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Chapter 9 - Three Competing Agendas of Addressing Stigma of Substance Use Disorder

Published online by Cambridge University Press:  23 June 2022

By
Carla D. Kundert  and
Patrick W. Corrigan
Edited by
Georg Schomerus  and
Patrick William Corrigan
Georg Schomerus
Affiliation:
Universität Leipzig
Patrick William Corrigan
Affiliation:
Illinois Institute of Technology
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Summary

Efforts to reduce stigma of substance use disorder can be described by three sometimes-competing agendas: (1) the services agenda, which aims to reduce public stigma that often serves as a barrier to treatment-seeking; (2) the rights agenda, which aims to replace stigma with rightful opportunity and full social inclusion; and (3) the self-worth agenda, which centers empowerment and self-determination over shame. Sometimes efforts to further one of these agendas can unintentionally undercut the efforts of another. However, efforts that elevate the lived experience voice may be critical in reducing stigma without undermining the various agendas. As researchers, advocates, and people with lived experience work to understand and reduce the stigma of substance use disorder, each must be intentional with their efforts to ensure that their pursuit in the name of one agenda does not impede the progress of the others.

Keywords

Stigma reductionagendatreatment-seekingrightspeer supportself-worthempowerment
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Chapter
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The Stigma of Substance Use Disorders , pp. 163 - 179
Publisher: Cambridge University Press
Print publication year: 2022

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References

Barney, L. J., Griffiths, K. M., Jorm, A. F., & Christensen, H. (2006). Stigma about depression and its impact on help-seeking intentions. Australian & New Zealand Journal of Psychiatry, 40(1), 51–54. https://doi.org/10.1080/j.1440-1614.2006.01741.xGoogle Scholar
Barry, C. L., Sherman, S. G., Stone, E., et al. (2019). Arguments supporting and opposing legalization of safe consumption sites in the US. International Journal of Drug Policy, 63, 18–22. https://doi.org/10.1016/j.drugpo.2018.10.008Google Scholar
Ben-Zeev, D., Corrigan, P. W., Britt, T. W., & Langford, L. (2012). Stigma of mental illness and service use in the military. Journal of Mental Health, 21(3), 264–273. https://doi.org/10.3109/09638237.2011.621468Google Scholar
Birtel, M. D., Wood, L., & Kempa, N. J. (2017). Stigma and social support in substance abuse: Implications for mental health and well-being. Psychiatry Research, 252, 1–8. https://doi.org/10.1016/j.psychres.2017.01.097Google Scholar
Bland, E., Oppenheimer, L. W., Oppenheimer, L., et al. (2001). Influence of an educational program on medical students’ attitudes to substance use disorders in pregnancy. The American Journal of Drug and Alcohol Abuse, 27(3), 483–490. https://doi-org.ezproxy.gl.iit.edu/10.1081/ADA-100104513Google Scholar
Cadiz, D. M., Butell, S. S., Epeneter, B. J., Basin, B., & O’Neill, C. (2012). Quasi-experimental evaluation of a substance use awareness educational intervention for nursing students. Journal of Nursing Education, 51(7), 411–415. https://doi.org/10.3928/01484834-20120515-02Google Scholar
Caulkins, J. P., & Chandler, S. (2006). Long-run trends in incarceration of drug offenders in the US. Crime and Delinquency, 52(4), 619–641. https://doi-org.ezproxy.gl.iit.edu/10.1177/0011128705284793Google Scholar
Caulkins, J. P., Kasunic, A., Kleiman, M., & Lee, M. A. C. (2014). Understanding drug legalization. International Public Health Journal, 6(3), 283–294.Google Scholar
Clement, S., Schauman, O., Graham, T., et al. (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, 45(1), 11–27. https://doi.org/10.1017/S0033291714000129Google Scholar
Corrigan, P. W. (2016). Lessons learned from unintended consequences about erasing the stigma of mental illness. World Psychiatry, 15(1), 67–73. https://doi-org.ezproxy.gl.iit.edu/10.1002/wps.20295Google Scholar
