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Keller A, Bosk EA, Mendez A, Greenfield B, Flynn C, Everett DelJones G, Julien F, Michael M. Exploring perceptions of genetic risk and the transmission of substance use disorders. Addict Sci Clin Pract 2024; 19:57. [PMID: 39095898 PMCID: PMC11295387 DOI: 10.1186/s13722-024-00470-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 05/06/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Substance use disorders (SUDs) have been consistently shown to exhibit moderate intergenerational continuity (1-3). While much research has examined genetic and social influences on addiction, less attention has been paid to clients' and lay persons' perceptions of genetic influences on the heritability of SUD (4) and implications for treatment. METHODS For this qualitative study, twenty-six structured Working Model of the Child Interviews (WMCI) were conducted with mothers receiving inpatient SUD treatment. These interviews were thematically analyzed for themes related to maternal perceptions around intergenerational transmission of substance use behaviours. RESULTS Findings show that over half of the mothers in this sample were preoccupied with their children's risk factors for addictions. Among this group, 29% spontaneously expressed concerns about their children's genetic risk for addiction, 54% shared worries about their children's propensity for addiction without mentioning the word gene or genetic. Additionally, 37% had challenges in even discussing their children's future when prompted. These concerns mapped onto internal working models of attachment in unexpected ways, with parents who were coded with balanced working models being more likely to discuss intergenerational risk factors and parents with disengaged working models displaying difficulties in discussing their child's future. CONCLUSION This research suggests that the dominant discourse around the brain-disease model of addictions, in its effort to reduce stigma and self-blame, may have unintended downstream consequences for parents' mental models about their children's risks for future addiction. Parents receiving SUD treatment, and the staff who deliver it, may benefit from psychoeducation about the intergenerational transmission of SUD as part of treatment.
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Affiliation(s)
- Amanda Keller
- McGill University School of Social Work, 550 Sherbrooke Ouest Suite 100, Tour Est Montreal, Montreal, H3A 1B9, QC, Canada.
| | - Emily A Bosk
- Rutgers University, 390 George St., Room 713, New Brunswick, NJ, USA
| | - Alicia Mendez
- School of Social Work, Boston University, 264 Bay State Rd, 02215, Boston, MA, USA
| | - Brett Greenfield
- School of Social Work, Rutgers University, 390 George St, New Brunswick, NJ, 08901, USA
| | - Carolynn Flynn
- The Center for Great Expectations, Somerset, NJ, 08873, USA
| | | | - Fabrys Julien
- McGill University School of Social Work, 550 Sherbrooke Ouest Suite 100, Tour Est Montreal, Montreal, H3A 1B9, QC, Canada
| | - MacKenzie Michael
- Research Chair in Child Well-Being, McGill University School of Social Work, 550 Sherbrooke Ouest Suite 100, Tour Est Montreal, Montreal, H3A 1B9, QC, Canada
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2
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Gaeta Gazzola M, Carmichael ID, Thompson E, Beitel M, Madden LM, Saeed G, Hoffman K, Hammouri M, Hsaio C, Barry DT. A Quantitative Examination of Illness Models Among People With Opioid Use Disorder Receiving Methadone Treatment. J Addict Med 2024; 18:262-268. [PMID: 38446859 DOI: 10.1097/adm.0000000000001282] [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: 03/08/2024]
Abstract
BACKGROUND Few studies have examined illness models among people with addiction. We investigated illness models and their associations with demographics and treatment beliefs among patients receiving methadone treatment for opioid use disorder. METHODS From January 2019 to February 2020, patients receiving methadone treatment at outpatient opioid treatment programs provided demographics and rated using 1 to 7 Likert-type scales agreement with addiction illness models (brain disease model, chronic medical condition model [CMCM], and no explanation [NEM]) and treatment beliefs. Pairwise comparisons and multivariate regressions were used to examine associations between illness models, demographics, and treatment beliefs. Statistical significance was set at P < 0.05. RESULTS A total of 450 patients participated in the study. Forty percent self-identified as female, 13% as Hispanic, and 78% as White; mean age was 38.5 years. Brain disease model was the most frequently endorsed illness model (46.2%), followed by CMCM (41.7%) and NEM (21.9%). In multivariate analyses, agreement with brain disease model was significantly positively associated with beliefs that methadone treatment would be effective, counseling is important, and methadone is lifesaving, whereas agreement with CMCM was significantly positively associated with beliefs that methadone treatment would be effective, counseling is important, 12-step is the best treatment, taking methadone daily is important, and methadone is lifesaving. In multivariate analyses, agreement with NEM was negatively significantly associated with beliefs that methadone would be effective, counseling is important, taking methadone daily is important, and methadone is lifesaving. DISCUSSION Many patients in methadone treatment endorsed medicalized addiction models. Agreement with addiction illness models appear to be related to treatment beliefs.
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Affiliation(s)
- Marina Gaeta Gazzola
- From the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (MGG, MB, CH, DTB); The APT Foundation, Inc., New Haven, Connecticut (MGG, ET, MB, LMM, CH, DTB); Department of Emergency Medicine, NYU Langone School of Medicine/NYC Health and Hospitals Bellevue, New York, New York (MGG); Department of Statistics, University of California at Berkeley, Berkeley, California (IDC); Department of Pathology and Laboratory Medicine, University of California at San Francisco School of Medicine, San Francisco, California (IDC); Rutgers New Jersey Medical School, Rutgers, New Jersey (ET); Department of Internal Medicine, Oregon Health and Science University, Portland OR (KH); Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut (LMM, GS); Child Study Center, Yale School of Medicine, New Haven, Connecticut (MB, DTB); and University of Jordan, Amman, Jordan (MH)
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3
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Fokuo JK, Hutman PJ, Gruber VA, Masson CL, Lum PJ, Bush DM, Naugle JA, Sorensen JL. Substance use Attitudes, Beliefs, Experience, and Knowledge Among Nursing and Nursing Assistant Students. J Psychoactive Drugs 2024:1-11. [PMID: 38646910 DOI: 10.1080/02791072.2024.2343402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 03/14/2024] [Indexed: 04/23/2024]
Abstract
Stigma is a public health concern. Stigmatizing attitudes toward persons with substance use disorders (SUDs) can adversely impact clinical care and outcomes. Beliefs about SUD, prior experience and familiarity to persons with SUD, and educational curricula drive attitudes among health-care workers. In 2019, nursing and nursing assistant students were recruited through an online survey platform. Participants completed an SUD knowledge test and a survey assessing education, beliefs, personal experience, and confidence in recognizing the signs and symptoms of SUD. One hundred and ten health-care students (nursing students, n = 67 and nursing assistant students, n = 43) completed the survey. Among nursing assistant students, endorsing a disease model of addiction (F(2, 40) = 5.83, p < .001, R2 = .23), and personal familiarity with SUD (F(2, 40) = 4.46, p < .001, R2 = .18), were significantly positively predictive of positive regard toward working with persons with SUD. For nursing students, endorsing a disease model of addiction, educational curricula involving persons with SUD, and personal familiarity were significantly positively predictive of positive regard toward working with persons with SUDs (F(2, 61) = 11.52, p < .001, R2 = .36). Interventions to mitigate drug-related stigma among health-care students should center students with personal familiarity, promote the disease concept of addiction, and incorporate contact-based training.
