The labels and models used to describe problematic substance use impact discrete elements of stigma: A registered report.

Abstract

Objectives: Problematic substance use is one of the most stigmatized health conditions leading research to examine how the labels and models used to describe it influence public stigma. Two recent studies examine whether beliefs in a disease model of addiction influence public stigma but result in equivocal findings—in line with the mixed-blessings model, Kelly et al. (2021) found that while the label “chronically relapsing brain disease” reduced blame attribution, it decreased prognostic optimism and increased perceived danger and need for continued care; however, Rundle et al. (2021) conclude absence of evidence. This study isolates the different factors used in these two studies to assess whether health condition (drug use vs. health concern), etiological label (brain disease vs. problem), and attributional judgment (low vs. high treatment stability) influence public stigma toward problematic substance use. Method: Overall, 1,613 participants were assigned randomly to one of the eight vignette conditions that manipulated these factors. They completed self-report measures of discrete and general public stigma and an indirect measure of discrimination. Results: Greater social distance, danger, and public stigma but lower blame were ascribed to drug use relative to a health concern. Greater (genetic) blame was reported when drug use was labeled as a “chronically relapsing brain disease” relative to a “problem.” Findings for attributional judgment were either inconclusive or statistically equivalent. Discussion: The labels used to describe problematic substance use appear to impact discrete elements of stigma. We suggest that addiction is a functional attribution, which may explain the mixed literature on the impact of etiological labels on stigma to date.

Contact reduces substance use stigma through bad character attributions, especially for U.S. health care professionals.

“…Thus, increasing biological knowledge may be somewhat helpful for the general population, but among health care professionals who already have medical training, targeting these beliefs may not produce meaningful change in stigma. Previous research suggests that though endorsing a biogenetic model may have reduce blame, it also has the ironic consequences of reducing perception that SUDs can be effectively treated (e.g., Kelly et al, 2021; Pennington et al, 2023). For example, when describing alcohol use disorder as either being genetic (i.e., uncontrollable) or not (i.e., personally controllable), the genetic explanations reduced blame but also reduced perceptions that treatment would be effective (Lebowitz & Appelbaum, 2017).…”

“…For example, when describing alcohol use disorder as either being genetic (i.e., uncontrollable) or not (i.e., personally controllable), the genetic explanations reduced blame but also reduced perceptions that treatment would be effective (Lebowitz & Appelbaum, 2017). While biogenetic explanations may reduce certain aspects of stigma (e.g., Kelly et al, 2021; Pennington et al, 2023), they do not remove all aspects of stigmatization (see Krendl & Perry, in press).…”

“…While not necessarily in line with other work (e.g., Ragsdale & Elliott, 2022), this should be explicitly tested in follow-up studies. Causality could be better tested if statements such as “their substance use stemmed from biological vulnerabilities” or “their substance use started due to their bad character” were included in the vignette (akin to other work examining etiological labeling; Kelly et al, 2021; Pennington et al, 2023; Rundle et al, 2021).…”

“…To counteract these detrimental effects of personal attributions, education-based interventions often try to improve knowledge about the neurobiological etiology of the disorder, thereby increasing biological attributions (e.g., Volkow et al, 2016). Meta-analytic evidence shows that biological attributions may not reduce stigma (i.e., perceptions of dangerousness, social distance; Angermeyer et al, 2011; Kvaale et al, 2013) even though using terms such as “chronic relapsing brain disease” reduces blame (Kelly et al, 2021; Pennington et al, 2023; cf. Rundle et al, 2021; for a review, see Krendl & Perry, in press).…”

“…To evaluate the following hypotheses, a well-validated vignette approach (Perry et al, 2020) was used to activate perceptions of SUD (i.e., attributions, social distance; see Krendl & Perry, 2022, for details on specific vignettes). By encouraging respondents to think about a specific person, vignettes may activate latent stigmatizing beliefs more effectively than traditional survey instrument, thus becoming a relatively standard way for studying these constructs (e.g., Kelly et al, 2021; Krendl & Perry, 2022; Pennington et al, 2023; Perry et al, 2020; Ragsdale & Elliott, 2022; Röhm et al, 2022; Rundle et al, 2021). Guided by a mixture of attribution theory (Link & Phelan, 2001; see also Weiner, 1980), genetic essentialism (e.g., Harden, 2023), and existing evidence (i.e., Jacobi et al, 2022; Ragsdale & Elliott, 2022; Röhm et al, 2022; Yang et al, 2017), bad character attributions were postulated to be the main drivers of substance use stigma (i.e., social distance), even when controlling for biological attributions (Hypothesis 1a).…”