medical conditions [4,5].…”

Section: Introductionmentioning

confidence: 99%

“…People with drug dependence are perceived as more blameworthy, less deserving of help than those with other stigmatized conditions and are less likely to be accepted as neighbors, coworkers or marriage partners [6,8,11–14]. This stigma has a profound impact on the lives of people who engage in non‐medical drug use, affecting their physical and mental health [15,16], treatment utilization and recovery [17] and public support for allocation of resources to addiction services and harm reduction [2].…”

Section: Introductionmentioning

confidence: 99%

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The unique nature of public stigma toward non‐medical prescription opioid use and dependence: a national study

2020

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Background and Aims Our ability to combat the opioid epidemic depends, in part, on dismantling the stigma that surrounds drug use. However, this epidemic has been unique and, to date, we have not understood the nature of public prejudices associated with it. Here, we examine the nature and magnitude of public stigma toward prescription opioid use disorder (OUD) using the only nationally representative data available on this topic. Design General Social Survey (GSS), a cross‐sectional, nationally representative survey of public attitudes. Setting United States, 2018. Participants/Cases A total of 1169 US residents recruited using a probability sample. Measurements Respondents completed a vignette‐based survey experiment to assess public stigma toward people who develop OUD following prescription of opioid analgesics. This condition is compared with depression, schizophrenia, alcohol use disorder (AUD) and subclinical distress using multivariable logistic or linear regression. Findings Adjusting for covariates (e.g. race, age, gender), US residents were significantly more likely to label symptoms of OUD a physical illness [73%, confidence interval (CI) = 66–80%; P < 0.001] relative to all other conditions, and less likely to label OUD a mental illness (40%, CI = 32–48%; P < 0.001). OUD was significantly less likely to be attributed to bad character (37%, CI = 30–44%; P < 0.001) or poor upbringing (17%, CI = 12–23%; P < 0.001) compared with AUD. Nonetheless, perceptions of competence associated with OUD (e.g. ability to manage money; 41%, CI = 33–49%; P < 0.01) were lower than AUD, depression and subclinical distress. Moreover, willingness to socially exclude people with OUD was very high (e.g. 76% of respondents do not want to work with a person with OUD), paralleling findings on traditional targets of strong stigma (i.e. AUD and schizophrenia). Conclusions US residents do not typically hold people with prescription opioid use disorder responsible for their addiction, but they express high levels of willingness to subject them to social exclusion.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The unique nature of public stigma toward non‐medical prescription opioid use and dependence: a national study

2020

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“…A large body of research exists on stigma of mental illness and other health conditions, for example, HIV/AIDS, but there is still lack of research on the stigma of addiction and the burden for people with substance use disorders (SUD) [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

“…Stigma can be distinguished into public stigma, which refers to stereotypes, prejudices and discrimination in the general population towards the person concerned, and self-stigma, the process of internalizing those external negative views and applying the corresponding stereotypes and prejudice to themselves [2].…”

Section: Introductionmentioning

confidence: 99%

Substance Abuse-Related Self-Stigma in Women with Substance Use Disorder and Comorbid Posttraumatic Stress Disorder

Melchior

Hüsing

Grundmann³

et al. 2019

Eur Addict Res

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Background: Self-stigma is a result of internalizing negative stereotypes by the affected person. Research on self-stigma in substance use disorders (SUD) is still scarce, especially regarding the role of childhood trauma and subsequent posttraumatic disorders. Objectives: The present study investigated the progressive model of self-stigma in women with SUD and posttraumatic stress disorder (PTSD), and the predictive value of PTSD severity and childhood trauma experiences on self-stigma. Method: In a cross-sectional study with 343 women with SUD and PTSD, we used the Self-Stigma in Alcohol Dependency Scale, the Childhood Trauma Questionnaire (CTQ), the PTSD Symptom Scale Interview (PSS-I), and to control for SUD severity and depression, the Addiction Severity Index Lite and the Beck Depression Inventory-II. Hierarchical regression analyses were conducted for each stage of self-stigma (aware-agree-apply-harm). Results: The interrelated successive stages of self-stigma were largely confirmed. In the regression models, no significant effects of the PSS-I- and the CTQ-scores were observed at any stage of self-stigma. Agreeing with negative stereotypes was solely predicted by younger age, applying these stereotypes to oneself was higher in women with younger age, higher depression and SUD severity, and suffering from the application (harm) was only predicted by depression. Conclusions: The progressive model of self-stigma could be confirmed in women with SUD and PTSD, but PTSD severity and childhood trauma did not directly affect this process. Self-stigma appears to be related to depression in a stronger way than PTSD is related to women with SUD and PTSD.

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“…While stigma towards substance use and people who use substances is well-documented (Kennedy-Hendricks et al, 2016, 2017; Kulesza et al, 2015; MacCoun, 2013; Pescosolido et al, 2010), its impact on stigmatized persons continues to be understudied and poorly understood (Corrigan et al, 2017; Kulesza et al, 2013; National Academies of Sciences, Engineering, and Medicine, 2016; Smith et al, 2016). We add to the literature by evaluating the relationship between internalized stigma and substance use problems (SUP), defined as negative consequences of substance use such as legal or financial problems (Blanchard et al, 2003).…”

Section: 0 Introductionmentioning

confidence: 99%

Internalized stigma as an independent risk factor for substance use problems among primary care patients: Rationale and preliminary support

Kulesza

Watkins

Ober

et al. 2017

Drug and Alcohol Dependence

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Background Little is known about internalized stigma among primary care patients, and whether the presence of internalized stigma is related to the severity of substance use problems independent of substance use-related variables. We sought to examine the relationship between internalized stigma and substance use problems among primary care patients with opioid or alcohol use disorders (OAUDs). Methods We present baseline data from 393 primary care patients who were enrolled in a study of collaborative care for OAUDs. Regression analyses examined the relationship between internalized stigma and substance use problems, controlling for demographics, psychiatric comorbidity, and quantity/frequency of use. Results The majority of participants reported thinking, at least sometimes, that they “have permanently screwed up” their lives (60%), and felt “ashamed” (60%), and “out of place in the world” (51%) as a result of their opioid or alcohol use. Higher internalized stigma was significantly related to more substance use problems (β = 2.68, p<0.01), even after the effects of covariates were accounted for. Stigma added 22%, out of 51% total variance explained, leading to a significant improvement in prediction of substance use problems. Conclusions Among this group of primary care patients with OAUDs, rates of internalized stigma were comparable to those reported in specialty substance use treatment settings. Consistent with extant specialty care literature, our results suggest that internalized stigma may be a unique contributor that is associated with treatment outcomes, such as substance use problems, among primary care patients with OAUDs.

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Developing a research agenda for understanding the stigma of addictions Part I: Lessons from the Mental Health Stigma Literature

Cited by 102 publications

References 53 publications

The unique nature of public stigma toward non‐medical prescription opioid use and dependence: a national study

The unique nature of public stigma toward non‐medical prescription opioid use and dependence: a national study

Substance Abuse-Related Self-Stigma in Women with Substance Use Disorder and Comorbid Posttraumatic Stress Disorder

Internalized stigma as an independent risk factor for substance use problems among primary care patients: Rationale and preliminary support

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