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Pinhal M, Schreck B, Leboucher J, Victorri-Vigneau C, Laforgue EJ, Grall-Bronnec M. Are the self-stigma and perceived stigma of patients treated with methadone or buprenorphine still a problem fifty years after the marketing authorization for opioid agonist treatment? The observational STIGMA study. Addict Sci Clin Pract 2024; 19:74. [PMID: 39415293 PMCID: PMC11481267 DOI: 10.1186/s13722-024-00506-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 09/23/2024] [Indexed: 10/18/2024] Open
Abstract
BACKGROUND In the context of the opioid overdose crisis, understanding the barriers to seeking, attaining and remaining in treatment for patients with opioid use disorder (OUD) is a public health issue. To date, very few studies have assessed the "self-stigma" (i.e., the internalization of negative societal attitudes and stereotypes about oneself, leading to self-judgment) and "perceived stigma" (i.e., the belief that others hold negative attitudes towards oneself due to a particular condition) experienced by patients with OUD receiving opioid agonist treatment (OAT), and none have done so in France. Our study aimed to quantify self-stigma, explore some aspects of perceived stigma, determine the factors associated with greater self-stigma and examine whether the level of self-stigma was related to a delay in seeking care. METHODS The STIGMA study was a monocentric, cross-sectional study. The data were collected in a French hospital addiction medicine department. Participants were outpatients with current or past OUD who were still receiving or had received OAT. A questionnaire assessing sociodemographics; OUD characteristics; perceived stigma; and quantification of self-stigma by the Self-Stigma Scale-Short, was administered. RESULTS A total of 73 questionnaires were included in the analysis. Nearly two-thirds of the patients had a "moderate to high" level of self-stigma. These patients were significantly younger at OUD onset and were significantly more likely to have at least one dependent child than patients reporting a "very low to low" level of self-stigma. Nearly half of the participants experienced perceived stigma from a healthcare professional regarding their OUD or OAT, and nearly one-third of the participants were refused care from a healthcare professional because of their OUD or OAT. Moreover, a quarter of the sample reported delaying care due to fear of being stigmatized. We did not find a relationship between self-stigma levels and a delay in seeking care. CONCLUSIONS Our study highlights the need to detect stigma and to improve training in addiction medicine.
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Affiliation(s)
- Mélanie Pinhal
- Addictive Medicine and Psychiatry Department, Nantes Université, CHU Nantes, 44000, Nantes, France
| | - Benoit Schreck
- Addictive Medicine and Psychiatry Department, Nantes Université, CHU Nantes, 44000, Nantes, France
- Nantes Université, Univ Tours, CHU Nantes, CHU Tours, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, 44000, Nantes, France
| | - Juliette Leboucher
- Addictive Medicine and Psychiatry Department, Nantes Université, CHU Nantes, 44000, Nantes, France
| | - Caroline Victorri-Vigneau
- Nantes Université, Univ Tours, CHU Nantes, CHU Tours, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, 44000, Nantes, France
- Pharmacology Department, Nantes Université, CHU Nantes, 44000, Nantes, France
| | - Edouard-Jules Laforgue
- Addictive Medicine and Psychiatry Department, Nantes Université, CHU Nantes, 44000, Nantes, France
- Nantes Université, Univ Tours, CHU Nantes, CHU Tours, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, 44000, Nantes, France
- Pharmacology Department, Nantes Université, CHU Nantes, 44000, Nantes, France
| | - Marie Grall-Bronnec
- Addictive Medicine and Psychiatry Department, Nantes Université, CHU Nantes, 44000, Nantes, France.
- Nantes Université, Univ Tours, CHU Nantes, CHU Tours, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, 44000, Nantes, France.
- Pharmacology Department, Nantes Université, CHU Nantes, 44000, Nantes, France.
- Addiction Medicine and Psychiatry Department, Saint Jacques Hospital, 85, Rue Saint Jacques, 44093, Nantes Cedex 1, France.
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Holland A, Freeman TP, Nicholls J, Burke C, Howkins J, Harris M, Hickman M, Attwood A, Carlisle V, Krykant P, Maynard OM. Making sense of drug use and dependence-A scoping review of mass media interventions intended to reduce stigma towards people who use drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 132:104543. [PMID: 39226769 DOI: 10.1016/j.drugpo.2024.104543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/12/2024] [Accepted: 07/22/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND People who use drugs face entrenched stigma, which fosters shame, restricts service access, and exacerbates inequalities. The use of mass media in anti-stigma interventions offers an opportunity to challenge stigmatising attitudes at scale. There are, however, inconsistencies in messaging approaches used in mass media anti-stigma interventions, and how authors conceptualise and measure 'stigma'. METHODS This scoping review maps literature on the development and/or evaluation of mass media interventions intended to reduce stigma towards people who use drugs. We systematically searched seven databases for reports about: (i) people who use drugs, (ii) stigma, (iii) mass media. We charted data about intervention (i) subjects and recipients, (ii) format, (iii) authors, (iv) content; and (v) conceptualisation and measurement of stigma. We narratively synthesised findings with qualitative content analyses. RESULTS From 14,256 records, we included 49 reports about 35 interventions. 25/35 were from the last five years and 19/35 were from the United States. Intended recipients included the public and/or specified sub-populations, often including healthcare workers. Most interventions were intended to reduce stigma towards people with patterns of drug use perceived to be problematic, as opposed to people who use drugs in general. Interventions ranged from single pieces of media to complex multi-format campaigns. People who use(d) drugs contributed to 22/35 interventions. Professionals working in medical disciplines co-authored 29/35 interventions. Intervention content often had a medical focus, describing dependence as a 'disease' or medical issue, and emphasised the benefits of recovery. Other interventions, however, criticised medical framings. In some interventions drug use and people who use drugs were described in markedly negative terms. 'Stigma' was often under-theorised, and measurement approaches were inconsistent, with 42 instruments used to measure phenomena associated with stigma across 19 quantitative evaluations. CONCLUSION We found inconsistencies in approaches to reduce and measure stigma, potentially reflecting different motivations for intervention development. The primary motivation of many interventions was seemingly to promote drug service engagement and recovery.
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Affiliation(s)
- Adam Holland
- School of Psychological Science, University of Bristol, 12a Priory Road, Clifton, Bristol, UK; Bristol Medical School, University of Bristol, Canynge Hall, Clifton, Bristol, UK; London School of Hygiene and Tropical Medicine, Department of Public Health, Environments and Society, Faculty of Public Health and Policy, 15-17 Tavistock Place, London, UK.
| | - Tom P Freeman
- University of Bath, Department of Psychology, Addiction and Mental Health Group, Bath, UK
| | | | - Chloe Burke
- School of Psychological Science, University of Bristol, 12a Priory Road, Clifton, Bristol, UK; University of Bath, Department of Psychology, Addiction and Mental Health Group, Bath, UK
| | - Joshua Howkins
- Bristol Medical School, University of Bristol, Canynge Hall, Clifton, Bristol, UK
| | - Magdalena Harris
- London School of Hygiene and Tropical Medicine, Department of Public Health, Environments and Society, Faculty of Public Health and Policy, 15-17 Tavistock Place, London, UK
| | - Matthew Hickman
- Bristol Medical School, University of Bristol, Canynge Hall, Clifton, Bristol, UK
| | - Angela Attwood
- School of Psychological Science, University of Bristol, 12a Priory Road, Clifton, Bristol, UK
| | - Vicky Carlisle
- Bristol Medical School, University of Bristol, Canynge Hall, Clifton, Bristol, UK
| | - Peter Krykant
- Cranstoun, Thames Mews, Portsmouth Road, Esher, Surrey, UK
| | - Olivia M Maynard
- School of Psychological Science, University of Bristol, 12a Priory Road, Clifton, Bristol, UK
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Nwanaji-Enwerem U, Beitel M, Oberleitner DE, Gazzola MG, Eggert KF, Oberleitner LMS, Jegede O, Zheng X, Redeker NS, Madden LM, Barry DT. Correlates of Perceived Discrimination Related to Substance Use Disorders Among Patients in Methadone Maintenance Treatment. J Psychoactive Drugs 2024; 56:530-540. [PMID: 37399330 PMCID: PMC10761588 DOI: 10.1080/02791072.2023.2230571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 07/05/2023]
Abstract
This study sought to examine demographic, treatment-related, and diagnosis-related correlates of substance use disorder (SUD)-related perceived discrimination among patients receiving methadone maintenance treatment (MMT). Participants were 164 patients at nonprofit, low-barrier-to-treatment-access MMT programs. Participants completed measures of demographics, diagnosis-related characteristics (Brief Symptom Inventory (BSI-18) and Depressive Experiences Questionnaire (DEQ)), and treatment-related characteristics. Perceived discrimination was measured on a seven-point Likert-type scale ranging from 1 ("Not at all") to 7 ("Extremely") in response to the item: "I often feel discriminated against because of my substance abuse." Given the variable's distribution, a median split was used to categorize participants into "high" and "low" discrimination groups. Correlates of high and low discrimination were analyzed with bivariate and logistic regression models. Ninety-four participants (57%) reported high SUD-related perceived discrimination. Bivariate analyses identified six statistically significant correlates of SUD-related perceived discrimination (P < .05): age, race, age of onset of opioid use disorder, BSI-18 Depression, DEQ Dependency, and DEQ Self-Criticism. In the final logistic regression model, those with high (versus low) SUD-related perceived discrimination were more likely to report depressive symptoms and be self-critical. Patients in MMT with high compared to low SUD-related perceived discrimination may be more likely to report being depressed and self-critical.
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Affiliation(s)
| | - Mark Beitel
- Yale School of Medicine, New Haven, CT
- APT Foundation, New Haven, CT
| | | | | | | | - Lindsay M. S. Oberleitner
- Yale School of Medicine, New Haven, CT
- APT Foundation, New Haven, CT
- Oakland University William Beaumont School of Medicine, Rochester, MI
| | - Oluwole Jegede
- Yale School of Medicine, New Haven, CT
- APT Foundation, New Haven, CT
| | - Xiaoying Zheng
- Yale School of Medicine, New Haven, CT
- APT Foundation, New Haven, CT
| | - Nancy S. Redeker
- Yale School of Nursing, New Haven, CT
- Yale School of Medicine, New Haven, CT
| | - Lynn M. Madden
- Yale School of Medicine, New Haven, CT
- APT Foundation, New Haven, CT
| | - Declan T. Barry
- Yale School of Medicine, New Haven, CT
- APT Foundation, New Haven, CT
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Ware OD, Zerden LDS, Krueger DK, Lombardi BN, Lombardi BM. How would a certification in harm reduction impact service delivery and the harm reduction workforce? A qualitative study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 164:209439. [PMID: 38876431 DOI: 10.1016/j.josat.2024.209439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 05/08/2024] [Accepted: 06/04/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Harm reduction utilizes evidence-based strategies to reduce the negative health and social impacts of substance use. As harm reduction services expand across the U.S. without the requirement of professional certification, variation in how the workforce is regarded and trained on harm reduction principles and practices persists. This study explores the harm reduction workforce's perspectives on how certification would impact service delivery and their profession. METHODS The study employed purposive sampling to identify and survey administrators within a publicly available syringe services program directory (N = 168). This sub-study utilized thematic analysis to evaluate 152 respondents' answers to one dichotomous closed-ended question, "Would a certification in the harm reduction field be helpful?" followed by an open-ended response to the follow-up statement, "Based on your answer to the previous question about a certification to work in harm reduction, please explain why or why not." Approximately 45 % of the respondents (n = 68) answered no, while 55 % (n = 84) answered yes. RESULTS Seven themes emerged in total. Among those against harm reduction certification, the four themes were: (1) certification is exclusionary and creates barriers, (2) lived experience is more important than certification, (3) certification does not equate to skills, and (4) no regulatory body exists to oversee the certification process. The study identified three themes from individuals who indicated harm reduction certification was helpful: (1) certification helps standardize training, (2) certification validates/legitimizes the harm reduction field, and (3) low barriers to receiving certificates. CONCLUSIONS The study presents participants' perspectives for and against harm reduction certification emphasizing implications for service delivery and the workforce. Despite varying perceptions on how certification may advance or hinder the field, the sample was unified in their commitment to harm reduction practices and endorsement of its integral role in confronting the U.S. drug use epidemic. This study highlights how certification can impact state and federal harm reduction service delivery and promotes future research on ways to address the needs of harm reduction organizations and their workforce.
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Affiliation(s)
- Orrin D Ware
- University of North Carolina at Chapel Hill, School of Social Work, Chapel Hill, NC 27599-3550, USA.
| | - Lisa D S Zerden
- University of North Carolina at Chapel Hill, School of Social Work, Chapel Hill, NC 27599-3550, USA; University of North Carolina at Chapel Hill, Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC 27516, USA.
| | - Danya K Krueger
- University of North Carolina at Chapel Hill, School of Social Work, Chapel Hill, NC 27599-3550, USA
| | - Brooke N Lombardi
- University of North Carolina at Chapel Hill, Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC 27516, USA
| | - Brianna M Lombardi
- University of North Carolina at Chapel Hill, School of Social Work, Chapel Hill, NC 27599-3550, USA; University of North Carolina at Chapel Hill, Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC 27516, USA; University of North Carolina at Chapel Hill, School of Medicine, Department of Family Medicine, Chapel Hill 27599, USA
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Witte TH, Oldenburg B. Substance Use Disorder Stigma and Professional Decision Making Among Pre-Professional Healthcare Trainees. JOURNAL OF DRUG EDUCATION 2024:472379241278326. [PMID: 39169754 DOI: 10.1177/00472379241278326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Provider stigma toward people who have substance use disorders (SUDs) may be a barrier to effective treatment delivery. The purpose of this study was to measure provider stigma among healthcare professionals-in-training and determine whether stigma levels were associated with professional decision making. A sample of 240 participants were recruited from the following academic programs at a large university in the southeastern United States: Nursing, Social Work, Counseling, Marriage and Family Therapy, and Psychology. Through an online, anonymous survey, provider stigma and other constructs were measured. The participants were also asked to make two hypothetical professional decisions: one regarding their choice to provide treatment for an SUD patient and the other regarding their likelihood of attending a professional development event (i.e., conference session) on the topic of SUDs. Results showed that self-reported stigma toward patients with SUDs was associated with a reduced likelihood of choosing to provide treatment for a patient with SUD (compared to patients with other conditions) and a reduced likelihood of attending SUD training at an upcoming conference (compared to other conference topics). Results have potential implications for the development of training programs for pre-professional healthcare trainees.