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Affiliation(s)
- J Konadu Fokuo
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Paul J Hutman
- Veterans Administration, Northern California Health Care System, Redding, CA, USA
| | - Valerie A Gruber
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Carmen L Masson
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Paula J Lum
- Division of HIV, Infectious Disease, and Global Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Dylan M Bush
- Division of Biology and Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jessica A Naugle
- San Francisco Department of Public Health, Street Medicine and Shelter Health, San Francisco, CA, USA
| | - James L Sorensen
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
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4
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Ochterbeck D, Frense J, Forberger S. A survey of international addiction researchers' views on implications of brain-based explanations of addiction and the responsibility of affected persons. NORDIC STUDIES ON ALCOHOL AND DRUGS 2024; 41:39-56. [PMID: 38356788 PMCID: PMC10863558 DOI: 10.1177/14550725231188802] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 07/04/2023] [Indexed: 02/16/2024] Open
Abstract
Aim: To complement existing stakeholder surveys by exploring addiction researchers' views on the implications of brain-based explanations of addiction and the responsibilities of addicted persons. Methods: A total of 190 researchers from 29 countries (13.2%) participated in a LimeSurvey. Their perspectives on implications of brain-based explanations of addiction were explored qualitatively using open-ended questions. In addition, respondents could indicate their views on the responsibility of addicted individuals for their condition and actions using a Likert scale and a free-text field ("mixed methods light"). Qualitative analyses inductively identified the most frequent themes and deductively assessed the overall impact (positive, negative or both/ambivalent). Quantitative analyses included frequencies and proportions. Results: The major themes mentioned were medicalisation and the neglect of other factors, better treatment options and access, (reduced) stigma and (impaired) agency of affected persons. The overall evaluation yielded 46% positive, 33% negative and 16% ambivalent views. Approximately 60% of the participants considered addicted persons to be responsible for their condition and 80% for their actions. Conclusions: According to researchers, a brain-based approach to addictions has positive and negative implications. In particular, the neglect of factors other than biomedical seems to be of concern. Thus, a re-consideration of research priorities as well as affected individuals' agency and role in treatment and care seems warranted.
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Affiliation(s)
- Doris Ochterbeck
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Jennifer Frense
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
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5
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Gregory VL, Ofner S, Ellis RJ. O-Know Opioid Knowledge Test: Development and Psychometric Testing in a Community Setting. J Psychoactive Drugs 2024; 56:135-145. [PMID: 36409628 DOI: 10.1080/02791072.2022.2147883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/22/2022] [Accepted: 09/23/2022] [Indexed: 11/22/2022]
Abstract
Given the various sources and consequences of opioid use disorder (OUD) stigma, the mechanisms by which stigma occurs becomes more important. Educational deficits regarding OUD as a disease and treatment influence OUD stigma. The purpose of the study was to develop, pilot test and psychometrically evaluate the Opioid-Knowledge (O-Know) test in a community setting. A social media strategy was used to recruit 294 participants, in 2019, from a midwestern region experiencing an HIV epidemic, stemming from opioid and injection drug use. The Factor analysis used a tetrachoric correlation matrix, with principal axis factor extraction and Promax rotation. Horn's parallel analysis supported the factorial validity of a two-factor model representing OUD as a Disease (Cronbach's alpha = .57) and OUD Treatment and Recovery (Cronbach's alpha = .62). The reliability estimates were deemed adequate given the intended group-level uses for the instrument. Convergent construct validity was partially supported via the OUD Treatment and Recovery factor's negative correlation with personal opioid stigmatization (B = -.29, p =.001). OUD research must produce measures that convert observations to empirical generalizations. The psychometric analysis of the O-Know scale demonstrated progress in reducing measurement error to facilitate that conversion.
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Affiliation(s)
- Virgil L Gregory
- Indiana University School of Social Work, MSW Direct Indianapolis and United States United States
| | - Susan Ofner
- Indiana University School of Medicine and Richard M. Fairbanks School of Public Health Indianapolis United States
| | - Rebecca J Ellis
- Indiana University School of Nursing Indianapolis United States
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6
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Morris J, Boness CL, Witkiewitz K. Should we promote alcohol problems as a continuum? Implications for policy and practice. DRUGS (ABINGDON, ENGLAND) 2023; 31:271-281. [PMID: 38682086 PMCID: PMC11052541 DOI: 10.1080/09687637.2023.2187681] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/01/2023] [Indexed: 04/03/2023]
Abstract
The highly heterogeneous nature of alcohol use and problems has presented significant challenges to those attempting to understand, treat or prevent what is commonly termed alcohol use disorder (AUD). However, any attempts to capture this complex phenomenon, including the various current criterion of AUD, come with a number of limitations. One particular limitation has been how alcohol problems are represented or understood in ways which do not capture the broad spectrum of alcohol use and harms and the many potential routes to prevention, treatment, and recovery. One possible response to this has been proposed as more explicitly framing or conceptualizing a continuum model of alcohol use and harms. In this commentary, we attempt to identify the key implications of a continuum model for policy and practice, examining the historical and current context of alcohol problem classifications and models. We argue a continuum model of alcohol use and problems holds a number of advantages for advancing public health goals, but also some potential limitations, both of which require further examination.
