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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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Bailey A, Taylor BG, Pollack HA, Schneider JA, Evans EA. Gender identity, stimulant drug use, and criminal justice history on internalized stigma among a nationally representative sample of adults who misuse opioids. Soc Psychiatry Psychiatr Epidemiol 2024; 59:305-313. [PMID: 37322292 PMCID: PMC10721725 DOI: 10.1007/s00127-023-02500-5] [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: 12/19/2022] [Accepted: 05/24/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE The rise of fatal stimulant use among adults who use opioids is a public health problem. Internalized stigma is a barrier to substance use treatment, which is greater for women and populations with criminal justice involvement. METHODS Using a nationally representative sample of adults in the United States from a probability-based survey on household opinions in 2021, we examined characteristics of women (n = 289) and men (n = 416) who misuse opioids. In gender-stratified multivariable linear regression, we investigated factors associated with internalized stigma, and tested for the interaction of stimulant use and criminal justice involvement. RESULTS Compared to men, women reported greater mental health symptom severity (3.2 vs. 2.7 on a 1 to 6 scale, p < 0.001). Internalized stigma was similar between women (2.3 ± 1.1) and men (2.2 ± 0.1). Among women and not men, however, stimulant use was positively associated with internalized stigma (0.36, 95% CI [0.07, 0.65]; p = 0.02). Interaction between stimulant use and criminal justice involvement was negatively associated with internalized stigma among women (- 0.60, 95% CI [- 1.16, -0.04]; p = 0.04); among men, the interaction was not significant. Predictive margins illustrate among women, stimulant use eliminated the gap in internalized stigma such that women with no criminal justice involvement had a similar level of internalized stigma as women with criminal justice involvement. CONCLUSION Internalized stigma between women and men who misuse opioids differed based on stimulant use and criminal justice involvement. Future research should assess whether internalized stigma influences treatment utilization among women with criminal justice involvement.
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Affiliation(s)
- Amelia Bailey
- Department of Behavioral and Social Sciences, School of Public Health, School of Public Health, Brown University, Box G-S121-3, Providence, RI, 02912, USA.
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 715 N. Pleasant St., Arnold House, Amherst, MA, 01003, USA.
| | - Bruce G Taylor
- Public Health Department, NORC at the University of Chicago, Chicago, IL, USA
| | - Harold A Pollack
- Crown Family School of Social Work, Policy, and Practice, The University of Chicago, Chicago, IL, USA
| | | | - Elizabeth A Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 715 N. Pleasant St., Arnold House, Amherst, MA, 01003, USA
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Patel K, Pokorski E, Norkoli D, Dunkel E, Wang X, Yang LH. Persistence of stigma and the cessation of substance use: comparing stigma domains between those who currently use and those who no longer use substances. Front Psychiatry 2024; 14:1308616. [PMID: 38260794 PMCID: PMC10800797 DOI: 10.3389/fpsyt.2023.1308616] [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: 10/06/2023] [Accepted: 11/27/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Cessation of substance use, a facet of recovery, as well as mitigating stigma experienced by individuals with substance use disorder (SUD), are important to supporting health and well-being of those who use substances. But there is limited and mixed evidence on whether cessation of substance use has a positive impact on individuals' stigma experiences. This study examined whether there were differences in stigma perceptions between those who self-report using substances and those who self-report not currently using substances associated with their SUD. Materials and methods A survey was conducted among individuals in 10 counties of Michigan with self-identified history with SUD. The survey aimed to understand five dimensions of stigma perceptions: enacted stigma, anticipated stigma, internalized stigma, social withdrawal, and treatment stigma. Survey items for each measure were adapted from prior literature. The mean was calculated for each stigma measure for analyses. Data analyses tested whether there were significant differences in each of the five stigma domains between the two groups using either regression or t-test, depending on the necessity to include covariates. Results Findings suggested that among the five stigma domains, only internalized stigma showed statistically significant differences between the two groups (b = 0.19, se = 0.08, p < 0.05) after adjusting for covariates (as needed). Those who were no longer using substances had lower internalized stigma compared to those who were currently using substances associated with their SUD. Analyses suggested that the other four stigma domains, enacted stigma, anticipated stigma, social withdrawal, and treatment stigma, did not show statistically significant differences between the two groups. Discussion While self-stigmatization (i.e., internalized stigma) was lower among those who report no longer using, our patterns suggest a persistence of stigma regardless of cessation of substances associated with SUD, particularly among stigma domains that are based on perceptions of how others may still perceive individuals who have used substances. Though more research is needed, results suggest that public health programmatic, policy, and campaign efforts that aim to eliminate stigma should account for and tailor to both people who report using and those who report no longer using substances to capture the breadth of needs in communities.
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Affiliation(s)
- Krishna Patel
- National Association of County and City Health Officials, Washington, DC, United States
| | - Emily Pokorski
- District Health Department #10, Cadillac, MI, United States
| | - Donna Norkoli
- District Health Department #10, Cadillac, MI, United States
| | - Emily Dunkel
- School of Global Public Health, New York University, New York, NY, United States
| | - Xinyue Wang
- Teachers College, Columbia University, New York, NY, United States
| | - Lawrence H. Yang
- School of Global Public Health, New York University, New York, NY, United States
- Mailman School of Public Health, Columbia University, New York, NY, United States
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Vidales CA, Smolenski DJ, Skopp NA, Vogel D, Wade N, Sheppard S, Speed K, Hood K, Cartwright P. Assessing the dimensionality and construct validity of the military stigma scale across current service members. MILITARY PSYCHOLOGY 2024; 36:49-57. [PMID: 38193877 PMCID: PMC10790807 DOI: 10.1080/08995605.2021.1997501] [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: 03/31/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
US service members are at elevated risk for distress and suicidal behavior, compared to the general US population. However, despite the availability of evidence-based treatments, only 40% of Service members in need of mental health care seek help. One potential reason for the lower use of services is that service members experience stigma or concerns that the act of seeking mental health care from a mental health provider carries a mark of disgrace. The Military Stigma Scale (MSS) was designed to assess two theoretical dimensions of help-seeking stigma (public and self), specifically among service members. The goal of the current study was to further examine the validity of the MSS among 347 active duty service members. Examination of unidimensional, two-factor, and bifactor models revealed that a bifactor model, with a general (overall stigma), two specific factors (public and self-stigma), and one method factor (accounting for negatively worded items) provided the best fit to the data. Ancillary reliability analyses also supported the MSS measuring a broad stigma factor associated with seeking mental health care in the military. Subsequent model analyses showed that the MSS was associated with other stigma-related constructs. Overall, findings suggest that the MSS is a reliable and validated scale that can be used to assess military help-seeking stigma and to evaluate results of programs designed to reduce stigma.
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Affiliation(s)
| | - Derek J. Smolenski
- Psychological Health Center of Excellence (PHCoE), Silver Spring, Maryland, USA
| | - Nancy A. Skopp
- Psychological Health Center of Excellence (PHCoE), Silver Spring, Maryland, USA
| | - David Vogel
- Department of Psychology, Iowa State University, Ames, Iowa, USA
| | - Nathaniel Wade
- Department of Psychology, Iowa State University, Ames, Iowa, USA
| | - Sean Sheppard
- Uniformed Services University of the Health Sciences (USUHS), Madigan Army Medical Center, Bethesda, Maryland, USA
| | - Katrina Speed
- Department of Psychology, Mississippi State University (MSU), Tacoma, Washington, USA
| | - Kristina Hood
- Department of Psychology, Mississippi State University (MSU), Tacoma, Washington, USA
| | - Patricia Cartwright
- Department of Psychology, Mississippi State University (MSU), Tacoma, Washington, USA
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Hassett-Walker C. Recovering Individuals' Feelings About Addict and Alcoholic as Stigmatized Terms: Implications for Treatment. Subst Abuse 2023; 17:11782218231213769. [PMID: 38033430 PMCID: PMC10687927 DOI: 10.1177/11782218231213769] [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: 05/18/2023] [Accepted: 10/26/2023] [Indexed: 12/02/2023]
Abstract
Background The current emphasis among addiction treatment providers is to use person-first language, such as "a person with a substance use disorder," as a way to reduce stigma around addiction and resulting barriers to treatment. This study considers how individuals recovering from substance use feel about the terms "alcoholic" and "addict," particularly how they self-identify and whether they believe the terms carry stigma. Method Thirty-five individuals were interviewed, recruited primarily, but not exclusively, from 12-step meetings (Alcoholics Anonymous, Narcotics Anonymous), from 3 locations throughout a rural New England state. Interviews were transcribed and coded in Atlas Ti qualitative analysis software, and a content analysis of text coded with "stigma" was conducted. Results Some comments reflected a belief that the terms "addict" and "alcoholic" carry a stigma. However, more comments rejected the notion of these being stigmatized terms; or acknowledged the stigma but reflected the subject's lack of internalizing of any stigma. Comments reflected other themes including a sense of pride, identity and ownership when self-identifying as an addict or alcoholic. Several comments suggested that person-first language is part of a larger movement to "soften everything," without changing the underlying condition (addiction). The findings may reflect the fact that subjects were recruited from 12-step programs, where the convention is to self-identity using the terms "alcoholic" and/or "addict." Conclusions Some individuals seeking treatment for addiction may prefer self-identifying using old-school terminology (addict, alcoholic) rather than person-first language, for a variety of reasons (eg, they do not internalize the stigma of such terms).
