Self-stigma in substance abuse: development of a new measure

Luoma, Jason B.; Nobles, Richard H.; Drake, Chad E.; Hayes, Steven C.; O’Hair, Alyssa; Fletcher, Lindsay; Kohlenberg, Barbara S.

doi:10.1007/s10862-012-9323-4

Cited by 150Substance Abuse Treatment and OutcomesMental Health Treatment and AccessOpioid Use Disorder Treatment

Self-stigma in substance abuse: development of a new measure

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Luoma, Jason B., Nobles, Richard H., Drake, Chad E., Hayes, Steven C., O’Hair, Alyssa, Fletcher, Lindsay, Kohlenberg, Barbara S.·2013·Journal of Psychopathology and Behavioral Assessment

DOI 10.1007/s10862-012-9323-4PMC PMC3680138

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Abstract

Little attention has been paid to the examination and measurement of self-stigma in substance misuse. This paper aims to fill this gap by reporting on the development of a new scale to measure self-stigma experienced by people who are misusing substances, the Substance Abuse Self-Stigma Scale. Content validity and item refinement occurred through an iterative process involving a literature search, focus groups, and expert judges. Psychometric properties were examined in a cross-sectional study of individuals (n = 352) receiving treatment for substance misuse. Factor analyses resulted in a 40-item measure with self devaluation, fear of enacted stigma, stigma avoidance, and values disengagement subscales. The measure showed a strong factor structure and good reliability and validity overall, though the values disengagement subscale showed a mixed pattern. Results are discussed in terms of their implications for studies of stigma impact and intervention.

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We measured substance use stigma by summing 12 items from the Substance Abuse Self-Stigma Scale (SASSS).
“We measured substance use stigma by summing 12 items from the Substance Abuse Self-Stigma Scale (SASSS).23”
From An acceptance-based, intersectional stigma coping intervention for people with HIV who inject drugs—a randomized clinical trial (2023) · cites this paper as [23]

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Fox, A. B., Earnshaw, V. A., Taverna, E. C., & Vogt, D. S. (2017) · Stigma and Health · doi:10.1037/sah0000104 · Cited by 437 · see citing works
The stigma of alcohol-related liver disease and its impact on healthcare
Schomerus, G., Leonhard, A., Manthey, J., Morris, J. K., Neufeld, M., Kilian, C., Speerforck, S., Winkler, P., & Corrigan, P. W. (2022) · Journal of Hepatology · doi:10.1016/j.jhep.2022.04.026 · Cited by 182 · see citing works
Developing a research agenda for understanding the stigma of addictions Part I: Lessons from the Mental Health Stigma Literature
Corrigan, P. W., Schomerus, G., Shuman, V., Kraus, D. J., Perlick, D., Harnish, A., Kulesza, M., Kane-Willis, K., Qin, S., & Smelson, D. A. (2016) · American Journal on Addictions · doi:10.1111/ajad.12458 · Cited by 136 · see citing works
“39 Research by Schomerus et al. partially validated the above model of self-stigma for people with alcohol dependence.”
Internalization process of stigma of people with mental illness across cultures: a meta-analytic structural equation modeling approach
Yu, B. C. L., Chio, F. H. N., Mak, W. W. S., Corrigan, P. W., & Chan, K. K. Y. (2021) · Clinical Psychology Review · doi:10.1016/j.cpr.2021.102029 · Cited by 110 · see citing works
Stigma predicts residential treatment length for substance use disorder
Luoma, J. B., Kulesza, M., Hayes, S. C., Kohlenberg, B. S., & Larimer, M. E. (2014) · The American Journal of Drug and Alcohol Abuse · doi:10.3109/00952990.2014.901337 · Cited by 90 · see citing works
A new brief opioid stigma scale to assess perceived public attitudes and internalized stigma: Evidence for construct validity
Yang, L. H., Grivel, M. M., Anderson, B. J., Bailey, G. L., Opler, M. G. A., Wong, L. Y., & Stein, M. D. (2019) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2019.01.005 · Cited by 88 · see citing works
Negative Impacts of Self-Stigma on the Quality of Life of Patients in Methadone Maintenance Treatment: The Mediated Roles of Psychological Distress and Social Functioning
Cheng, C.-M., Chang, C.-C., Wang, J., Chang, K., Ting, S.-Y., & Lin, C. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16071299 · Cited by 79 · see citing works
“To the best of our knowledge, current research on self-stigma among substance users focuses on instrument development [16] and self-stigma reduction intervention [15,19].”
Background
Stigmatization among methadone maintenance treatment patients in mountainous areas in northern Vietnam
Nguyen, H. V., Nguyen, H. L. T., Thi, H., Le, H. Q., Tran, B. X., Hoang, C. D., Le, H. T., Nguyen, C. T., Tran, T. D., Latkin, C. A., et al. (2017) · Harm Reduction Journal · doi:10.1186/s12954-016-0127-9 · Cited by 77 · see citing works
“and measures of HIV-related stigma [26].”
Internalized stigma as an independent risk factor for substance use problems among primary care patients: Rationale and preliminary support
Kulesza, M., Watkins, K. E., Ober, A. J., Osilla, K. C., & Ewing, B. (2017) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2017.08.002 · Cited by 73 · see citing works
“A uthor M anuscript A uthor M anuscript A uthor M anuscript A uthor M anuscript Table 2 Prediction of substance use problems by internalized stigma (n=393) Predictor Standardized B SE B Adjusted R2 ΔR2 Step 1: Covariates 0.29 Age −0.05* 0.02 Race/ethnicity1 −0.19 0.19 OAUD diagnosis2 2.02*** 0.48 Psychiatric comorbidi…”
MethodResultInfluential
The role of stigma in cannabis use disclosure: an exploratory study
King, D. D., Gill, C. J., Cadieux, C. S., & Singh, N. (2024) · Harm Reduction Journal · doi:10.1186/s12954-024-00929-8 · Cited by 74 · see citing works
“Prior publications validating the SU-SMS and SASSS scales generated sample population numbers of 178 and 352 participants, respectively [41, 49].”
BackgroundMethodInfluential
Implicit and explicit internalized stigma: Relationship with risky behaviors, psychosocial functioning and healthcare access among people who inject drugs.
von Hippel, C., Brener, L., & Horwitz, R. (2018) · Addictive Behaviours · doi:10.1016/j.addbeh.2017.08.036 · Cited by 66 · see citing works
“Research on addiction self-stigma is growing, with outcomes mostly consistent with those found in the mental health field (for a notable exception see Luoma et al. (2013) where higher self-stigma was associated with longer stays in residential rehabilitation).”
Result
Psychological inflexibility and stigma: A meta-analytic review
Krafft, J., Ferrell, J., Levin, M. E., & Twohig, M. P. (2018) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2017.11.002 · Cited by 76 · see citing works
Correlates of Self-Stigma among Individuals with Substance Use Problems
Brown, S. A., Kramer, K., Lewno, B., Dumas, L., Sacchetti, G. M., & Powell, E. (2015) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-015-9559-9 · Cited by 56 · see citing works
“More specifically, this study examined the relationship of four components of a contextual functional model of self-stigma (Luoma et al. 2013; see description of Substance Use Stigma measure below) with type/level of substance use/diagnoses, and a number of demographic, treatment, and mental health…”
BackgroundMethodInfluential
Substance use stigma and antiretroviral therapy adherence among a drug-using population living with HIV
Stringer, K. L., Marotta, P., Baker, E., Turan, B., Kempf, M.-C., Drentea, P., Stepanikova, I., & Turan, J. M. (2019) · AIDS Patient Care and STDs · doi:10.1089/apc.2018.0311 · Cited by 54 · see citing works
“907) to measure anticipated SU stigma.(33) This subscale consists of eight items describing possible ways people may react to someone with a history of drug involvement.”
BackgroundMethod
Stigma among Individuals with Substance Use Disorders: Does it Predict Substance Use, and Does it Diminish with Treatment?
Kulesza, M., Ramsey, S., Brown, R. A., & Larimer, M. E. (2014) · Journal of Addictive Behaviors Therapy & Rehabilitation · doi:10.4172/2324-9005.1000115 · Cited by 54 · see citing works
“Aim 2 To test Aim 2, we conducted a within subject analysis with the baseline, post-treatment, and follow-up SASS as the DV.”
BackgroundMethodInfluential
The effect of bundling medication-assisted treatment for opioid addiction with mHealth: study protocol for a randomized clinical trial
Gustafson, D. H., Landucci, G., Mctavish, F. M., Kornfield, R., Johnson, R. A., Mares, M., Westergaard, R. P., Quanbeck, A., Alagöz, E., Pe‐Romashko, K., et al. (2016) · Trials · doi:10.1186/s13063-016-1726-1 · Cited by 51 · see citing works
“visits and stays (in addition to emergency room visits and hospital detox); urgent care visits for any reason (to which we will apply cost estimates derived from a national survey of urgent care clinics [66]; individual psychotherapy or psychiatric care; and self-reported outpatient addiction treatment services after…”
MethodInfluential
Factor structure, internal reliability and construct validity of the Methadone Maintenance Treatment Stigma Mechanisms Scale (MMT‐SMS)
Smith, L. R., Mittal, M. L., Wagner, K. D., Copenhaver, M. M., Cunningham, C. O., & Earnshaw, V. A. (2019) · Addiction · doi:10.1111/add.14799 · Cited by 53 · see citing works
HIV and substance use stigma, intersectional stigma and healthcare among HIV-positive PWID in Russia
Vetrova, M. V., Cheng, D. M., Bendiks, S., Gnatienko, N., Lloyd-Travaglini, C., Jiang, W., Luoma, J., Blokhina, E., Krupitsky, E., Lioznov, D., et al. (2021) · AIDS and Behavior · doi:10.1007/s10461-021-03172-5 · Cited by 52 · see citing works
Self-citation
Drug addiction stigma in relation to methadone maintenance treatment by different service delivery models in Vietnam
Tran, B. X., Vu, P. B., Nguyen, L. H., Latkin, S. K., Nguyen, C. T., Phan, H. T. T., & Latkin, C. A. (2016) · BMC Public Health · doi:10.1186/s12889-016-2897-0 · Cited by 52 · see citing works
Patient predictors of substance use disorder treatment initiation in primary care
Ober, A. J., Watkins, K. E., McCullough, C. M., Setodji, C. M., Osilla, K., & Hunter, S. B. (2018) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2018.04.004 · Cited by 50 · see citing works
“A uthor M anuscript A uthor M anuscript A uthor M anuscript A uthor M anuscript Abbreviations ASSIST Alcohol, Smoking and Substance Involvement Screening Test AUD Alcohol use disorder BT Brief treatment BUP/NX Buprenorphine/naloxone CC Collaborative care CI Confidence interval CIDI Comprehensive International Diagnost…”
BackgroundInfluential
Attitudes towards Alcohol Dependence and Affected Individuals: Persistence of Negative Stereotypes and Illness Beliefs between 1990 and 2011
Schomerus, G., Matschinger, H., & Angermeyer, M. C. (2014) · European Addiction Research · doi:10.1159/000362407 · Cited by 50 · see citing works
Social, psychological, and substance use characteristics of U.S. adults who use kratom: Initial findings from an online, crowdsourced study.
Smith, K. E., Dunn, K. E., Grundmann, O., Garcia‐Romeu, A., Rogers, J. M., Swogger, M. T., & Epstein, D. H. (2021) · Experimental and Clinical Psychopharmacology · doi:10.1037/pha0000518 · Cited by 51 · see citing works
Challenges and opportunities for implementation of substance misuse interventions in conflict-affected populations
Greene, M. C., Kane, J. C., Khoshnood, K., Ventevogel, P., & Tol, W. A. (2018) · Harm Reduction Journal · doi:10.1186/s12954-018-0267-1 · Cited by 47 · see citing works
Social Determinants of Stigma and Discrimination in Vietnamese Patients with Chronic Hepatitis B
Le, T. V., Vu, T. M. T., Thi, H., Nguyen, L. H., Truong, N. T., Hoang, C. L., Nguyen, S. H., Nguyen, C. T., Nguyen, B. C., Tran, T. H., et al. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16030398 · Cited by 47 · see citing works
“[18], and adapted the conceptual framework by Parker and Aggleton which is used to measure stigma against the MMT (methadone maintenance treatment) and HIV/AIDS population [19].”