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Affiliation(s)
- J Morris
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, United Kingdom
| | - C L Boness
- Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, New Mexico
| | - K Witkiewitz
- Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, New Mexico
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7
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Siddiqui H, Rutherford MD. Belief that addiction is a discrete category is a stronger correlate with stigma than the belief that addiction is biologically based. Subst Abuse Treat Prev Policy 2023; 18:3. [PMID: 36627629 PMCID: PMC9830773 DOI: 10.1186/s13011-022-00512-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/25/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Drug addiction is stigmatized, and this stigma contributes to poor outcomes for individuals with addiction. Researchers have argued that providing genetic explanations of addiction will reduce stigma, but there has been limited research testing this prediction. METHODS We presented participants (N = 252) with news articles that either provided genetic or anti-genetic explanations of addiction. RESULTS There was no effect of article condition on stigma. Participants' biological essentialism correlated with stigma in the context of both opioid and methamphetamine addiction. However, participants' non-biological essentialism was a significantly stronger correlate with stigma. CONCLUSIONS This suggests that other essentialist beliefs, like belief that categories are discrete, may be more useful than biological essentialism for understanding addiction stigma.
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Affiliation(s)
- Hasan Siddiqui
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
| | - M. D. Rutherford
- grid.25073.330000 0004 1936 8227McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
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8
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Effects of media representations of drug related deaths on public stigma and support for harm reduction. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 111:103909. [PMID: 36399962 DOI: 10.1016/j.drugpo.2022.103909] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/21/2022] [Accepted: 11/04/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Drug related deaths (DRD) are at historically high levels in the United Kingdom (UK), but some approaches that have the potential to reduce risk of mortality remain controversial. Public support makes an important contribution to drug policy development but there are high levels of public stigma towards people who use drugs (PWUD), and this is partly shaped by media representations. We investigated whether depiction of the characteristics of decedents represented in news articles about DRD was associated with differences in stigmatising attitudes and support for harm reduction policy. METHODS We undertook a cross-sectional online study with a randomised design, conducted with a nationally representative sample (UK). Participants (N = 1280) were randomly presented with one of eight simulated news stories that reported on a DRD that differed with respect to drug (ecstasy or heroin), and the gender (male or female) and age (younger or older) of the decedent. Data were analysed using MANOVA. RESULTS Data were obtained for 1248 participants (51.0% female; mean age 45.7±15.4). Stigma was higher towards depictions of male, older, and heroin deaths (all p < .001). Harm reduction support was higher in those participants seeing older compared to younger subjects (p = .035), and the older ecstasy decedent compared to younger decedent (p = .029). CONCLUSION Presentation of some types of DRD are associated with higher public stigma towards the decedent than others. Those groups developing agenda-setting activities designed to reduce stigma or foster public support for harm reduction policies should consider the different ways in which audiences may respond to the depiction and framing of DRD in news media.
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9
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Nguyen Thu T, Dinh TTT, Nguyen Bich D, Hoffman K, Nguyen Thu H, Edsall A, Bart G, Korthuis PT, Le Minh G. Stigma as a barrier to integrated substance use and HIV care in Vietnam: A qualitative examination of patient and provider perspectives. J Ethn Subst Abuse 2022; 23:182-197. [PMID: 35635379 PMCID: PMC9708927 DOI: 10.1080/15332640.2022.2080785] [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: 10/18/2022]
Abstract
Integration of substance use disorder (SUD) treatment and HIV care can increase antiretroviral therapy coverage among people with opioid use disorder (OUD). However, implementation of integrated treatment models remains limited. Stigma towards people with OUD poses a barrier to initiation of, and adherence to, HIV treatment. We sought to understand the extent of stigma towards SUD and HIV among people with OUD in Vietnam, and the effect of stigma on integrated OUD and HIV treatment services utilization. Between 2013 and 2015, we conducted in-depth interviews with 43 patients and 43 providers at 7 methadone clinics and 8 HIV clinics across 4 provinces in Vietnam. We used thematic analysis with a mixed deductive and inductive approach at the semantic level to analyze key topics. Two main themes were identified: (1) Confidentiality concerns about HIV status make patients reluctant to receive integrated care at HIV clinics, given the requirements for daily buprenorphine dosing at HIV clinics. (2) Provider stigma existed mostly toward people with OUD and seemed to center on the belief that substance use causes a deterioration in one's morals, and was most frequently manifested in the form of providers' apprehensive approach towards patients. Concerns regarding stigmatization may cause patients to feel reluctant to receive treatment for both OUD and HIV at a single integrated clinic. Interventions to reduce stigma at the clinic and policy levels may thus serve to improve initiation of and adherence to integrated care.
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Affiliation(s)
| | | | | | - Kim Hoffman
- Oregon Health and Science University, Portland, Oregon
| | | | | | - Gavin Bart
- Hennepin Healthcare and University of Minnesota, Minneapolis, Minnesota
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10
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Barry DT, Oberleitner DE, Beitel M, Oberleitner LMS, Gazzola MG, Eller A, Madden LM, Zheng X, Bergman E, Tamberelli JF. A Student Walks into Class … Vignettes to Identify Substance Use Disorder Models of Illness among College Students. Subst Use Misuse 2022; 57:1523-1533. [PMID: 35787230 DOI: 10.1080/10826084.2022.2091787] [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] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Illness models, including illness recognition, perceived severity, and perceived nature can affect treatment-seeking behaviors. Vignettes are a leading approach to examine models of illness but are understudied for substance use disorders (SUDs). We created vignettes for multiple common DSM-5 SUDs and assessed SUD illness models among college students. METHODS Seven vignettes in which the protagonist meets DSM-5 diagnostic criteria for SUDs involving tobacco, alcohol, cannabis, Adderall, cocaine, Vicodin, and heroin were pilot tested and randomly assigned to 216 college students who completed measures related to illness recognition, perceived severity, and perceived nature. MANOVAs with Scheffe post-hoc tests were conducted to examine vignette group differences on models of illness. RESULTS Vignettes met acceptable levels of clarity and plausibility. Participants characterized the protagonist's substance use as a problem, a SUD, or an addiction most frequently with Vicodin, heroin, and cocaine and least frequently with tobacco and cannabis. Participants assigned to the Vicodin, heroin, and cocaine vignettes were the most likely to view the protagonist's situation as serious and life-threatening, whereas those assigned to the cannabis vignette were the least likely. Numerically more participants characterized the pattern of substance use as a problem (91%) or an addiction (90%) than a SUD (76%), while only 15% characterized it as a chronic medical condition. CONCLUSIONS Illness recognition and perceived severity varied across substances and were lowest for cannabis. Few participants conceptualized SUDs as chronic medical conditions. College students may benefit from psychoeducation regarding cannabis use disorder and the chronic medical condition model of SUDs.
