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

Abstract

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.

Stigma as a fundamental hindrance to the United States opioid overdose crisis response

“…When people with OUDs internalize or anticipate the public stigma attached to their illness, maladaptive behaviors leading to poorer health outcomes may occur [132,133]. Among people with OUDs, internalized stigma has been associated with psychological distress and poorer quality of life [134][135][136], continued substance use [137], and reduced engagement with substance use treatment [138]. Anticipated stigma has also been associated with psychological distress [135,139] and reduced engagement in care [71, [140][141][142].…”

Trastornos por consumo de sustancias: entre las inequidades y el estigma

“…Por lo tanto, es de esperar alta frecuencia de autoestigma en personas con consumo de sustancias 42,51,52 . Ahern et al 42 , investigación antes citada, informaron que 85% de personas con TCS se sintieron percibidos como peligrosos, 76%, malas personas y 86%, como poco confiables por aquellas personas que no consumen regularmente sustancias.…”

Urban Residents Attitudes Towards People With Drug Abuse in Five Districts of Concepcion Commune, Chile

“…Although religiosity and spirituality appear associated to protective behavior for use and abuse of drugs. 4,[16][17] In this case, the fact of have religiosity or spirituality or religious beliefs is more related to negative attitudes towards those who abuse of drugs, stigmatizing attitudes that can become a challenge aimed to break barriers of access to health care of these people. 6,[8][9][10][13][14] Attitudes also may vary if the interviewee had personal experience with drug use and if knows some family member or close friend with abuse of alcohol, marijuana, cocaine and base paste, being more ambivalent to who they know with alcohol abuse, which no surprises, when 91% of interviewees use the drug and it is the biggest consumption in country.…”

“…There are studies that indicate that is necessary to combat stigma and negative attitude towards the mentally ill, including those who have drug abuse. [2][3][4][5] Positive attitudes foster social acceptance at the interpersonal level and at the socio contextual levels. It is acknowledged that negative and stigmatizing attitudes can increase social isolation, relapse and worsening condition of people with mental illness and those who present drug abuse.…”

“…15 Others pose religiosity or spirituality as a protective factor, where female gender possesses higher level of spirituality than male gender. 4,[16][17] It was also being described that women had less stigmatizing attitudes than men. 18 Few studies in Chile focused on population attitude towards people with drug abuse; rather they relate drug use with the perception of safety of population.…”