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Affiliation(s)
- Tricia H Witte
- Department of Human Development and Family Studies, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Brantley Oldenburg
- Department of Human Development and Family Studies, The University of Alabama, Tuscaloosa, Alabama, USA
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Ma Q, Whipple CR, Kaynak Ö, Saylor E, Kensinger WS. Somebody to Lean on: Understanding Self-Stigma and Willingness to Disclose in the Context of Addiction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1044. [PMID: 39200654 PMCID: PMC11354585 DOI: 10.3390/ijerph21081044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 08/02/2024] [Accepted: 08/05/2024] [Indexed: 09/02/2024]
Abstract
Substance use self-stigma is a barrier to treatment and can negatively impact individuals' well-being and treatment engagement. Given the mixed findings in previous research and the limited specific investigation into the concept of self-stigma within the context of opioid misuse, examining factors associated with self-stigma in the context of opioid use disorder (OUD) is warranted. The current study examines the influence of individual-level factors (race, sex, urban/rural status, support group attendance) on self-stigma and willingness to disclose opioid use. Data for this study were from a larger study of OUD-related stigma among adults in Pennsylvania, U.S. The current study included participants who indicated a personal past or current history with OUD were included (n = 84). Exploratory factor analysis and multiple indicators, multiple causes (MIMIC) model were used to explore the associations between demographic factors (i.e., sex, age, race/ethnicity, urban/rural status), attendance at mutual support groups, and self-stigma factors. Results indicated that sex and attendance at mutual support groups significantly predicted levels of self-stigma. Women and individuals with no previous experience attending mutual support groups endorsed lower levels of self-stigma. Additionally, attendance at mutual support groups predicted willingness to self-disclose past and present opioid use. Individuals who reported no history of attending mutual support groups demonstrated less willingness to disclose past and present OUD use compared to participants who were support group attendees. The current research findings enhance the understanding of OUD-related self-stigma by examining its relationship with individual-level factors, disclosure, and attendance to mutual support groups. The results offer insights into the influence of sex and support group attendance on self-stigma and disclosure. These findings have significant clinical implications for developing future interventions and promoting health policy changes.
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Affiliation(s)
| | | | - Övgü Kaynak
- School of Behavioral Sciences and Education, Penn State University, Harrisburg, Middletown, PA 17057, USA; (Q.M.); (C.R.W.); (E.S.); (W.S.K.)
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Kershaw S, Sunderland M, Grager A, Birrell L, Deen H, Newton NC, Stapinski LA, Champion KE, Kay-Lambkin F, Teesson M, Chapman C. Perceived barriers to help-seeking for people who use crystal methamphetamine: Perspectives of people with lived experience, family members and health workers. Drug Alcohol Rev 2024. [PMID: 38965840 DOI: 10.1111/dar.13897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 05/16/2024] [Accepted: 06/20/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION Barriers to help-seeking for illicit drug use cross psychosocial (e.g., knowledge of where to seek help, attitudinal beliefs like being afraid of what people will think) and structural (e.g., service availability) domains. Along with people who use illicit drugs, it is important to consider the perspectives of other key groups who are often involved in the help-seeking and recovery process. This study aimed to examine the perceived barriers to help-seeking for people who use crystal methamphetamine ('ice') among key groups (people who use crystal methamphetamine, families and friends, health workers) as well as the general community. METHODS A cross-sectional online survey open to all Australian residents (aged ≥18 years) was conducted November 2018-March 2019. Four key groups of interest were recruited to examine and compare perceived barriers to help-seeking for crystal methamphetamine use. RESULTS Participants (n = 2108) included: people who use/have used crystal methamphetamine (n = 564, 39%), health workers (n = 288, 26.8%), affected family/friends (n = 434, 13.7%) and general community (n = 822, 20.6%). People who used crystal methamphetamine demonstrated increased odds of reporting attitudinal (OR 1.35; 1.02-1.80) or structural (OR 1.89; 1.09-3.27) barriers, or a previous negative help-seeking experience (OR 2.27; 1.41-3.66) compared to knowledge barriers. Health workers demonstrated decreased odds of reporting attitudinal compared to knowledge barriers (OR 0.69; 0.50-0.95). DISCUSSION AND CONCLUSIONS Perceived barriers to seeking help for crystal methamphetamine use differed among key groups involved in treatment and recovery. Acknowledging and addressing the mismatches between key groups, through targeted interventions may better support people to seek help for crystal methamphetamine use.
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Affiliation(s)
- Steph Kershaw
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Matthew Sunderland
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Anna Grager
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Louise Birrell
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Hannah Deen
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Nicola C Newton
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Lexine A Stapinski
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Katrina E Champion
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | | | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Cath Chapman
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
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Sutherland R, King C, Karlsson A, Treloar C, Broady T, Chandrasena U, Salom C, Dietze P, Peacock A. Stigma, and factors associated with experiencing stigma, while visiting health-care services among samples of people who use illegal drugs in Australia. Drug Alcohol Rev 2024; 43:1264-1279. [PMID: 38644679 DOI: 10.1111/dar.13846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 03/13/2024] [Accepted: 03/16/2024] [Indexed: 04/23/2024]
Abstract
INTRODUCTION People who inject drugs experience stigma across multiple settings, including when accessing health-care services, however, comparatively little is known about experiences of stigma towards other groups of people who use illegal drugs. This paper examines experience of, and factors associated with, stigma among two samples of people who use illegal drugs when visiting both specialist alcohol and other drug (AOD) and general health-care services. METHODS Australians who regularly (i.e., ≥monthly) inject drugs (n = 879; illicit drug reporting system [IDRS]) or use ecstasy and/or other illegal stimulants (n = 700; ecstasy and related drugs reporting system [EDRS]) were surveyed between April and July 2022 about past 6-month experience of stigma in the above services. Multi-variable regression analyses were performed to determine the socio-demographic, drug use and health factors associated with stigma. RESULTS Experiences of stigma in general health-care services were more common among IDRS (40%) than EDRS (24%; p < 0.001) participants, however, experiences were comparable in specialist AOD health-care settings (22% and 20%, respectively; p = 0.687). Gender identity and experiencing high psychological distress were associated with experiencing stigma across both samples. Past-year overdose was associated with experiencing stigma among the IDRS sample, while unstable housing and incomplete high school education were associated with experiencing stigma in the EDRS sample. DISCUSSION AND CONCLUSIONS Experiences of stigma when accessing health-care services are relatively common across different populations of people who use illegal drugs. Our findings highlight the multiple and intersecting dimensions of stigma and provide further support for recent calls for a universal precautions approach to stigma in health care.
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Affiliation(s)
- Rachel Sutherland
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Cate King
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Antonia Karlsson
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Timothy Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Udesha Chandrasena
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Caroline Salom
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia
| | - Paul Dietze
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Australia
- National Drug Research Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- School of Psychology, University of Tasmania, Hobart, Australia
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Grace Choung HY, Nast CC, Haas M, Lin M, Yamashita M, Hou J. Spectrum of Kidney Biopsy Findings Associated With Methamphetamine Use. Kidney Int Rep 2024; 9:2180-2188. [PMID: 39081731 PMCID: PMC11284416 DOI: 10.1016/j.ekir.2024.04.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction Methamphetamine (METH) is one of the most used drugs of abuse worldwide. However, there are few reports and series examining the toxic kidney effects of METH, and associated histopathological changes are not well-described. Methods We retrospectively identified 112 patients with a history significant for METH abuse, of whom 62 were using METH-only and 60 were using METH plus other drugs of abuse. Results In the METH-only cohort, the mean age was 41 years (interquartile range [IQR]: 33-49) and most (76%) were male. Almost all cases (97%) showed evidence of kidney dysfunction at the time of biopsy. Of the cases, 65% had proteinuria, of which 53% were nephrotic range and 10% had nephrotic syndrome. The most common biopsy diagnosis was acute tubular necrosis (ATN) (66%), of which 19% had myoglobin casts; followed by focal segmental glomerulosclerosis (FSGS) in 53% (not otherwise specified [NOS] in 76% and collapsing FSGS [cFSGS] in 18%). Biopsy findings also include tubulointerstitial nephritis (TIN) (37%), thrombotic microangiopathy (TMA) (24%), and diabetic glomerulosclerosis (DG) (31%). Glomerulonephritis (GN) was identified in one-third of cases, the most common of which were infection-related GN (IRGN) (15%) and IgA nephropathy (IgAN) (11%). Of those with GN, 64% had underlying infection. Of interest, there was increased association for myoglobinuric ATN in those with concurrent ethanol-abuse (P = 0.002). Moreover, the METH-only patients were more likely to have DG compared to those with multiple substance-use (P = 0.01). More than half of the patients demonstrated at least moderate to severe tubulointerstitial scarring and marked hypertensive vascular disease. Conclusion Most patients with METH-use present with acute kidney injury (AKI) and often have proteinuria associated with a wide spectrum of renal pathology.
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Affiliation(s)
- Hae Yoon Grace Choung
- Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Cynthia C. Nast
- Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Mark Haas
- Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Mercury Lin
- Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Michifumi Yamashita
- Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Jean Hou
- Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
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Steinhauser S, Haroz R, Jones I, Skelton W, Fuller BM, Roberts MB, Jones CW, Trzeciak S, Roberts BW. Emergency department staff compassion is associated with lower fear of enacted stigma among patients with opioid use disorder. Acad Emerg Med 2024. [PMID: 38881343 DOI: 10.1111/acem.14970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/15/2024] [Accepted: 04/21/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVES Fear of enacted stigma (fear of discrimination or being treated unfairly) is associated with decreased health care-seeking behaviors among patients with opioid use disorder (OUD). We sought to describe the prevalence of fear of enacted stigma among patients presenting to the emergency department (ED) with OUD and to test whether experiencing greater compassion from ED staff is associated with lower fear of enacted stigma. METHODS We conducted a cross-sectional study in the ED of an academic medical center between February and August 2023. We included adult patients with OUD presenting to the ED and assessed patient experience of compassion from ED staff using a previously validated 5-item compassion measure (score range 5-20). The primary outcome measure was fear of enacted stigma in the ED, measured using the validated 9-item subscale of the Substance Abuse Self-Stigma Scale (score range 9-45). RESULTS Of the 116 subjects enrolled, 97% (95% confidence interval [CI] 91%-99%) reported some degree of stigma, with a median (interquartile range) score of 23 (16-31). In a multivariable model adjusting for potential confounders, patient experience of greater ED compassion was independently associated with lower fear of enacted stigma, β = -0.66 (95% CI -1.03 to -0.29), suggesting that every 1-point increase in the 5-item compassion measure score is associated with a 0.66-point decrease in the fear of enacted stigma score. CONCLUSIONS Among ED patients with OUD, fear of enacted stigma is common. Patient experience of compassion from ED staff is associated with lower fear of enacted stigma. Future research is warranted to test if interventions aimed at increasing compassion from ED staff reduce patient fear of enacted stigma among patients with OUD.
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Affiliation(s)
- Savannah Steinhauser
- The Department of Emergency Medicine, Cooper University Health Care (CUHC), Cooper Medical School of Rowan University (CMSRU), Camden, New Jersey, USA
| | - Rachel Haroz
- The Department of Emergency Medicine, Cooper University Health Care (CUHC), Cooper Medical School of Rowan University (CMSRU), Camden, New Jersey, USA
- The Department of Emergency Medicine, Division of Toxicology and Addiction Medicine, CUHC/CMSRU, Camden, New Jersey, USA
- Cooper Center for Healing, CUHC/CMSRU, Camden, New Jersey, USA
| | - Iris Jones
- Cooper Center for Healing, CUHC/CMSRU, Camden, New Jersey, USA
| | - William Skelton
- The Department of Emergency Medicine, Cooper University Health Care (CUHC), Cooper Medical School of Rowan University (CMSRU), Camden, New Jersey, USA
- Department of Behavioral Medicine, CUHC/CMSRU, Camden, New Jersey, USA
| | - Brian M Fuller
- Division of Critical Care Medicine, Departments of Emergency Medicine and Anesthesia, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Michael B Roberts
- Institutional Research and Outcomes Assessment, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Christopher W Jones
- The Department of Emergency Medicine, Cooper University Health Care (CUHC), Cooper Medical School of Rowan University (CMSRU), Camden, New Jersey, USA
| | | | - Brian W Roberts
- The Department of Emergency Medicine, Cooper University Health Care (CUHC), Cooper Medical School of Rowan University (CMSRU), Camden, New Jersey, USA
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Todd-Kvam J, Clausen T. Practitioner perspectives on working with older patients in opioid agonist treatment (OAT) in Norway: opportunities and challenges. Addict Sci Clin Pract 2024; 19:44. [PMID: 38783382 PMCID: PMC11118995 DOI: 10.1186/s13722-024-00473-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Norway has a growing proportion of ageing opioid agonist treatment (OAT) patients, with 42% of the 8300 Norwegian OAT patients aged over 50 in 2022. This study aims to explore practitioners' views and experiences from treatment of ageing OAT patients. METHODS Data were collected as a series of semi-structured interviews with treatment staff (roles interviewed: doctor, psychologist, social worker, nurse, and learning disability nurse). Participants were recruited from three OAT outpatient clinics, one with an urban catchment area and two with a mix of urban and rural. The interviews incorporated questions on patients' somatic and mental health, strengths and weaknesses of the service for this group, and patients' quality of life. RESULTS Older patients were perceived to be more often stable in terms of substance use and housing situation, but also experiencing some key challenges in terms of cognitive impairment, loneliness and isolation, and comorbidities. Both the practitioner-patient relationship and healthcare interactions outside OAT had the potential to impact treatment quality positively or negatively depending on how they were managed. CONCLUSIONS Treating older patients in a way that respects and enhances their dignity is important. We argue that this requires better services for those whose functioning is impacted by cognitive impairment/dementia, an age-informed treatment model for this patient group, along with urgent work to improve municipal-level services given practitioners describe them as unacceptable in certain areas.
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Affiliation(s)
- John Todd-Kvam
- Norwegian Centre for Addiction Research, University of Oslo, Blindern, Postboks 1039, 0315, Oslo, Norway.
- Sørlandet Sykehus HF, Lundsiden, Postboks 416, 4604, Kristiansand, Norway.
| | - Thomas Clausen
- Norwegian Centre for Addiction Research, University of Oslo, Blindern, Postboks 1039, 0315, Oslo, Norway
- Sørlandet Sykehus HF, Lundsiden, Postboks 416, 4604, Kristiansand, Norway
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12
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Yinger OS, Jones A, Fallin-Bennett K, Gibbs C, Farr RH. Family-Centered Care for LGBTQ+ Parents of Infants in the Neonatal Intensive Care Unit: An Integrative Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:615. [PMID: 38929195 PMCID: PMC11201882 DOI: 10.3390/children11060615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/08/2024] [Accepted: 05/16/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Having an infant in the Neonatal Intensive Care Unit (NICU) can disrupt parent well-being, the transition to parenthood, and the typical trajectories of infant and child health. For lesbian, gay, bisexual, transgender, queer, or other sexual and gender minority identity (LGBTQ+) parents, this stress may be compounded by health disparities and fear of stigma and discrimination; however, research is lacking about LGBTQ+ parents of infants in the NICU. OBJECTIVES The purpose of this integrative review was to better understand the experiences of LGBTQ+ parents of NICU infants, with a focus on experiences of stigma and discrimination, sources of strength and resilience, and provision of family-centered care. METHOD We searched EBSCOHost, ProQuest, Web of Science, and Google Scholar between 30 May 2023 and 18 September 2023 for empirical studies published in English in peer-reviewed scholarly journals in which LGBTQ+ parents shared their experiences with having infants admitted to the NICU. RESULTS We identified six articles that met inclusion criteria, all of which were qualitative studies that included 12-14 LGBTQ+ parents of NICU infants. CONCLUSIONS LGBTQ+ parents in all studies reported instances of perceived stigma and discrimination while their infants were in the NICU, whereas parents in two studies mentioned strength and resilience, and parents in three studies described elements of family-centered care. There is a need for rigorous research on family-centered NICU care that includes questions about sources of strength and resilience in addition to challenges. We propose that future researchers use community engaged methods to center perspectives of LGBTQ+ parents.
