Substance Use Related Stigma: What we Know and the Way Forward

Abstract

Aims To conduct a systematic review of the literature investigating the relationship between stigma experienced by individuals who use drugs. Methods We conducted an online literature search and identified articles related to stigma among individuals who use drugs. Studies evaluating associations between stigma and socio-demographic variables and if applicable clinical and substance use variables are presented. In addition, recommendations for future research are provided. Results We identified 26 articles describing 28 studies evaluating stigma. The majorities of studies were published in the last 11 years and conducted in the U.S. Samples were relatively diverse: 41.7% of all participants who provided data identified as racial/ethnic minorities. The vast majority of the relationships between stigma and socio-demographic characteristics were included in only one or very few studies, which limits conclusions. The relationship between stigma and psychological well-being is the only consistent finding reported in the literature. Specifically, results suggest that stigma has a detrimental effect on psychological well-being among individuals who use drugs. Conclusions While this literature is expanding at a rapid pace, this review indicates several areas for future research and needed improvements in research methodology in this area. Specifically, lack of comprehensive description of sample characteristics, lack of construct identification and proper definition, a dearth of longitudinal studies and limited research describing relationships between stigma and substance use behavior are a few areas identified for further research.

Substance Abuse-Related Self-Stigma in Women with Substance Use Disorder and Comorbid Posttraumatic Stress Disorder

“…Results on the predictive value of further demographic measures on stigma are also inconsistent [24]. While lower educational level was associated with higher stigma in patients with depression [55], higher education was found to be a risk factor for self-stigma in patients with SUD [56].…”

“…Schomerus et al [7] found that among individuals who drink alcohol, self-stigma was negatively correlated with self-efficacy to refuse drinking. Results regarding sociodemographic variables are inconsistent, presumably due to the variance of the investigated samples and stigma types [24]. However, higher perceived stigma towards people who use alcohol seems to be associated with a lower level of education.…”

“…A systematic review of Kulesza et al [24] concludes that self-stigma is positively associated with substance use frequency and drug and alcohol use severity. Among those individuals who use drugs, self-stigma is also related to higher depression and anxiety and lower psychological well-being.…”

“Turning the tide” in Treatment of substance use: A nursing response

“…[22] Such stigma is also fueled from the common misconceptions that surround groups such as individuals with SUDs. [23] As the Surgeon General points out, health professionals may attribute the impaired decision making of individuals with SUDs as a character flaw.…”

Stigma in the Dutch Health Care Sector: HIV-Positive Substance Users’ Experiences and Health Care Providers’ Perspectives

“…In fact, substance use is, compared to other conditions, one of the most stigmatized [3,4]. It is 'strongly moralized' [5] and often seen as a condition over which one has personal control [6]. Consequently, substance users are frequently viewed as weak and immoral people that can be held personally responsible for both the onset and continuation of their substance use dependence [3,7,8].…”