Opioid addiction, attributions, and stigma: An online vignette experimental study.

Abstract

Stigma toward opioid addiction is a barrier to reversing the opioid epidemic. This study examined stigma, preferred consequences, and attributions of the cause(s) of addiction based on responses to a character portrayed as recently laid off and addicted to opioids. This study employed a 2 (race: Black vs. White) × 2 (status: janitor vs. computer scientist) × 2 (source of opioids: from a doctor vs. on the street) vignette between-subjects experimental design in an online survey. Equal numbers of political conservatives and liberals (n = 513) were recruited. The sample was mostly White with equal proportions of males and females. Stigma was measured with four scales and two items, and causal attributions and preferred consequences were each measured with three scales. Stigma was greater toward the janitor than the computer scientist and toward obtaining opioids on the street versus from a doctor. Respondent political conservatism predicted greater stigma including social distance (b = .29, p < .001). Bad character attributions predicted greater stigma including more negative feelings (b = .23, p < .001). Attributing addiction to being laid off predicted less stigma such as negative stereotypes (b = −.11, p < .001) and support for economic relief (b = .24, p < .001), whereas attributing it to biology predicted negative stereotypes (b = .07, p < .001). Political conservatism and attributing addiction to bad character predict stigma and unwillingness to help people with opioid addiction, whereas attributing it to being laid off and struggling financially predicts the opposite.

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

“…Attributing substance use to bad character may relate to assigning greater blame and personal agency for SUDs relative to other mental health conditions (e.g., Barry et al, 2014; Perry et al, 2020). Bad character attributions may shape perceptions of treatments and public policy initiatives (e.g., Ragsdale & Elliott, 2022), perhaps by “othering” of people who use substances as being either unable to change or not worth the resources to help, once again operating similar to ideas of genetic essentialism (Harden, 2023).…”

“…Indeed, bad character attributions are exceptionally strong enhancers of substance use stigma (Jacobi et al, 2022), above and beyond many well-documented predictors (e.g., age, gender, political affiliation; Ragsdale & Elliott, 2022). Moreover, other models have linked such attributions to robust negative emotions that also feed into stigmatization (e.g., Weiner, 1980) with evidence suggesting that personal attributions (i.e., bad character) predict greater anger and anxiety and less pity, support, or tolerance (e.g., Dijker & Koomen, 2003; Röhm et al, 2022).…”

“…Consequently, causal attributions may be a good candidate pathway for explaining how the effects of contact may emerge between the general population and health care professionals. While other work has shown the importance of contact for increasing positive social judgments (e.g., Corrigan et al, 2012; see Pettigrew & Tropp, 2006), causal attributions have only recently been explored (e.g., Ragsdale & Elliott, 2022). The juxtaposition of personal and biological attributions as respectively enhancing or reducing unique aspects of stigma distinguishes potential intervention targets if one is perhaps more influential than the other.…”

“…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).…”

“…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). Due to the novelty of the research questions, no a priori predictions were made regarding differences between health care professionals and the general population.…”