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Affiliation(s)
- Olivia Swedberg Yinger
- School of Music, College of Fine Arts, University of Kentucky, Lexington, KY 40506, USA;
| | - Aubrey Jones
- College of Social Work, University of Kentucky, Lexington, KY 40506, USA;
| | - Keisa Fallin-Bennett
- Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY 40536, USA;
| | - Chelsea Gibbs
- School of Music, College of Fine Arts, University of Kentucky, Lexington, KY 40506, USA;
| | - Rachel H. Farr
- Department of Psychology, College of Arts and Sciences, University of Kentucky, Lexington, KY 40506, USA;
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13
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Mejia MC, Kowalchuk A, Gonzalez S, Sunny A, Scamp N. Expanding Treatment, Recovery, and Reentry Services for Female Offenders: Improving Outcomes through Client-Centered Interventions. Community Ment Health J 2024; 60:713-721. [PMID: 38175318 DOI: 10.1007/s10597-023-01223-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024]
Abstract
This study investigated the impact of a specialized program aimed at improving substance use disorder and trauma treatment, recovery, and reentry services for adult female offenders. Trained recovery coaches delivered pretreatment interventions such as prescreening, motivational interviewing, and support-building to facilitate treatment entry and improve outcomes. Of 113 participants, 40% identified as racial/ethnic minorities, and 72% fell within the 25-45 age range. A notable 44.5% reduction in self-reported psychiatric symptoms was observed, alongside significant improvements in abstinence and trauma symptoms. Recovery capital and psychosocial functioning showed marked improvement including significant changes in employment status and housing stability and a decrease in criminal justice involvement. The results suggest that targeted, client-centered approaches can effectively improve recovery and psychosocial functioning among female offenders while reducing re-incarceration rates. These findings underscore the importance of addressing the unique needs of this population in both pre-and post-release settings to ensure equitable access to reentry services.
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Affiliation(s)
- Maria Carmenza Mejia
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Dr., Suite 600, Houston, TX, 77098, USA.
| | - Alicia Kowalchuk
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Dr., Suite 600, Houston, TX, 77098, USA
| | - Sandra Gonzalez
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Dr., Suite 600, Houston, TX, 77098, USA
| | - Ajeesh Sunny
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Dr., Suite 600, Houston, TX, 77098, USA
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Jones A, Sharples D, Burton S, Montgomery C, Rose AK. The Associations among Perceived Courtesy Stigma, Health and Social Behaviours in Family Members and Friends of People Who Use Substances: An Ecological Momentary Assessment Study. Subst Use Misuse 2024; 59:1440-1445. [PMID: 38629645 DOI: 10.1080/10826084.2024.2340971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Background: The stigma and discrimination experienced by individuals with an alcohol/substance use disorder often extends to the family members and friends who provide care, which is known as courtesy stigma. This courtesy stigma can lead to isolation, poor mental health and might impact the quality-of-care these individuals provide. The aim of this study was to examine the frequency of experienced courtesy stigma/discrimination in individuals in a family support service for a loved one's substance use, and to examine any cross-sectional associations with changes in mood, health- and social-related outcomes. Methods: Thirty-six individuals (25 female) with a mean age of 51.91 years took part in an ecological momentary assessment study in which the experience of courtesy stigma/discrimination and measures of mood, health (e.g. alcohol use, nicotine use, healthy eating, sleep, physical activity) and social connections were taken 3 times per day for fourteen days. Results: Across 1029 competed assessments (compliance ∼68%), there were 122 (∼11%) reports of courtesy stigma/discrimination. The most common sources of stigma/discrimination were from family members (∼43% of occurrences) and friends (∼31% of occurrences). Experiencing this stigma/discrimination was associated with increases in alcohol and nicotine use, as well as reductions in healthy eating, physical activity, sleep, social connections, and mood. Conclusions: The experience of courtesy stigma/discrimination was common in a sample of individual's who support a loved one with alcohol or substance use disorder. These experiences are associated with changes in health and social behaviors and may lead to a poorer quality of care.
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Affiliation(s)
- Andrew Jones
- School of Psychology, Liverpool John Moores University, Liverpool, UK
| | - Diane Sharples
- School of Psychology, Liverpool John Moores University, Liverpool, UK
| | - Sam Burton
- School of Psychology, Liverpool John Moores University, Liverpool, UK
| | | | - Abigail K Rose
- School of Psychology, Liverpool John Moores University, Liverpool, UK
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15
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Sibley AL, Klein E, Cooper HLF, Livingston MD, Baker R, Walters SM, Gicquelais RE, Ruderman SA, Friedmann PD, Jenkins WD, Go VF, Miller WC, Westergaard RP, Crane HM. The relationship between felt stigma and non-fatal overdose among rural people who use drugs. Harm Reduct J 2024; 21:77. [PMID: 38582851 PMCID: PMC10998326 DOI: 10.1186/s12954-024-00988-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 03/19/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND Drug overdose deaths in the United States exceeded 100,000 in 2021 and 2022. Substance use stigma is a major barrier to treatment and harm reduction utilization and is a priority target in ending the overdose epidemic. However, little is known about the relationship between stigma and overdose, especially in rural areas. We aimed to characterize the association between felt stigma and non-fatal overdose in a multi-state sample of rural-dwelling people who use drugs. METHODS Between January 2018 and March 2020, 2,608 people reporting past 30-day opioid use were recruited via modified chain-referral sampling in rural areas across 10 states. Participants completed a computer-assisted survey of substance use and substance-related attitudes, behaviors, and experiences. We used multivariable logistic regression with generalized estimating equations to test the association between felt stigma and recent non-fatal overdose. RESULTS 6.6% of participants (n = 173) reported an overdose in the past 30 days. Recent non-fatal overdose was significantly associated with felt stigma after adjusting for demographic and substance use-related covariates (aOR: 1.47, 95% CI: 1.20-1.81). The association remained significant in sensitivity analyses on component fear of enacted stigma items (aOR: 1.48, 95% CI: 1.20-1.83) and an internalized stigma item (aOR: 1.51, 95% CI: 1.07-2.14). CONCLUSIONS Felt stigma related to substance use is associated with higher risk of non-fatal overdose in rural-dwelling people who use drugs. Stigma reduction interventions and tailored services for those experiencing high stigma are underutilized approaches that may mitigate overdose risk.
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Affiliation(s)
- Adams L Sibley
- Department of Health Behavior, UNC Gillings School of Global Public Health, 170 Rosenau Hall CB #7400, 135 Dauer Dr, Chapel Hill, NC, 27599, USA.
| | - Emma Klein
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Hannah L F Cooper
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Melvin D Livingston
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Robin Baker
- OHSU-PSU School of Public Health, Oregon Health & Science University, 1810 SW 5th Ave, Suite 510, Portland, OR, 97201, USA
| | - Suzan M Walters
- Division of Epidemiology, Department of Population Health, New York University School of Medicine, 180 Madison, New York, NY, 10016, USA
| | - Rachel E Gicquelais
- School of Nursing, University of Wisconsin-Madison, 4257 Signe Skott Cooper Hall, 701 Highland Avenue, Madison, WI, 53705, USA
| | - Stephanie A Ruderman
- Department of Medicine, University of Washington, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA
| | - Peter D Friedmann
- University of Massachusetts Chan Medical School-Baystate and Baystate Health, 3601 Main St, Springfield, MA, 01199, USA
| | - Wiley D Jenkins
- Southern Illinois University School of Medicine, 201 E Madison Street, Springfield, IL, 62702, USA
| | - Vivian F Go
- Department of Health Behavior, UNC Gillings School of Global Public Health, 170 Rosenau Hall CB #7400, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - William C Miller
- Department of Epidemiology, UNC Gillings School of Global Public Health, CB#8050, 3rd Floor Carolina Square, Chapel Hill, NC, 27516, USA
| | - Ryan P Westergaard
- University of Wisconsin-Madison, 1685 Highland Avenue, 5th Floor, Madison, WI, 53705-2281, USA
| | - Heidi M Crane
- Department of Medicine, University of Washington, Mail Stop 359931, Seattle, WA, 98104, USA
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16
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Lew BJ, Balasanova AA. Medical Student Attitudes Toward Patients With Substance Use Disorder After Experiential Learning on an Addiction Psychiatry Consultation-Liaison Service: A Pilot Study. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:292-298. [PMID: 38258820 PMCID: PMC11185928 DOI: 10.1177/29767342231216885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Stigma surrounding substance use disorder (SUD) is highly prevalent in health care. Negative attitudes toward patients with SUD have been shown to negatively impact patient care. Addressing SUD stigma in medical students is a promising approach, however, few curricula include experiential learning on addiction psychiatry clinical services. We describe a medical student rotation on an addiction psychiatry clinical service and examine its effect on attitudes toward patients with SUD. METHODS Medical students were integrated onto an addiction psychiatry consultation-liaison service serving medically/surgically hospitalized patients with co-occurring SUD and other psychiatric disorders. Students learned and practiced in-person assessment of patients and received instruction on basic principles of psychiatry and evaluation and management of SUD. A targeted anti-stigma curriculum was included. Attitudes toward patients with SUD were measured with the Medical Condition Regard Scale (MCRS) before and after the experience. Each item of the MCRS and an overall composite attitude score were analyzed. RESULTS Of the 36 students on the clinical rotation, 33 completed the survey. Attitudes showed widespread improvement toward patients with SUD. Mann-Whitney U tests showed significant improvement in most items of the MCRS. Further analysis of composite scores showed an improvement in overall attitudes toward patients with SUD. CONCLUSIONS Inclusion of medical students on an addiction psychiatry consult service as part of the core psychiatry clerkship may hold promise for helping improve student attitudes and decrease stigma toward patients with SUD. Controlled study is needed to compare other clinical experiences and determine specific causative effects.
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Affiliation(s)
- Brandon J. Lew
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Alëna A. Balasanova
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE, USA
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17
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Koh KA, Szymkowiak D, Tsai J. Benzodiazepine Prescriptions for Homeless Veterans Affairs Service Users With Mental Illness. Psychiatr Serv 2024; 75:316-325. [PMID: 37904492 DOI: 10.1176/appi.ps.20220472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
OBJECTIVE Despite elevated risk for substance use disorder and overdose death in the homeless population, benzodiazepine prescribing for this population has not been examined. In this study, the authors used data from the U.S. Department of Veterans Affairs (VA) health care system to examine benzodiazepine prescribing and risky and potentially inappropriate benzodiazepine prescribing practices for homeless VA service users. METHODS Using national VA administrative data (2018-2019), the authors conducted logistic regression to compare likelihood of benzodiazepine prescribing and t tests to compare indicators of risky and potentially inappropriate benzodiazepine prescribing patterns for homeless service users with mental illness (N=244,113) and their housed peers (N=2,763,513). RESULTS Unadjusted analyses showed that benzodiazepines were prescribed for 7.5% of homeless VA service users with mental illness, versus 9.4% of their housed peers (p<0.001). Analyses adjusted for sociodemographic and clinical characteristics and health care utilization showed that homeless service users were less likely than their housed peers to receive a benzodiazepine prescription (AOR=0.70, 99% CI=0.68-0.72). However, compared with their housed peers, homeless service users received higher rates of risky and potentially inappropriate benzodiazepine prescriptions, including multiple concurrent benzodiazepine prescriptions (9.4% vs. 7.0%, p<0.001) and concurrent prescriptions for benzodiazepines and opioids (36.9% vs. 31.2%, p<0.001) or sedatives (61.9% vs. 45.9%, p<0.001). CONCLUSIONS Although homeless VA service users with mental illness were less likely than their housed peers to receive a benzodiazepine prescription, benzodiazepine prescriptions for these service users had more characteristics of risky and potentially inappropriate prescribing.
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Affiliation(s)
- Katherine A Koh
- Department of Psychiatry, Massachusetts General Hospital-Harvard Medical School, and Boston Health Care for the Homeless Program, Boston (Koh); National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs (VA), Tampa, Florida (Szymkowiak, Tsai); School of Public Health, University of Texas Health Science Center at Houston, Houston (Tsai)
| | - Dorota Szymkowiak
- Department of Psychiatry, Massachusetts General Hospital-Harvard Medical School, and Boston Health Care for the Homeless Program, Boston (Koh); National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs (VA), Tampa, Florida (Szymkowiak, Tsai); School of Public Health, University of Texas Health Science Center at Houston, Houston (Tsai)
| | - Jack Tsai
- Department of Psychiatry, Massachusetts General Hospital-Harvard Medical School, and Boston Health Care for the Homeless Program, Boston (Koh); National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs (VA), Tampa, Florida (Szymkowiak, Tsai); School of Public Health, University of Texas Health Science Center at Houston, Houston (Tsai)
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18
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Sibley AL, Colston DC, Go VF. Interventions to reduce self-stigma in people who use drugs: A systematic review. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 159:209284. [PMID: 38159909 DOI: 10.1016/j.josat.2023.209284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/29/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Substance use stigma is a key barrier to treatment and harm reduction engagement among people who use drugs (PWUD). Previous systematic reviews have focused on interventions to reduce stigma in healthcare providers and the public; less is known about interventions to address self-stigma among PWUD. The purpose of this review is to evaluate the evidence for substance use self-stigma reduction interventions. METHODS We reviewed English-language studies published between 2011 and 2023 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO #CRD42022321305). We searched seven bibliographic databases (PubMed; SCOPUS; APA PsycInfo; CINAHL; Social Work Abstracts; Sociological Abstracts; ProQuest Dissertations & Theses). This review included studies if 1) they evaluated the effectiveness of a psychosocial intervention, 2) participants were PWUD, 3) authors reported self-stigma as a primary outcome, 4) the study design was experimental or quasi-experimental. We reviewed, interpreted and reported intervention characteristics and effectiveness using narrative synthesis. We assessed study quality with the Downs & Black checklist. RESULTS Among 1195 screened studies, 15 met the inclusion criteria (N = 2280 PWUD). We categorized the interventions according to three approaches: psychotherapeutic (n = 8), psychoeducational (n = 5), and multimodal (n = 2). Most interventions were delivered in clinical settings (n = 11) and in a group format (n = 13). Study quality was fair-to-good and included nine randomized controlled trials (RCTs) and six quasi-experiments. Measurement heterogeneity was high, with 11 different stigma-related scales used across the 15 studies. Eleven studies showed significant favorable effects in at least one stigma measure. Six of these demonstrated positive effects in all stigma measures. Evidence was mixed for all three intervention categories; however, Acceptance and Commitment Therapy, a form of group psychotherapy, demonstrated effectiveness in four of five RCTs incorporating this approach. CONCLUSIONS Overall, there is promising evidence for the effectiveness of substance use self-stigma interventions, although more studies are needed to determine which approaches are most effective. Consistent conceptualization and measurement of self-stigma across studies will improve comparability in future intervention trials. Current offerings are largely limited to clinical settings and group-based formats; self-help interventions, available for other stigmatized conditions, could be developed to serve the majority of PWUD not engaged in treatment.