Corrigan, P. W. (2019). Beware the word police. Psychiatric Services, 70(3), 234–236. https://doi.org/10.1176/appi.ps.201800369CrossRefGoogle ScholarPubMed
Corrigan, P. W., Druss, B. G., & Perlick, D. A. (2014). The impact of mental illness stigma on seeking and participating in mental health care. Psychological Science in the Public Interest, 15(2), 37–70. https://doi-org.ezproxy.gl.iit.edu/10.1177/1529100614531398Google Scholar
Corrigan, P. W., Larson, J. E., Michaels, P. J., et al. (2015). Diminishing the self-stigma of mental illness by coming out proud. Psychiatry Research, 229(1–2), 148–154. https://doi.org/10.1016/j.psychres.2015.07.053Google Scholar
Corrigan, P. W., Larson, J. E., Smelson, D., & Andra, M. (2019). Recovery, peer support and confrontation in services for people with mental illness and/or substance use disorder. The British Journal of Psychiatry, 214(3), 130–132. https://doi.org/10.1192/bjp.2018.242Google Scholar
Corrigan, P. W., Morris, S. B., Michaels, P. J., Rafacz, J. D., & Rüsch, N. (2012). Challenging the public stigma of mental illness: A meta-analysis of outcome studies. Psychiatric Services, 63(10), 963–973. https://doi.org/10.1176/appi.ps.201100529Google Scholar
Corrigan, P. W., Michaels, P. J., & Morris, S. B. (2015). Do the effects of anti-stigma programs persist over time? Findings from a meta-analysis. Psychiatric Services, 66, 543–546. https://doi.org/10.1176/appi.ps.201400291Google Scholar
Corrigan, P. W., Powell, K. J., & Al-Khouja, M. A. (2015). Examining the impact of public service announcements on help seeking and stigma: Results of a randomized controlled trial. Journal of Nervous and Mental Disease, 203, 836–842. https://doi.org/10.1097/NMD.0000000000000376Google Scholar
Corrigan, P. W., Qin, S., Davidson, L., Schomerus, G., Shuman, V., & Smelson, D. (2019). How does the public understand recovery from severe mental illness versus substance use disorder? Psychiatric Rehabilitation Journal, 42(4), 341–334. https://doi.org/10.1037/prj0000380Google Scholar
Corrigan, P. W., Qin, S., Davidson, L., Schomerus, G., Shuman, V., & Smelson, D. (2020). Recovery from mental illness versus substance use disorder. Advances in Dual Diagnosis, 13(3), 101–110. https://doi.org/10.1108/ADD-10-2019-0012Google Scholar
Corrigan, P. W., River, L. P., Lundin, R. K., et al. (2001). Three strategies for changing attributions about severe mental illness. Schizophrenia Bulletin, 27(2), 187–195. https://doi.org/10.1093/oxfordjournals.schbul.a006865CrossRefGoogle ScholarPubMed
Corrigan, P. W., Schomerus, G., Shuman, V., et al. (2017). Developing a research agenda for reducing the stigma of addictions, part II: Lessons from the mental health stigma literature. American Journal on Addictions, 26(1), 67–74. https://doi-org.ezproxy.gl.iit.edu/10.1111/ajad.12436Google Scholar
Corrigan, P., Schomerus, G., & Smelson, D. (2017). Are some of the stigmas of addictions culturally sanctioned?. The British Journal of Psychiatry, 210(3), 180–181. https://doi.org/10.1192/bjp.bp.116.185421Google Scholar
Crapanzano, K. A., Hammarlund, R., Ahmad, B., Hunsinger, N., & Kullar, R. (2018). The association between perceived stigma and substance use disorder treatment outcomes: A review. Substance Abuse and Rehabilitation, 10, 1–12. https://doi.org/10.2147/SAR.S183252Google Scholar
Crapanzano, K., Vath, R. J., & Fisher, D. (2014). Reducing stigma towards substance users through an educational intervention: Harder than it looks. Academic Psychiatry, 38(4), 420–425. https://doi.org/10.1007/s40596-014-0067-1Google Scholar
Cunningham, J. A., Sobell, L. C., & Chow, V. M. C. (1993). What’s in a label? The effects of substance types and labels on treatment considerations and stigma. Journal of Studies on Alcohol, 54(6), 693–699. https://doi.org/10.15288/jsa.1993.54.693Google Scholar
Drug Policy Alliance. (2020). About us. https://drugpolicy.org/about-us#vision-missionGoogle Scholar
Eddie, D., Hoffman, L., Vilsaint, C., et al. (2019). Lived experience in new models of care for substance use disorder: A systematic review of peer recovery support services and recovery coaching. Frontiers in Psychology, 10, Article 1052. https://doi.org/10.3389/fpsyg.2019.01052Google Scholar
Ennett, S. T., Tobler, N. S., Ringwalt, C. L., & Flewelling, R. L. (1994). How effective is drug abuse resistance education? A meta-analysis of Project DARE outcome evaluations. American Journal of Public Health, 84(9), 1394–1401. https://doi.org/10.2105/AJPH.84.9.1394Google Scholar
Federal Student Aid. (n.d.). Students with criminal convictions have limited eligibility for federal student aid. Office of the US Department of Education. https://studentaid.gov/understand-aid/eligibility/requirements/criminal-convictionsGoogle Scholar
Griffiths, K. M., Carron‐Arthur, B., Parsons, A., & Reid, R. (2014). Effectiveness of programs for reducing the stigma associated with mental disorders: A meta‐analysis of randomized controlled trials. World Psychiatry, 13(2), 161–175. https://doi-org.ezproxy.gl.iit.edu/10.1002/wps.20129Google Scholar
Highet, N. J., Luscombe, G. M., Davenport, T. A., Burns, J. M., & Hickie, I. B. (2006). Positive relationships between public awareness activity and recognition of the impacts of depression in Australia. Australian & New Zealand Journal of Psychiatry, 40(1), 55–58. https://doi-org.ezproxy.gl.iit.edu/10.1080/j.1440-1614.2006.01742.xCrossRefGoogle ScholarPubMed
Hingson, R., Mangione, T., Meyers, A., & Scotch, N. (1982). Seeking help for drinking problems: A study in the Boston Metropolitan Area. Journal of Studies on Alcohol, 43(3), 273–288. https://doi.org/10.15288/jsa.1982.43.273Google Scholar
Hogan, M. F. (2003). New Freedom Commission Report: The President’s New Freedom Commission: Recommendations to transform mental health care in America. Psychiatric Services, 54, 1467–1474. https://doi.org/10.1176/appi.ps.54.11.1467Google Scholar
International Society of Addiction Journal Editors. (2015). Statements and guidelines: Addiction terminology. www.isaje.net/addiction-terminology.htmlGoogle Scholar
Jorm, A. F., Nakane, Y., Christensen, H., Yoshioka, K., Griffiths, K. M., & Wata, Y. (2005). Public beliefs about treatment and outcome of mental disorders: A comparison of Australia and Japan. BMC Medicine, 3(1), 1–14. https://doi.org/10.1186/1741-7015-3-12Google Scholar
Kellogg, S. H. (2003). On ‘gradualism’ and the building of the harm reduction-abstinence continuum. Journal of Substance Abuse Treatment, 25(4), 241–247. https://doi.org/10.1016/S0740-5472(03)00068-0Google Scholar
Kellogg, S. H. & Kreek, M. J. (2005). Gradualism, identity, reinforcements, and change. International Journal of Drug Policy, 16(6), 369–375. https://doi.org/10.1016/j.drugpo.2005.08.001Google Scholar
Kelly, J. F., Dow, S. J., & Westerhoff, C. (2010). Does our choice of substance-related terms influence perceptions of treatment need? An empirical investigation with two commonly used terms. Journal of Drug Issues, 40(4), 805–818. https://doi.org/10.1177/002204261004000403Google Scholar
Kelly, J. F., & Westerhoff, C. M. (2010). Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms. The International Journal on Drug Policy, 21(3), 202–207. https://doi.org/10.1016/j.drugpo.2009.10.010Google Scholar
Kelly, M. P., Heath, I., Howick, J., & Greenhalgh, T. (2015). The importance of values in evidence-based medicine. BMC Medical Ethics, 16(1), 69. https://doi.org/10.1186/s12910-015-0063-3Google Scholar
Klingemann, H. K.-H. (1991). The motivation for change from problem alcohol and heroin use. Addiction, 86(6), 727–744. https://doi.org/10.1111/j.1360-0443.1991.tb03099.xGoogle Scholar
Laqueur, H. (2015). Uses and abuses of drug decriminalization in Portugal. Law & Social Inquiry, 40(3), 746–781. https://doi.org/10.1111/lsi.12104Google Scholar
LePage, J. P., Lewis, A. A., Crawford, A. M., et al. (2016). Incorporating individualized placement and support principles into vocational rehabilitation for formerly incarcerated veterans. Psychiatric Services, 67(7), 735–742. https://doi.org/10.1176/appi.ps.201500058Google Scholar
Livingston, J. D., Milne, T., Fang, M. L., & Amari, E. (2012). The effectiveness of interventions for reducing stigma related to substance use disorders: A systematic review. Addiction, 107(1), 39–50. https://doi-org.ezproxy.gl.iit.edu/10.1111/j.1360-0443.2011.03601.xGoogle Scholar
Lones, C. E., Bond, G. R., McGovern, M. P., et al. (2017). Individual placement and support (IPS) for methadone maintenance therapy patients: A pilot randomized controlled trial. Administration and Policy in Mental Health and Mental Health Services Research, 44(3), 359–364. https://doi.org/10.1007/s10488-017-0793-2Google Scholar
Lopez, G. (2020, November 11). America’s war on drugs has failed. Oregon is showing a way out. www.vox.com/future-perfect/21552710/oregon-drug-decriminalization-marijuana-legalizationGoogle Scholar
Luciano, A., Bond, G. R., & Drake, R. E. (2014). Does employment alter the course and outcome of schizophrenia and other severe mental illnesses? A systematic review of longitudinal research. Schizophrenia Research, 159(2–3), 312–321. https://doi.org/10.1016/j.schres.2014.09.010Google Scholar
Luoma, J. B. (2011). Substance use stigma as a barrier to treatment and recovery. In Johnson, B. A. (Ed.), Addiction medicine: Science and practice (pp. 1195–1215). Springer. https://doi.org/10.1007/978-1-4419-0338-9_59Google Scholar
McGinty, E. E., Goldman, H. H., Pescosolido, B., & Barry, C. L. (2015). Portraying mental illness and drug addiction as treatable health conditions: Effects of a randomized experiment on stigma and discrimination. Social Science & Medicine, 126, 73–85. https://doi.org/10.1016/j.socscimed.2014.12.010Google Scholar
McGuire, A. B., Powell, K. G., Treitler, P. C., et al. (2020). Emergency department-based peer support for opioid use disorder: Emergent functions and forms. Journal of Substance Abuse Treatment, 108, 82–87. https://doi.org/10.1016/j.jsat.2019.06.013Google Scholar
Mooney, A. C., Neilands, T. B., Giannella, E., Morris, M. D., Tulsky, J., & Glymour, M. M. (2019). Effects of a voter initiative on disparities in punishment severity for drug offenses across California counties. Social Science & Medicine, 230, 9–19. https://doi.org/10.1016/j.socscimed.2019.03.010Google Scholar
Morris, J., Albery, I. P., Heather, N., & Moss, A. C. (2020). Continuum beliefs are associated with higher problem recognition than binary beliefs among harmful drinkers without addiction experience. Addictive Behaviors, 105, Article 106292. https://doi.org/10.1016/j.addbeh.2020.106292Google Scholar
National Academies of Sciences, Engineering, and Medicine. (2016). Ending discrimination against people with mental and substance use disorders: The evidence for stigma change. The National Academies Press. https://doi.org/10.17226/23442Google Scholar
National Harm Reduction Coalition. (2020). Principles of harm reduction. https://harmreduction.org/hrc2/wp-content/uploads/2020/08/NHRC-PDF-Principles_Of_Harm_Reduction.pdfGoogle Scholar
National Institute on Drug Abuse. (n.d.) Public service announcements. National Institutes of Health. www.drugabuse.gov/news-events/public-education-projects/public-service-announcementsGoogle Scholar
Office of National Drug Control Policy. (2017). Memorandum to heads of executive departments and agencies: Changing federal terminology regarding substance use and substance use disorders. https://obamawhitehouse.archives.gov/sites/whitehouse.gov/files/images/Memo%20-%20Changing%20Federal%20Terminology%20Regrading%20Substance%20Use%20and%20Substance%20Use%20Disorders.pdfGoogle Scholar
Reif, S., Braude, L., Lyman, D. R., et al. (2014). Peer recovery support for individuals with substance use disorders: Assessing the evidence. Psychiatric Services, 65(7), 853–861. https://doi.org/10.1176/appi.ps.201400047Google Scholar
Ross, A., Potter, G. R., Barratt, M. J., & Aldridge, J. A. (2020). “Coming out”: Stigma, reflexivity and the drug researcher’s drug use. Contemporary Drug Problems, 47(4), 268–285. https://doi-org.ezproxy.gl.iit.edu/10.1177/0091450920953635Google Scholar
Rüsch, N., Abbruzzese, E., Hagedorn, E., et al. (2014). Efficacy of coming out proud to reduce stigma’s impact among people with mental illness: Pilot randomised controlled trial. British Journal of Psychiatry, 204(5), 391–397. https://doi.org/10.1192/bjp.bp.113.135772Google Scholar
Rüsch, N., Corrigan, P. W., Todd, A. R. & Bodenhausen, G. V. (2010). Implicit self-stigma in people with mental illness. Journal of Nervous and Mental Disease, 198(2), 150–153. https://doi.org/10.1097/nmd.0b013e3181cc43b5Google Scholar