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Affiliation(s)
- Declan T Barry
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,APT Foundation, Inc, New Haven, Connecticut, USA
| | - David E Oberleitner
- APT Foundation, Inc, New Haven, Connecticut, USA.,Department of Psychology, University of Bridgeport, Bridgeport, Connecticut, USA
| | - Mark Beitel
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,APT Foundation, Inc, New Haven, Connecticut, USA
| | - Lindsay M S Oberleitner
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,APT Foundation, Inc, New Haven, Connecticut, USA.,Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Marina Gaeta Gazzola
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,APT Foundation, Inc, New Haven, Connecticut, USA
| | - Anthony Eller
- APT Foundation, Inc, New Haven, Connecticut, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lynn M Madden
- APT Foundation, Inc, New Haven, Connecticut, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Xiaoying Zheng
- APT Foundation, Inc, New Haven, Connecticut, USA.,Yale University, New Haven, Connecticut, USA
| | - Emma Bergman
- APT Foundation, Inc, New Haven, Connecticut, USA.,Quinnipiac School of Medicine, Hamden, Connecticut, USA
| | - Joseph F Tamberelli
- APT Foundation, Inc, New Haven, Connecticut, USA.,Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
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11
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Murphy J, Russell B. Police Officers' addiction frameworks and policy attitudes. Addict Behav 2021; 122:107007. [PMID: 34146796 DOI: 10.1016/j.addbeh.2021.107007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 04/08/2021] [Accepted: 06/03/2021] [Indexed: 01/01/2023]
Abstract
Police officers have frequent encounters with people who use drugs, either by making an arrest for a drug-related offense or responding to a drug overdose call. Yet, little is known about how police officers view drug addiction - as a disease, a moral failure, or something else - and how their frameworks for conceptualizing addiction impact their attitudes toward drug policies, including the use of naloxone. This research examined police officers' adherence to a moralistic addiction framework in relation to their support for treatment-oriented drug policies. Officers (N = 618) were surveyed about their beliefs on drug policy and the extent to which drug addiction was a product of one's morals or related to social or biological reasons. Results found that approximately 22% of the variance in drug policy attitudes could be explained by addiction frameworks and control variables. Officers who embraced a biological perspective of addiction were more supportive of policies that expanded treatment, including access to naloxone, and less punitive sanctions. Those with stronger moralistic views were less supportive of expanding treatment initiatives and endorsed expanding punitive sanctions. Officer age and education was positively related with expanding treatment and naloxone use while exposure to overdoses was negatively related to policy support. These results demonstrate that officers' frameworks about drug addiction play an important role in drug policy attitudes and, by extension, how they might interact with people who use drugs.
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12
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Meyers SA, Earnshaw VA, D’Ambrosio B, Courchesne N, Werb D, Smith LR. The intersection of gender and drug use-related stigma: A mixed methods systematic review and synthesis of the literature. Drug Alcohol Depend 2021; 223:108706. [PMID: 33901753 PMCID: PMC8168566 DOI: 10.1016/j.drugalcdep.2021.108706] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Substance use-related stigma is a significant barrier to care among persons who use drugs (PWUD). Less is known regarding how intersectional identities, like gender, shape experiences of substance use-related stigma. We sought to answer the following question: Do men or women PWUD experience more drug use stigma? METHODS Data were drawn from a systematic review of the global, peer-reviewed scientific literature on substance use-related stigma conducted through 2017 and guided by the Stigma and Substance Use Process Model and PRISMA guidelines. Articles were included in the present analysis if they either qualitatively illustrated themes related to the gendered nature of drug use-related stigma, or quantitatively tested the moderating effect of gender on drug use-related stigma. RESULTS Of the 75 studies included, 40 (53 %) were quantitative and 35 (47 %) were qualitative. Of the quantitative articles, 22 (55 %) found no association between gender and drug use-related stigma, 4 (10 %) identified women who use drugs (WWUD) were more stigmatized, and 2 (5 %) determined men who use drugs (MWUD) were more stigmatized. In contrast, nearly all (34; 97 %) of the qualitative articles demonstrated WWUD experienced greater levels of drug use-related stigma. CONCLUSION The quantitative literature is equivocal regarding the influence of gender on drug use-related stigma, but the qualitative literature more clearly demonstrates WWUD experience greater levels of stigma. The use of validated drug use-related stigma measures and the tailoring of stigma scales to WWUD are needed to understand the role of stigma in heightening the disproportionate harms experienced by WWUD.
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Affiliation(s)
- S. A. Meyers
- Department of Psychology, 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
| | - V. A. Earnshaw
- Human Development and Family Sciences, University of Delaware,
Newark, DE, 19716, USA
| | - B. D’Ambrosio
- Division of Infectious Diseases and Global Public Health,
Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla,
CA 92093, USA,School of Social Work, College of Health and Human Services,
San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - N. Courchesne
- Department of Psychiatry, University of California San Diego,
9500 Gilman Drive, La Jolla, CA 92093, USA
| | - D. 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 1W8 Canada
| | - L. 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
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Kilian C, Manthey J, Carr S, Hanschmidt F, Rehm J, Speerforck S, Schomerus G. Stigmatization of people with alcohol use disorders: An updated systematic review of population studies. Alcohol Clin Exp Res 2021; 45:899-911. [PMID: 33970504 DOI: 10.1111/acer.14598] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/04/2021] [Accepted: 03/10/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND We summarize research on the public stigmatization of persons with alcohol use disorder (AUD) in comparison with other mental health conditions and embed the results into a conceptual framework of the stigma process. METHODS We conducted a systematic search using Embase, MEDLINE, PubMed and PsycINFO (via Ovid), and Web of Science for population-based studies on the public stigma in AUD and at least 1 other mental health condition, published between October 1, 2010 and December 20, 2020, thus including all studies published since the last systematic review on this topic. The study is registered with PROSPERO (registration number: CRD42020173054). RESULTS We identified 20,561 records, of which 24 met the inclusion criteria, reporting results from 16 unique studies conducted in 9 different countries. Compared to substance-unrelated mental disorders, persons with AUD were generally less likely to be considered mentally ill, while they were perceived as being more dangerous and responsible for their condition. Further, the public desire for social distance was consistently higher for people with AUD. We found no consistent differences in the public stigma toward persons with AUD in comparison with other substance use disorders. CONCLUSION The stigmatization of persons with AUD remains comparatively high and is distinct from that of other substance-unrelated disorders.
