The association between perceived stigma and substance use disorder treatment outcomes: a review

Kathleen A Crapanzano, Rebecca Hammarlund, Bilal Ahmad, Natalie Hunsinger, Rumneet Kullar, Kathleen A Crapanzano, Rebecca Hammarlund, Bilal Ahmad, Natalie Hunsinger, Rumneet Kullar

Abstract

Substance use disorders (SUDs) take a heavy toll on those who have them and on society more broadly. These disorders are often difficult to treat, and relapse is common. Perhaps, because of these factors, these disorders are highly stigmatized worldwide. The purpose of this study is to examine empirical work intended to determine the impact of perceived social stigma and self-stigma on the process of recovering from SUDs with the assistance of formal treatment services. Qualitative studies confirmed that stigma experiences are common among those with these disorders and that these experiences can negatively impact feelings and beliefs about treatment. One quantitative study provided good statistical support for a direct effect of stigma on outcomes, but this was contradicted by other longitudinal data. In general, quantitative articles suggested an indirect effect of stigma on treatment outcomes, via negative emotions and cognitive mechanisms such as feelings of self-efficacy. However, it was notable that there was little consistency in the literature as to definitions and measurement of the constructs of recovery, perceived social stigma, and self-stigma. Future work should focus on bringing clarity, and validated measures, to this problem in order to better determine the nature of these relationships.

Keywords: perceived social stigma; self-stigma; substance use disorders; treatment outcomes.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
PRISMA flow diagram.

