Representation of adverse childhood experiences is associated with lower public stigma towards people who use drugs: an exploratory experimental study

Abstract

BackgroundStigmatising attitudes towards people who use drugs are pervasive amongst the public. We investigated whether public stigma was affected by presentation of a history of adversity, and how substance use was described. MethodsA cross-sectional online study using a convenience sample, with a randomised 2 x 2 x 2 factorial design. Participants read one of eight randomly presented vignettes that described a fictional case history of substance use. In each vignette the gender of the subject (male or female), description of the subject's substance use ('addict' vs substance use disorder), and life history ('tough life' vs description of four adverse childhood experiences (ACEs)) were varied.Participants then completed an adapted version of the attribution questionnaire (AQ-9), which assessed stigmatising beliefs. ResultsData were obtained from 502 participants (53.0% Female; mean age 36.5 ± 13.5 years). There was a significant effect of life history on AQ-9 scores (p = .012), and presentation of ACEs was associated with lower stigmatising attitudes. ConclusionOur findings suggest that describing the life histories of people who have experienced problems with substances may lead to less stigmatising public attitudes. Further research should explore the best ways to utilise this information to develop public-targeted anti-stigma interventions.

‘Not at all what I had expected’: Discontinuing treatment with extended-release naltrexone (XR-NTX): A qualitative study

“…Strengthening efforts to educate wider society regarding opioid use and the complexity of treatment and recovery might be another way of preventing stigma from influencing patients' treatment decisions. For example, calling attention to the life stories of people with SUD may reduce stigmatizing public attitudes (Sumnall et al, 2020). This study's overall findings support an emerging notion in both research and clinical work that the dominant understanding of successful treatment outcomes is rigid, unrealistic, and potentially harmful.…”

Less than human: dehumanisation of people who use heroin

“…These types of approach may also face some additional challenges. Rather than particular behaviours or perceived characteristic leading to beliefs that out-groups are simply 'less than human', dehumanising attitudes may reflect automatic perceptions that out-groups deserve low social hierarchical status, with foundations in long-standing inter-group interactions, and individual and societal attitudes towards intersecting factors such as class, ethnicity, and gender (Haslam and Loughnan, 2014), and beliefs about the blame and controllability of substance use disorders, and the dangerousness of PWUD (Corrigan, Kuwabara and O'Shaughnessy, 2009;Sattler et al, 2017;Ashford, Brown and Curtis, 2018;Sumnall et al, 2021). Furthermore, in accordance with social dominance theory, those who dehumanise may not simply perceive others as threatening, but may value asserting power and support efforts to separate groups through the use of discriminatory policy and other prejudicial actions, and are therefore less likely to respond to humanising interventions (Pratto, Sidanius and Levin, 2006;Markowitz and Slovic, 2020).…”

“…Acknowledging these challenges, one approach to humanisation could be through addressing popular media representations of PWUD (Fraser et al, 2016;McGinty, Kennedy-Hendricks and Barry, 2019). PWUD are typically framed in popular media as dangerous, 'contaminated', and lacking human agency (Atkinson and Sumnall, 2018;Atkinson and Sumnall, 2021), but previous work has shown that manipulations such as sympathetic framing and the use of neutral and person first terminology is associated with reduced stigma (Goodyear, Haass-Koffler and Chavanne, 2018;Sumnall et al, 2021). This is an area that requires further research with respect to dehumanisation.…”

“…chronic relapsing condition; Kelly et al, 2021). Conversely, studies that have presented sympathetic and humanising narratives of PWUD (Bachhuber et al, 2015;Sumnall et al, 2020a;Sumnall et al, 2021) are associated with reduced public stigma, and increased support for policies benefiting PWUD, but only when associated with groups of higher socioeconomic status (Kennedy-Hendricks, Barry and McGinty, 2016) There has been relatively less research undertaken on the processes of stigmatisation of PWUD and how this may lead to discrimination and inequity in practice and policy responses (Kilian et al, 2021). One route may be through the dehumanisation of PWUD.…”

“…chronic relapsing condition; Kelly et al , 2021). Conversely, studies that have presented sympathetic and humanising narratives of PWUD (Bachhuber et al , 2015; Sumnall et al , 2020a, 2021a) are associated with reduced public stigma and increased support for policies benefiting PWUD, but only when associated with groups of higher socio-economic status (Kennedy-Hendricks et al , 2016).…”