Exploring the Association Between Models of Addiction and Stigma: Findings from the public and patients in treatment
Background: The stigmatization of addiction is a key barrier to treatment seeking among individuals with substance use concerns. Our understanding of and knowledge on the etiology and chronicity of substance use disorders is theorized to relate to their stigmatization. For instance, past literature posits that a brain disease model of addiction (BDMA) may reduce stigmatizing beliefs as it will commiserate addictive disorders. Limited empirical research has been conducted on these relationships with the majority only investigating beliefs in a BDMA. Two studies were conducted to explore the relationships between six different models of addiction (MOAs), including the BDMA, among two different populations: the general public and patients in treatment for an alcohol (AUD) or opioid use disorder (OUD).
Methods: In study 1,755 adults completed an online survey on MTurk (Mage = 36.2, SD = 10.1, 59.4% men) and were randomized to one of four vignette conditions describing an individual with either an AUD, OUD, problem gambling disorder (PGD), or diabetes. Participants completed measures assessing perceived stigma towards the vignette character and beliefs related to six MOAs (BDMA, disease, moral, psychological, sociological, nature). In study 2, 109 adults (Mage = 44.57, SD = 11.52, 51.4% men) who had sought treatment for an AUD or OUD completed a one-time online survey assessing their beliefs and acceptance of the six different MOAs. Participants also completed a measure quantifying their level of self-stigmatization (i.e., enacted, anticipated and internalized) for their disorder.
Results: Study 1: Stigma ratings were significantly higher in the AUD (p < .001) and OUD (p = .005) conditions compared to the diabetes conditions. Greater beliefs in the moral MOA were associated with greater stigma for all addiction conditions (p < .001 for each condition), and greater beliefs in the disease MOA were associated with greater stigma for the PGD condition (p = .005). Greater beliefs in the psychological MOA were associated with lower stigma for the AUD (p < .001), OUD (p = .001) and PGD (p < .001) conditions. Study 2: Self-stigma ratings were significantly higher in the OUD participant group in comparison to the AUD participant group (p = .001). Greater beliefs in the nature MOA (p = .002 for both groups) related to lower internalized stigma scores for both groups and greater beliefs in the psychological MOA (p = .001) related to greater enacted stigma scores for the AUD group.
Conclusions: The current studies provide further support that addictive disorders are more stigmatized than other health disorders and suggest that beliefs in specific MOAs are differentially associated with stigma across both the public and patients. Namely, greater beliefs in a psychological MOA and nature MOA are related to lower public and self-stigma scores, respectively. Interventions to address addiction stigma may thus consider other MOAs to decrease stigma besides a BDMA.