Thornicroft, G. (2013). Premature death among people with mental illness. British Medical Journal, 346, Article F2969. https://doi.org/10.1136/bmj.f2969CrossRefGoogle ScholarPubMed
Sanders, J. M. (2012). Use of mutual support to counteract the effects of socially constructed stigma: Gender and drug addiction. Journal of Groups in Addiction & Recovery, 7(2–4), 237–252. https://doi-org.ezproxy.gl.iit.edu/10.1080/1556035X.2012.705705Google Scholar
Schober, R., & Annis, H. M. (1996). Barriers to help-seeking for change in drinking: A gender-focused review of the literature. Addictive Behaviors, 21(1), 81–92. https://doi.org/10.1016/0306-4603(95)00041-0Google Scholar
Schomerus, G., Matschinger, H., & Angermeyer, M. C. (2013). Continuum beliefs and stigmatizing attitudes towards persons with schizophrenia, depression and alcohol dependence. Psychiatry Research, 209(3), 665–669. https://doi.org/10.1016/j.psychres.2013.02.006Google Scholar
Simpson, D. D. (1981). Treatment for drug abuse: Follow-up outcomes and length of time spent. Archives of General Psychiatry, 38(8), 875–880. https://doi.org/10.1001/archpsyc.1981.01780330033003Google Scholar
Stark, M. J. (1992). Dropping out of substance abuse treatment: A clinically oriented review. Clinical Psychology Review, 12(1), 93–116. https://doi.org/10.1016/0272-7358(92)90092-MGoogle Scholar
Stolzenburg, S., Freitag, S., Evans-Lacko, S., Muehlan, H., Schmidt, S., & Schomerus, G. (2017). The stigma of mental illness as a barrier to self labeling as having a mental illness. The Journal of Nervous and Mental Disease, 205(12), 903–909. https://doi.org/10.1097/NMD.0000000000000756Google Scholar
Substance Abuse and Mental Health Services Administration. (2018). Overcoming stigma, ending discrimination resource guide. www.samhsa.gov/sites/default/files/programs_campaigns/02._webcast_1_resources-508.pdfGoogle Scholar
Substance Abuse and Mental Health Services Administration. (2019). 2018 National Survey of Drug Use and Health (NSDUH). www.samhsa.gov/data/release/2018-national-survey-drug-use-and-health-nsduh-releasesGoogle Scholar
Thornicroft, G. (2013). Premature death among people with mental illness. British Medical Journal, 346, Article F2969. https://doi.org/10.1136/bmj.f2969Google Scholar
Tuchfeld, B. S. (1981). Spontaneous remission in alcoholics: Empirical observations and theoretical implications. Journal of Studies on Alcohol, 42(7), 626–641. https://doi.org/10.15288/jsa.1981.42.626Google Scholar
United Nations (2006). Convention on the rights of persons with disabilities. Department of Economic and Social Affairs. www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.htmlGoogle Scholar
Van Boekel, L. C., Brouwers, E. P. M., Van Weeghel, J., & Garretsen, H. F. L. (2013). Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: Systematic review. Drug and Alcohol Dependence, 131(1–3), 23–35. https://doi.org/10.1016/j.drugalcdep.2013.02.018Google Scholar
Walter, R. J., Viglione, J., & Tillyer, M. S. (2017). One strike to second chances: Using criminal backgrounds in admission decisions for assisted housing. Housing Policy Debate, 27(5), 734–750. https://doi-org.ezproxy.gl.iit.edu/10.1080/10511482.2017.1309557Google Scholar
Werb, D., Mills, E. J., DeBeck, K., Kerr, T., Montaner, J. S., & Wood, E. (2011). The effectiveness of anti-illicit-drug public-service announcements: A systematic review and meta-analysis. Journal of Epidemiology and Community Health, 65(10), 834–840. http://dx.doi.org/10.1136/jech.2010.125195Google Scholar
West, M. L., Yanos, P. T., & Mulay, A. L. (2014). Triple stigma of forensic psychiatric patients: Mental illness, race, and criminal history. International Journal of Forensic Mental Health, 13(1), 75–90. https://doi-org.ezproxy.gl.iit.edu/10.1080/14999013.2014.885471Google Scholar
Westat. (2006). Evaluation of the National Youth Anti-Drug Media Campaign: 2004 report of findings executive summary. National Institute on Drug Abuse, National Institutes of Health. https://archives.drugabuse.gov/sites/default/files/execsumvolume.pdfGoogle Scholar

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