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Affiliation(s)
- Adams L Sibley
- Department of Health Behavior, UNC Gillings School of Global Public Health, 170 Rosenau Hall CB #7400, 135 Dauer Dr., Chapel Hill, NC 27599, USA.
| | - David C Colston
- Department of Health Behavior, UNC Gillings School of Global Public Health, 170 Rosenau Hall CB #7400, 135 Dauer Dr., Chapel Hill, NC 27599, USA.
| | - Vivian F Go
- Department of Health Behavior, UNC Gillings School of Global Public Health, 170 Rosenau Hall CB #7400, 135 Dauer Dr., Chapel Hill, NC 27599, USA.
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Kyzar EJ, Arbuckle MR, Abba-Aji A, Balachandra K, Cooper J, Dela Cruz A, Edens E, Heward B, Jibson M, Jordan A, Moreno-De-Luca D, Pazderka H, Singh M, Weleff JJ, Yau B, Young J, Ross DA. Leveraging neuroscience education to address stigma related to opioid use disorder in the community: a pilot study. Front Psychiatry 2024; 15:1360356. [PMID: 38563031 PMCID: PMC10982477 DOI: 10.3389/fpsyt.2024.1360356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Opioid use disorder (OUD) and overdose deaths are a public health crisis. One contributing factor is stigma towards people who use opioids. We developed and conducted a public-facing, half-day educational event designed to challenge misperceptions about OUD from a contemporary neuroscience perspective. Participants engaged with three different resources on the neurobiology of addiction, and, at the end of the event, they rated its effectiveness. We also collected and compared pre- and post-event composite OUD stigma scales. Participants rated our approach and the overall event as highly effective. Additionally, OUD stigma scores were lower immediately following the event, and this decrease was primarily driven by decreased internalized stigma. Here, we demonstrate an effective proof-of-concept that an accessible, public-facing, neuroscience education event may reduce OUD stigma in the community.
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Affiliation(s)
- Evan J Kyzar
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY, United States
| | - Melissa R Arbuckle
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY, United States
| | - Adam Abba-Aji
- Department of Psychiatry, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada
| | - Krishna Balachandra
- Department of Psychiatry, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada
| | - Joseph Cooper
- Department of Psychiatry, University of Illinois, Chicago, IL, United States
| | - Adriane Dela Cruz
- Department of Psychiatry, University of Texas, Dallas, TX, United States
| | - Ellen Edens
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Brady Heward
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
- Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington, VT, United States
| | - Michael Jibson
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan MI, United States
| | - Ayana Jordan
- Department of Psychiatry, New York University School of Medicine, New York, NY, United States
| | - Daniel Moreno-De-Luca
- Department of Psychiatry, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada
- CASA Mental Health, Edmonton, AB, Canada
| | - Hannah Pazderka
- Department of Psychiatry, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada
| | - Mohit Singh
- Department of Psychiatry, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada
| | - Jeremy J Weleff
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Bernice Yau
- Department of Psychiatry, University of Texas, Dallas, TX, United States
| | - Justin Young
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - David A Ross
- Department of Psychiatry, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada
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Forchuk C, Serrato J, Scott L. Perceptions of stigma among people with lived experience of methamphetamine use within the hospital setting: qualitative point-in-time interviews and thematic analyses of experiences. Front Public Health 2024; 12:1279477. [PMID: 38414902 PMCID: PMC10896942 DOI: 10.3389/fpubh.2024.1279477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/25/2024] [Indexed: 02/29/2024] Open
Abstract
Objectives As part of a larger mixed-methods study into harm reduction in the hospital setting and people with lived experience of methamphetamine use, stigma was found to be a prominent issue. The aim of this secondary analysis was to investigate the issue of stigma. Design Participants completed a one-time qualitative interview component to assess their experiences in the hospital setting. Setting The study setting included secondary and tertiary care in Southwestern Ontario, Canada. Participants who had received care from these settings were also recruited from an overdose prevention site, a primary healthcare center, a national mental health organization, an affordable housing agency, and six homeless-serving agencies between October 2020 and April 2021. Participants A total of 104 individuals completed the qualitative component of a mixed-methods interview. Sixty-seven participants identified as male, thirty-six identified as female, and one identified as non-binary. Inclusion criteria included past or current use of methamphetamine, having received services from a hospital, and being able to communicate in English. Methods Open-ended questions regarding experiences in the hospital setting were asked in relation to the lived experience of methamphetamine. A secondary analysis was conducted post-hoc using a thematic ethnographic approach due to prominent perceptions of stigma. Results Three themes were identified. The first theme identified that substance use was perceived as a moral and personal choice; the second theme pertained to social stigmas such as income, housing and substance use, and consequences such as being shunned or feeling less worthy than the general patient population; and the third theme highlighted health consequences such as inadequate treatment or pain management. Conclusion This study revealed that stigma can have consequences that extend beyond the therapeutic relationship and into the healthcare of the individual. Additional training and education for healthcare providers represents a key intervention to ensure care is non-stigmatizing and patient-centered, as well as changing hospital culture.
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Affiliation(s)
- Cheryl Forchuk
- Lawson Health Research Institute, London, ON, Canada
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | | | - Leanne Scott
- Lawson Health Research Institute, London, ON, Canada
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
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21
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Lu A, Kim C, Rosen JG, Thompson E, Tardif J, Welwean R, Park JN. Supervised Inhalation Sites: Preventing Overdose and Reducing Health Inequities among People Who Use Drugs. Subst Use Misuse 2024; 59:520-526. [PMID: 38044494 PMCID: PMC10922979 DOI: 10.1080/10826084.2023.2287195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Policy and research on the implementation of services for people who inhale drugs lag behind similar efforts for people who inject drugs, limiting access to adequate harm reduction resources for people who inhale drugs. This commentary considers why supervised inhalation sites (SIS) are needed, highlights operational characteristics of four existing services, and advocates for future SIS research. Our hope is to encourage the expansion of SIS worldwide for overdose prevention and reduction of health inequities. Given the limited literature regarding SIS, more extensive study of these programs is warranted to incorporate inhalation into the implementation of supervised consumption sites to provide fair opportunities for all people who use drugs to do so safely without fear of stigma and overdose.
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Affiliation(s)
- Alison Lu
- School of Public Health, Brown University, Providence, Rhode Island
- Department of Neuroscience, Brown University, Providence, Rhode Island
| | - Claire Kim
- Department of Neuroscience, Brown University, Providence, Rhode Island
- Harm Reduction Innovation Lab, Rhode Island Hospital, Providence, Rhode Island
| | - Joseph G. Rosen
- Harm Reduction Innovation Lab, Rhode Island Hospital, Providence, Rhode Island
| | - Erin Thompson
- Harm Reduction Innovation Lab, Rhode Island Hospital, Providence, Rhode Island
| | - Jessica Tardif
- Harm Reduction Innovation Lab, Rhode Island Hospital, Providence, Rhode Island
| | - Ralph Welwean
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ju Nyeong Park
- Harm Reduction Innovation Lab, Rhode Island Hospital, Providence, Rhode Island
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
- Division of General Internal Medicine, The Department of Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island
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22
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Luo T, Xu S, Zhang K. Policies for recovery from drug use: Differences between public stigma and perceived stigma and associated factors. Drug Alcohol Rev 2024. [PMID: 38326226 DOI: 10.1111/dar.13818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Public stigma towards people who use drugs is widespread and places obstacles in way of their recovery. Previous studies have used different approaches to measure public stigma, resulting in a notable gap in the understanding of the relationship between it and its associated factors. Some studies measure public stigma by assessing stigma perceived by those who use drugs, while others investigate attitudes towards them among the general public. This study aimed to compare perceived and public stigma, and factors related to these two variables. METHODS The study comprised a cross-sectional survey in China of two samples: males who used drugs (N = 257) and the general public (N = 376). The survey assessed demographic variables, social distance, public stigma and perceived stigma of those who use drugs. The data were analysed using t-tests and linear regression. RESULTS Public stigma was significantly higher than perceived stigma. The findings indicated that gender, knowledge of drugs, family relationships with people who use drugs, attributions of drug use and social distance were significantly related to levels of public stigma. Among those who use drugs, perceived stigma was significantly correlated with age, marital status, duration of drug abstinence and social distance. DISCUSSION AND CONCLUSIONS Findings indicate that public stigma undermines the recovery of people who use drugs and highlight the importance of interaction between them and the social environment. The study also underscores the necessity of developing policies to enhance their integration into mainstream culture and provide access to social support and life activities.
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Affiliation(s)
- Tingyu Luo
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong
| | - Shuping Xu
- Department of Social Work, East China University of Political Science & Law, Shanghai, China
| | - Kun Zhang
- Department of Social Work, East China University of Political Science & Law, Shanghai, China
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23
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Nwanaji-Enwerem U, Sadler LS, O'Connell M, Barry D, Knobf TM, Jeon S, Scheinost D, Yaggi K, Redeker NS. "It's all connected:" A mixed methods study of insomnia, stigma, and discrimination among individuals on medication for opioid use disorder. Sleep Health 2024; 10:31-40. [PMID: 37980246 DOI: 10.1016/j.sleh.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 09/01/2023] [Accepted: 09/11/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVES Insomnia is one of the most common sleep disorders among those with opioid use disorder (OUD), including those on medication for OUD. There is a dearth of literature exploring the role of social stressors on sleep outcomes among this group. The purpose of this study was to explore the association between OUD-related stigma and intersectional discrimination with insomnia among individuals on medication for OUD. METHODS Participants were recruited from treatment clinics in the Northeast United States. Using a convergent mixed-methods research design, we explored associations with stigma (The Brief Opioid Stigma Scale), intersectional discrimination (Intersectional Discrimination Index), and insomnia (Insomnia Severity Index) through quantitative survey data and qualitative data from interviews for participant experiences. Data from the quantitative (n = 120) and qualitative (n = 25) components of the study were integrated for interpretation. RESULTS Quantitative analysis indicated weak to moderate positive correlations between intersectional discrimination, and exploratory variables including pain, perceived stress, and psychological distress with insomnia severity. The qualitative analysis generated 4 main themes, which highlighted negative emotions and ruminations as factors that participants connected experiences with stigma and discrimination to poor sleep outcomes. Integration of data identified concordant and discordant findings. CONCLUSIONS Stigma, discrimination, physical symptoms, and psychological distress appear to contribute to poor sleep outcomes among those with OUD. Future research should target maladaptive outcomes of rumination and negative emotions to improve sleep outcomes among those with OUD.
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Affiliation(s)
- Uzoji Nwanaji-Enwerem
- Yale School of Nursing, Orange, Connecticut, USA; Yale School of Public Health, New Haven, Connecticut, USA.
| | - Lois S Sadler
- Yale School of Nursing, Orange, Connecticut, USA; Yale School of Public Health, New Haven, Connecticut, USA
| | - Meghan O'Connell
- UCONN School of Nursing, Storrs, Connecticut, USA; Yale School of Public Health, New Haven, Connecticut, USA
| | - Declan Barry
- APT Foundation, New Haven, Connecticut, USA; Yale School of Medicine, New Haven, Connecticut, USA; Yale School of Public Health, New Haven, Connecticut, USA
| | - Tish M Knobf
- Yale School of Nursing, Orange, Connecticut, USA; Yale School of Public Health, New Haven, Connecticut, USA
| | - Sangchoon Jeon
- Yale School of Nursing, Orange, Connecticut, USA; Yale School of Public Health, New Haven, Connecticut, USA
| | - Dustin Scheinost
- Yale School of Medicine, New Haven, Connecticut, USA; Yale School of Public Health, New Haven, Connecticut, USA
| | - Klar Yaggi
- Yale School of Medicine, New Haven, Connecticut, USA; Yale School of Public Health, New Haven, Connecticut, USA
| | - Nancy S Redeker
- UCONN School of Nursing, Storrs, Connecticut, USA; Yale School of Public Health, New Haven, Connecticut, USA
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24
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Schutz C, Smout MF. Effects of Positive versus Negative Framing on Stigma toward Individuals Recovering from Methamphetamine Use Disorder during Randomized Brief Video Exposure. J Psychoactive Drugs 2024; 56:88-96. [PMID: 36417295 DOI: 10.1080/02791072.2022.2149436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/24/2022] [Accepted: 10/07/2022] [Indexed: 11/24/2022]
Abstract
Eighty-two Australians (mean age = 30.07; 61% female) were blindly randomized to view either a video edited to depict a positive or negative presentation of individuals in recovery from methamphetamine use disorder. Participants completed the Social Distance Scale for Substance Users, Dangerousness Scale for Substance Users and Affect Scale for Substance Users before and after video exposure. Following video exposure, those exposed to the positive video portrayal reported lower desire for social distance (p < .001), lower perceptions of dangerousness (p = .011), and more favorable affective reactions (p < .001). Participants' previous level of contact with the target group did not predict baseline stigma or moderate the experimental effect. Participants' qualitative responses to the experiment were assessed via content analysis and indicated mainly positive or ambivalent attitudes, unchanged by the video; however, 18% of those receiving the positive video reported attitudes becoming more sympathetic/favorable. Findings suggest that media depictions which include people with methamphetamine use disorder displaying friendliness and recovery narratives may improve community perceptions of people recovering from methamphetamine use disorder, and conversely, unsmiling portrayals focusing on harm done to others increases desire for social distance and perceived dangerousness.
