Social functioning and internalized stigma in individuals diagnosed with substance use disorder

Substance Abuse Stigma: Concept Analysis

ABSTRACT

Substance abuse stigma is a social phenomenon that negatively impacts individuals who use illicit substances or alcohol. This stigma includes the derogatory terms used to describe people who use substances; perceptions that individuals with alcohol and substance use disorder are dangerous, immoral, and of weak character; and the public blaming of the addicted people for their addiction. Substance abuse took the life of over 100,000 Americans between 2020 and 2021, and one identified barrier to treatment is the stigma associated with substance abuse. When someone is ashamed, they are less likely to seek treatment, and when someone is seeking help and is greeted with negative preconceptions, they are again deterred from treatment. The stigma exists in multiple layers of society including the general public, policy makers, the police, doctors, and nurses and within the person using the substance. The purpose of this article is to define substance abuse stigma in multiple contexts and explore its effects on treatment.

The New Zealand drug harms ranking study: A multi-criteria decision analysis

AIMS

The harms arising from psychoactive drug use are complex, and harm reduction strategies should be informed by a detailed understanding of the extent and nature of that harm. Drug harm is also context specific, and so any comprehensive assessment of drug harm should be relevant to the characteristics of the population in question. This study aimed to evaluate and rank drug harms within Aotearoa New Zealand using a multi-criteria decision analysis (MCDA) framework, and to separately consider harm within the total population, and among youth.

METHODS

Two facilitated workshops involved the separate ranking of harm for the total population, and then for youth aged 12-17, by two expert panels. In the total population workshop, 23 drugs were scored against 17 harm criteria, and those criteria were then evaluated using a swing weighting process. Scoring and weighting were subsequently updated during the youth-specific workshop. All results were recorded and analysed using specialised MCDA software.

RESULTS

When considering overall harm, the MCDA modelling results indicated that alcohol, methamphetamine and synthetic cannabinoids were the most harmful to both the overall population and the youth, followed by tobacco in the total population. Alcohol remained the most harmful drug for the total population when separately considering harm to those who use it, and harm to others.

CONCLUSIONS

The results provide detailed and context-specific insight into the harm associated with psychoactive drugs use within Aotearoa New Zealand. The findings also demonstrate the value of separately considering harm for different countries, and for different population subgroups.

Are the “Big 5” Personality Traits Associated With Substance Use Self-Stigma?

Self-stigma among individuals with substance use problems is notably high, but not all individuals with substance use problems experience elevated self-stigma. Unfortunately, there is limited research to account for such variation. A few studies have examined the association between personality traits from the five-factor model (FFM; “Big 5”) and self-stigma among those with mental illness, but no research exists among individuals with substance use disorders. Based on data from 125 individuals residing in a substance use treatment unit, the FFM personality traits collectively account for 33% to 56% of the variance across four components of self-stigma. More specifically, individuals with high neuroticism, low conscientiousness, and/or low extraversion experience greater self-stigma. The identification of at-risk individuals, via personality traits, could allow for development of targeted interventions to address self-stigma, and ultimately improve treatment retention and outcomes.

Effectiveness of Interventions in Reducing Substance-Related Stigma: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

The purpose of this study was to undertake a quantitative analysis to determine the effectiveness of interventions designed in reducing different types of stigma (self-stigma, social stigma, and structural stigma) for the substance use. This study followed the Cochrane Handbook for Systematic Reviews of Interventions guideline. This study followed the Cochrane Handbook for Systematic Reviews of Interventions guideline. Systematic searches were conducted in PubMed, Science Direct, Web of Science, Scopus, and MEDLINE. These electronic databases were searched research published in English from date of their inception to July 15, 2021. Randomized controlled trials that evaluated interventions on stigma associated with substance use were included. Studies should include at least one stigma outcome involving self-stigma, social stigma, or structural stigmatization. Ten randomized controlled studies were included. The overall Hedges'g for the interventions' impact on reducing stigma was 0.301, 95%CI = [-0.154- 0.755], p = 0.195, that there was no statistically significant difference. However, the meta-analysis showed that interventions had no significant impact on self-stigma [0.682, 95% CI=(-0.015-1.380), p = 0.055] and social stigma [0.198, 95% CI=(-1.271-0.876), p = 0.718] but had a small but significant impact in favor of the experimental group on reducing structural stigma [0.360 (95% CI= 0.156-0.564), p = 0.00]. According to subgroup analyses, there was no difference in the effects of stigma according to the type of intervention, the number of sessions, or the type of group. The interventions for reducing stigma related to substance use are promising. It seems to have a small but significant positive impact on structural stigma.