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Jassar SK, Hundley A, Giesler A. Enhancing Knowledge and Attitudes Regarding Opioid Use Disorder Among Private Primary Care Clinics: A Quality Improvement Project. J Addict Nurs 2023; 34:E145-E152. [PMID: 38015582 DOI: 10.1097/jan.0000000000000553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
ABSTRACT Opioid use disorder (OUD) continues to impact communities worldwide. British Columbia specifically declared a public health emergency in April 2016. It is known that patients with OUD often experience barriers in access to care, including limited knowledge and training among providers, as well as persisting stigma in the medical community. The Doctor of Nursing Practice quality improvement project sought to provide barrier-targeted OUD education while using multiple effective teaching methods, such as test-enhanced learning, to family nurse practitioners (FNPs) working among private primary care clinics to assess the impact on knowledge and attitudes. In review of an experience survey, zero participants had received prior education on OUD (N = 7). The Drug and Drug Problems Perceptions Questionnaire was used to assess attitudes. In review of the data, attitudes before receiving education (Mdn = 74) improved after receiving barrier-targeted education (Mdn = 66), W = 0, p < .05. Knowledge was tested at three time points. After a review of unique identifiers, four participant tests were successfully linked. It was found that knowledge after receiving education (M = 7.75, Mdn = 7.5) improved in comparison with baseline knowledge (M = 6, Mdn = 6) and further improved after a 1-month time frame (M = 8.5, Mdn = 8.5). Although the project was limited by sample size, providing education to FNPs who have not received prior education on OUD, and using modalities such as test-enhanced learning, showed a favorable impact on knowledge and attitudes. In light of the opioid epidemic, nursing leaders must continue to actively engage practicing FNPs and students with OUD education. FNPs are well positioned to be champions in this area and may mobilize teams to overcome barriers among private primary care clinics and increase access to care.
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Becker TD, Eschliman EL, Thakrar AP, Yang LH. A conceptual framework for how structural changes in emerging acute substance use service models can reduce stigma of medications for opioid use disorder. Front Psychiatry 2023; 14:1184951. [PMID: 37829763 PMCID: PMC10565357 DOI: 10.3389/fpsyt.2023.1184951] [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: 03/12/2023] [Accepted: 09/07/2023] [Indexed: 10/14/2023] Open
Abstract
Stigma toward people taking medication for opioid use disorder (MOUD) is prevalent, harmful to the health and well-being of this population, and impedes MOUD treatment resource provision, help-seeking, and engagement in care. In recent years, clinicians have implemented new models of MOUD-based treatment in parts of the United States that integrate buprenorphine initiation into emergency departments and other acute general medical settings, with post-discharge linkage to office-based treatment. These service models increase access to MOUD and they have potential to mitigate stigma toward opioid use and MOUD. However, the empirical literature connecting these emerging service delivery models to stigma outcomes remains underdeveloped. This paper aims to bridge the stigma and health service literatures via a conceptual model delineating how elements of emerging MOUD service models can reduce stigma and increase behavior in pursuit of life goals. Specifically, we outline how new approaches to three key processes can counter structural, public, and self-stigma for this population: (1) community outreach with peer-to-peer influence, (2) clinical evaluation and induction of MOUD in acute care settings, and (3) transition to outpatient maintenance care and early recovery. Emerging service models that target these three processes can, in turn, foster patient empowerment and pursuit of life goals. There is great potential to increase the well-being of people who use opioids by reducing stigma against MOUD via these structural changes.
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Affiliation(s)
- Timothy D. Becker
- Department of Psychiatry, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, United States
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Evan L. Eschliman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Ashish P. Thakrar
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Lawrence H. Yang
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, NY, United States
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
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Osilla KC, Meredith LS, Griffin BA, Martineau M, Hindmarch G, Watkins KE. Design of CLARO+ (Collaboration Leading to Addiction Treatment and Recovery from Other Stresses, Plus): A randomized trial of collaborative care to decrease overdose and suicide risk among patients with co-occurring disorders. Contemp Clin Trials 2023; 132:107294. [PMID: 37454728 PMCID: PMC10528487 DOI: 10.1016/j.cct.2023.107294] [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: 03/30/2023] [Revised: 06/14/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The United States is mired in two intertwined epidemics of death from suicide and overdose. Opioid use disorder (OUD) and mental illness contribute to both, and individuals with co-occurring disorders (CODs) are a complex population at high risk. Although universal prevention makes sense from a public health perspective, medical and behavioral health providers often lack the time to proactively address these issues with all patients. In this study, we build upon a parent study called Collaboration Leading to Addiction Treatment and Recovery from Other Stresses (CLARO), a model of collaborative care in which care coordinators deliver preventative measures to high-risk patients and coordinate care with the patients' care team, with the goal of increasing MOUD retention and decreasing risk of suicide and overdose. METHODS CLARO+ adds intervention components on overdose prevention, recognition, and response training; lethal means safety counseling; and an effort to mail compassionate messages called Caring Contacts. Both CLARO and CLARO+ have been implemented at 17 clinics in New Mexico and California, and this study seeks to determine the difference in effectiveness between the two versions of the intervention. This paper describes the design protocol for CLARO+. CONCLUSION CLARO+ is an innovative approach that aims to supplement existing collaborative care with additional suicide and overdose prevention strategies. CLINICALTRIALS gov: NCT04559893.
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Affiliation(s)
- Karen Chan Osilla
- Stanford University School of Medicine, 1070 Arastradero Road, Palo Alto, CA 94304-5590, United States.
| | - Lisa S Meredith
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States.
| | - Beth Ann Griffin
- RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202, United States.
| | - Monique Martineau
- RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202, United States.
| | - Grace Hindmarch
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States.
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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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Wang K, Schick MR, Quinn DL, Weiss NH. The Role of Emotion Dysregulation in the Association Between Substance Use Stigma and Depressive Symptoms Among Trauma-Exposed, Substance-Using Individuals. STIGMA AND HEALTH 2023; 8:243-251. [PMID: 37577451 PMCID: PMC10419118 DOI: 10.1037/sah0000313] [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] [Indexed: 08/15/2023]
Abstract
Despite the well-documented association between experiences of substance use stigma and adverse mental health outcomes, little is known about the mechanisms underlying this association. Utilizing a community sample of substance-using adults who have experienced at least one traumatic event in their lifetime, the current study examined the role of dysregulation stemming from both negative and positive emotions in the relation between substance use stigma and depressive symptoms. Community participants (N = 320, 46.9% women) completed self-report measures of substance-use-related stigma experiences, negative and positive emotion dysregulation, and depressive symptoms. Results showed that, adjusting for gender and substance use severity, substance use stigma was positively associated with emotion dysregulation, which in turn related to depressive symptoms. Substance use stigma was also found to be indirectly associated with depressive symptoms through emotion dysregulation, suggesting that emotion dysregulation accounted for the significant association between substance use stigma and depressive symptoms. These findings provide initial support for the role of emotion dysregulation as a mechanism through which stigma operates to undermine the mental health of substance-using, trauma-exposed individuals. Results underscore the potential utility of targeting emotion dysregulation in intervention efforts that are designed to facilitate stigma coping among individuals who use alcohol and/or drugs.