References

    1. Association AP. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.
    1. Goffman E. Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs, NJ: Prentice Hall; 1963.
    1. Room R, Rehm J, Paglia A, Ustun TB. Cross cultural views on stigma, valuation, parity, and societal views towards disability. In: Ustun TB, editor. Disability and Culture. Seattle: Hogrefe & Huber Publishers; 2001. pp. 247–291.
    1. Palomar J, Halkitis PN, Kiang M. Perceived public stigma and stigmatization in explaining lifetime illicit drug use among emerging adults. Addict Res Theory. 2012;21(6)
    1. Spears R, Manstead ASR. The social context of stereotyping and differentiation. Eur J Soc Psychol. 1989;19(2):101–121.
    1. Room R, Reuter P. How well do international drug conventions protect public health? Lancet. 2012;379(9810):84–91.
    1. Schomerus G, Lucht M, Holzinger A, Matschinger H, Carta MG, Angermeyer MC. The stigma of alcohol dependence compared with other mental disorders: a review of population studies. Alcohol Alcohol. 2011;46(2):105–112.
    1. Luoma JB, Twohig MP, Waltz T, et al. An investigation of stigma in individuals receiving treatment for substance abuse. Addict Behav. 2007;32(7):1331–1346.
    1. Luoma JB, O’Hair AK, Kohlenberg BS, Hayes SC, Fletcher L. The development and psychometric properties of a new measure of perceived stigma toward substance users. Subst Use Misuse. 2010;45(1-2):47–57.
    1. Livingston JD, Milne T, Fang ML, Amari E. The effectiveness of interventions for reducing stigma related to substance use disorders: a systematic review. Addiction. 2012;107(1):39–50.
    1. van Boekel LC, Brouwers EP, van Weeghel J, Garretsen HF. Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. Drug Alcohol Depend. 2013;131(1-2):23–35.
    1. Cumming C, Troeung L, Young JT, Kelty E, Preen DB. Barriers to accessing methamphetamine treatment: A systematic review and meta-analysis. Drug Alcohol Depend. 2016;168:263–273.
    1. Moos RH. Iatrogenic effects of psychosocial interventions for substance use disorders: prevalence, predictors, prevention. Addiction. 2005;100(5):595–604.
    1. White WL. Addiction recovery: its definition and conceptual boundaries. J Subst Abuse Treat. 2007;33(3):229–241.
    1. Frank D. The trouble with morality: the effects of 12-step discourse on addicts’ decision-making. J Psychoactive Drugs. 2011;43(3):245–256.
    1. Hill JV, Leeming D. Reconstructing ‘the Alcoholic’: Recovering from Alcohol addiction and the stigma this entails. Int J Ment Health Addict. 2014;12(6):759–771.
    1. Brooks AJ. Dissertation. University of Arizona; 1996. Factors Influencing Women’s Recovery from Substance Abuse: A Grounded Theory Approach.
    1. Grønnestad TE, Sagvaag H. Stuck in limbo: illicit drug users’ experiences with opioid maintenance treatment and the relation to recovery. Int J Qual Stud Health Well-being. 2016;11:31992.
    1. Sanders JJ, Roose RJ, Lubrano MC, Lucan SC, Meaning LSC. Meaning and methadone: patient perceptions of methadone dose and a model to promote adherence to maintenance treatment. J Addict Med. 2013;7(5):307–313.
    1. Radcliffe P, Stevens A. Are drug treatment services only for ‘thieving junkie scumbags’? Drug users and the management of stigmatised identities. Soc Sci Med. 2008;67(7):1065–1073.
    1. McCallum SL, Mikocka-Walus AA, Gaughwin MD, Andrews JM, Turn-bull DA. ‘I’m a sick person, not a bad person’: patient experiences of treatments for alcohol use disorders. Health Expect. 2016;19(4):828–841.
    1. Pauly BB, Gray E, Perkin K, et al. Finding safety: a pilot study of managed alcohol program participants’ perceptions of housing and quality of life. Harm Reduct J. 2016;13(1):15.
    1. Tang S. Factors Associated with Effectiveness of Methadone Maintenance Treatment in Yunnan Province of China. Los Angeles: UCLA; 2015.
    1. Mak WW, Chan RC, Wong SY, et al. A Cross-Diagnostic Investigation of the Differential Impact of Discrimination on Clinical and Personal Recovery. Psychiatr Serv. 2017;68(2):159–166.
    1. Link BG, Struening EL, Rahav M, Phelan JC, Nuttbrock L. On stigma and its consequences: evidence from a longitudinal study of men with dual diagnoses of mental illness and substance abuse. J Health Soc Behav. 1997;38(2):177–190.
    1. Brown SA, Kramer K, Lewno B, Dumas L, Sacchetti G, Powell E. Correlates of self-stigma among individuals with substance use problems. Int J Ment Health Addict. 2015;13(6):687–698.
    1. Frischknecht U, Beckmann B, Heinrich M, et al. The vicious circle of perceived stigmatization, depressiveness, anxiety, and low quality of life in substituted heroin addicts. Eur Addict Res. 2011;17(5):241–249.
    1. Kulesza M, Ramsey S, Brown R, Larimer M. Stigma among individuals with substance use disorders: does it predict substance use, and does it diminish with treatment? J Addict Behav Ther Rehabil. 2014;3(1):1000115.
    1. Schomerus G, Corrigan PW, Klauer T, Kuwert P, Freyberger HJ, Lucht M. Self-stigma in alcohol dependence: consequences for drinking-refusal self-efficacy. Drug Alcohol Depend. 2011;114(1):12–17.
    1. Randles D, Tracy JL. Nonverbal displays of shame predict relapse and declining health in recovering alcoholics. Clinical Psychological Science. 2013;1(2):149–155.
    1. Luoma JB, Kulesza M, Hayes SC, Kohlenberg B, Larimer M. Stigma predicts residential treatment length for substance use disorder. Am J Drug Alcohol Abuse. 2014;40(3):206–212.
    1. Kamaradova D, Latalova K, Prasko J, et al. Connection between self-stigma, adherence to treatment, and discontinuation of medication. Patient Prefer Adherence. 2016;10:1289–1298.
    1. Schomerus G, Corrigan PW, Klauer T, Kuwert P, Freyberger HJ, Lucht M. Self-stigma in alcohol dependence: consequences for drinking-refusal self-efficacy. Drug Alcohol Depend. 2011;114(1):12–17.
    1. Kaskutas LA, Borkman TJ, Laudet A, et al. Elements that define recovery: the experiential perspective. J Stud Alcohol Drugs. 2014;75(6):999–1010.
    1. Tsogia D, Copello A, Orford J. Entering treatment for substance misuse: a review of the literature. J Ment Health. 2001;10(5):481–499.
    1. Bobrova N, Rhodes T, Power R, et al. Barriers to accessing drug treatment in Russia: a qualitative study among injecting drug users in two cities. Drug Alcohol Depend. 2006;82(Suppl 1):S57–S63.
    1. Bojko MJ, Mazhnaya A, Makarenko I, et al. “Bureaucracy & beliefs”: assessing the barriers to accessing opioid substitution therapy by people who inject drugs in Ukraine. Drugs. 2015;22(3):255–262.
    1. Gilchrist G, Moskalewicz J, Slezakova S, et al. Staff regard towards working with substance users: a European multi-centre study. Addiction. 2011;106(6):1114–1125.
    1. van Boekel LC, Brouwers EP, van Weeghel J, Garretsen HF. Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. Drug Alcohol Depend. 2013;131(1–2):23–35.
    1. Corrigan P, Schomerus G, Smelson D. Are some of the stigmas of addictions culturally sanctioned? Br J Psychiatry. 2017;210(3):180–181.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa