Breaking Chains: Interventions for Reducing Internalized Stigma and Boosting Self-Esteem in Substance Use Behaviors

Background: Some studies indicate that individuals with substance use disorders are significantly more stigmatized compared to other mental illnesses. The path to recovery for these individuals is often clouded by internalized stigma. This stigma has significant implications regarding treatment-seeking behavior, as it is often associated with low self-esteem, diminished self-efficacy, increased severity of psychiatric symptoms, and reduced quality of life. The objective is to develop a psychotherapeutic intervention program aimed at reducing internalized stigma and enhancing self-esteem in individuals with addictive behaviors and substance dependence.
Methods: In an initial phase, a scoping review was conducted using the Joanna Briggs Institute methodology in August 2023. The analysis covered articles from six databases (Academic Search Complete, Cochrane, CINAHL Complete, MEDLINE Complete, Psychology and Behavioral Sciences Collection, and ERIC) on addictive behaviors, internalized stigma, and self-esteem from 2018 to 2023 in Portuguese, English, and Spanish. Due to the limitation in the number of articles found, the initial criteria were maintained, with the research adjusted to address issues related to mental health. A total of 116 articles were obtained, of which only seven met the criteria for in-depth analysis. The study selection and data extraction process were independently conducted by two authors. Based on insights gained during this review, the second phase of the study involved developing a psychotherapeutic intervention program for individuals with addictive behaviors, internalized stigma, and low self-esteem.
Results: Mental health professionals should employ varied intervention methods to combat and alleviate self-stigma in different populations, considering diverse psychiatric diagnoses. The results underscore the paramount importance of psychoeducation and cognitive-behavioral approaches, particularly cognitive restructuring. In this context, a six-session program is proposed, with three dedicated to psychoeducation and three to cognitive restructuring, held on a weekly basis.
Conclusions: It is crucial for healthcare professionals to adopt an empowerment and recovery-focused approach when working with these individuals. The implementation of a specialized mental health nursing intervention program, focused on empowering this population to address their own stigma and societal stigma, indicates promising outcomes and benefits in terms of recovery and quality of life. This approach aims not only to treat the symptoms of the disease but also to strengthen individuals' resilience, fostering a positive transformation in their recovery journey.