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Affiliation(s)
- Katie Wang
- Department of Social and Behavioral Sciences, Yale School of Public Health
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Sori LM, Sema FD, Tekle MT. Internalized stigma and associated factors among people with mental illness at University of Gondar Comprehensive Specialized Hospital, Northwest, Ethiopia, 2021. Int J Ment Health Syst 2022; 16:58. [PMID: 36587213 PMCID: PMC9805673 DOI: 10.1186/s13033-022-00567-2] [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: 03/30/2022] [Accepted: 11/30/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Internalized stigma has been found to be high among people with mental illness (PWMI) and it results in poor treatment outcome, increased disability and high economic burden. So, this study was designed to determine the prevalence and associated factors of high internalized stigma among PWMI attending psychiatric follow-up at University of Gondar Comprehensive Specialized Hospital, Northwest, Ethiopia, 2021. METHODS A cross-sectional study was conducted among PWMI (n = 365), and internalized stigma was measured by using internalized stigma of mental illness 29 (ISMI-29) scale. The data was entered in to EPI DATA software (4.6.0.2) and analyzed by Statistical Package for Social Sciences version 20. A binary logistic regression was used to identify factors associated with internalized stigma and reported with 95% confidence interval (CI). P-value < 0.05 was considered as statistically significant. RESULTS The prevalence of high internalized stigma was found to be 27.9% (95% CI 23.1-32.6). A male gender (AOR = 0.332; 95% CI 0.175-0.629), occupation, specifically government employee (AOR = 0.309; 95% CI 0.118-0.809), life time substance use (AOR = 3.561; 95% CI 1.867-6.793), low self-esteem (AOR = 8.313; 95% CI 3.641-18.977), and history of hospitalization (AOR = 4.236; 95% CI 1.875, 9.570) were factors significantly associated with higher internalized stigma. CONCLUSION The result of this study showed that there was an intermediate prevalence of high internalized stigma among PWMI at University of Gondar Comprehensive Specialized Hospital. The hospital needs to take immediate action to fight internalized stigma by focusing on females, people with low self-esteem, individuals with history of lifetime substance use, and people who have history of hospital admission.
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Affiliation(s)
- Lamesa Melese Sori
- grid.59547.3a0000 0000 8539 4635Department of Psychiatry, University of Gondar Comprehensive Specialized Hospital, P. Box: 196, Gondar, Ethiopia
| | - Faisel Dula Sema
- grid.59547.3a0000 0000 8539 4635Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, P. Box: 196, Gondar, Ethiopia
| | - Masho Tigabe Tekle
- grid.59547.3a0000 0000 8539 4635Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, P. Box: 196, Gondar, Ethiopia
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Schuman‐Olivier Z, Fatkin T, Creedon TB, Samawi F, Moore SK, Okst K, Fredericksen A(K, Oxnard A(S, Roll D, Smith L, Cook BL, Weiss RD. Effects of a trauma‐informed mindful recovery program on comorbid pain, anxiety, and substance use during primary care buprenorphine treatment: A proof‐of‐concept study. Am J Addict 2022; 32:244-253. [PMID: 36470641 DOI: 10.1111/ajad.13364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/21/2022] [Accepted: 11/19/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A mindfulness-based intervention that reduces comorbid pain, anxiety, and substance use during office-based opioid treatment (OBOT) could enhance retention and prevent overdose. We conducted a pilot study of the Mindful Recovery OUD Care Continuum (M-ROCC), a 24-week trauma-informed program with a motivationally-sensitive curriculum. METHODS Patients prescribed buprenorphine (N = 18) enrolled in M-ROCC. We collected urine toxicology biweekly. At 0, 4, and 24 weeks, participants completed PROMIS-Pain, PROMIS-Anxiety, Mindfulness (FFMQ), Experiential Avoidance (BEAQ), Interoceptive Awareness (MAIA), and Self-Compassion (SCS-SF) scales. We estimated changes over time using mixed models. Participants completed qualitative interviews at 4 and 24 weeks. RESULTS Positive urine toxicology decreased over time for cocaine (β = -.266, p = .008) and benzodiazepines (β = -.208, p = .028). M-ROCC reduced PROMIS-Pain (Z = -2.29; p = .022), BEAQ (Z = -2.83; p = .0005), and increased FFMQ (Z = 3.51; p < .001), MAIA (Z = 3.40; p = .001), and SCS-SF (Z = 2.29; p = .022). Participants with co-morbid anxiety had decreased PROMIS-Anxiety (Z = -2.53; p = .012). Interviewed participants commonly used mindfulness practices for stress and anxiety (12/12, 100%), and to reduce pain catastrophizing and rumination (7/12, 58%). CONCLUSION AND SCIENTIFIC SIGNIFICANCE This is the first study to report the effects of a 24-week mindfulness program during buprenorphine treatment on common comorbidities, including pain interference, anxiety, cocaine, and benzodiazepine use. The findings that M-ROCC is associated with reduced experiential avoidance, as well as increased interoceptive awareness and self-compassion, align with proposed mechanisms that are now extended to OUD treatment. Future larger randomized controlled trials are needed before effectiveness can be established and the role of these mechanisms can be confirmed.
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Affiliation(s)
- Zev Schuman‐Olivier
- Department of Psychiatry Harvard Medical School Boston Massachusetts USA
- Center for Mindfulness and Compassion, Department of Psychiatry Cambridge Health Alliance Cambridge Massachusetts USA
- Center for Technology and Behavioral Health (CTBH), Department of Biomedical Data Science Geisel School of Medicine Dartmouth College Lebanon New Hampshire USA
| | - Thomas Fatkin
- Center for Mindfulness and Compassion, Department of Psychiatry Cambridge Health Alliance Cambridge Massachusetts USA
| | - Timothy B. Creedon
- Health Equity Research Lab, Department of Psychiatry Cambridge Health Alliance Cambridge Massachusetts USA
| | - Farah Samawi
- Center for Mindfulness and Compassion, Department of Psychiatry Cambridge Health Alliance Cambridge Massachusetts USA
| | - Sarah K. Moore
- Center for Technology and Behavioral Health (CTBH), Department of Biomedical Data Science Geisel School of Medicine Dartmouth College Lebanon New Hampshire USA
| | - Kayley Okst
- Center for Mindfulness and Compassion, Department of Psychiatry Cambridge Health Alliance Cambridge Massachusetts USA
| | - Alaine (Kiera) Fredericksen
- Center for Mindfulness and Compassion, Department of Psychiatry Cambridge Health Alliance Cambridge Massachusetts USA
| | - Alexandra (Sasha) Oxnard
- Department of Family Medicine Cambridge Health Alliance Cambridge Massachusetts USA
- Department of Medicine Harvard Medical School Boston Massachusetts USA
| | - David Roll
- Department of Medicine Harvard Medical School Boston Massachusetts USA
- Department of Medicine Cambridge Health Alliance Cambridge Massachusetts USA
| | - Lydia Smith
- Center for Mindfulness and Compassion, Department of Psychiatry Cambridge Health Alliance Cambridge Massachusetts USA
| | - Benjamin Lê Cook
- Department of Psychiatry Harvard Medical School Boston Massachusetts USA
- Health Equity Research Lab, Department of Psychiatry Cambridge Health Alliance Cambridge Massachusetts USA
| | - Roger D. Weiss
- Department of Psychiatry Harvard Medical School Boston Massachusetts USA
- Division of Alcohol, Drugs, and Addiction, Department of Psychiatry McLean Hospital Belmont Massachusetts USA
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Gheyoh Ndzi E, Holmes A. Examining the Relationship between Paternal Mental Health and Informal Support Networks: Reflections on the Impact of the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912751. [PMID: 36232050 PMCID: PMC9566537 DOI: 10.3390/ijerph191912751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 05/13/2023]
Abstract
Paternal mental health remains an under-researched area in the UK. Consequently, father-focused formal and informal support provisions fail to address the complex emotional and psychological wellbeing needs of fathers. Drawing on data from twenty semi-structured interviews with fathers in the York area, this study seeks to better understand how access to and participation in informal support networks is influenced by gendered perceptions and the impact hegemonic perceptions of masculinity have on fathers' access to support prior and during the COVID-19 pandemic. The findings demonstrate that fathers internalise stereotypical masculine tropes, such as stoicism, which prevent them from actively seeking support. While fathers value informal support network, they generally struggle to engage in mental health talks. The COVID-19 lockdown exacerbated fathers' struggles to access informal support or prioritise their mental health. Fathers felt the pandemic presented a unique challenge that only people that became parents at the time understood. This meant that fathers could not rely on their parents or other parents who did not have similar experiences of the COVID-19 pandemic. This paper aims at challenging structural and cultural barriers that inhibit fathers' participation in informal support networks, and to promote more meaningful, supportive engagement with peer groups.