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Affiliation(s)
- Carolin Kilian
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Centre for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany.,Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Sinclair Carr
- Centre for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany
| | - Franz Hanschmidt
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Jürgen Rehm
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Centre for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany.,Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Sven Speerforck
- Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Georg Schomerus
- Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany
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14
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Abstract
The addictions are subject to a great deal of stigma, the constituents of which include negative attributions such as being immoral, weak-willed, or sick. Negative outcomes include exclusion from positive life opportunities. In this commentary, I briefly discuss the definition of stigma, descriptors of addiction-related stigma, and negative consequences. Solutions to reduce addiction-related stigma are mentioned including providing greater interpersonal exposure to persons recovering from addiction, corrective information education, altering the language used to describe and classify persons who have suffered from addiction, and possibly viewing addiction vulnerability as an example of neurodiversity, as opposed to a character flaw or a disease. Suggestions for future research on reducing addiction-related stigma are suggested.
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Affiliation(s)
- Steve Sussman
- 5116University of Southern California, Los Angeles, CA, USA
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15
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16
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Rundle SM, Cunningham JA, Hendershot CS. Implications of addiction diagnosis and addiction beliefs for public stigma: A cross-national experimental study. Drug Alcohol Rev 2021; 40:842-846. [PMID: 33493359 DOI: 10.1111/dar.13244] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 12/04/2020] [Accepted: 12/15/2020] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Stigmatisation of alcohol and other drug (AOD) use disorders poses a significant barrier to treatment access. A review by the World Health Organization concluded that addictive disorders were the most stigmatised health condition. Few studies have examined whether different etiological models of addiction (MOA) have implications for public stigma toward AOD disorders. The current study examined whether beliefs representative of five MOA predict public stigma levels and whether stigma differs for AOD use disorders relative to other health conditions. METHODS Survey data were collected from Canada, the USA and Australia using an online data collection platform. Participants were randomised to one of four vignette manipulations describing an individual with an alcohol use disorder and/or other disorder. Participants' stigma toward the vignette character and beliefs related to five MOA (disease, moral, psychological, sociological, nature) were measured. RESULTS Stigma ratings were significantly higher in the alcohol use disorder condition compared to other conditions. Two MOA accounted for significant variance in stigma ratings, where greater beliefs in the nature and psychological MOA predicted significantly lower levels of stigma toward alcohol use disorder. Contrary to predictions, beliefs in the disease MOA did not relate to lower stigma. Lastly, beliefs in the moral MOA partly accounted for geographical region differences (the USA vs. Canada) in public stigma. DISCUSSION AND CONCLUSIONS The current study provides further experimental support that AOD disorders are more stigmatised than others. Additionally, the findings suggest that MOA may relate differentially to perceived stigma, and that regional variability in such beliefs exists.
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Affiliation(s)
- Samantha M Rundle
- Department of Psychology, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, Toronto, Canada
| | - John A Cunningham
- Department of Psychology, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, Toronto, Canada
| | - Christian S Hendershot
- Department of Psychology, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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17
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Deen H, Kershaw S, Newton N, Stapinski L, Birrell L, Debenham J, Champion KE, Kay-Lambkin F, Teesson M, Chapman C. Stigma, discrimination and crystal methamphetamine (‘ice’): Current attitudes in Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 87:102982. [DOI: 10.1016/j.drugpo.2020.102982] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 10/23/2022]
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18
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Thu Trang N, Jauffret-Roustide M, Minh Giang L, Visier L. How to be self-reliant in a stigmatising context? Challenges facing people who inject drugs in Vietnam. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 87:102913. [PMID: 32855011 PMCID: PMC8118722 DOI: 10.1016/j.drugpo.2020.102913] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 06/17/2020] [Accepted: 08/09/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Stigma works to reinforce dominant social values. The meaning of stigma is therefore not static but dependant on the regime in power. Taking into account the significant socioeconomic changes that took place in Vietnam over the last thirty years, this study explores the meaning of stigma directed at Vietnamese people who inject drugs in different social spheres. METHODS This qualitative study was conducted as part of an evaluation of a peer outreach program that distributes harm-reduction supplies and information, and provides treatment referral assistance to people who inject drugs in Haiphong, Vietnam. We conducted ethnographic field observations with peer outreach workers, home visits, and 54 in-depth interviews with participants in 2017 and 2018. Grounded theory led our theoretical sampling and analysis. RESULTS Stigma towards people who inject drugs seems to centre on the ability to be self-reliant rather than on drug-using behaviours. Participants described how their families and neighbours expressed expectations that they should manage their substance use issues by themselves, without considering the barriers they face in the job market. Participants interpret stigma directed at them in terms of poverty rather than drug use. As a result, they sometimes engage in illegal income-generating activities to pursue financial autonomy and to regain their social status. CONCLUSION People who inject drugs were struggling to conform to social expectations of self-reliance with limited support to realise it. Effective interventions must consider the many facets and challenges individuals encounter in their daily lives.
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Affiliation(s)
- Nguyen Thu Trang
- Centre for Research and Training on Substance Abuse - HIV, Hanoi Medical University, Hanoi, Vietnam.
| | - Marie Jauffret-Roustide
- Centre for Research and Training on Substance Abuse - HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Le Minh Giang
- Centre for Research and Training on Substance Abuse - HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Laurent Visier
- Centre for Research and Training on Substance Abuse - HIV, Hanoi Medical University, Hanoi, Vietnam
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19
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Richards SN, Broadus AD, Yelderman LA. Treatment and Non-Treatment Professionals in Texas: Race, Sex, Age, and Level of Education Influencing Attitudes About Addiction. JOURNAL OF DRUG ISSUES 2020. [DOI: 10.1177/0022042620971857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Using a two-step process, attitudes about addiction among Texas professionals working primarily with youth were examined. In Step 1, researchers examined attitudes about addiction in Texas ( n = 1,078), across professionals working with youth. In Step 2, researchers selected a subset of treatment and non-treatment professionals ( n = 522) and tested two hypotheses related to differences in attitudes between the two professional groups. Two research questions were also explored. Step 1 analyses revealed stronger endorsement of attitudes related to the psychological and sociological models, and that demographic variables were modest but significant predictors of attitudes about addiction. Step 2 analyses revealed that professional status and demographic variables were significant predictors of attitudes about addiction. Findings have implications for treatment seeking, treatment and non-treatment professional behavior toward adolescents with substance use issues, and the need for continuing education to reduce stigma.