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Affiliation(s)
- C Schutz
- Justice and Society, University of South Australia, Adelaide, Australia
| | - M F Smout
- Justice and Society, University of South Australia, Adelaide, Australia
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25
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Chen G. Identity Construction in Recovery from Substance Use Disorders. J Psychoactive Drugs 2024; 56:109-116. [PMID: 36538493 DOI: 10.1080/02791072.2022.2159592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022]
Abstract
Long-term recovery from substance use disorders has been described as a process of identity construction, through which the stigma of being a substance user is replaced by a new identity of a non-user. Identity construction has been widely acknowledged as a significant factor in different pathways of substance use cessation, such as self-change and treatment-change. However, almost no articles have discussed the role of identity construction in desistance and recovery among both self-changers and treatment-change. The aim of this narrative review was to explore this subject in the two groups. Based on the recovery capital approach and the social identity model of recovery, I posited that self-changers and treatment-changers undergo different processes of identity construction. Moreover, the prospects for successful identity construction depend upon personal and social resources (recovery capital) that provide identity-building materials such as relationships, attitudes, and role models. This article contributes to the field by presenting the different identity constructions in the process of long-term recovery from SUDs.
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Affiliation(s)
- Gila Chen
- Department of Criminology, Ashkelon Academic College, Ashkelon, Israel
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26
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Thal SB, Baker P, Marinis J, Wieberneit M, Sharbanee JM, Bruno R, Skeffington PM, Bright SJ. Therapeutic frameworks in integration sessions in substance-assisted psychotherapy: A systematised review. Clin Psychol Psychother 2023. [PMID: 38148518 DOI: 10.1002/cpp.2945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/07/2023] [Accepted: 11/24/2023] [Indexed: 12/28/2023]
Abstract
Serotonergic psychedelics and related substances have been explored as potential adjuncts in substance-assisted psychotherapy (SAPT) for treating various disorders. SAPT can be divided into three phases: preparation, administration and integration. Integration is commonly defined as the comprehension and effective application of insights from psychedelic experiences into everyday life. However, there is limited research regarding the most appropriate therapeutic approach during SAPT. In this article, we discuss the current evidence for different therapeutic frameworks for integration sessions when serotonergic psychedelics and entactogens are used as adjuncts to psychotherapy. We conducted a systematised review of the literature following PRISMA guidelines and searched PsycINFO, MEDLINE and Cochrane Library databases. The final synthesis included 75 clinical trials, mixed-methods investigations, treatment manuals, study protocols, quasi-experiments, qualitative investigations, descriptive studies, opinion papers, reviews, books and book chapters, published until 11 November 2022. The effects that various therapeutic approaches for integration sessions have on therapeutic outcomes have not been investigated by means of rigorous research. Most of the available evidence we retrieved was not supported by empirical data, thus limiting any conclusive statements regarding appropriate therapeutic frameworks for integration sessions for SAPT. Current clinical studies have used a range of therapeutic frameworks with the majority drawing from the humanistic-experiential tradition. While integration is regarded as crucial for the safe application of SAPT, there is currently an insufficient evidence base to suggest that any type of therapy is effective for guiding integration sessions. A systematic investigation of different therapeutic frameworks for integration and additional therapy-related factors is needed.
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Affiliation(s)
- Sascha B Thal
- Curtin School of Population Health, Curtin University, Bentley, Western Australia, Australia
- School of Psychology, College of Health & Education, Murdoch University, Murdoch, Western Australia, Australia
| | - Paris Baker
- School of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia
| | - Jonathon Marinis
- Orygen Youth Health, University of Melbourne, Parkville, Victoria, Australia
| | - Michelle Wieberneit
- Law School, University of Western Australia, Crawley, Western Australia, Australia
| | - Jason M Sharbanee
- Enable Institute, Discipline of Psychology, Curtin School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Raimundo Bruno
- School of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia
| | - Petra M Skeffington
- School of Psychology, College of Health & Education, Murdoch University, Murdoch, Western Australia, Australia
| | - Stephen J Bright
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Psychedelic Research in Science and Medicine (PRISM), Balwyn North, Victoria, Australia
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27
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Cazalis A, Lambert L, Auriacombe M. Stigmatization of people with addiction by health professionals: Current knowledge. A scoping review. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 9:100196. [PMID: 38023342 PMCID: PMC10656222 DOI: 10.1016/j.dadr.2023.100196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023]
Abstract
Background Stigma of people with substance and non-substance use disorders (SNSUD) is a long-known phenomenon. The aim of this review was to assess the stigmatization, by health professionals, of people with SNSUD, its characteristics and change over time. Methods A scoping review of literature reviews was conducted with systematic search of PubMed, Scopus and PsycINFO databases. Results From the 19 selected reviews, all focused on people with SUD (PWSUD) only and 20 % to 51 % of health professionals had negative attitudes/beliefs about SUD. Addiction training and clinical experience with PWSUD were associated with a less negative attitude. Health professionals' negative beliefs, lack of time or support were associated with less involvement in addiction care. Tobacco use disorder, SUDs other than alcohol and tobacco, relapse, psychiatric comorbidity or criminal records were associated with a more negative attitude. The influence of several variables potentially related to stigmatization was inconsistent across selected reviews. The evolution of stigmatization over time was not systematically assessed and showed mixed results. Conclusions The stigmatization of PWSUD has an impact on their care, and a change in some variables could reduce its importance: moral model of addiction, health professionals' negative beliefs, lack of training, time, and role support. Teaching what addiction is according to the medical chronic disease model, and developing stigma-focused training could improve caregivers' attitudes and further reduce stigma. Further studies are needed to determine whether stigma of PWSUD by health professionals has changed over time and to characterize stigma for people with non-substance use disorders.
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Affiliation(s)
- Anthony Cazalis
- University of Bordeaux, Bordeaux, France
- Addiction Team, Sleep, Addiction and Neuropsychiatry, (Sanpsy), Centre National de la Recherche Scientifique (CNRS) Unité mixte de recherche (UMR) 6033, University of Bordeaux, Bordeaux, France
- Pôle interétablissement d'Addictologie, CH Charles Perrens and CHU de Bordeaux, Bordeaux, France
| | - Laura Lambert
- University of Bordeaux, Bordeaux, France
- Addiction Team, Sleep, Addiction and Neuropsychiatry, (Sanpsy), Centre National de la Recherche Scientifique (CNRS) Unité mixte de recherche (UMR) 6033, University of Bordeaux, Bordeaux, France
- Pôle interétablissement d'Addictologie, CH Charles Perrens and CHU de Bordeaux, Bordeaux, France
| | - Marc Auriacombe
- University of Bordeaux, Bordeaux, France
- Addiction Team, Sleep, Addiction and Neuropsychiatry, (Sanpsy), Centre National de la Recherche Scientifique (CNRS) Unité mixte de recherche (UMR) 6033, University of Bordeaux, Bordeaux, France
- Pôle interétablissement d'Addictologie, CH Charles Perrens and CHU de Bordeaux, Bordeaux, France
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28
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Blyth SH, Cowie K, Jurinsky J, Hennessy EA. A qualitative examination of social identity and stigma among adolescents recovering from alcohol or drug use. Addict Behav Rep 2023; 18:100505. [PMID: 37415909 PMCID: PMC10319988 DOI: 10.1016/j.abrep.2023.100505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 05/18/2023] [Accepted: 06/17/2023] [Indexed: 07/08/2023] Open
Abstract
Introduction Alcohol and other drug (AOD) use disorders are stigmatized conditions, but little is known about youth's experience of this stigma, which may threaten their developing social identity and recovery process. This study investigates youth's perceptions of AOD use-related stigma in the context of their social identity. Methods This study uses data from 12 youth (ages 17-19) who were in recovery from problematic AOD use. Participants completed a Social Identity Mapping in Addiction Recovery (SIM-AR) exercise, in which they created a visual map of their social groups, and semi-structured interview, in which participants were asked about their experience creating their SIM-AR and reflections on their social network. SIM-AR data were descriptively analyzed, and interviews were thematically analyzed for instances of stigma. Results Using stigmatizing terminology, participants expressed some stigmatizing attitudes towards themselves and others in their network who used substances and perceived both positive and negative reactions from those who knew about their disorder. Findings suggest that youth may experience some internalized stigma and perceive stigma from others in their social networks, which may be a barrier to the development of a healthy social identity and engagement in recovery supports. Conclusions These findings should be considered when seeking to engage youth in treatment and recovery programming. Despite the small sample, the findings suggest the importance of considering how stigma may influence adolescents' treatment and recovery experience in the context of their social environment.
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Affiliation(s)
| | - Kiefer Cowie
- The Wright Institute Clinical Psychology Program, Berkeley, CA 94704, USA
| | - Jordan Jurinsky
- Vanderbilt University, Peabody College of Education and Human Development, Nashville, TN 37203-5721, USA
| | - Emily A. Hennessy
- Massachusetts General Hospital, Psychiatry, Recovery Research Institute, 151 Merrimac Road, Boston, MA 02114-2696, USA
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29
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Lihi R, Yael D, Silviu B, Anat S, Marsha W, Stacy S, Shaul S, Miriam A, Einat P. Stigma and level of familiarity with opioid maintenance treatment (OMT) among specialist physicians in Israel. Harm Reduct J 2023; 20:134. [PMID: 37715237 PMCID: PMC10503015 DOI: 10.1186/s12954-023-00869-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 09/07/2023] [Indexed: 09/17/2023] Open
Abstract
CONTEXT Opioid use disorder (OUD) poses significant public health problems that have increased dramatically, resulting in high rates of morbidity and mortality. OBJECTIVES To minimize the risk of an opioid epidemic in Israel and be prepared, we evaluated physicians' objective knowledge, level of stigma, and approach to prescribing opioids, risk factors, and identification of patients with substance use disorder (SUD), as well as their knowledge about opioid maintenance treatment (OMT) for OUD. METHODS Anonymous computerized questionnaires were distributed nationally to physicians by the Israel Medical Association. Knowledge, stigma, and approach were scored. RESULTS Of only 249 responders, 58.6% prescribe opioids, 32.1% prescribe cannabis, and 18.5% daily encounter patients with SUD. Logistic regression found the high knowledge group had daily encounters with SUD (Odds Ratio (OR) = 3.5, 95% CI 1.7-7.1) and were familiar with OMT (OR = 10.1, 95% CI 3.5-29.0). The high stigma group was characterized by physicians who prescribe opioids (OR = 1.7, 95% CI 1.0-2.9), but who self-reported having limited knowledge regarding OMT (OR = 2, 95% CI 1.1-3.7). The high approach group was characterized by those who prescribe opioids (OR = 11.7, 95% CI 4.9-28), prescribe cannabis (OR = 2.1, 95% CI 1.0-4.3), self-report having limited knowledge regarding OMT (OR = 11.2, 95% CI 1.4-89) and self-report identifying SUD (OR = 32.5, 95% CI 4.1-260). CONCLUSION High stigma was most evident among physicians who prescribe opioids but, importantly, who had limited knowledge specifically regarding OMT. Gaps in knowledge and approach were observed. An educational intervention is highly recommended to reduce stigma and increase referrals of patients for OMT, the most effective treatment for opioid use disorder.
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Affiliation(s)
- Rozner Lihi
- Department of Psychiatry, Maayenei Hayeshua Medical Center, Bnei Brak, Israel
| | - Delayahu Yael
- Psychiatry, Abarbanel Mental Health Center, Bat Yam, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Brill Silviu
- Pain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Sason Anat
- Adelson Clinic for Drug Abuse Treatment and Research, Tel Aviv Sourasky Medical Center, 10 Dafna Street, 6492805, Tel Aviv, Israel
| | - Weinstein Marsha
- Adelson Clinic for Drug Abuse Treatment and Research, Tel Aviv Sourasky Medical Center, 10 Dafna Street, 6492805, Tel Aviv, Israel
| | - Shoshan Stacy
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Adelson Clinic for Drug Abuse Treatment and Research, Tel Aviv Sourasky Medical Center, 10 Dafna Street, 6492805, Tel Aviv, Israel
| | - Schreiber Shaul
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Adelson Clinic for Drug Abuse Treatment and Research, Tel Aviv Sourasky Medical Center, 10 Dafna Street, 6492805, Tel Aviv, Israel
- Division of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Adelson Miriam
- Adelson Clinic for Drug Abuse Treatment and Research, Tel Aviv Sourasky Medical Center, 10 Dafna Street, 6492805, Tel Aviv, Israel
| | - Peles Einat
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Adelson Clinic for Drug Abuse Treatment and Research, Tel Aviv Sourasky Medical Center, 10 Dafna Street, 6492805, Tel Aviv, Israel.
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30
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Hutton HE, Aggarwal S, Gillani A, Chander G. A Digital Counselor-Delivered Intervention for Substance Use Among People With HIV: Development and Usability Study. JMIR Form Res 2023; 7:e40260. [PMID: 37639294 PMCID: PMC10495853 DOI: 10.2196/40260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 03/25/2023] [Accepted: 06/22/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Substance use disorders are prevalent and undertreated among people with HIV. Computer-delivered interventions (CDIs) show promise in expanding reach, delivering evidence-based care, and offering anonymity. Use in HIV clinic settings may overcome access barriers. Incorporating digital counselors may increase CDI engagement, and thereby improve health outcomes. OBJECTIVE We aim to develop and pilot a digital counselor-delivered brief intervention for people with HIV who use drugs, called "C-Raven," which is theory grounded and uses evidence-based practices for behavior change. METHODS Intervention mapping was used to develop the CDI including a review of the behavior change research in substance use, HIV, and digital counselors. We conducted in-depth interviews applying the situated-information, motivation, and behavior skills model and culturally adapting the content for local use with people with HIV. With a user interaction designer, we created various digital counselors and CDI interfaces. Finally, a mixed methods approach using in-depth interviews and quantitative assessments was used to assess the usability, acceptability, and cultural relevance of the intervention content and the digital counselor. RESULTS Participants found CDI easy to use, useful, relevant, and motivating. A consistent suggestion was to provide more information about the negative impacts of drug use and the interaction of drug use with HIV. Participants also reported that they learned new information about drug use and its health effects. The CDI was delivered by a "Raven," digital counselor, programmed to interact in a motivational interviewing style. The Raven was perceived to be nonjudgmental, understanding, and emotionally responsive. The appearance and images in the intervention were perceived as relevant and acceptable. Participants noted that they could be more truthful with a digital counselor, however, it was not unanimously endorsed as a replacement for a human counselor. The C-Raven Satisfaction Scale showed that all participants rated their satisfaction at either a 4 (n=2) or a 5 (n=8) on a 5-point Likert scale and all endorsed using the C-Raven program again. CONCLUSIONS CDIs show promise in extending access to care and improving health outcomes but their development necessarily requires integration from multiple disciplines including behavioral medicine and computer science. We developed a cross-platform compatible CDI led by a digital counselor that interacts in a motivational interviewing style and (1) uses evidence-based behavioral change methods, (2) is culturally adapted to people with HIV who use drugs, (3) has an engaging and interactive user interface, and (4) presents personalized content based on participants' ongoing responses to a series of menu-driven conversations. To advance the continued development of this and other CDIs, we recommend expanded testing, standardized measures to evaluate user experience, integration with clinician-delivered substance use treatment, and if effective, implementation into HIV clinical care.