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Pérez-Pedrogo C, Planas-García BY, Ortega-Guzmán J, Rivera-Suazo S, Caraballo JN, Albizu-García CE. Cultural adaptation and psychometric properties of the Substance Abuse Self-Stigma Scale among Latinos with Substance Use Disorders: An effective screening tool for correctional and community settings. STIGMA AND HEALTH 2022; 7:347-357. [PMID: 35978841 PMCID: PMC9377646 DOI: 10.1037/sah0000383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
The present study involves a psychometric evaluation of the Substance Abuse Self-Stigma Scale (SASSS), a 40-item dimensional measure of internalized or self-stigma developed by Jason Luoma and collaborators, among Latinos with Substance Use Disorders (SUDs). The current study's specific aim is to assess the psychometric properties (factor structure and reliability) of the translated and culturally adapted SASSS instrument in a cross-sectional study of individuals (n = 412) with SUDs with or without HIV from correctional facilities and community treatment programs. A confirmatory factor analysis evidenced the four-factor structure of SASSS. Results showed significant correlations with HIV felt stigma among those participants with co-occurring SUD and HIV (n=119), internalized shame, stigma-related interpersonal rejection due to substance abuse, symptoms of depression, substance use within the last 30 days, psychological flexibility, self-esteem, and self-efficacy, supporting good convergent validity. The measure showed a strong factor structure and adequate reliability estimates supporting its applicability to Latinos with SUDs from community and criminal justice settings. Findings are discussed in terms of their implications for studies of stigma impact and intervention.
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Chen AT, Johnny S, Conway M. Examining stigma relating to substance use and contextual factors in social media discussions. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 3:100061. [PMID: 36845987 PMCID: PMC9948814 DOI: 10.1016/j.dadr.2022.100061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 04/02/2022] [Accepted: 04/29/2022] [Indexed: 10/18/2022]
Abstract
Background Stigma associated with substance use can have severe negative consequences for physical and mental health and serve as a barrier to treatment. Yet, research on stigma processes and stigma reduction interventions is limited. Aim We use a social media dataset to examine: 1) the nature of stigma-related experience related to substance use; and 2) salient affective and temporal factors in the use of three substances: alcohol, cannabis, and opioids. Methods We harvested several years of data pertaining to three substances - alcohol, cannabis, and opioids - from Reddit, a popular social networking platform. For Part I, we selected posts based on stigma-related keywords, performed content analysis, and rendered word clouds to examine the nature of stigma associated with these substances. In Part II, we employed natural language processing in conjunction with hierarchical clustering and visualization to explore temporal and affective factors. Results In Part I, internalized stigma was most commonly exhibited. Anticipated and enacted stigma were less common in posts relating to cannabis compared to the other two substances. Work, home, and school were important contexts in which stigma was observed. Part II showed that temporal markers were prominent; post authors shared stories of substance use journeys, and timelines of their experience with quitting and withdrawals. Shame, sadness, anxiety, and fear were common, with shame being more prominent in alcohol-related posts. Conclusion Our findings highlight the importance of contextual factors in substance use recovery and stigma reduction and offer directions for future interventions.
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Affiliation(s)
- Annie T. Chen
- University of Washington School of Medicine, Biomedical Informatics and Medical Education, Box 358047, 850 Republican St., Seattle, WA 98109, United States,Corresponding author at: University of Washington School of Medicine, Biomedical Informatics and Medical Education, Box 358047, 850 Republican St., Seattle, WA 98109.
| | - Shana Johnny
- University of Washington School of Nursing, Box 357260, Seattle, WA 98195, United States
| | - Mike Conway
- University of Utah, Department of Biomedical Informatics, 421 Wakara Way #140, Salt Lake City, UT 84108, United States,University of Melbourne, School of Computing and Information Systems, Parkville VIC 3052, Australia
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Woodhams E, Samura T, White K, Patton E, Terplan M. Society of Family Planning Clinical Recommendations: Contraception and abortion care for persons who use substances. Contraception 2022; 112:2-10. [DOI: 10.1016/j.contraception.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 05/19/2022] [Accepted: 05/21/2022] [Indexed: 11/24/2022]
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Baker EA, Hamilton M, Culpepper D, McCune G, Silone G. The effect of person‐first language on attitudes toward people with addiction. JOURNAL OF ADDICTIONS & OFFENDER COUNSELING 2022. [DOI: 10.1002/jaoc.12102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Emily A. Baker
- College of Pharmacy The Ohio State University Columbus Ohio USA
| | - Mark Hamilton
- College of Pharmacy The Ohio State University Columbus Ohio USA
| | | | - Grace McCune
- College of Pharmacy The Ohio State University Columbus Ohio USA
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Moore JR, Castro Y, Cubbin C, von Sternberg K. Associations of At-Risk Drinking, Current Smoking, and Their Co-Occurrence With Primary Care Service Utilization. Am J Health Promot 2022; 36:429-439. [PMID: 34865517 PMCID: PMC10409595 DOI: 10.1177/08901171211056130] [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] [Indexed: 11/16/2022]
Abstract
PURPOSE Smoking and at-risk drinking are each associated with lower primary care utilization, but the influence of their co-occurrence is not known. The current study compared associations of endorsement of one behavior vs endorsement of both with primary care utilization. DESIGN Cross-sectional telephone survey. SETTING All United States and Territories. SUBJECTS 246 801 adults aged 18-64. MEASURES The outcome was endorsement of attending a past-year primary care visit. Predictor variables included drinking and smoking status examined individually and combined. ANALYSIS Multivariable logistic regressions, adjusted for socio-demographics and number of chronic health conditions. RESULTS The odds of attending a past-year primary care visit were 24% lower for persons who drank at risk levels compared to the odds of persons who did not drink and 36% lower for persons who smoked vs those who did not smoke. Among persons who endorsed at least one risk behavior, the odds of attending a past-year primary care visit were 25-35% lower for those who engaged in multiple behaviors compared to the odds of persons who engaged in one behavior. CONCLUSION Substance use screening and intervention services in primary care may not be reaching individuals with the greatest need for services. Proactive outreach and identification of primary care utilization barriers are needed, with special consideration of those with co-occurring substance use.
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Affiliation(s)
- John R. Moore
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - Yessenia Castro
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - Catherine Cubbin
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - Kirk von Sternberg
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
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Garpenhag L, Dahlman D. Perceived healthcare stigma among patients in opioid substitution treatment: a qualitative study. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2021; 16:81. [PMID: 34702338 PMCID: PMC8549326 DOI: 10.1186/s13011-021-00417-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 12/02/2022]
Abstract
Background People with substance use disorders (SUD) including patients in opioid substitution treatment (OST) are subject to stigma, and have generally poor health and barriers towards seeking healthcare. Experience of stigma might negatively affect healthcare seeking, but this topic is sparsely investigated. The aim of this study was to explore OST patients’ past and present experiences of substance use stigma in healthcare settings, in order to provide insight into the challenges that people with opioid use disorder may face when using health services, and the strategies they use to cope with them. Methods Six focus groups with 23 OST patients were moderated by OST staff, and conducted with a questioning route focusing on health literacy. Experiences associated with stigma and its consequences that were spontaneously brought up by participants were assessed in a secondary analysis using a thematic approach. Results Experiences of stigma from a wide range of healthcare settings were reported. Medical records and patients’ oral information regarding substance use, OST medication or hepatitis C infection were identified as circumstances bringing unwanted attention to the SUD. Participants reported various forms of poor treatment, believed to reflect views of people with SUD as morally culpable, intimidating, curious, untrustworthy and less valuable than other patients, sometimes with tangible effects on the quality of healthcare. Stigma in healthcare settings affected healthcare seeking behaviors, and could result in patients concealing their OST status or substance use history. Conclusion This study highlights several aspects of perceived healthcare stigma that can shed light on difficulties that OST patients might experience when navigating the healthcare system. The results implicate a need to investigate attitudes towards OST patients, and the aptitude to deal with patients with SUD, among healthcare professionals, as well as a need for interventions addressing knowledge deficits and issues tied to values and patient reception among healthcare staff. Supplementary Information The online version contains supplementary material available at 10.1186/s13011-021-00417-3.
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Affiliation(s)
- Lars Garpenhag
- Center for Primary Health Care Research, Department of Clinical Sciences, Malmö, Lund University/Region Skåne, Sweden, Box, 503 22, Malmö, Sweden
| | - Disa Dahlman
- Center for Primary Health Care Research, Department of Clinical Sciences, Malmö, Lund University/Region Skåne, Sweden, Box, 503 22, Malmö, Sweden. .,Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden.