The Meaning of Stigma About Illegal Drug Use and Its Contribution to Public Policymaking in Colombia

The objective of this study is to understand the meaning of the stigma about illegal drug consumption and its contribution to public policymaking in Colombia from the perspective of experts on this topic. Research was carried out based on the methodological perspective of the grounded theory. Twenty participants with extensive experience in the design of regulations, plans, or programs about demand reduction in Colombia were interviewed, using tools such as in-depth interviews and analytical memos. The analysis was performed by means of open, axial, and selective coding techniques and the development of a conditional/consequential matrix. The findings are presented according to the structure of the pattern matrix to show the social process found and include (a) the phenomenon, the fear of being stigmatized as a promoter of more liberal public policies; (b) the context, the Colombia’s history and the policymaking to reduce drug consumption; (c) the conditions, control of governance by influential groups in power; and (d) the strategies to address it, prioritize less sensitive issues, and the consequences, formulation of repressive public policies with the impact on the rights of people who use drugs. From the perspective of the interviewees, the fear of being stigmatized as promoters of more liberal public policies and contrary to the expectations of the social and power classes leads the rulers to have a low-profile discourse on this subject so as not to assume the costs politicians that this fact would imply.

The Adaptation of the Substance Use Stigma Mechanism Scale (SU-SMS) Into Turkish: A Validity and Reliability Study

BACKGROUND

Substance users are among the most highly stigmatized individuals by both the public and health care providers. However, no multidimensional scale for measuring substance use stigma for substance use disorders (SUDs) currently exists in Turkey.

AIMS

The aim of this study was to determine the validity and reliability of the Turkish version of the Substance Use Stigma Mechanism Scale (SU-SMS).

METHOD

The study was conducted at the AMATEM (Alcohol and Substance Addiction Treatment Center Clinic). The sample group of this methodological study consisted of 156 participants with SUDs who met the inclusion criteria. "Social-demographics Questionnaire," "The Substance Use Stigma Mechanism Scale," and "Internalized Stigma of Mental Illness Scale" were used for data collection. In the validity-reliability analysis of the scale, language and content validity, explanatory and confirmatory factor analysis, criterion-concurrent validity, Cronbach's alpha coefficient, item-total score correlation, split-half reliability analysis, and test-retest reliability methods were used.

RESULTS

Using exploratory factor analysis, it was found that the SU-SMS has five factors. Its five-factor structure was confirmed using confirmatory factor analysis. Its Cronbach's alpha coefficient was .828, and factor loading was between .402 and .971. Analyses indicated that each of the factors of the Turkish version of the scale had high internal consistency. The test-retest correlation value was .752, p = .000.

CONCLUSIONS

It was concluded that the Turkish version of the SU-SMS is a reliable and valid instrument for assessing substance use-related stigma in individuals with SUDs.

Stigma Surrounding the Use of Medically Assisted Treatment for Opioid Use Disorder

This study sought to determine whether certain factors influenced public stigma toward the use of medication to treat opioid use disorders (MOUD). Method: In a series of 3 studies using between-subjects designs, hypothetical MOUD patients matched in age and educational status with the participants were varied in systematic ways to determine whether certain factors influenced stigmatizing views of the patients. Results: Study 1 (n = 142) determined that stigma levels were elevated for hypothetical patients receiving agonist medication for OUD compared to other medications or no medication at all. Study 2 (n = 144) found that hypothetical patients receiving opioid agonist medication for either heroin or pain pills were equally stigmatized and stigmatized more than hypothetical patients on nicotine agonist medication. Study 3 (n = 151) showed that stigmatizing attitudes did not change as a result of enhanced treatment services for hypothetical MOUD patients (i.e. therapy as a supplement to medication). Conclusions/Importance: Results indicate that patients receiving agonist medication for an OUD may be the target of public stigma. Public education on the efficacy of agonist medications for OUD is urgently needed to help reduce such stigma, which may facilitate treatment delivery, treatment adherence, and treatment success.