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Affiliation(s)
- Heidi E Hutton
- Department of Psychiatry & Behaviorial Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Saavitri Aggarwal
- Department of Psychiatry & Behaviorial Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Afroza Gillani
- College of Dentistry, New York University, New York, NY, United States
| | - Geetanjali Chander
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, United States
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31
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Saleem HT, West NS, Likindikoki S. Prevalence and predictors of depressive and anxiety symptoms in a sample of women who use drugs in Tanzania: the key role of drug use stigma. BMC Psychiatry 2023; 23:517. [PMID: 37464339 DOI: 10.1186/s12888-023-05008-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 07/07/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Globally, women who use drugs face multiple health vulnerabilities, including poor mental health. Little is known about the mental health burden among women who use drugs in sub-Saharan Africa. This cross-sectional study examined the prevalence and predictors of depressive and anxiety symptoms among a sample of women who use drugs in Dar es Salaam, Tanzania. METHODS We administered a cross-sectional survey to a non-random sample of 200 women who use drugs in Dar es Salaam between November 2018 and March 2019. We used descriptive statistics to characterize the study sample and fitted separate logistic regression models to assess depressive and anxiety symptoms and their predictors. RESULTS The percentages of women reporting depressive and anxiety symptoms were 67.5% and 43.7%, respectively. Internalized drug use stigma (AOR = 1.34, 95% CI: 1.03-1.75) and prior attempts to stop heroin use (AOR = 2.99, 95% CI: 1.28-7.00) were associated with depressive symptoms. Enacted drug use stigma from health workers (AOR = 2.02, 95% CI: 1.34-3.04) and anticipated drug use stigma from family (AOR = 1.49, 95% CI: 1.02-2.16) were associated with anxiety symptoms. CONCLUSIONS Depressive and anxiety symptoms were high among our study sample, with higher reports of symptoms of depression than anxiety. Drug use stigma was a key factor that contributed to elevated symptoms of depression and anxiety.
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Affiliation(s)
- Haneefa T Saleem
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Nora S West
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Samuel Likindikoki
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Weiner SG, Lo YC, Carroll AD, Zhou L, Ngo A, Hathaway DB, Rodriguez CP, Wakeman SE. The Incidence and Disparities in Use of Stigmatizing Language in Clinical Notes for Patients With Substance Use Disorder. J Addict Med 2023; 17:424-430. [PMID: 37579100 PMCID: PMC10387497 DOI: 10.1097/adm.0000000000001145] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The language used to describe people with substance use disorder impacts stigma and influences clinical decision making. This study evaluates the presence of stigmatizing language (SL) in clinical notes and detects patient- and provider-level differences. METHODS All free-text notes generated in a large health system for patients with substance-related diagnoses between December 2020 and November 2021 were included. A natural language processing algorithm using the National Institute on Drug Abuse's "Words Matter" list was developed to identify use of SL in context. RESULTS There were 546,309 notes for 30,391 patients, of which 100,792 (18.4%) contained SL. A total of 18,727 patients (61.6%) had at least one note with SL. The most common SLs used were "abuse" and "substance abuse." Nurses were least likely to use SL (4.1%) while physician assistants were most likely (46.9%). Male patients were more likely than female patients to have SL in their notes (adjusted odds ratio [aOR], 1.17; 95% confidence internal [CI], 1.11-1.23), younger patients aged 18 to 24 were less likely to have SL than patients 45 to 54 years (aOR, 0.55; 95% CI, 0.50-0.61), Asian patients were less likely to have SL than White patients (aOR, 0.45; 95% CI, 0.36-0.56), and Hispanic patients were less likely to have SL than non-Hispanic patients (aOR, 0.88; 95% CI, 0.80-0.98). CONCLUSIONS The majority of patients with substance-related diagnoses had at least one note containing SL. There were also several patient characteristic disparities associated with patients having SL in their notes. The work suggests that more clinician interventions about use of SL are needed.
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Affiliation(s)
- Scott G. Weiner
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Ying-Chih Lo
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Aleta D. Carroll
- Mass General Brigham, Enterprise Analytics, Boston, Massachusetts
| | - Li Zhou
- Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Ashley Ngo
- Mass General Brigham, Enterprise Analytics, Boston, Massachusetts
| | - David B. Hathaway
- Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Claudia P. Rodriguez
- Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Sarah E. Wakeman
- Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Mass General Brigham, Office of the Chief Medical Officer, Boston, Massachusetts
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Judd H, Yaugher AC, O'Shay S, Meier CL. Understanding stigma through the lived experiences of people with opioid use disorder. Drug Alcohol Depend 2023; 249:110873. [PMID: 37390780 DOI: 10.1016/j.drugalcdep.2023.110873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 06/05/2023] [Accepted: 06/20/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Stigma toward substance use disorders reduces treatment seeking and recovery efforts of persons who could most benefit from services. This is particularly true for opioid use disorder (OUD) stigma, which in recent years has likely fueled the overdose epidemic. Understanding the stigma surrounding OUD and stigma reduction efforts that can be implemented are needed to enhance treatment and recovery efforts. This project explores the lived experiences of persons who were in recovery from OUD or a family member of someone with OUD with a focus on stigma. METHODS We utilized a qualitative method to examine secondary data of published transcripts where people's (N = 30) experiences with stigma emerged through storytelling. RESULTS Thematic analysis found three overarching types of stigma that were described by participants, 1) Social stigma: misconceptions contributing to social stigma, labeling and associative stereotypes, persistence of stigma throughout recovery; 2) Self-stigma: internalized feelings due to stigma, concealing and continuing substance use, inadequacies of navigating recovery; and 3) Structural stigma: treatment and recovery resource barriers, challenges of reintegration. CONCLUSIONS The experiences described by participants highlight the multifaceted impact of stigma on the individual as well as society and add to our understanding of the lived experience of stigma. Future recommendations are discussed to improve the experience of individuals with lived experience of OUD; including implementing evidence-based strategies to reduce stigma such as using stigma-free or person first language, dispelling common myths, and supporting comprehensive recovery pathways.
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Affiliation(s)
- Hailey Judd
- Utah State University, 4900 Old Main Hill, Logan, UT84321, United States
| | - Ashley C Yaugher
- Utah State University, 4900 Old Main Hill, Logan, UT84321, United States.
| | - Sydney O'Shay
- Utah State University, 4900 Old Main Hill, Logan, UT84321, United States
| | - Cristian L Meier
- Utah State University, 4900 Old Main Hill, Logan, UT84321, United States
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Luoma JB, Rossi SL, Sereda Y, Pavlov N, Toussova O, Vetrova M, Bendiks S, Kiriazova T, Krupitsky E, Lioznov D, Blokhina E, Lodi S, Lunze K. An acceptance-based, intersectional stigma coping intervention for people with HIV who inject drugs-a randomized clinical trial. THE LANCET REGIONAL HEALTH. EUROPE 2023; 28:100611. [PMID: 37180745 PMCID: PMC10173263 DOI: 10.1016/j.lanepe.2023.100611] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 02/09/2023] [Accepted: 02/22/2023] [Indexed: 05/16/2023]
Abstract
Background People with HIV who inject drugs experience intersecting forms of stigma that adversely impact care access. This RCT aimed to evaluate effects of a behavioral intersectional stigma coping intervention on stigma and care utilization. Methods We recruited 100 participants with HIV and past-30-day injection drug use at a non-governmental harm reduction organization in St. Petersburg, Russia, and randomized them 1:2 to receive usual services only or an additional intervention of three weekly 2-h group sessions. Primary outcomes were change in HIV and substance use stigma scores at one month after randomization. Secondary outcomes were initiation of antiretroviral treatment (ART), substance use care utilization, and changes in frequency of past-30-days drug injection at six months. The trial was registered as NCT03695393 at clinicaltrials.gov. Findings Participant median age was 38.1 years, 49% were female. Comparing 67 intervention and 33 control group participants recruited October 2019-September 2020, the adjusted mean difference (AMD) in change in HIV and substance use stigma scores one month after baseline were 0.40, (95% CI: -0.14 to 0.93, p = 0.14) and -2.18 (95% CI: -4.87 to 0.52, p = 0.11), respectively. More intervention participants than control participants initiated ART (n = 13, 20% vs n = 1, 3%, proportion difference 0.17, 95% CI: 0.05-0.29, p = 0.01) and utilized substance use care (n = 15, 23% vs n = 2, 6%, proportion difference 0.17, 95% CI: 0.03-0.31, p = 0.02). The adjusted median difference in change in injecting drug use frequency 6 months after baseline was -3.33, 95% CI: -8.51 to 1.84, p = 0.21). Five not intervention-related serious adverse events (7.5%) occurred in the intervention group, one (3.0%) serious adverse event in the control group. Interpretation This brief stigma-coping intervention did not change stigma manifestations or drug use behaviors in people with HIV and injection drug use. However, it seemed to reduce stigma's impact as an HIV and substance use care barrier. Funding R00DA041245, K99DA041245, P30AI042853.
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Affiliation(s)
- Jason B. Luoma
- Portland Psychotherapy Clinic, Research, and Training Center, 3700 North Williams Avenue, Portland, OR, 97227, USA
| | - Sarah L. Rossi
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, 801 Massachusetts Avenue, 2 Floor, Boston, MA, 02118, USA
| | - Yuliia Sereda
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | - Nikolai Pavlov
- Life in Balance Psychotherapy Clinic, 137 Roncesvalles Avenue, Suite 208, Toronto, ON, M6R 2L2, Canada
| | - Olga Toussova
- Pavlov University, L'va Tolstogo St., 6-8, St. Petersburg, 197022, Russian Federation
| | - Marina Vetrova
- Pavlov University, L'va Tolstogo St., 6-8, St. Petersburg, 197022, Russian Federation
| | - Sally Bendiks
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, 801 Massachusetts Avenue, 2 Floor, Boston, MA, 02118, USA
| | | | - Evgeny Krupitsky
- Pavlov University, L'va Tolstogo St., 6-8, St. Petersburg, 197022, Russian Federation
- V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology, Bekhtereva St., 3, St. Petersburg, 192019, Russian Federation
| | - Dmitry Lioznov
- Pavlov University, L'va Tolstogo St., 6-8, St. Petersburg, 197022, Russian Federation
- Smorodintsev Research Institute of Influenza, 15/17, Prof. Popov Street, St. Petersburg, 197376, Russian Federation
| | - Elena Blokhina
- Pavlov University, L'va Tolstogo St., 6-8, St. Petersburg, 197022, Russian Federation
| | - Sara Lodi
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, 3 Floor, Boston, MA, 02118, USA
| | - Karsten Lunze
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, 801 Massachusetts Avenue, 2 Floor, Boston, MA, 02118, USA
- Boston University Chobanian & Avedisian School of Medicine, 72 E Concord St, Boston, MA, 02118, USA
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Francia L, Lam T, Berg A, Morgan K, Savic M, Lubman Am DI, Nielsen S. Alcohol and other drug use: A qualitative exploration of staff and patient's experiences of language use as a means of stigma communication in hospital and primary care settings. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 149:209050. [PMID: 37086790 DOI: 10.1016/j.josat.2023.209050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/21/2022] [Accepted: 04/13/2023] [Indexed: 04/24/2023]
Abstract
INTRODUCTION The hospital and primary care settings present opportunities to interact, initiate conversations, and instigate referrals for patients experiencing harm from their alcohol and other drug use. Using a stigma communication model, our qualitative study explored whether stigma communication materialized in staff's language in the hospital and primary care settings, and if so, whether this had any impact on staff's and patients' experiences. METHOD The study conducted thematic analysis on 39 semi-structured interviews comprising both male and female adults (n = 20) who had experienced or were currently experiencing problematic alcohol or other drug use; and staff (n = 19) from either alcohol and other drug specialist services, or other broader health care services. RESULTS The study identified three themes where language use materialized as a means of stigma communication: (i) language that positioned a patient as undeserving; (ii) language that separated a patient from other patients; and (iii) language that blamed a patient. Where language use materialized as a means of stigma communication, this appeared to influence staff's decision-making, or potential avoidance of staff's obligations related to health care. Where language use materialized as a means of stigma communication for patients, poor experiences occurred for both staff and patients, that potentially influenced health care provision and future treatment-seeking intentions. CONCLUSIONS The use of language as a means of stigma communication was present in staff/patient interactions. Although a number of targeted interventions exist that address language and stigma toward people who use alcohol and other drugs, our findings indicate that change may be inhibited if staff do not realize that their own use of language may contribute to the perpetuation of stigma. The findings also suggest that aspects of language that materialize as a means of stigma communication may impact the "no wrong door" approach, which intends that people, regardless of which service they attend, receive appropriate support.
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Affiliation(s)
- Leanne Francia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia.
| | - Tina Lam
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
| | - Amelia Berg
- Association of Participating Services Users, Self Help Addiction Resource Centre, 140 Grange Road, Carnegie, VIC 2063, Australia
| | - Kirsty Morgan
- Peninsula Health, 2 Hastings Road, Frankston, VIC 3199, Australia
| | - Michael Savic
- Eastern Health Clinical School, Turning Point, Richmond, Victoria 3121, Australia
| | - Dan I Lubman Am
- Eastern Health Clinical School, Turning Point, Richmond, Victoria 3121, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
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Carl A, Pasman E, Broman MJ, Lister JJ, Agius E, Resko SM. Experiences of Healthcare and Substance Use Treatment Provider-based Stigma Among Patients Receiving Methadone. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 6:100138. [PMID: 36994374 PMCID: PMC10040326 DOI: 10.1016/j.dadr.2023.100138] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 01/14/2023] [Accepted: 01/27/2023] [Indexed: 02/10/2023]
Abstract
Background Medications for Opioid Use Disorder (MOUD) are efficacious, however only one-third of individuals with an opioid use disorder (OUD) enter into treatment. Low rates of MOUD utilization are partially due to stigma. This study examines provider-based stigma toward MOUD and identifies factors associated with experiencing stigma related to MOUD from substance use treatment and healthcare providers among people receiving methadone. Methods Clients receiving MOUD at an opioid treatment program (N = 247) were recruited to complete a cross-sectional computer-based survey assessing socio-demographics, substance use, depression and anxiety symptoms, self-stigma, and recovery supports/barriers. Logistic regression was used to examine factors associated with hearing negative comments about MOUD from substance use treatment and healthcare providers. Results 27.9% and 56.7% of respondents reported they sometimes/often hear negative comments about MOUD from substance use treatment and healthcare providers, respectively. Logistic regression results indicate that individuals who experience more negative consequences resulting from their OUD (OR=1.09, p=.019) had greater odds of hearing negative comments from substance use treatment providers. Age (OR=0.966, p=.017) and treatment stigma (OR=1.42, p=.030) were associated with greater odds of hearing negative comments from healthcare providers. Conclusions Stigma can be a deterrent to seeking substance use treatment, healthcare, and recovery support. Understanding factors associated with experiencing stigma from substance use treatment providers and healthcare providers is important as these individuals may act as advocates for those with OUD. This study highlights individual factors associated with hearing negative comments about methadone and other MOUD and point to areas for targeted education.