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Hudgins A, Uzwiak B, Pizzicato L, Viner K. Barriers to effective care: Specialty drug treatment in Philadelphia. J Subst Abuse Treat 2021; 131:108639. [PMID: 34728133 DOI: 10.1016/j.jsat.2021.108639] [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: 01/07/2021] [Revised: 09/23/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION In Philadelphia, the poorest big city in the United States, an estimated 60,000 people misuse opioids and more than 3500 have died of overdose in the past three years. In 2019, fentanyl was detected in 76% of drug-related deaths and 94% of opioid-involved deaths. While much attention has been directed at the public face of the city's drug problem, more than 75% of drug deaths in 2017 took place in a private residence. METHOD Based on qualitative research to understand the vulnerabilities of this hidden population of drug users, we interviewed kin of 35 people who had died of opioid overdose in 2017 to learn whether their loved one had interacted with any social services or harm-reduction interventions. RESULTS In our demographically and geographically representative sample of decedents, we found that while most had received treatment at least once, many faced barriers to getting treatment when they needed it, including barriers related to stigma, structural racism, gender inequities, bureaucracy, insurance requirements, and cost. CONCLUSION We argue that these barriers place an undue burden on people with substance use disorder and their kin during particularly fraught moments of heightened vulnerability. The failure of state and federal policies, practices, and infrastructure to address these barriers, and the failure to require that evidence-based care be provided during treatment have deleterious effects on people affected by the opioid epidemic in the United States.
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Affiliation(s)
| | - Beth Uzwiak
- Ethnologica, 4732 Stenton Ave., Philadelphia, PA 19144, USA
| | - Lia Pizzicato
- Division of Substance Use Prevention and Harm Reduction, Philadelphia Department of Public Health, 123 S. Broad Street, Suite 1120, Philadelphia, PA 19109, USA
| | - Kendra Viner
- Division of Substance Use Prevention and Harm Reduction, Philadelphia Department of Public Health, 123 S. Broad Street, Suite 1120, Philadelphia, PA 19109, USA
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Quality Improvement Initiative to Improve Healthcare Providers' Attitudes towards Mothers with Opioid Use Disorder. Pediatr Qual Saf 2021; 6:e453. [PMID: 34476305 PMCID: PMC8389895 DOI: 10.1097/pq9.0000000000000453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 03/03/2021] [Indexed: 12/01/2022] Open
Abstract
Supplemental Digital Content is available in the text. Introduction: Individuals with opioid use disorder often report feelings of shame and describe feeling judged negatively. These feelings are especially true for pregnant women with opioid use disorder. The Ohio Perinatal Quality Collaborative conducted a multimodal quality improvement initiative for infants born with Neonatal Abstinence Syndrome (NAS). An important component of the project was focused on improving staff attitudes toward mothers of infants with NAS. Methods: The Ohio Perinatal Quality Collaborative implemented an education program for healthcare providers at 39 participating hospital units regarding opioid use as a chronic disease and principles of nonjudgmental, trauma-informed care. Healthcare providers partnered with the mother of infants with NAS in the care of the infant and connected with local community resources. This work was a subcomponent of an overall multimodal quality improvement project. Healthcare provider attitudes were measured with the “Attitude Measurement: Brief Scales” questionnaire anonymously, at 3 different time points throughout the project. Attitude change was measured by pretraining and posttraining scores. ANOVA methods were used to compare individual items and a summary score across the 3 surveys. Results: Summary scores improved significantly from 18.99 at baseline (January–March 2014) to 19.94 (P < 0.0001) in February 2015 and were maintained at 20.05 in July 2016. Conclusions: A nonjudgmental attitude toward mothers of infants with NAS is an important component of compassionate care. Improving healthcare provider attitudes can benefit a mother of an infant with NAS and help preserve the mother–infant dyad.
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Judd H, Meier CL, Yaugher AC, Campbell E, Atismé-Bevins K. Opioid Use Disorder Stigma Reduction Through Story Telling Narrative and Sharing: a Qualitative Review and Lessons Learned. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-021-00606-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Cernasev A, Hohmeier KC, Frederick K, Jasmin H, Gatwood J. A systematic literature review of patient perspectives of barriers and facilitators to access, adherence, stigma, and persistence to treatment for substance use disorder. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 2:100029. [PMID: 35481114 PMCID: PMC9029901 DOI: 10.1016/j.rcsop.2021.100029] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/21/2021] [Accepted: 05/21/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction The opioid crisis has left a devastating impact on the United States (U.S.) for over 20 years. The over-prescribing of opioid medications and availability of illicit opioids have contributed to the U.S. opioid epidemic. Given the complexity of the epidemic, substance use disorder, and its treatment, there is an urgent need for a thorough review of the qualitative literature which has captured the patient's experiences Such patient-derived qualitative data on lived experiences and perspectives may allow researchers, clinicians, and policy makers to glean new insights into addressing this epidemic. Objectives The objective of this paper is to present a systematic literature review of the existing U.S. qualitative research and provide a patient perspective on medications for opioid use disorder (MOUD), including barriers and facilitators to MOUD use. Methods In November 2019, four electronic databases (PubMed, CINAHL, Scopus, and Web of Science) were searched by a medical librarian using a combination of keywords, Medical Subject Headings (MeSH), and/or CINAHL subject headings. 8766 results were imported into EndNote, then duplicate records were removed, leaving a total of 4722 articles. The unique records were imported into Rayyan QCRI an online platform designed to expedite screening. Blinded screening was undertaken in duplicate by four reviewers. Two researchers abstracted all the articles and used thematic analysis. Results The screening in the abstract phase excluded 4681 results, leaving 41 studies for full-text screening to determine their eligibility for inclusion in the review. After screening, 21 articles were included in the study and the analysis is based on these articles Common themes across studies included stigmatization, perceived barriers to MOUD, and MOUD treatment deserts and provider shortages. Conclusions Qualitative research studies conducted to date have uncovered substantial MOUD treatment barriers which are both social and structural in nature. Such barriers to treatment may serve to exacerbate the current epidemic and must be taken into consideration in designing policy and treatment solutions for patients with OUD.
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Bozdağ N, Çuhadar D. Internalized stigma, self-efficacy and treatment motivation in patients with substance use disorders. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.1916846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Neslihan Bozdağ
- Medicine Faculty, Şahinbey Research and Practice Hospital, Gazantep University, Gaziantep, Turkey
| | - Döndü Çuhadar
- Health Science Faculty, Psychiatric Nursing Department, Gaziantep University, Gaziantep, Turkey
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Shadowen C, Wheeler R, Terplan M. Patient and provider knowledge of and attitudes toward medical conditions and medication during pregnancy. Addict Sci Clin Pract 2021; 16:22. [PMID: 33781326 PMCID: PMC8008637 DOI: 10.1186/s13722-021-00228-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 03/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Knowledge of medical conditions and their evidence-based medications varies among individuals. This range of knowledge may affect attitudes and influence medical decision-making of both patients and providers. Perceptions may be even more impactful in pregnancy, a timeframe subject to bias, and in diseases that include behavioral symptoms and often carry significant societal stigma, such as opioid use disorder (OUD). We present our findings from a survey assessing participants' knowledge of three distinct medical conditions (diabetes mellitus, bipolar disorder, and OUD) and how this knowledge affects perceptions of these disease states during pregnancy. METHODS Using existing surveys in the literature as a guideline, we designed a cross-sectional survey including multiple-choice questions to evaluate our hypothesis that less knowledge about a medical condition would result in more negative opinions towards that condition and its treatment throughout pregnancy. Participants responded to perception statements using a 5-point Likert scale (1 = "strongly disagree," 5 = "strongly agree"). Surveys were administered to patients in prenatal care, patients in OUD treatment, medical students, and medical residents within a single institution. Response means were generated and compared using t tests and ANOVA. RESULTS A total of 323 participants completed the survey. There were differences in knowledge between respondent groups and by disease state, with prenatal patients having the least knowledge of all groups about OUD diagnosis (88.5% of prenatal patients answered correctly) and its treatment (91.8% answered correctly). Overall Likert means of all responses demonstrated that participants agreed that new mothers with OUD (mean 4.27, 5 = "strongly agree") and their babies (4.12) would have challenges that others would not, compared to mothers with bipolar disorder (4.03) and their babies (3.60) as well as mothers with diabetes (3.87) and their babies (3.47), p < .001. Overall, respondents were likely to agree that women with OUD should not try to get pregnant (3.47), whereas they overall disagreed with that statement when it pertained to women with bipolar disorder (2.69, 2 = "disagree") or diabetes (2.12), p = 0.03. CONCLUSIONS With this single-center study, we found that, though there were gaps in knowledge regarding disease and disease treatment during pregnancy, less knowledge was not associated with more negative perceptions of disease and disease treatment during pregnancy. Perceptions were especially negative toward pregnant women with OUD. Increasing awareness of lived experiences of patients with disease, as well as the biases carried by both patients and providers, could improve treatment of chronic diseases and outcomes for patients.