Method
Self-stigma among criminal offenders: Risk and protective factors.
Moore, K. E., Milam, K. C., Folk, J. B., & Tangney, J. P. (2017) · Stigma and Health · doi:10.1037/sah0000092 · Cited by 45 · see citing works
“Substance dependence symptoms may only be a relevant risk factor for self-stigma associated with addiction, which carries its own set of psychological and behavioral consequences (Luoma et al., 2013).”
The Affective and Neural Correlates of Heroin versus Cocaine Use in Addiction Are Influenced by Environmental Setting But in Opposite Directions
Pirro, S. D., Galati, G., Pizzamiglio, L., & Badiani, A. (2018) · Journal of Neuroscience · doi:10.1523/jneurosci.0019-18.2018 · Cited by 45 · see citing works
“…rapidly without relying on the cognitive processes required for the verbal description and interpretation of emotional states, which could have represented a confounding factor given the participants’ negative feelings about their own addiction (Dearing et al., 2005; Luoma et al., 2012, 2013).”
Background
Sober social networks: The role of online support groups in recovery from alcohol addiction
Bliuc, A., Doan, T., & Best, D. W. (2018) · Journal of Community & Applied Social Psychology · doi:10.1002/casp.2388 · Cited by 59 · see citing works
“and perceived stigma, and the consequent self-devaluation which results in changes in behaviour (Corrigan et al., 2011; Luoma et al., 2013).”
BackgroundMethodInfluential
Fear of Stigma Mediates the Relationship between Internalized Stigma and Treatment-Seeking among Individuals with Substance Use Problems
Benz, M. B., Cabrera, K. B., Kline, N. K., Bishop, L. S., & Reed, K. M. P. (2021) · Substance Use & Misuse · doi:10.1080/10826084.2021.1899224 · Cited by 43 · see citing works
Stigma Predicts Treatment Preferences and Care Engagement Among Veterans Affairs Primary Care Patients with Depression
Campbell, D. G., Bonner, L. M., Bolkan, C. R., Lanto, A. B., Zivin, K., Waltz, T. J., Klap, R. S., Rubenstein, L. V., & Chaney, E. F. (2016) · Annals of Behavioral Medicine · doi:10.1007/s12160-016-9780-1 · Cited by 38 · see citing works
“, depression) that confer stigma may lead people with mental health concerns to avoid the health care system and to reject diagnoses (9-13).”
Background
The steatotic liver disease burden paradox: unravelling the key role of alcohol
Torp, N., Israelsen, M. E., & Krag, A. A. (2024) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/s41575-024-01022-y · Cited by 39 · see citing works
“Self-stigma occurs when individuals internalize negative societal attitudes and beliefs about alcohol use 59 .”
Problematic smartphone use and two types of problematic use of the internet and self-stigma among people with substance use disorders
Chang, C.-W., Chen, J., Huang, S.-W., Potenza, M. N., Su, J.-A., Chang, K., Pakpour, A. H., & Lin, C. (2023) · Addictive Behaviors · doi:10.1016/j.addbeh.2023.107807 · Cited by 34 · see citing works
Recovery dialects: A pilot study of stigmatizing and nonstigmatizing label use by individuals in recovery from substance use disorders.
Ashford, R. D., Brown, A. M., Ashford, A., & Curtis, B. L. (2019) · Experimental and Clinical Psychopharmacology · doi:10.1037/pha0000286 · Cited by 26 · see citing works
“Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. van Boekel LC, Brouwers EPM, van Weeghel J, & Garretsen HFL (2013).”