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Affiliation(s)
- Alexis Carl
- School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI 48202, USA
| | - Emily Pasman
- School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI 48202, USA
| | - Michael J. Broman
- School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI 48202, USA
| | - Jamey J. Lister
- School of Social Work, Rutgers University – New Brunswick, 120 Albany Street, Tower One, New Brunswick, NJ 08901, USA
| | - Elizabeth Agius
- School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI 48202, USA
| | - Stella M. Resko
- School of Social Work, Wayne State University, 5447 Woodward Ave, Detroit, MI 48202, USA
- Merrill Palmer Skillman Institute, Wayne State University, 71 E Ferry St, Detroit, MI 48202, USA
- Corresponding author.
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Lodi S, Rossi SL, Bendiks S, Gnatienko N, Lloyd-Travaglini C, Vetrova M, Toussova O, Bushara N, Blokhina E, Krupitsky E, Ekstrand ML, Lioznov D, Samet JH, Lunze K. Correlates of Intersectional HIV and Substance Use Stigma Affecting People with HIV and Substance Use in St. Petersburg, Russia. AIDS Behav 2023; 27:462-472. [PMID: 35916947 PMCID: PMC9892353 DOI: 10.1007/s10461-022-03781-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 02/04/2023]
Abstract
People with HIV (PWH) who inject drugs often experience coexisting HIV- and substance use-related stigma manifestations. We assessed correlates of HIV stigma (Berger HIV stigma scale), substance use stigma (Substance Abuse Self-stigma scale) and intersectional HIV and substance use stigma in a cohort of PWH with a lifetime history of drug use in St. Petersburg, Russia. Intersectional stigma was defined as having a score greater than the median for both forms of stigma. Of the 208 participants, 56 (27%) had intersectional stigma. Depressive symptoms and alcohol dependence were significantly associated with a higher HIV and substance stigma score, but not with intersectional stigma. Individual and community interventions to reduce the impact of HIV stigma and substance use stigma affecting PWH who inject drugs should consider assessing and addressing mental health and unhealthy substance use. Further work with longitudinal data is needed to understand mechanisms leading to intersectional stigma.
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Affiliation(s)
- Sara Lodi
- Boston University School of Public Health, Boston, MA, USA.
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA.
| | - Sarah L Rossi
- Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Sally Bendiks
- Department of Medicine, Boston Medical Center, Boston, MA, USA
| | | | | | - Marina Vetrova
- Laboratory of Clinical Psychopharmacology of Addictions, First Pavlov State Medical University of Saint Petersburg, St. Petersburg, Russia
| | - Olga Toussova
- Laboratory of Clinical Psychopharmacology of Addictions, First Pavlov State Medical University of Saint Petersburg, St. Petersburg, Russia
| | - Natalia Bushara
- Laboratory of Clinical Psychopharmacology of Addictions, First Pavlov State Medical University of Saint Petersburg, St. Petersburg, Russia
| | - Elena Blokhina
- Laboratory of Clinical Psychopharmacology of Addictions, First Pavlov State Medical University of Saint Petersburg, St. Petersburg, Russia
| | - Evgeny Krupitsky
- Laboratory of Clinical Psychopharmacology of Addictions, First Pavlov State Medical University of Saint Petersburg, St. Petersburg, Russia
- Department of Addiction, Bekhterev National Medical Research Center for Psychiatry and Neurology, St. Petersburg, Russia
| | - Maria L Ekstrand
- Center for AIDS Prevention Studies, School of Medicine, University of California San Francisco, San Francisco, CA, USA
- St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, India
| | - Dmitry Lioznov
- Laboratory of Clinical Psychopharmacology of Addictions, First Pavlov State Medical University of Saint Petersburg, St. Petersburg, Russia
| | - Jeffrey H Samet
- Boston University School of Public Health, Boston, MA, USA
- Department of Medicine, Boston Medical Center, Boston, MA, USA
- School of Medicine, Boston University, Boston, MA, USA
| | - Karsten Lunze
- Department of Medicine, Boston Medical Center, Boston, MA, USA
- School of Medicine, Boston University, Boston, MA, USA
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Hanoa K, Bilgrei OR, Buvik K. The Importance of Perceived Safety, Stigma and Pleasure for Solitary Injecting. JOURNAL OF DRUG ISSUES 2023. [DOI: 10.1177/00220426231151377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Many people who inject drugs (PWID) inject when they are alone which increases the risk for drug-related mortality, and the majority of overdose-related deaths occur among solitary users in residential environments. Drawing on qualitative data from interviews with 80 PWID in Norway, this study explores the complex practices of solitary injecting. The analysis illustrates that the risk environments in which they participated involved high levels of distress, fear and stigma that made them prefer solitary injecting. This involved a perceived notion of safety from an unpredictable social environment. Stigma was described as causing additional harms and they therefore wanted to hide their drug-using practices. Finally, injecting drug use involved contextual pleasures that were maximised by injecting alone. The study illustrates how the risk environment the PWID inhabited caused additional harms, by which solitary injections was rationalized, despite its increased mortality risks. Future harm-reduction initiatives should reflect this important aspect.
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Affiliation(s)
- Kristin Hanoa
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
- Agency for Social and Welfare Services, Oslo Municipality, Norway
| | - Ola Røed Bilgrei
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| | - Kristin Buvik
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
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Public Stigma Toward Schizophrenia Within Latino Communities in the United States. Community Ment Health J 2023; 59:915-928. [PMID: 36617355 PMCID: PMC9826702 DOI: 10.1007/s10597-022-01075-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/13/2022] [Indexed: 01/09/2023]
Abstract
Public stigma toward those experiencing symptoms of schizophrenia in the general population is high; yet research into such stigma within the diverse Latino communities remains under-investigated. This study employed a randomized experimental vignette methodology to assess various domains of public stigma toward individuals experiencing psychosis and/or diabetes within Latino communities. A communitybased sample of 243 Latino adults participated. Contrary to our expectations, respondents who were more sympathetic toward those with mental health problems tended to score higher on public stigma. The belief that a person was responsible for their own mental health problems was associated with higher levels of stigma. Results indicate that perceptions of dangerousness toward someone experiencing psychosis were common, and the perception that a person was responsible for their mental health problems was associated with higher levels of stigma Results emphasize the complex nature of stigma within the diverse Latino communities and the need for ongoing research.
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Bovell-Ammon BJ, Kimmel SD, Cheng DM, Truong V, Michals A, Vetrova M, Hook K, Idrisov B, Blokhina E, Krupitsky E, Samet JH, Lunze K. Incarceration history, antiretroviral therapy, and stigma: A cross-sectional study of people with HIV who inject drugs in St. Petersburg, Russia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 111:103907. [PMID: 36402082 PMCID: PMC9868071 DOI: 10.1016/j.drugpo.2022.103907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/07/2022] [Accepted: 11/06/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The HIV epidemic is intertwined with substance use and incarceration in Russia. The relationships between incarceration history, HIV treatment history, and stigma experiences among people with HIV (PWH) who inject drugs in Russia have not been well described. METHODS We conducted a cross-sectional study of a cohort of PWH with opioid use disorder who inject drugs (n=201) recruited at a narcology (substance use treatment) hospital in St. Petersburg, Russia from September 2018 to December 2020. The primary analysis evaluated the association between self-reported prior incarceration and prior antiretroviral therapy (ART) initiation using multivariable logistic regression to adjust for demographic, social, and clinical covariates. We used multivariable linear regression models to analyze associations between prior incarceration and two secondary outcomes: HIV stigma score (11-item abbreviated Berger scale) and substance use stigma score (21-item combination of Substance Abuse Self-Stigma Scale and Stigma-related Rejection Scale). RESULTS Mean age was 37 (SD 5) years; 58.7% were male. Participants had been living with HIV for a mean of 13 (SD 6) years. Over two thirds (69.2%) of participants reported prior incarceration. One third (35.3%) of participants reported prior ART initiation. Prior incarceration was not significantly associated with prior ART initiation (AOR 1.76; 95% CI: 0.81, 3.83). Prior incarceration was associated with a lower HIV stigma score (adjusted mean difference in z-score: -0.50; 95%CI: -0.81, -0.19) but was not significantly associated with substance use stigma score (adjusted mean difference in z-score: -0.10; 95%CI: -0.42, 0.21). CONCLUSION Prior incarceration was common, and rates of prior ART initiation were low even though most participants had been living with HIV for at least a decade. We did not find an association between prior incarceration and prior ART initiation, which suggests a need to explore whether opportunities to initiate ART during or after incarceration are missed. CLINICAL TRIAL NUMBER NCT03290391.
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Affiliation(s)
- Benjamin J Bovell-Ammon
- Department of Medicine, Boston Medical Center; and Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown Center 2nd Floor, Boston, MA 02118, USA.
| | - Simeon D Kimmel
- Department of Medicine, Boston Medical Center; and Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown Center 2nd Floor, Boston, MA 02118, USA
| | - Debbie M Cheng
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center 3rd Floor, Boston, MA 02118, USA
| | - Ve Truong
- Department of Medicine, Boston Medical Center; and Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown Center 2nd Floor, Boston, MA 02118, USA
| | - Amy Michals
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, 85 East Newton Street, M921, Boston, MA 02118, USA
| | - Marina Vetrova
- Pavlov First St. Petersburg State Medical University, Lev Tolstoy Street, 6-8, St. Petersburg 197022, Russian Federation
| | - Kimberly Hook
- Department of Psychiatry, Boston Medical Center and Boston University School of Medicine, 720 Harrison Avenue 9th Floor, Boston, MA 02118, USA
| | - Bulat Idrisov
- Department of Health Systems and Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA 98195-1621, USA; Bashkir State Medical University, 3 Lenin Street, Ufa, Republic of Bashkortostan 450008, Russian Federation
| | - Elena Blokhina
- Pavlov First St. Petersburg State Medical University, Lev Tolstoy Street, 6-8, St. Petersburg 197022, Russian Federation
| | - Evgeny Krupitsky
- Pavlov First St. Petersburg State Medical University, Lev Tolstoy Street, 6-8, St. Petersburg 197022, Russian Federation; V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology, Bekhtereva Street, 3, St. Petersburg 192019, Russian Federation
| | - Jeffrey H Samet
- Department of Medicine, Boston Medical Center; and Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown Center 2nd Floor, Boston, MA 02118, USA; Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center 4th Floor, Boston, MA 02118, USA
| | - Karsten Lunze
- Department of Medicine, Boston Medical Center; and Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown Center 2nd Floor, Boston, MA 02118, USA
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ÇİLEK NZ, AKKAYA C. A Review on Mental Illness and Stigma. PSIKIYATRIDE GUNCEL YAKLASIMLAR - CURRENT APPROACHES IN PSYCHIATRY 2022. [DOI: 10.18863/pgy.1069845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The concept of stigma is a universal problem that has been the subject of many studies. The phenomenon of stigmatization in psychiatric disorders is also an issue that should be particularly emphasized. Studies have reported that the diagnostic groups most exposed to stigmatization are psychotic disorders, bipolar disorders, depressive disorders, anxiety disorders, and substance use disorders. The stigma process is shaped especially by the clinical features of psychiatric disorders and the society’s attributions to the causes of psychiatric disorders. IIn order for interventions to be developed to prevent stigmatization to be effective, the causes of stigmatization must first be understood.. Therefore, in this study, it is aimed to review the stigmatization processes separately according to the types of psychiatric disorders.
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Jalali A, Tamimi RM, McPherson SM, Murphy SM. Econometric Issues in Prospective Economic Evaluations Alongside Clinical Trials: Combining the Nonparametric Bootstrap With Methods That Address Missing Data. Epidemiol Rev 2022; 44:67-77. [PMID: 36104860 PMCID: PMC10362933 DOI: 10.1093/epirev/mxac006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/09/2022] [Accepted: 09/07/2022] [Indexed: 12/29/2022] Open
Abstract
Prospective economic evaluations conducted alongside clinical trials have become an increasingly popular approach in evaluating the cost-effectiveness of a public health initiative or treatment intervention. These types of economic studies provide improved internal validity and accuracy of cost and effectiveness estimates of health interventions and, compared with simulation or decision-analytic models, have the advantage of jointly observing health and economics outcomes of trial participants. However, missing data due to incomplete response or patient attrition, and sampling uncertainty are common concerns in econometric analysis of clinical trials. Missing data are a particular problem for comparative effectiveness trials of substance use disorder interventions. Multiple imputation and inverse probability weighting are 2 widely recommended methods to address missing data bias, and the nonparametric bootstrap is recommended to address uncertainty in predicted mean cost and effectiveness between trial interventions. Although these methods have been studied extensively by themselves, little is known about how to appropriately combine them and about the potential pitfalls and advantages of different approaches. We provide a review of statistical methods used in 29 economic evaluations of substance use disorder intervention identified from 4 published systematic reviews and a targeted search of the literature. We evaluate how each study addressed missing data bias, whether the recommended nonparametric bootstrap was used, how these 2 methods were combined, and conclude with recommendations for future research.
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Affiliation(s)
- Ali Jalali
- Correspondence to Dr. Ali Jalali, Department of Population Health Sciences, Weill Cornell Medicine, 425 East 61st Street, Suite 301, New York, NY 10065 (e-mail: )
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Linde J, Luoma JB, Rück C, Ramnerö J, Lundgren T. Acceptance and Compassion-Based Therapy Targeting Shame in Body Dysmorphic Disorder: A Multiple Baseline Study. Behav Modif 2022; 47:693-718. [PMID: 36373413 PMCID: PMC10150257 DOI: 10.1177/01454455221129989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Shame is considered central in body dysmorphic disorder (BDD) and empirical accounts highlight the link between shame and BDD symptoms as well as common negative psychosocial effects of the disorder, yet there is a lack of interventions addressing shame in this context. In the past decade, Acceptance and commitment therapy (ACT) and interventions that foster self-compassion have shown promise for reducing the negative effects of shame in a range of clinical problems. The aim of the present study was to develop and evaluate an acceptance and compassion-based treatment specifically targeting shame in BDD. Using a randomized nonconcurrent multiple baseline design, the 12-session intervention, ACT with Compassion (ACTwC), was examined in a psychiatric outpatient sample of five adults diagnosed with BDD. The daily ratings showed marked reductions in BDD-behaviors and self-criticism at posttreatment for four of five participants, while three participants demonstrated decreases in body shame compared to baseline. Improvements were maintained at 6-months follow-up. The intervention also led to reliable long-term improvements in general shame, overall BDD-symptoms, depressive symptoms, and quality of life for four of five participants. All treatment responders showed significant gains in psychological flexibility and self-compassion. Participants reported high credibility and satisfaction with the treatment. These preliminary results suggest that ACTwC may be a promising approach to treating shame in BDD, worthy of further investigation.