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Affiliation(s)
- Caroline Shadowen
- Virginia Commonwealth University School of Medicine, 1201 East Marshall Street, #4-100, Richmond, VA, 23298, USA
| | - Rachel Wheeler
- Department of Obstetrics and Gynecology, VCU Hospital System, 1101 East Marshall Street, Sanger Hall, #11-022, Richmond, VA, 23298, USA
| | - Mishka Terplan
- Friends Research Institute, 1040 Park Ave, Suite 103, Baltimore, MD, 21201, USA. .,National Clinician Consultation Center, University of California, San Francisco, USA.
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Wang K, Schick MR, Weiss NH. The role of executive functioning deficits in the association between substance-use-related stigma and substance use problems among trauma-exposed individuals. Subst Abus 2021; 43:171-178. [PMID: 33759728 PMCID: PMC8460690 DOI: 10.1080/08897077.2021.1903652] [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] [Indexed: 10/21/2022]
Abstract
Background: Previous research has linked the internalization of shame and negative stereotypes associated with substance use to increased severity of substance use problems (i.e., negative consequences associated with alcohol and drug use, including occupational or relational difficulties and illegal behavior). However, little work has examined how other aspects of substance-use-related stigma (e.g., encounters with and anticipation of discrimination) might be related to the severity of substance use problems. Further, the psychological mechanisms through which stigma drives substance use problems remain poorly understood. Addressing these key limitations, the current study examined the role of executive functioning (EF) deficits in the relation between substance-use-related stigma and severity of substance use problems. Methods: In fall 2019, adults exposed to trauma who use substances were recruited via Amazon's Mechanical Turk (N = 320, 46.9% women) and completed self-report measures of substance-use-related stigma, EF deficits, and substance use problems. Results: Substance-use-related stigma was positively associated with EF deficits, which in turn related to substance use problems. Substance-use-related stigma was also indirectly associated with substance use problems through EF deficits, suggesting that EF deficits accounted for the significant association between substance-use-related stigma and substance use problems. Conclusions: These findings provide initial support for the role of EF deficits as a mechanism through which stigma drives substance use problems among individuals exposed to trauma. Results underscore the potential utility of addressing stigma coping and EF deficits in interventions aimed at preventing and treating substance use disorders.
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Affiliation(s)
- Katie Wang
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Melissa R. Schick
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Nicole H. Weiss
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
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Mallik S, Starrels JL, Shannon C, Edwards K, Nahvi S. "An undercover problem in the Muslim community": A qualitative study of imams' perspectives on substance use. J Subst Abuse Treat 2021; 123:108224. [PMID: 33612187 DOI: 10.1016/j.jsat.2020.108224] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 11/09/2020] [Accepted: 11/26/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mainstream Islam prohibits alcohol and other drugs, yet substance use is prevalent in Muslim-American communities. Previous studies have not examined how imams, leaders of mosques, address substance use in their communities. This study aimed to explore imams' perspectives and approaches toward Muslim Americans with substance use disorders (SUD). METHODS Qualitative study of imams in New York City recruited by convenience sampling. We conducted one-on-one semi-structured interviews to address how imams perceive and address substance use. Using an inductive thematic analysis approach, we created an initial coding scheme which was refined iteratively, identified prominent themes, and created an explanatory model to depict relationships between themes. RESULTS All imams described substance use within a shared underlying framework of religious prohibition of alcohol and other drugs. Their perceptions of individuals with SUD diverged between a focus on sin, shame, and social disruption vs. a focus on acceptance and forgiveness. Furthermore, imams diverged between conceptualizing their communities as comprising mosque-going individuals without SUD vs. broader communities that include individuals with SUD. While imams acknowledged how some imams' judgmental language toward SUD may perpetuate stigma, they also identified therapeutic approaches toward SUD: non-judgmental engagement, encouragement of recovery, prayer, and referral to resources. CONCLUSIONS This study is among the first to illustrate the range of perceptions and approaches to substance use among Muslim American imams. These perceptions have potentially divergent impacts- shaming or assisting individuals with SUD. An understanding of these complexities can inform provision of culturally competent care to Muslim-American patients with SUD.
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Affiliation(s)
- Sarah Mallik
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Health System, 111 East 210th Street, Bronx, NY 10467, USA.
| | - Joanna L Starrels
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Health System, 111 East 210th Street, Bronx, NY 10467, USA.
| | | | - Kea Edwards
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Health System, 111 East 210th Street, Bronx, NY 10467, USA.
| | - Shadi Nahvi
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Health System, 111 East 210th Street, Bronx, NY 10467, USA.
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Witte TH, Jaiswal J, Mumba MN, Mugoya GCT. Stigma Surrounding the Use of Medically Assisted Treatment for Opioid Use Disorder. Subst Use Misuse 2021; 56:1467-1475. [PMID: 34116605 DOI: 10.1080/10826084.2021.1936051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
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.
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HIV-related stigma and life goals among people living with HIV (PLWH) in Florida. Qual Life Res 2020; 30:781-789. [PMID: 33131019 DOI: 10.1007/s11136-020-02687-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Goals are an important component of quality of life (QoL) as they provide motivation to accomplish tasks we strive to achieve. Stigma has been identified as a factor that may be deleterious to achieving personal goals. People living with HIV(PLWH) continue to face HIV-related stigma. As HIV prevalence continues to grow in the U.S., it is important to focus on factors that can help improve the health and QoL of PLWH. This study aims to examine the association between HIV-related stigma and goal-setting behaviors among PLWH in Florida. METHODS We used baseline data collected from the Marijuana and Potential Long-term Effects (MAPLE) observational cohort study. We collected life goals data using an abbreviated version of the Personal Projects Analysis inventory. Participants listed up to three goals in five domains and were asked about each goal's difficulty and importance. HIV-related stigma was measured using an abbreviated version of the Herek HIV-related stigma scale. Relative risk estimates and 95% confidence intervals were estimated using multivariate linear regression models. RESULTS The overall sample (n = 232) was majority male (52.4%), Black (72.4%), and non-Latino (84.9%). HIV-related stigma was positively associated with the total number of listed goals (β = 0.042[0.003, 0.082]; p = 0.037) and perceived goal difficulty (β = 0.010[0.003, 0.017]; p = 0.004), but not significantly associated with perceived goal importance (β = 0.001[- 0.002, 0.004]; p = 0.562). CONCLUSION The results suggest that HIV-related stigma may be affecting the pursuit of goals among PLWH. There is a need to develop and evaluate QoL interventions that are tailored to PLWH and focused on achieving goals in the face of HIV-related stigma.
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30
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Bloom BE, Jain S, Sun X, Garfein RS, Strathdee SA, Milloy MJ, Hayashi K, DeBeck K, Bluthenthal R, Werb D, Rafful C. Self-perception of assisting with future injection drug initiation: The influence of relationships in the process of drug injecting initiation. Drug Alcohol Rev 2020; 40:109-117. [PMID: 32840027 DOI: 10.1111/dar.13145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 07/01/2020] [Accepted: 07/12/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND AIMS People who inject drugs (PWID) play critical roles in assisting others into injection drug use (IDU) initiation. Understanding perceptions of PWID's risk of initiating others is needed to inform interventions for prevention. The objective was to examine factors associated with self-perception of assisting with future IDU initiation events. The primary variables of interest are the relationships of PWID with the person(s) they assisted and their reasons for previously providing initiation assistance. DESIGN AND METHODS Data from Preventing Injecting by Modifying Existing Responses, a multi-site prospective community-recruited cohort study, were analysed. Analyses were restricted to PWID who reported ever providing IDU initiation assistance. Site-specific (Vancouver, Canada [n = 746]; San Diego, USA [n = 95] and Tijuana, Mexico [n = 92]) multivariable logistic regression analyses were performed to determine factors associated with self-perception of assisting with future IDU initiation. RESULTS Having provided IDU initiation assistance to a family member or intimate partner decreased the odds of self-perception of assisting with future IDU initiation in Vancouver (AOR = 0.4; 95% CI 0.2-0.8); however, previous IDU initiation assistance to an 'other' increased the odds of self-perception of assisting with future IDU in Tijuana (AOR = 12.0; 95% CI 2.1-70.3). Daily IDU (Vancouver: AOR = 3.7; 95% CI 2.1-6.4) and less than daily IDU (San Diego: AOR = 5.9; 95% CI 1.3-27.1) (Vancouver: AOR = 2.6; 95% CI 1.4-2.9) were associated with increased self-perception of assisting with future IDU compared to current non-injectors. DISCUSSION AND CONCLUSIONS Relationship to past initiates and IDU frequency might increase PWID's self-perception of assisting with future IDU. Interventions focused on social support and reducing IDU frequency may decrease occurrences of IDU initiation assistance.