Stigmatization and Social Functioning Levels of Patients With Alcohol Use Disorders

AIM

The aim of this stu dy was to determine the levels of internalized stigma and social functioning of patients with alcohol use disorders.

METHOD

The study is cross-sectional and descriptive. The data were collected between August 2017 and August 2018 using face-to-face interviews with 104 alcohol-dependent patients who were undergoing inpatient treatment. The data collection was done so through personal information forms, the Internalized Stigma of Mental Illness Scale (ISMIS), and the Social Functioning Scale (SFS). Descriptive statistics, t test, and correlation analysis were used in evaluating data.

RESULTS

Analysis of the sociodemographic characteristics of the patients showed that the mean age was 47.28 ± 10.10 years and 92.3% of the patients were male. The mean age of patients when they first started drinking alcohol is 19.37 ± 6.25 years. It was determined that 85.5% of the patients were also cigarette smokers, 37.5% were previously treated because of alcohol dependence, and 34.6% are currently having legal problems. Patients' ISMIS mean score was 71.99 ± 13.78, and the mean scores of subscales were moderate. In SFS, the mean scores of the "preliminary social activity" and "leisure activities" subscales and the total scale scores were at a moderate level and those of the other subscales (social withdrawal, interpersonal functionality, independent competence, independent performance, job-profession) were below average. As the ISMIS mean score increases, the SFS subscales' mean scores decrease (p < .05).

CONCLUSION

Alcohol-dependent patients negatively stigmatize themselves, and the functionality of their prosocial activity skills, along with their recreational activities, is inadequate. Furthermore, as ISMIS tends to increase, SFS (interpersonal functioning, prosocial activities, recreational activities, independence-performance) levels decrease.

Psychoeducation Program for Substance Use Disorder: Effect on Relapse Rate, Social Functioning, Perceived Wellness, and Coping

The current study was designed to assess the effect of a psychoeducation program on relapse rate, social functioning, perceived wellness, and ways of coping in individuals with substance use disorder (SUD). The study sample comprised 92 individuals (n = 46 intervention group, n = 46 control group) who received SUD treatment, had undergone detoxification, and agreed to participate in the study. A 10-session psychoeducation program was applied to individuals in the intervention group. Data collection included a urine sample and completion of the Personal Information Form, Social Functioning Scale, Perceived Wellness Scale, and Ways of Coping Scale. The relapse rate in the control group was found to be higher than in the intervention group; thus, it was determined that the relapse prevention psychoeducation program led to positive changes in relapse rate, social functioning, perceived wellness, and stress in individuals with SUD. [Journal of Psychosocial Nursing and Mental Health Services, 58(8), 39-47.].

Multi-model implementation of evidence-based care in the treatment of opioid use disorder in Pennsylvania

Pennsylvania has the third highest rate of death due to drug overdose (44.3 per 100,000) in the country, which is significantly higher than the national rate. This continues to have drastic societal impact. Medication assisted treatment (MAT), which includes opioid agonist medications, is the gold standard in treatment for OUD; however, a significant gap remains between the number of individuals in need of treatment and the number of MAT providers. Penn State Health established a system to address the opioid epidemic through the Pennsylvania Coordinated Medication Assisted Treatment program utilizing lessons learned from existing validated models. Connecting primary care sites and hospital systems through a combination of Hub and Spoke, bridge clinic services provided at the Hub, peer recovery services, Project Extension for Community Health Outcomes (ECHO), and layered emergency department (ED) initiation of buprenorphine, this model is an innovative approach that addresses many known barriers to MAT treatment initiation. Early results within the first six months indicate significantly shortened wait time for patients seeking treatment, provision of waiver training to 70 local physicians to prescribe buprenorphine, and improved knowledge and ability to provide patient care for providers participating in our first Project ECHO cohort.