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Affiliation(s)
- Johanna Linde
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jason B. Luoma
- Portland Psychotherapy Clinic, Research, & Training Center, OR, USA
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Ramnerö
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Tobias Lundgren
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Simha A, Ahmed S, Prasad R, Dinesh AS, Kandasamy A, Rao NP. Effect of national cultural dimensions and consumption rates on stigma toward alcohol and substance use disorders. Int J Soc Psychiatry 2022; 68:1411-1417. [PMID: 34213385 DOI: 10.1177/00207640211028611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite the notion of stigma as a socio-cultural process with the concept rooted in social space rather than in individual space, global studies examining impact of cultural differences on stigma toward substance use disorders are lacking. AIM In this study, we aim to study the influence of national culture differences on stigma toward alcohol and substance use disorders. METHODS We analyzed individual-level data from 68,041 respondents from 49 countries on stigma toward alcohol and substance use disorders. We examined the effect of the national culture dimensions and national alcohol and substance consumption rates on stigma toward alcohol and substance use disorders using hierarchical linear modeling. RESULTS Our hierarchical linear modeling results indicate that cultural dimensions and consumption rates significantly influence stigma. We found significant positive associations between stigma toward AUD and institutional collectivism and assertiveness, but a negative association with future orientation dimension. Like AUD, stigma toward SUD was also positively associated with institutional collectivism and assertiveness, but negatively associated with power distance. CONCLUSIONS The study findings have immense implications for national interventions to decrease stigma and influence policy making.
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Affiliation(s)
| | | | - Ramakrishna Prasad
- PCMH Restore Health, National Center for Primary Care Research and Policy, Academy of Family Physicians of India, Bengaluru, Karnataka, India
| | - Akshay S Dinesh
- PCMH Restore Health, Metastring Foundation, Bengaluru, Karnataka, India
| | - Arun Kandasamy
- National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Naren P Rao
- National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Kiburi SK, Paruk S, Chiliza B. Mobile phone ownership, digital technology use and acceptability of digital interventions among individuals on opioid use disorder treatment in Kenya. Front Digit Health 2022; 4:975168. [PMID: 36093384 PMCID: PMC9452845 DOI: 10.3389/fdgth.2022.975168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background There is limited research on the use of digital interventions among individuals with opioid use disorders (OUD) in low-and-middle income countries. This study aimed to assess mobile phone ownership, digital technology use and acceptability of digital interventions for treatment among individuals on treatment for OUD in Nairobi, Kenya. Methods A cross-sectional study was conducted among individuals with OUD. Structured questionnaires were used to collect data on socio-demographic and clinical characteristics, use of mobile phones and other digital technology and acceptability of digital interventions for treatment. Results One hundred and eighty participants were enrolled comprising 83.3% males with mean age of 31.5 years (SD 8.6). Mobile phone ownership was reported by 77.2% of participants of which 59.7% used smartphones. One hundred and sixty-six (92.2%) used phones to call, 82.8 and 77.2% used phones to send and receive text messages respectively; 30% used the internet; 57.2% had replaced the phone in past year and 51.1% of participants reported use of at least one social media platform, of these 44.4% had searched social media for information on drug use. Acceptability to receive treatment by phone was 95% and computer 49.4% with majority (88.1%) preferring a text message-based intervention. The preferred approach of delivery of a text message-based intervention were: one text message per day once a week, message to be personalized and individuals allowed to choose time and day to receive the message. Factors associated with acceptability of digital interventions were education level, being single, smartphone ownership and employment. Conclusion Majority of individuals on treatment for OUD had access to mobile phones but with high device turnover and limited access to computers and internet. There was high acceptability of digital interventions to provide treatment for OUDs, mostly through phones. These findings highlight factors to consider in the design of a digital intervention for this population.
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Affiliation(s)
- Sarah Kanana Kiburi
- Discipline of psychiatry, Nelson Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
- Mbagathi Hospital, Nairobi Metropolitan Services, Nairobi, Kenya
- Correspondence: Sarah Kanana Kiburi
| | - Saeeda Paruk
- Discipline of psychiatry, Nelson Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Bonginkosi Chiliza
- Discipline of psychiatry, Nelson Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
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Schiestl ET, Wolfson JA, Gearhardt AN. The qualitative evaluation of the Yale Food addiction scale 2.0. Appetite 2022; 175:106077. [PMID: 35537659 PMCID: PMC9663207 DOI: 10.1016/j.appet.2022.106077] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/07/2022] [Accepted: 05/02/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND The Yale Food Addiction Scale 2.0 (YFAS 2.0) operationalizes food addiction (FA) by applying the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM 5) criteria for substance use disorder (SUD) to the overconsumption of highly processed foods. The YFAS 2.0 has been quantitatively validated across numerous populations, but has never undergone qualitative analysis. AIMS Using qualitative methods we aimed to determine if the interpretation YFAS 2.0 is aligned with the DSM 5 conceptualization of SUD, to determine if any items are perceived as irrelevant to the lived-experience of FA, and to determine if there are constructs central to the lived-experience of FA that are not captured by the scale. METHODS We interviewed 16 participants who met criteria for FA on the modified YFAS 2.0 using semi-structured interviews to understand each participants' interpretation of items on the scale and their perceptions of how the scale matched their lived-experience of FA. Reflexive thematic analysis was used to code responses and identify themes. RESULTS Most interpretations aligned with the DSM 5 conceptualization of SUDs. Withdrawal and tolerance-related items were subject to some misinterpretations. Participants viewed problem-focused symptoms (e.g., interpersonal problems) as the least relevant to their lived-experience. Novel themes not included on the YFAS 2.0 (e.g., emotional eating) emerged. SUMMARY Our study supports the validity of the YFAS 2.0 by showing consistency with the DSM 5 conceptualization of SUDs and consistency with the lived-experience of individuals who endorse FA. Future research should explore the novel themes that emerged in this study.
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Affiliation(s)
| | - Julia A Wolfson
- Department of International Health, Ann Arbor, USA; Department of Health Policy and Management, USA
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47
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Krendl AC, Perry BL. Addiction onset and offset characteristics and public stigma toward people with common substance dependencies: A large national survey experiment. Drug Alcohol Depend 2022; 237:109503. [PMID: 35644088 DOI: 10.1016/j.drugalcdep.2022.109503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 11/03/2022]
Abstract
Drug-related overdose deaths topped 100,000 between 2020 and 2021. Opioids and stimulants are implicated as the primary drivers of this public health crisis. Stigma remains one of the primary barriers to treatment and recovery from substance use disorders. However, little is known about how stigma varies across different substance types, whether individuals are actively using or in recovery, and medical versus recreational onset. We examined these questions using data from the 2021 Shatterproof Addiction Stigma Index, the only nationally representative data available on this topic. Respondents (N = 7051) completed a vignette-based survey experiment to assess public stigma (social distance, prejudice, competence, and causal attributions) toward people with alcohol, opioid (following a prescription pain or recreational use onset), heroin, or methamphetamine dependencies. Vignette characters were described as active users or in recovery. Adjusting for covariates (e.g., race, age, gender), prejudice and desire for social distance were highest toward heroin and methamphetamine, and lowest toward alcohol dependence. The perceived onset of the dependency affected stigma. Specifically, prescription opioids with a recreational onset were more stigmatized than those with a medical onset. Moreover, individuals depicted as being in recovery were less stigmatized than those depicted as active users. Recovery status had the largest impact on prejudice and social distance toward methamphetamine, relative to other conditions. The nature and magnitude of substance dependency stigma differs across substance types and onset and offset conditions. Reducing stigma will require tailored strategies that consider the multidimensional nature of stigma toward people with addiction.
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Affiliation(s)
- Anne C Krendl
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA.
| | - Brea L Perry
- Department of Sociology, Indiana University, Bloomington, IN, USA
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Kassie GM, Lemu YM, Biresaw MS, Dessie GM, Tadesse GT, Gared WM, Belay MW. Suicidal ideation and attempt and associated factors among patients with substance use disorder: institution-based cross-sectional study. BJPsych Open 2022; 8:e150. [PMID: 35912979 PMCID: PMC9380183 DOI: 10.1192/bjo.2022.551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND No published research in Ethiopia has examined the prevalence of suicidal ideation and suicide attempts and associated factors among patients with substance use disorder. AIMS The main aim of this study was to assess the prevalence of suicidal ideation, suicide attempt and associated factors among patients with substance use disorders. METHOD An institution-based cross-sectional study was conducted from 5 May to 13 June 2019 in Addis Ababa. A total of 408 patients were identified using a systematic sampling technique. Data were collected through interviews using the suicidality module of the Composite International Diagnostic Interview. Data were entered into EpiData and analysed using SPSS. Logistic regression analyses were employed. Variables with P < 0.05 were considered to be statistically significant with 95% confidence intervals. RESULTS Prevalence rates of suicidal ideation and attempt were found to be 39.5% and 18.6%, respectively. Family history of mental illness (adjusted odds ratio (AOR) = 3.60, 95% CI: 2.17, 5.97), comorbid mental illness (AOR = 3.61, 95% CI: 2.11, 6.16), perceived stigma related to substance misuse (AOR = 4.00, 95% CI: 2.26, 7.07) and alcohol use (AOR = 7.49, 95% CI: 1.99, 28.19) were associated with suicidal ideation. Being female (AOR = 2.46, 95% CI: 1.08, 5.70), family history of suicide (AOR = 3.08, 95% CI: 1.68, 5.64), comorbid mental illness (AOR = 4.09, 95% CI: 2.23, 7.49) and khat use (AOR = 3.73, 95% CI: 1.24, 11.17) were associated with suicide attempt. CONCLUSIONS The prevalence of suicidal ideation and attempt were both found to be high. In particular, patients who had a comorbid mental illness were at high risk of both suicidal ideation and attempt. Therefore, special attention should be given to those with a family history of suicide or comorbid mental illness.
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Affiliation(s)
- Gebeyaw Molla Kassie
- Department of Psychiatry, College of Health Science, Aksum University, Aksum, Ethiopia
| | - Yohanes Mirekena Lemu
- Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Mengesha Srahbzu Biresaw
- Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | | | | | - Woredaw Minichil Gared
- Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Mesele Wonde Belay
- Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Bustos-Gamiño M, Mora-Ríos J, Villatoro-Velázquez J, Fleiz-Bautista C, Molina-López A, Medina-Mora ME. Changes in Attitudes toward People with Substance Use Disorder: A Comparative Study of the General Population in Mexico. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8538. [PMID: 35886390 PMCID: PMC9316581 DOI: 10.3390/ijerph19148538] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Substance use disorders are among the most stigmatized conditions worldwide. People with substance use disorder (PWSUD) are often considered responsible for their use of drugs. The objectives are to analyze changes in Mexican attitudes toward PWSUD in the general population over the period 2011 to 2016 and to use the latest Mexican household survey to determine which segments of the population are most likely to have negative attitudes. METHODS Two representative national household surveys employing similar methodologies were conducted in Mexico in 2011 and 2016 with persons aged 12-65 years. Participants were asked about their attitudes toward PWSUD, and changes were compared across GLM. RESULTS The surveys found a decrease from 2011 to 2016 in the number of respondents who considered PWSUD "sick" or in "need of help" and an increase in the number who believed they were "selfish" or "criminal". The 2016 survey found that men, people 18 years of age or older, people who do not use drugs and people with lower educational levels were the groups with the most negative attitudes toward PWSUD. CONCLUSIONS These results suggest that it may not be recognized that PWSUD may have a health problem and that this helps to increase stigmatization towards this population.
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Affiliation(s)
- Marycarmen Bustos-Gamiño
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Mexico City 14370, Mexico; (M.B.-G.); (J.V.-V.); (C.F.-B.); (M.E.M.-M.)
| | - Jazmín Mora-Ríos
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Mexico City 14370, Mexico; (M.B.-G.); (J.V.-V.); (C.F.-B.); (M.E.M.-M.)
| | - Jorge Villatoro-Velázquez
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Mexico City 14370, Mexico; (M.B.-G.); (J.V.-V.); (C.F.-B.); (M.E.M.-M.)
- Seminario de Estudios de la Globalidad, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City 04510, México
| | - Clara Fleiz-Bautista
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Mexico City 14370, Mexico; (M.B.-G.); (J.V.-V.); (C.F.-B.); (M.E.M.-M.)
- Seminario de Estudios de la Globalidad, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City 04510, México
| | - Alejandro Molina-López
- Sudirección de Servicios Clínicos, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Mexico City 14370, Mexico;
| | - María Elena Medina-Mora
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Mexico City 14370, Mexico; (M.B.-G.); (J.V.-V.); (C.F.-B.); (M.E.M.-M.)
- Seminario de Estudios de la Globalidad, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City 04510, México
- Director of Faculty of Psychology, Universidad Nacional Autónoma de México (UNAM), Mexico City 04510, Mexico
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Hsieh YP, Wang YJ, Feng LY, Wu LT, Li JH. Mifepristone (RU-486 ®) as a Schedule IV Controlled Drug-Implications for a Misleading Drug Policy on Women's Health Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8363. [PMID: 35886217 PMCID: PMC9323789 DOI: 10.3390/ijerph19148363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mifepristone (RU-486) has been approved for abortion in Taiwan since 2000. Mifepristone was the first non-addictive medicine to be classified as a schedule IV controlled drug. As a case of the "misuse" of "misuse of drugs laws," the policy and consequences of mifepristone-assisted abortion for pregnant women could be compared with those of illicit drug use for drug addicts. METHODS The rule-making process of mifepristone regulation was analyzed from various aspects of legitimacy, social stigma, women's human rights, and access to health care. RESULTS AND DISCUSSION The restriction policy on mifepristone regulation in Taiwan has raised concerns over the legitimacy of listing a non-addictive substance as a controlled drug, which may produce stigma and negatively affect women's reproductive and privacy rights. Such a restriction policy and social stigma may lead to the unwillingness of pregnant women to utilize safe abortion services. Under the threat of the COVID-19 pandemic, the US FDA's action on mifepristone prescription and dispensing reminds us it is time to consider a change of policy. CONCLUSIONS Listing mifepristone as a controlled drug could impede the acceptability and accessibility of safe mifepristone use and violates women's right to health care.
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Affiliation(s)
- Yi-Ping Hsieh
- Department of Social Work, University of North Dakota, Grand Forks, ND 58202, USA;
| | - Yun-Ju Wang
- College of Law, National Chung-Cheng University, Chia-Yi 62102, Taiwan;
| | - Ling-Yi Feng
- Doctoral/Master Degree Program in Toxicology, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences and Department of Medicine, School of Medicine, Duke University, Durham, NC 27710, USA;
| | - Jih-Heng Li
- Doctoral/Master Degree Program in Toxicology, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
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