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20
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Sumnall HR, Hamilton I, Atkinson AM, Montgomery C, Gage SH. Representation of adverse childhood experiences is associated with lower public stigma towards people who use drugs: an exploratory experimental study. DRUGS-EDUCATION PREVENTION AND POLICY 2020. [DOI: 10.1080/09687637.2020.1820450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Harry R. Sumnall
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Ian Hamilton
- Department of Health Sciences, University of York, York, UK
| | - Amanda M. Atkinson
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | | | - Suzanne H. Gage
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
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21
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Morris J, Albery IP, Heather N, Moss AC. Continuum beliefs are associated with higher problem recognition than binary beliefs among harmful drinkers without addiction experience. Addict Behav 2020; 105:106292. [PMID: 32007833 DOI: 10.1016/j.addbeh.2020.106292] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 01/03/2020] [Accepted: 01/05/2020] [Indexed: 11/18/2022]
Abstract
Low problem recognition may be an important barrier to opportunities for self-change or help-seeking in harmful drinkers. Little is known about how the beliefs harmful drinkers hold about the nature and causes of alcohol problems affect problem recognition and subsequent behaviour change processes. Participants (n = 597) recruited online were randomised to one of two conditions designed to promote beliefs according to (a) a continuum model of alcohol problems or (b) a binary disease model, or (c) a control condition. Participants completed measures of alcohol problem beliefs, problem recognition and other indices including the Alcohol Use Disorder Identification Test (AUDIT), addiction beliefs, addiction experience and demographics. Results showed that harmful drinkers without addiction experience exposed to the continuum condition had significantly higher problem recognition than those in binary disease model or control conditions. Continuum beliefs appear to offer self-evaluative benefits for harmful drinkers with low alcohol problem recognition, thus potentially facilitating help-seeking or self-change regarding alcohol use. Further research to understand the mechanisms by which continuum beliefs may promote more accurate drinking self-evaluation and its potential for behaviour change is warranted. The role of continuum beliefs may have important consequences for alcohol-related messaging and interventions seeking to promote self-change or help-seeking.
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Affiliation(s)
- J Morris
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, United Kingdom.
| | - I P Albery
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, United Kingdom
| | - N Heather
- Faculty of Health & Life Sciences, Northumbria University, United Kingdom
| | - A C Moss
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, United Kingdom
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22
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Berryessa CM, Krenzer WLD. The Stigma of Addiction and Effects on Community Perceptions of Procedural Justice in Drug Treatment Courts. JOURNAL OF DRUG ISSUES 2020. [DOI: 10.1177/0022042620918950] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present a series of four between-subject, multifactorial experiments that examine how labeling offenders with addiction, as well as if that psychiatric label is described to be biologically influenced, may affect community perceptions regarding the importance of procedural justice in drug treatment courts. Stigmatization toward addiction is hypothesized to moderate community views on procedural justice. Labeling with addiction garnered nonsignificant effects on community perceptions of the importance of procedural justice in drug treatment courts. Yet, patterns of moderation analyses indicated that participants with higher degrees of stigmatization toward an offender with addiction, and particularly if that psychiatric label was also described to be biologically influenced, rated the importance of offenders experiencing aspects of procedural justice as significantly higher. Higher degrees of public stigmatization associated with the “brain disease model” of addiction appear to coexist with increased community support for offenders with such labels experiencing increased procedural justice and fairness.
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23
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Hopper JW. Values and visions for the field of psychological trauma, from brain to re-moralization and social transformation. J Trauma Dissociation 2020; 21:279-292. [PMID: 32026755 DOI: 10.1080/15299732.2020.1718968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- James W Hopper
- Independent Consultant and Department of Psychiatry, Harvard Medical School
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24
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Obesity Stigma: Is the 'Food Addiction' Label Feeding the Problem? Nutrients 2019; 11:nu11092100. [PMID: 31487868 PMCID: PMC6770691 DOI: 10.3390/nu11092100] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/27/2019] [Accepted: 08/30/2019] [Indexed: 02/06/2023] Open
Abstract
Obesity is often attributed to an addiction to high-calorie foods. However, the effect of "food addiction" explanations on weight-related stigma remains unclear. In two online studies, participants (n = 439, n = 523, respectively, recruited from separate samples) read a vignette about a target female who was described as 'very overweight'. Participants were randomly allocated to one of three conditions which differed in the information provided in the vignette: (1) in the "medical condition", the target had been diagnosed with food addiction by her doctor; (2) in the "self-diagnosed condition", the target believed herself to be a food addict; (3) in the control condition, there was no reference to food addiction. Participants then completed questionnaires measuring target-specific stigma (i.e., stigma towards the female described in the vignette), general stigma towards obesity (both studies), addiction-like eating behavior and causal beliefs about addiction (Study 2 only). In Study 1, participants in the medical and self-diagnosed food addiction conditions demonstrated greater target-specific stigma relative to the control condition. In Study 2, participants in the medical condition had greater target-specific stigma than the control condition but only those with low levels of addiction-like eating behavior. There was no effect of condition on general weight-based stigma in either study. These findings suggest that the food addiction label may increase stigmatizing attitudes towards a person with obesity, particularly within individuals with low levels of addiction-like eating behavior.
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25
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Rise J, Halkjelsvik T. Conceptualizations of Addiction and Moral Responsibility. Front Psychol 2019; 10:1483. [PMID: 31316438 PMCID: PMC6610207 DOI: 10.3389/fpsyg.2019.01483] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/11/2019] [Indexed: 11/13/2022] Open
Abstract
The present study explored the connection between conceptualizations of addiction and lay people's inferences about moral responsibility. In Study 1, we investigated how natural variations in people's views of addiction were related to judgments of responsibility in a nationwide sample of Norwegian adults. In Study 2, respondents recruited from Mechanical Turk were asked to consider different conceptualizations of addiction and report on how these would affect their judgments of moral responsibility. In Study 3, we tested whether manipulating conceptualizations through textual information and through the framing of addiction in terms of states versus behavior could influence participants' judgments of moral responsibility. We found that attributions of moral responsibility were lower when addiction was connected to diseases and disorders, such as dysfunctional processes in the brain, and greater when addiction was associated with agency and addictive behaviors. In conclusion, different conceptualizations of addiction imply different moral judgments, and conceptualizations are malleable.
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Affiliation(s)
- Jostein Rise
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| | - Torleif Halkjelsvik
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
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26
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Abstract
Background: Recent literature on addiction and judgments about the characteristics of agents has focused on the implications of adopting a “brain disease” versus “moral weakness” model of addiction. Typically, such judgments have to do with what capacities an agent has (e.g., the ability to abstain from substance use). Much less work, however, has been conducted on the relationship between addiction and judgments about an agent’s identity, including whether or to what extent an individual is seen as the same person after becoming addicted. Methods: We conducted a series of vignette-based experiments (total N = 3,620) to assess lay attitudes concerning addiction and identity persistence, systematically manipulating key characteristics of agents and their drug of addiction. Conclusions: In Study 1, we found that U.S. participants judged an agent who became addicted to drugs as being closer to “a completely different person” than “completely the same person” as the agent who existed prior to the addiction. In Studies 2–6, we investigated the intuitive basis for this result, finding that lay judgments of altered identity as a consequence of drug use and addiction are driven primarily by perceived negative changes in the moral character of drug users, who are seen as having deviated from their good true selves.