Negative Impacts of Self-Stigma on the Quality of Life of Patients in Methadone Maintenance Treatment: The Mediated Roles of Psychological Distress and Social Functioning

A sample of heroin users (n = 250) in methadone maintenance treatment (MMT) was used in this cross-sectional study to clarify the mechanisms of the effects of stigma on quality of life (QoL) through psychological distress and social functioning. All the participants had their self-stigma, psychological distress, social functioning, and QoL measured. Psychological distress and social functioning were proposed to be mediators between self-stigma and QoL. Several linear models using structural equation modeling were conducted to examine the mediated effects. The negative effects of self-stigma on QoL were significantly mediated by psychological distress, as self-stigma directly and significantly influenced psychological distress, but not social functioning. This study demonstrated a linear model describing the effects of self-stigma on QoL for opioid-dependent individuals; psychological distress was also an important mediator between self-stigma and their QoL. Clinicians were able to notice the importance of reducing self-stigma for opioid-dependent individuals according to the following results: higher levels of self-stigma were associated with high psychological distress, decreased social functioning, and impaired QoL. Our mediation findings suggest that treating psychological distress is better than treating social functioning if we want to eliminate the effects of self-stigma on QoL for heroin users.

Perceived Causes of Personal versus Witnessed Overdoses among People who Inject Opioids

Background: Studies show that people who inject drugs (PWID) underestimate their overdose risk. We sought to explore this phenomenon by comparing how PWID perceive causes of personal overdoses compared to witnessed overdoses. Methods: We analyzed 40 interviews from participants enrolled in a randomized-controlled behavioral intervention to reduce overdose among at-risk PWID in San Francisco from 2014 to 2016. Subjects were current illicit opioid injectors with opioid use disorder, had received take-home naloxone, and had overdosed within five years. Interviews were audio-recorded and transcribed verbatim. Using thematic content analysis, three analysts coded the interviews and measured interrater reliability. The analysts developed a codebook of a priori and inductively generated codes, and applied it to all interviews. Coding discrepancies were discussed. Results: We used two theoretical frameworks - actor observer bias (AOB) and intragroup stigma - to analyze participants' descriptions of personal and witnessed overdoses. AOB suggests individuals may assign responsibility of their actions to external factors, while assigning responsibility for others' actions to internal mechanisms. Intragroup stigma describes the process whereby people perpetuate stigma within their own group. Related to these concepts, two principal themes were used to describe personal overdose: (1) drug volatility and (2) ascribing blame to others, and witnessed overdoses: (1) greed and (2) inexperience/foolishness. Conclusion/Importance: The differences in perceived causes of personal versus witnessed overdose align with AOB and intragroup stigma. Understanding how these theories shape overdose experiences may improve behavioral interventions by introducing peer based supports and encouraging PWIDs to employ evidence-based safety precautions when using opioids.

Social functioning outcomes among individuals with substance use disorders receiving internet-delivered community reinforcement approach

BACKGROUND

The community reinforcement approach (CRA) is an evidence-based practice for the treatment of substance use disorders and achieving and maintaining abstinence, but few studies have systematically explored the effect of CRA on secondary, yet also important outcomes, such as social functioning.

OBJECTIVES

The purpose of this study was to examine whether an internet-based version of the CRA plus contingency management is associated with improved social functioning of individuals seeking substance use disorder treatment in a multi-site clinical effectiveness trial.

METHODS

Social functioning was measured using the 54-item Social Adjustment Scale assessing role performance in six domains (work, social and leisure activities, extended family relationships, marital relationship, parenting, and immediate family). Generalized linear mixed models tested the effects of treatment, time, sex, baseline abstinence, baseline social functioning and baseline psychological distress on overall social functioning and across social functioning subscales at the end of the 12-week treatment phase and 3 and 6 months post treatment.

RESULTS

Results showed no significant association between treatment and total social functioning score or any subscale scores. Being male was significantly associated with better social functioning overall at the end of treatment (p = .024). Higher levels of psychological distress at baseline predicted significantly worse social functioning at the end of treatment overall (p = .037).