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Affiliation(s)
- Brittnie E Bloom
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, San Diego, USA.,Graduate School of Public Health, San Diego State University, San Diego, USA
| | - Sonia Jain
- Department of Family Medicine and Public Health, Biostatistics Research Center, University of California, San Diego, San Diego, USA
| | - Xiaoying Sun
- Department of Family Medicine and Public Health, Biostatistics Research Center, University of California, San Diego, San Diego, USA
| | - Richard S Garfein
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, San Diego, USA
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, San Diego, USA
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Kanna Hayashi
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Kora DeBeck
- Department of Medicine, University of British Columbia, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Ricky Bluthenthal
- Department of Preventive Medicine, Keck School of Medicine of University of Southern California, Los Angeles, USA
| | - Dan Werb
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, San Diego, USA.,Centre on Drug Policy Evaluation, St. Michael's Hospital, Toronto, Canada
| | - Claudia Rafful
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Toronto, Canada.,Universidad Nacional Autónoma de México, Mexico City, Mexico.,Center on Global Mental Health Research, National Institute of Psychiatry, Mexico City, Mexico
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31
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Hall EA, Cernasev A, Nasritdinova U, Veve MP, Hohmeier KC. Stigma of Opioid Use Disorder and Its Indirect Effects on Student Pharmacists' Perceptions and Attitudes. PHARMACY 2020; 8:pharmacy8030144. [PMID: 32823836 PMCID: PMC7559077 DOI: 10.3390/pharmacy8030144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives: Pharmacists play a vital role in serving patients during the ongoing nationwide opioid epidemic, and so it is also critical to educate the next generation of pharmacists on opioids and opioid use disorder (OUD). The primary objective of this study was to quantitatively characterize student perceptions of opioid use and the stigma associated with OUD. Secondary aims were to determine whether differences in perceptions exist based upon the student’s year in the Doctor of Pharmacy program or employment in a community pharmacy. Methods: First-, second-, third-, and fourth-year student pharmacists voluntarily completed an electronic survey regarding perceptions of opioid use and stigma associated with OUD. Results: Of the 9 survey items, students were most uncomfortable referring patients to community resources for addiction support and/or treatment (25.3% comfortable or very comfortable). Students working in a community pharmacy were significantly more comfortable talking to patients attempting to refill opioids early and providing opioid counseling as compared to their peers not working in community pharmacy. Fourth-year students reported a higher level of comfort talking to a patient attempting to refill an opioid prescription early, counseling a patient on an opioid prescription, and providing information about alternatives to opioids. Third-year students responded most favorably to the items regarding how well the curriculum has prepared them to interact with patients taking opioids and those with OUD. Conclusions: These findings reveal that students are comfortable counseling on opioids and discussing alternative options. Differences in perceptions were observed based upon the student’s year in the program and whether or not they were employed in a community pharmacy setting.
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Wilson JD, Lanzkron S, Pecker LH, Bediako SM, Han D, Beach MC. Psychosocial and Clinical Risk Factors Associated with Substance Use in Observational Cohort of Patients with Sickle Cell Disease. Subst Use Misuse 2020; 55:2205-2212. [PMID: 32762425 PMCID: PMC8208322 DOI: 10.1080/10826084.2020.1797807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patients with sickle cell disease (SCD) experience high rates of chronic pain, and have a high burden of mental health comorbidities shown to negatively influence health. There is limited research on substance use among individuals with SCD. Objective: The aim of this study is to measure the prevalence of substance use in patients with SCD and determine whether psychosocial or clinical risk factors are associated with substance use. Methods: This study was conducted as part of an observational study of patients with SCD at two academic medical centers. We asked participants (ages 15 and older) about the lifetime use of heroin, cocaine, amphetamines, and marijuana/cannabis. We measured stigma, depression, urban life stress, pain catastrophizing, and asked about a brief pain inventory. Results: Of 258 participants, 24.9% (n = 71) reported substance use. Marijuana was the most common substance used (22.5%; n = 65). The mean depressive score met criteria for positive screen amongst individuals who reported a history of substance use (mean 10.7(5.76)). Adjusting for age, sex, yearly family income, and education level, odds of substance use increased with higher levels of internalized stigma (aOR: 1.38; 95% CI: 1.07, 1.77; p = 0.012); higher urban life stress scores (aOR 1.06; 95% CI: 1.01, 1.12; p = 0.017) and higher pain catastrophizing scores (aOR: 1.03; 95% CI: 1.01, 1.06; p = 0.008). Conclusions: Among individuals with SCD who endorse substance use, there was markedly more stress and distress with higher rates of depression and poorer quality of life. Interventions focusing on improving distress tolerance and coping to not only pain, but also social stressors, might reduce substance use.
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Affiliation(s)
- J. Deanna Wilson
- Division of General Internal Medicine, University of Pittsburgh, PA
| | - Sophie Lanzkron
- Department of Hematology, Johns Hopkins University School of Medicine
| | - Lydia H. Pecker
- Department of Pediatric Hematology, Johns Hopkins University School of Medicine
| | - Shawn M. Bediako
- Department of Psychology, University of Maryland, Baltimore County, MD
| | - Dingfen Han
- Division of General Internal Medicine, Johns Hopkins University School of Medicine
| | - Mary Catherine Beach
- Division of General Internal Medicine, Johns Hopkins University School of Medicine
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33
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Meyers SA, Smith LR, Werb D. Preventing transitions into injection drug use: A call for gender-responsive upstream prevention. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 83:102836. [PMID: 32679459 DOI: 10.1016/j.drugpo.2020.102836] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 01/30/2023]
Abstract
In 2017, there were large increases (260-500%) in overdose deaths among women in the United States across age groups (30-64 years and 55-64 years). In addition, U.S. women who inject drugs (WWID) are at increased risk for substance use-related disease transmission, bacterial infections, as well as sexual and physical violence compared to men who inject drugs. Relatedly, women face unique access barriers to substance use-related services, such as stigma and low coverage of gender-specific drug use-related services. Despite these heightened risks experienced by WWID, interventions specifically tailored to preventing women from transitioning into injection drug use have not been developed to date. As such, we advocate for the development of gender-responsive programs to prevent injection drug use initiation. This is critical to ensuring a comprehensive approach to preventing injection drug use initiation among those populations at highest risk of injection-related morbidity and mortality.
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Affiliation(s)
- Stephanie A Meyers
- School of Social Work, College of Health and Human Services, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA; Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Laramie R Smith
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Dan Werb
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1T8, Canada.
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34
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Tsai AC, Kiang MV, Barnett ML, Beletsky L, Keyes KM, McGinty EE, Smith LR, Strathdee SA, Wakeman SE, Venkataramani AS. Stigma as a fundamental hindrance to the United States opioid overdose crisis response. PLoS Med 2019; 16:e1002969. [PMID: 31770387 PMCID: PMC6957118 DOI: 10.1371/journal.pmed.1002969] [Citation(s) in RCA: 208] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Alexander Tsai and co-authors discuss the role of stigma in responses to the US opioid crisis.