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Affiliation(s)
- Brian D Earp
- a Departments of Philosophy and Psychology, Yale University, New Haven, Connecticut, United States.,b Yale-Hastings Program in Ethics and Health Policy, The Hastings Center, Garrison, New York, United States.,c Uehiro Centre for Practical Ethics, University of Oxford, Oxford, United Kingdom
| | | | - Jim A C Everett
- c Uehiro Centre for Practical Ethics, University of Oxford, Oxford, United Kingdom
| | - Julian Savulescu
- c Uehiro Centre for Practical Ethics, University of Oxford, Oxford, United Kingdom
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27
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Loughman A, Haslam N. Neuroscientific explanations and the stigma of mental disorder: a meta-analytic study. COGNITIVE RESEARCH-PRINCIPLES AND IMPLICATIONS 2018; 3:43. [PMID: 30426319 PMCID: PMC6234201 DOI: 10.1186/s41235-018-0136-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 08/09/2018] [Indexed: 12/31/2022]
Abstract
Genetic and other biological explanations appear to have mixed blessings for the stigma of mental disorder. Meta-analytic evidence shows that these “biogenetic” explanations reduce the blame attached to sufferers, but they also increase aversion, perceptions of dangerousness, and pessimism about recovery. These relationships may arise because biogenetic explanations recruit essentialist intuitions, which have known associations with prejudice and the endorsement of stereotypes. However, the adverse implications of biogenetic explanations as a set may not hold true for the subset of those explanations that invoke neurobiological causes. Neurobiological explanations might have less adverse implications for stigma than genetic explanations, for example, because they are arguably less essentialist. Although this possibility is important for evaluating the social implications of neuroscientific explanations of mental health problems, it has yet to be tested meta-analytically. We present meta-analyses of links between neurobiological explanations and multiple dimensions of stigma in 26 correlational and experimental studies. In correlational studies, neurobiological explanations were marginally associated with greater desire for social distance from people with mental health problems. In experimental studies, these explanations were associated with greater desire for social distance, greater perceived dangerousness, and greater prognostic pessimism. Neurobiological explanations were not linked to reduced blame in either set of studies. By implication, neurobiological explanations have the same adverse links to stigma as other forms of biogenetic explanation. These findings raise troubling implications about the public impact of psychiatric neuroscience research findings. Although such findings are not intrinsically stigmatizing, they may become so when viewed through the lens of neuroessentialism.
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Affiliation(s)
- Amy Loughman
- Food & Mood Centre, Deakin University, Geelong, VIC, 3220, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Nick Haslam
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, 3010, Australia.
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28
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Racine E, Sattler S, Escande A. Free Will and the Brain Disease Model of Addiction: The Not So Seductive Allure of Neuroscience and Its Modest Impact on the Attribution of Free Will to People with an Addiction. Front Psychol 2017; 8:1850. [PMID: 29163257 PMCID: PMC5672554 DOI: 10.3389/fpsyg.2017.01850] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 10/04/2017] [Indexed: 12/18/2022] Open
Abstract
Free will has been the object of debate in the context of addiction given that addiction could compromise an individual's ability to choose freely between alternative courses of action. Proponents of the brain-disease model of addiction have argued that a neuroscience perspective on addiction reduces the attribution of free will because it relocates the cause of the disorder to the brain rather than to the person, thereby diminishing the blame attributed to the person with an addiction. Others have worried that such displacement of free will attribution would make the person with a drug addiction less responsible. Using the paradigmatic literature on the seductive allure of neuroscience explanations, we tested whether neuroscience information diminishes attributions of free will in the context of addiction and whether respondent characteristics influence these attributions and modulate the effect of neuroscience information. We performed a large-scale, web-based experiment with 2,378 German participants to explore how attributions of free will in the context of addiction to either alcohol or cocaine are affected by: (1) a text with a neurobiological explanation of addiction, (2) a neuroimage showing effects of addiction on the brain, and (3) a combination of a text and a neuroimage, in comparison to a control group that received no information. Belief in free will was measured using the FAD-Plus scale and was, subsequent to factor analysis, separated into two factors: responsibility and volition. The investigated respondent characteristics included gender, age, education, self-reported knowledge of neuroscience, substance-use disorder (SUD), and having a friend with SUD. We found that attributions of volition (in the cocaine-subsample) were reduced in the text and neuroimage-treatment compared to the control group. However, respondent characteristics such as education and self-reported knowledge of neuroscience were associated with lower attributions of responsibility for both substances, and education was associated with lower attribution of volition for the alcohol sub-sample. Interaction analyses showed that knowledge of neuroscience was found to generally decrease attribution of responsibility. Further research on attribution of free will should consider the effects of context and respondent characteristics, which appeared surprisingly larger than those induced by experimental treatments.
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Affiliation(s)
- Eric Racine
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
- Biomedical Ethics Unit, Division of Experimental Medicine, Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
- Department of Medicine and Department of Social and Preventive Medicine, Université de Montréal, Montréal, QC, Canada
| | - Sebastian Sattler
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
- Institute for Sociology and Social Psychology, University of Cologne, Cologne, Germany
| | - Alice Escande
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
- Cognitive Science Program, McGill University, Montréal, QC, Canada
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29
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Fraser S, Pienaar K, Dilkes-Frayne E, Moore D, Kokanovic R, Treloar C, Dunlop A. Addiction stigma and the biopolitics of liberal modernity: A qualitative analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 44:192-201. [DOI: 10.1016/j.drugpo.2017.02.005] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/24/2017] [Accepted: 02/24/2017] [Indexed: 11/25/2022]
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30
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Piras AP, Preti A, Moro MF, Giua A, Sini G, Piras M, Pintus M, Pintus E, Manca A, Cannas G, Cossu G, Angermeyer MC, Carta MG. Does calling alcoholism an illness make a difference? The public image of alcoholism in Italy. Drug Alcohol Depend 2016; 166:39-44. [PMID: 27373185 DOI: 10.1016/j.drugalcdep.2016.06.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 06/15/2016] [Accepted: 06/17/2016] [Indexed: 10/21/2022]
Abstract
AIMS Using data from a population survey in two communities in the region of Sardinia, Italy, we examined the association between illness definition and attribution of personal characteristics to people with alcoholism. METHODS Quota samples, stratified by gender and age, were drawn from the general population (males: 48%; mean age 48±18; range: 15-90). A fully-structured interview was conducted face-to-face with 404 respondents. The assessment of the public view of 'alcoholics' was measured by their reactions to stimulus words rated on bipolar scales, and defined with adjectives with opposite meanings at each end. RESULTS 322 participants (80%) rated the 'alcoholic' as 'ill'. The definition of the 'alcoholic' as being ill showed a statistically higher odd of stigma across all the dimensions of personal attributes. CONCLUSIONS The expectation that people adopting the illness model would tend to blame less those afflicted for their condition and, consequently, stigmatize them less, was not confirmed.