CONCLUSIONS

The addition of an internet-based version of the CRA was not associated with greater improvements in social functioning compared to standard outpatient care after 12 weeks of treatment. Implications for internet-delivered CRA are discussed.

Internalized stigma among patients with substance use disorders at a tertiary care center in India

Internalized stigma among individuals with substance use disorders is a major barrier for accessing mental health services. This study aimed to assess internalized stigma among individuals with substance use disorders and to assess the relationship of internalized stigma with the quality of life. This cross-sectional study recruited 201 patients with a clinical diagnosis of at least opioid or alcohol use disorder according to Diagnostic and Statistical Manual 5 at a public-funded tertiary care center in India. The study participants were interviewed using a sociodemographic questionnaire, the Internalized Stigma of Mental Illness Scale (ISMIS), and the World Health Organization's Quality of Life (WHOQOL-Bref) questionnaire. Seven participants (3.5% of the sample) had mild stigma according to ISMI scores, 62 (30.8%) had moderate stigma, and 132 (65.7%) had severe stigma. The various quality-of-life domains generally had a negative correlation with the internalized stigma scores. Participants using opioids as the primary substance of use were more likely to have severe internalized stigma. The experience of internalized stigma and dissatisfaction with quality of life is quite high among people suffering with substance use disorders in India. These results emphasize the need for interventions to reduce internal perception of stigma and improve the quality of life of individuals with substance use disorders.

Internalized stigma among psychiatric outpatients: Associations with quality of life, functioning, hope and self-esteem

This study aimed to: (i) determine the prevalence, socio-demographic and clinical correlates of internalized stigma and (ii) explore the association between internalized stigma and quality of life, general functioning, hope and self-esteem, among a multi-ethnic Asian population of patients with mental disorders. This cross-sectional, survey recruited adult patients (n=280) who were seeking treatment at outpatient and affiliated clinics of the only tertiary psychiatric hospital in Singapore. Internalized stigma was measured using the Internalized Stigma of Mental Illness scale. 43.6% experienced moderate to high internalized stigma. After making adjustments in multiple logistic regression analysis, results revealed there were no significant socio-demographic or clinical correlates relating to internalized stigma. Individual logistic regression models found a negative relationship between quality of life, self-esteem, general functioning and internalized stigma whereby lower scores were associated with higher internalized stigma. In the final regression model, which included all psychosocial variables together, self-esteem was the only variable significantly and negatively associated with internalized stigma. The results of this study contribute to our understanding of the role internalized stigma plays in patients with mental illness, and the impact it can have on psychosocial aspects of their lives.

Social Functioning and Self-Esteem of Substance Abuse Patients

AIM

This descriptive study was conducted to examine the levels of social functioning and self-esteem in individuals diagnosed with substance abuse.

MATERIAL AND METHOD

The study was conducted at the AMATEM (Alcohol and Substance Abuse Treatment Center) service of a psychiatry clinic in the Elazığ province in eastern Turkey between September 1, 2014 and February 1, 2015. The population is comprised of 249 patients being treated in this clinic, and the sample included 203 patients who comply with the research criteria and agreed to participate in the study. A Socia-Demographic Questionnaire, Coopersmith Self-esteem Scale (CSI) and Social Functioning Scale (SFS) were used for data collection. Percentages, averages, standard deviations and Pearson's correlation were used for data analysis.

RESULTS

This study found that the patients' mean sore on the Self-esteem Scale is 50.97±18.01. Their score on the Social Functioning Scale is 115.76±22.41. A significant correlation between the patients' self-esteem and the age of first substance use was detected (p=0.001). A significant correlation was detected between their social functioning and the duration of their substance use (p<0.005). This study found a positive significant correlation between social functioning and self-esteem (p<0.001).

CONCLUSION

This study found that substance abuse patients have a medium level of self-esteem and social functioning. A significant positive correlation between social functioning and self-esteem was found. It was also found that the age of first substance use and self-esteem are directly correlated. Counseling to increase patients' levels of self-esteem and improve their social functioning is recommended.