MethodInfluential
Interventions to reduce self-stigma in people who use drugs: A systematic review
Sibley, A. L., Colston, D. C., & Go, V. F.-L. (2023) · Journal of Substance Use and Addiction Treatment · doi:10.1016/j.josat.2023.209284 · Cited by 27 · see citing works
Substance use stigma: A systematic review of measures and their psychometric properties
Spata, A., Gupta, I., Lear, M. K., Lunze, K., & Luoma, J. B. (2024) · Drug and Alcohol Dependence Reports · doi:10.1016/j.dadr.2024.100237 · Cited by 24 · see citing works
“The effects of these internalized beliefs and resulting emotions and perceptions may be further exacerbated by the person ’ s coping attempts, such as avoidance of social situations or internal avoidance behaviors (Luoma et al., 2013).”
BackgroundMethodInfluentialSelf-citation
“I am not a junkie”: Social categorization and differentiation among people who use drugs
Sibley, A. L., Baker, R., Levander, X. A., Rains, A., Walters, S. M., Nolte, K., Colston, D. C., Piscalko, H. M., Schalkoff, C. A., Bianchet, E., et al. (2023) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2023.103999 · Cited by 23 · see citing works
Talking about parental substance abuse with children: eight families’ experiences of Beardslee’s family intervention
Pihkala, H., Dimova-Bränström, N., & Sandlund, M. (2017) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2017.1308009 · Cited by 22 · see citing works
“persons with substance abuse and results in avoidance, withdrawal, and secrecy (5,6).”
Background
A multi-level intervention to reduce the stigma of substance use and criminal involvement: a pilot feasibility trial protocol
Moore, K. E., Johnson, J. E., Luoma, J. B., Taxman, F. S., Pack, R. P., Corrigan, P. W., Hart, J., & Slone, J. D. (2023) · Health & Justice · doi:10.1186/s40352-023-00224-x · Cited by 21 · see citing works
The Medications for Opioid Use Disorder Study: Methods and Initial Outcomes From an 18-Month Study of Patients in Treatment for Opioid Use Disorder
Dever, J. A., Hertz, M. F., Dunlap, L. J., Richardson, J. S., Wolicki, S. B., Biggers, B. B., Edlund, M. J., Bohm, M. K., Turcios, D., Jiang, X., et al. (2024) · Public Health Reports · doi:10.1177/00333549231222479 · Cited by 19 · see citing works
Opposite environmental gating of the experienced utility (‘liking’) and decision utility (‘wanting’) of heroin versus cocaine in animals and humans: implications for computational neuroscience
Badiani, A., Caprioli, D., & Pirro, S. D. (2019) · Psychopharmacology · doi:10.1007/s00213-019-05318-9 · Cited by 20 · see citing works
“…in the recollection of affective states (e.g., Kahneman et al. 1997; Kahneman 1999; Robinson and Clore 2002; Gorlin et al. 2019), and in particular, the framing effects deriving from the participants’ negative feelings toward their own addiction (Dearing et al. 2005; Luoma et al. 2012, 2013).”
Effects of Bundling Medication for Opioid Use Disorder With an mHealth Intervention Targeting Addiction: A Randomized Clinical Trial
Gustafson, D. H., Landucci, G., Vjorn, O., Gicquelais, R. E., Goldberg, S. B., Johnston, D. C., Curtin, J. J., Bailey, G. L., Shah, D. V., Pe‐Romashko, K., et al. (2023) · American Journal of Psychiatry · doi:10.1176/appi.ajp.20230055 · Cited by 17 · see citing works
Validation of the Gambling Perceived Stigma Scale (GPSS) and the Gambling Experienced Stigma Scale (GESS)
Donaldson, P., Langham, E., Best, T., & Browne, M. (2015) · Journal of Gambling Issues · doi:10.4309/jgi.2015.31.8 · Cited by 19 · see citing works
“The perception of stigma (an individual’s beliefs about how others feel towards the stigmatised condition) may also contribute to internalising or personally applying these beliefs to oneself (Link, 1987), although this is not always the case (Luoma et al., 2013).”
