Correlates of Expressed Emotion Among Family Members of Individuals Who Sought Treatment for Opioid Use

Stigma Communication Surrounding Nonmedical Opioid Use Among Affected Family Members

A growing body of research demonstrates the role of language in stigma toward nonmedical opioid use (NMOU). Terms like "substance abuser" perpetuate stereotypes and evoke punitive judgments. This study examines how affected family members (AFMs) communicate stigma when discussing their loved one's NMOU. Semi-structured interviews were conducted with 34 adults with a close family member with a history of NMOU. An iterative approach was used to analyze instances when stigmatizing terms or messages were used. AFMs described people engaged in NMOU as underweight, "dirty," or "nodding off," and often labeled these individuals "addicts" or opioid "abusers." Responsibility for the NMOU was attributed to both internal (e.g. choice) and external (e.g. brain disease) factors. People engaged in NMOU were linked to physical danger, resource threats, and threats to the family members' reputation and relationships. While most stigma messages related to the person engaged in NMOU, stigmatizing messages directed toward AFMs also emerged; family members labeled "enablers" were judged, blamed, and described as a threat to the person engaged in NMOU. Although AFMs expressed care and desire to support their loved ones, they often conveyed stigma in their language choices. This language among AFMs may reflect internalized stigma. Increased efforts are needed to help AFMs cope with the challenges of a loved one's NMOU and identify effective ways to support their loved one. One way AFMs can support their loved one is by using more inclusive, person-first language.

Effects of Affective Proximity and Treatment on Emotional Response toward People with Substance Use

BACKGROUND

Emotions act as mediators of the relationship between stereotypes and inclinations to discriminate against and isolate individuals with substance use disorders (SUD). Emotional responses toward people with SUD are more negative than toward those people with non-drug-related mental disorders. This study explored the effects of affective bonds with substance users and treatment on the type and frequency of emotions, valence, and interpersonal distance.

METHODS

A convenience sample of 1,195 individuals was included in this survey-based study. Participants responded to questions regarding their knowledge of psychoactive drugs and beliefs about substance use disorders and were requested to report the emotions they imagined having felt in four scenarios depicting a substance user whose characteristics varied according to two dimensions: the substance user was a relative or an unknown; the substance user was in treatment for SUD, or not.

RESULTS

Emotions toward relative drug users were more negative and expressed greater interpersonal distance. Treatment was associated with more positive valence and lower interpersonal distance, but emotions toward relatives in treatment were more negative than those not.

CONCLUSION

Specific interventions for relatives of people with SUD may be necessary because of the emotional burden caused by the courtesy stigma.

Experiences of Healthcare and Substance Use Treatment Provider-based Stigma Among Patients Receiving Methadone

Background

Medications for Opioid Use Disorder (MOUD) are efficacious, however only one-third of individuals with an opioid use disorder (OUD) enter into treatment. Low rates of MOUD utilization are partially due to stigma. This study examines provider-based stigma toward MOUD and identifies factors associated with experiencing stigma related to MOUD from substance use treatment and healthcare providers among people receiving methadone.

Methods

Clients receiving MOUD at an opioid treatment program (N = 247) were recruited to complete a cross-sectional computer-based survey assessing socio-demographics, substance use, depression and anxiety symptoms, self-stigma, and recovery supports/barriers. Logistic regression was used to examine factors associated with hearing negative comments about MOUD from substance use treatment and healthcare providers.

Results

27.9% and 56.7% of respondents reported they sometimes/often hear negative comments about MOUD from substance use treatment and healthcare providers, respectively. Logistic regression results indicate that individuals who experience more negative consequences resulting from their OUD (OR=1.09, p=.019) had greater odds of hearing negative comments from substance use treatment providers. Age (OR=0.966, p=.017) and treatment stigma (OR=1.42, p=.030) were associated with greater odds of hearing negative comments from healthcare providers.

Conclusions

Stigma can be a deterrent to seeking substance use treatment, healthcare, and recovery support. Understanding factors associated with experiencing stigma from substance use treatment providers and healthcare providers is important as these individuals may act as advocates for those with OUD. This study highlights individual factors associated with hearing negative comments about methadone and other MOUD and point to areas for targeted education.