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Affiliation(s)
- Anna Paola Piras
- Centro di Psichiatria e di Consultazione Psicosomatica Azienda Ospedaliero Universitaria S. Giovanni di Dio, Cagliari, Italy; Dipartimento di Sanità Pubblica, Medicina Clinica e Molecolare, Università di Cagliari, Cagliari, Italy
| | - Antonio Preti
- Centro di Psichiatria e di Consultazione Psicosomatica Azienda Ospedaliero Universitaria S. Giovanni di Dio, Cagliari, Italy.
| | - Maria Francesca Moro
- Centro di Psichiatria e di Consultazione Psicosomatica Azienda Ospedaliero Universitaria S. Giovanni di Dio, Cagliari, Italy
| | - Alice Giua
- Corso di Laurea in Tecnico della Riabilitazione Psichiatrica, Università di Cagliari, Cagliari, Italy
| | - Giulia Sini
- Corso di Laurea in Tecnico della Riabilitazione Psichiatrica, Università di Cagliari, Cagliari, Italy
| | - Martina Piras
- Corso di Laurea in Tecnico della Riabilitazione Psichiatrica, Università di Cagliari, Cagliari, Italy
| | - Mirra Pintus
- Centro di Psichiatria e di Consultazione Psicosomatica Azienda Ospedaliero Universitaria S. Giovanni di Dio, Cagliari, Italy
| | - Elisa Pintus
- Centro di Psichiatria e di Consultazione Psicosomatica Azienda Ospedaliero Universitaria S. Giovanni di Dio, Cagliari, Italy
| | - Annaraffaela Manca
- Centro di Psichiatria e di Consultazione Psicosomatica Azienda Ospedaliero Universitaria S. Giovanni di Dio, Cagliari, Italy
| | - Glenda Cannas
- Centro di Psichiatria e di Consultazione Psicosomatica Azienda Ospedaliero Universitaria S. Giovanni di Dio, Cagliari, Italy
| | - Giulia Cossu
- Dipartimento di Sanità Pubblica, Medicina Clinica e Molecolare, Università di Cagliari, Cagliari, Italy
| | - Matthias Claus Angermeyer
- Dipartimento di Sanità Pubblica, Medicina Clinica e Molecolare, Università di Cagliari, Cagliari, Italy
| | - Mauro Giovanni Carta
- Centro di Psichiatria e di Consultazione Psicosomatica Azienda Ospedaliero Universitaria S. Giovanni di Dio, Cagliari, Italy; Dipartimento di Sanità Pubblica, Medicina Clinica e Molecolare, Università di Cagliari, Cagliari, Italy; Corso di Laurea in Tecnico della Riabilitazione Psichiatrica, Università di Cagliari, Cagliari, Italy
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Howard MO, Mackridge AJ. Editorial. J Addict Dis 2016; 35:71-2. [PMID: 27049547 DOI: 10.1080/10550887.2016.1156412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Vederhus JK, Clausen T, Humphreys K. Assessing understandings of substance use disorders among Norwegian treatment professionals, patients and the general public. BMC Health Serv Res 2016; 16:52. [PMID: 26873360 PMCID: PMC4752790 DOI: 10.1186/s12913-016-1306-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 02/10/2016] [Indexed: 11/17/2022] Open
Abstract
Background Beliefs about substance use disorder (SUD) shape how patients, treatment professionals and the general public view addiction and its treatment. A U.S. developed scale exists to assess such beliefs, but it has never been tested in Norway nor normed on any general population sample. Methods The Short Understanding of Substance Abuse Scale (SUSS) was translated from English to Norwegian and used to assess beliefs about the nature of addiction among addiction treatment professionals (N = 291), patients with SUDs (N = 133) and respondents from the general public (N = 216). The disease and psychosocial model subscales of the SUSS were examined with a multigroup factor analysis to confirm that the constructs were invariant across the studied groups. We also controlled for demographic covariates in a multiple indicator multiple cause model. Results The multigroup confirmatory factor analysis of the SUSS yielded a partial scalar invariant model and thus, we were able to compare latent means between groups. In unadjusted comparisons, patients and the general public reported significantly higher endorsement of disease model beliefs than did professionals. However, the difference between professionals and the general public disappeared when the comparison was adjusted for covariates (i.e., age, gender, education). In both unadjusted and adjusted analyses, the general public group but not the patient group scored significantly lower than professionals on the psychosocial belief scale. Conclusion The SUSS is useable with slight adaptations in Norwegian samples. Norwegian treatment professionals have different views of substance use disorder than do patients and the general public. This may create opportunities for dialogue and mutual learning, but also presents risk of miscommunication and distrust.
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Affiliation(s)
- John-Kåre Vederhus
- Addiction Unit, Sørlandet Hospital HF, P.b. 416, 4604, Kristiansand, Norway.
| | - Thomas Clausen
- Addiction Unit, Sørlandet Hospital HF, P.b. 416, 4604, Kristiansand, Norway.,Norwegian Center for Addiction Research, University of Oslo, Oslo, Norway
| | - Keith Humphreys
- Veterans Health Administration, Palo Alto, California, USA.,Stanford University School of Medicine, Stanford, California, USA
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The brain disease model of addiction: challenging or reinforcing stigma? Lancet Psychiatry 2015; 2:292. [PMID: 26360071 DOI: 10.1016/s2215-0366(15)00050-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 01/28/2015] [Indexed: 11/20/2022]
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Hall W, Carter A, Forlini C. The brain disease model of addiction: challenging or reinforcing stigma?--Authors' reply. Lancet Psychiatry 2015; 2:292. [PMID: 26360069 DOI: 10.1016/s2215-0366(15)00083-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 02/11/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Wayne Hall
- Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, Queensland, Australia; Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia; National Addiction Centre, Kind's College London, London, UK.
| | - Adrian Carter
- Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia; School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Cynthia Forlini
- Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
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