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Affiliation(s)
- Alexander C. Tsai
- Center for Global Health, Massachusetts General Hospital, Boston,
Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of
America
- Mbarara University of Science and Technology, Mbarara,
Uganda
| | - Mathew V. Kiang
- Center for Population Health Sciences, Stanford University School of
Medicine, Stanford, California, United States of America
| | - Michael L. Barnett
- Harvard Medical School, Boston, Massachusetts, United States of
America
- Department of Health Policy and Management, Harvard T. H. Chan School of
Public Health, Boston, Massachusetts, United States of America
- Division of General Internal Medicine and Primary Care, Brigham and
Women’s Hospital, Boston, Massachusetts, United States of
America
| | - Leo Beletsky
- Northeastern University School of Law, Boston, Massachusetts, United
States of America
- Bouvé College of Health Sciences, Northeastern University, Boston,
Massachusetts, United States of America
- Division of Infectious Diseases and Global Public Health, University of
California at San Diego School of Medicine, San Diego, California, United States
of America
| | - Katherine M. Keyes
- Mailman School of Public Health, Columbia University, New York City, New
York, United States of America
| | - Emma E. McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg
School of Public Health, Baltimore, Maryland, United States of
America
| | - Laramie R. Smith
- Division of Infectious Diseases and Global Public Health, University of
California at San Diego School of Medicine, San Diego, California, United States
of America
| | - Steffanie A. Strathdee
- Division of Infectious Diseases and Global Public Health, University of
California at San Diego School of Medicine, San Diego, California, United States
of America
| | - Sarah E. Wakeman
- Harvard Medical School, Boston, Massachusetts, United States of
America
- Department of Medicine, Massachusetts General Hospital, Boston,
Massachusetts, United States of America
| | - Atheendar S. Venkataramani
- Department of Medical Ethics and Health Policy, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
of America
- Leonard Davis Institute of Health Economics, University of Pennsylvania,
Philadelphia, Pennsylvania, United States of America
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35
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Rayner C, Coleman JRI, Purves KL, Cheesman R, Hübel C, Gaspar H, Glanville K, Krebs G, Morneau-Vaillancourt G, Breen G, Eley TC. Genetic influences on treatment-seeking for common mental health problems in the UK biobank. Behav Res Ther 2019; 121:103413. [PMID: 31491689 PMCID: PMC6873796 DOI: 10.1016/j.brat.2019.103413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 05/17/2019] [Accepted: 05/26/2019] [Indexed: 10/26/2022]
Abstract
The majority of those who experience clinical anxiety and/or depressive symptoms in the population do not receive treatment. Studies investigating inequalities in treatment outcomes rarely consider that individuals respond differently to their experience of the environment. Much of our environment is under genetic influence, via our behaviour, whereby individuals actively select their experiences. If genes influence who seeks and receives treatment, selection bias will confound genomic studies of treatment response. Furthermore, if some individuals are at high genetic risk of needing but not commencing treatment, then greater efforts could be made to engage them. The role of common genetic variation on four lifetime treatment-seeking behaviours (treatment-seeking, treatment-receipt, self-help, self-medication with alcohol/drugs) was examined in participants of the UK Biobank (sample size range: 48,106 - 75,322). Treatment-related behaviours were only modestly heritable in these data. Nonetheless, genetic correlations reveal substantial genetic overlap between lifetime treatment-related behaviours and psychiatric disorders, symptoms and behavioural traits. To our knowledge, this is the first study to examine genetic influences on treatment-related behaviours. Further work is required to determine whether genetic factors could be used alongside clinical, social and demographic factors to identify at risk groups and inform strategies which target early intervention.
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Affiliation(s)
- Christopher Rayner
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Jonathan R I Coleman
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK; NIHR Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Kirstin L Purves
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Rosa Cheesman
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Christopher Hübel
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK; NIHR Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Helena Gaspar
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Kylie Glanville
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Georgina Krebs
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | | | - Gerome Breen
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK; NIHR Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK.
| | - Thalia C Eley
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK; NIHR Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK.
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Stringer KL, Marotta P, Baker E, Turan B, Kempf MC, Drentea P, Stepanikova I, Turan JM. Substance Use Stigma and Antiretroviral Therapy Adherence Among a Drug-Using Population Living with HIV. AIDS Patient Care STDS 2019; 33:282-293. [PMID: 31166784 PMCID: PMC6588110 DOI: 10.1089/apc.2018.0311] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Among people living with HIV (PLWH), HIV-related stigma predicts nonadherence to antiretroviral therapy (ART); however, the role of stigma associated with drug use is largely unknown. We examined the association between substance use (SU) stigma and optimal ART adherence in a sample of 172 self-reported HIV-infected drug users. Participants completed surveys on SU, stigma, and ART adherence. The three substance classes with the greatest number of participants exhibiting moderate/high-risk scores were for cocaine/crack cocaine (66.28%), cannabis (64.53%), and hazardous alcohol consumption (65.70%). Multivariable logistic regression was conducted to investigate associations between levels of SU stigma and optimal ART adherence, adjusting for sociodemographic characteristics, severity of illicit drug use (alcohol, smoking and substance involvement screening test) and alcohol use severity (Alcohol Use Disorders Identification Test-C), HIV-related stigma, and social support. The odds of optimal adherence among participants experiencing moderate [Adjusted Odds Ratio (AOR) = 0.36, p = 0.039] and very high (AOR = 0.25, p = 0.010) levels of anticipated SU stigma were significantly lower than participants experiencing low levels of anticipated SU stigma. No other stigma subscales were significant predictors of ART adherence. Interventions aiming to improve ART adherence among drug-using PLWH need to address anticipated SU stigma.
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Affiliation(s)
| | - Phillip Marotta
- Department of Social Work, Columbia University, New York, New York
| | - Elizabeth Baker
- Department of Sociology, and University of Alabama at Birmingham, Birmingham, Alabama
| | - Bulent Turan
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health, and Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Patricia Drentea
- Department of Sociology, and University of Alabama at Birmingham, Birmingham, Alabama
| | - Irena Stepanikova
- Department of Sociology, and University of Alabama at Birmingham, Birmingham, Alabama
| | - Janet M. Turan
- Department of Healthcare Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
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37
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Cassiani-Miranda CA, Campo-Arias A, Herazo E. Trastornos por consumo de sustancias: entre las inequidades y el estigma. DUAZARY 2019. [DOI: 10.21676/2389783x.2751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Las personas que reúnen criterios para trastornos por consumo de sustancias (TCS) con frecuencia son víctimas del complejo estigma-discriminación (CED), no sólo por parte de la sociedad general, sino también por profesionales de la salud y la presencia de autoestigma. No obstante, la relación de los TCS con factores biológicos predisponentes y condiciones sociales adversas se considera que estos son ‘autoinducidos’. Asimismo, se conoce que en los TCS se presentan cambios biológicos, psicológicos o del desarrollo que menoscaban la decisión de abandono y la persistencia en el consumo, a pesar de las consecuencias negativas físicas, emocionales y sociales. El CED relacionado con el TCS es un estresor que deteriora aún más la calidad de vida de las personas consumidoras y, al mismo tiempo, se configura como una barrera de acceso a servicios de salud. Es necesario diseñar e investigar la efectividad de estrategias para reducir el CED relacionado con TCS en diferentes poblaciones y contextos.
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Affiliation(s)
| | | | - Edwin Herazo
- Instituto de Investigación del Comportamiento Humano
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38
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Jara-Concha P, Cumsille F. URBAN RESIDENTS ATTITUDES TOWARDS PEOPLE WITH DRUG ABUSE IN FIVE DISTRICTS OF CONCEPCION COMMUNE, CHILE. TEXTO & CONTEXTO ENFERMAGEM 2019. [DOI: 10.1590/1980-265x-tce-cicad-6-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to analyze the attitudes of residents in an urban commune of Concepción, Chile towards people with drug abuse according to drug type, personal experience and socio-demographic variables. Method: descriptive and cross-sectional study that examines the attitude of 121 people of five census districts of commune of Concepción, Chile, regarding who has abuse of four types of drugs: alcohol, marijuana, cocaine and base paste, and its relation with socio-demographic variables, personal experience, drug type, using the Multidimensional Inventory of Attitudes. Results: ambivalent attitudes are observed towards those who abuses of alcohol and marijuana; on the other hand, attitude is negative towards those who abuse of cocaine and base paste. Female gender and religiosity were significantly associated with negative attitudes and young adults presented more ambivalent and less negative attitudes than middle-aged adults and older did. Personal experience is significantly related only if people that abuse of marijuana and cocaine are known. Conclusion: it is concluded that ambivalent and negative attitudes prevail towards people who abuse of drugs, what constitutes an obstacle to access treatment and social integration. It is necessary to keep investigating about attitudes, social distance and personal contact in order to elaborate strategies that allow to address stigma and discrimination towards those who present drug abuse in Chile
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