Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2021 Jul;116(7):1757-1767.
doi: 10.1111/add.15333. Epub 2020 Dec 14.

A US national randomized study to guide how best to reduce stigma when describing drug-related impairment in practice and policy

John F Kelly  1   2 , M Claire Greene  3 , Alexandra Abry  1
Affiliations
Randomized Controlled Trial

A US national randomized study to guide how best to reduce stigma when describing drug-related impairment in practice and policy

John F Kelly et al. Addiction. 2021 Jul.

Abstract

Background and aims: Drug-related impairment is persistently stigmatized delaying and preventing treatment engagement. To reduce stigma, various medical terms (e.g. 'chronically relapsing brain disease', 'disorder') have been promoted in diagnostic systems and among national health agencies, yet some argue that over-medicalization of drug-related impairment lowers prognostic optimism and reduces personal agency. While intensely debated, rigorous empirical study is lacking. This study investigated whether random exposure to one of six common ways of describing drug-related impairment induces systematically different judgments.

Design, setting and participants: Cross-sectional survey, US general population, among a nationally representative non-institutionalized sample (n = 3635; 61% response rate; December 2019-January 2020).

Intervention: Twelve vignettes (six terms × gender) describing someone treated for opioid-related impairment depicted in one of six ways as a(n): 'chronically relapsing brain disease', 'brain disease', 'disease', 'illness', 'disorder' or 'problem'.

Measurements: Multi-dimensional stigma scale assessing: blame; social exclusion; prognostic optimism, continuing care, and danger (a = 0.70-0.83).

Findings: US adults [mean age = 47.81, confidence interval (CI) = 47.18-48.44; 52.4% female; 63.14% white] rated the same opioid-impaired person differently across four of five stigma dimensions depending on which of six terms they were exposed to. 'Chronically relapsing brain disease' induced the lowest stigmatizing blame attributions (P < 0.05); at the same time, this term decreased prognostic optimism [mean difference (MD) = 0.18, 95% CI = 0.05, 0.30] and increased perceived need for continuing care (MD = -0.26, 95% CI = -0.43, -0.09) and danger (MD = -0.13, 95% CI = -0.25, -0.02) when compared with 'problem'. Compared with a man, a woman was blamed more for opioid-related impairment (MD = -0.08, 95% CI = -0.15, -0.01); men were viewed as more dangerous (MD = 0.13, 95% CI = 0.06, 0.19) and to be socially excluded (MD = 0.16, 95% CI = 0.09, 0.23).

Conclusions: There does not appear to be one single medical term for opioid-related impairment that can meet all desirable clinical and public health goals. To reduce stigmatizing blame, biomedical 'chronically relapsing brain disease' terminology may be optimal; to increase prognostic optimism and decrease perceived danger/social exclusion use of non-medical terminology (e.g. 'opioid problem') may be optimal.

Keywords: National; nationally representative; randomized controlled study; stigma, discrimination; vignettes.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Contrary effects of the same terminology: ‘Chronically relapsing brain disease’ decreases blame (top figure) but also decreases prognostic optimism (bottom figure) [Colour figure can be viewed at wileyonlinelibrary.com]
Figure 2
Figure 2
Levels of different type of stigma as a function of opioid‐related impairment terminology and gender.             [Colour figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

Comment in

References

    1. Earnshaw V. A., Bergman B. G., Kelly J. F. Whether, when, and to whom?: an investigation of comfort with disclosing alcohol and other drug histories in a nationally representative sample of recovering persons. J Subst Abuse Treat 2019; 101: 29–37. - PMC - PubMed
    1. Room R., Rehm J., Trotter R. T. II, Paglia A., Üstün T. B. Cross‐cultural views on stigma, valuation, parity, and societal values towards disability. In: Üstün T. B., Chatterji S., Bickenbach J. E., et al., editors. Disability and Culture: Universalism and Diversity. Seattle, WA: Hogrefe & Huber; 2001, pp. 247–291.
    1. Kennedy‐Hendricks A., Barry C. L., Gollust S. E., Ensminger M. E., Chisolm M. S., McGinty E. E. Social stigma toward persons with prescription opioid use disorder: associations with public support for punitive and public health‐oriented policies. Psychiatr Serv 2017; 68: 462–469. - PubMed
    1. Ustun B. T., Chatterji S., Bickenbach J. E., Trotter R. T. II, Room R., Rehm J. et al, editors. Cross‐Cultural Views on Stigma, Valuation, Parity, and Societal Values Towards Disability. Disability and Culture: Universalism and Diversity. Seattle, WA: Hogrefe & Huber; 2001, pp. 247–291.
    1. Substance Abuse and Mental Health Services Administration Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (HHS Publication no. PEP19–5068, NSDUH Series H‐54). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration; 2019.

Publication types

Substances