Background
The Stigmatization of Drug Use as Mechanism of Legitimation of Exclusion
Santos da Silveira, P., Andrade de Tostes, J. G., Wan, H. T., Ronzani, T. M., & Corrigan, P. W. (2018) · Drugs and Social Context · doi:10.1007/978-3-319-72446-1_2 · Cited by 18 · see citing works
“” Self-stigma seems to have an equally egregious effect on the well-being of people with addictions (Luoma et al. 2013).”
Background
Pilot randomized controlled trial of a hospital-based substance use treatment and recovery team (START) to improve initiation of medication for alcohol or opioid use disorder and linkage to follow-up care
Ober, A. J., Osilla, K. C., Klein, D. J., Burgette, L. F., Leamon, I. M., Mazer, M. W., Messineo, G., Collier, S., Korouri, S., Watkins, K. E., et al. (2023) · Journal of Substance Use and Addiction Treatment · doi:10.1016/j.josat.2023.209063 · Cited by 18 · see citing works
The relationship between felt stigma and non-fatal overdose among rural people who use drugs
Sibley, A. L., Klein, E., Cooper, H. L. F., Livingston, M. D., Baker, R., Walters, S. M., Gicquelais, R. E., Ruderman, S. A., Friedmann, P. D., Jenkins, W. D., et al. (2024) · Harm Reduction Journal · doi:10.1186/s12954-024-00988-x · Cited by 18 · see citing works
“PWUD with heightened perceived and internalized stigma may behave in ways so as to avoid experiencing stigma and its manifestations (e.g., prejudice and discrimination) [95, 96].”
Background
Quality of life improvement, social stigma and antiretroviral treatment adherence: implications for long-term HIV/AIDS care
Tran, B. X., Fleming, M., Do, H. P., Nguyen, L. H., & Latkin, C. A. (2018) · AIDS Care · doi:10.1080/09540121.2018.1510094 · Cited by 18 · see citing works
Resilience and Influencing Factors Among Youths Undergoing Substance Abuse Treatment in Thailand: A Cross-Sectional Study
Dallas, J. C., Jullamate, P., Vatanasin, D., Moungkum, S., Nadarajan, S., & Krungkraipetch, N. (2023) · SAGE Open Nursing · doi:10.1177/23779608231157986 · Cited by 17 · see citing works
An acceptance-based, intersectional stigma coping intervention for people with HIV who inject drugs—a randomized clinical trial
Luoma, J. B., Rossi, S. L., Sereda, Y., Pavlov, N., Toussova, O., Vetrova, M., Bendiks, S., Kiriazova, T., Krupitsky, E., Lioznov, D., et al. (2023) · The Lancet Regional Health - Europe · doi:10.1016/j.lanepe.2023.100611 · Cited by 16 · see citing works
Burn self-stigma: A hybrid concept analysis
Maslakpak, M. H., Ajoudani, F., Lotfi, M., & Alinejad, V. (2021) · Burns · doi:10.1016/j.burns.2021.11.007 · Cited by 15 · see citing works
Unemployment and Illiteracy Are Predictors of Hepatitis B Virus-Related Stigma and Discrimination
Behera, M. K., Nath, P., Behera, S. K., Padhi, P. K., Singh, A., & Singh, S. P. (2021) · Journal of Clinical and Experimental Hepatology · doi:10.1016/j.jceh.2021.12.006 · Cited by 14 · see citing works
Assessing self-stigma levels and associated factors among substance use disorder patients at two selected psychiatric hospitals in Egypt: a cross-sectional study
Elkalla, I. H. R., El‐Gilany, A., Baklola, M. I., Terra, M., Aboeldahab, M., Sayed, S. E., & Elwasify, M. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-05093-0 · Cited by 14 · see citing works
“Self-stigma occurs when individuals internalize the stigma and discrimination directed toward them, causing harm to their mental health and self-esteem [7].”
Background
Implicit internalized homophobia in India: Cognitive and sociodemographic factors
Dhabhar, M. C., & Deshmukh, A. S. (2020) · Journal of Gay & Lesbian Mental Health · doi:10.1080/19359705.2020.1828216 · Cited by 13 · see citing works
Assessing the validity of implicit and explicit measures of stigma toward clients with substance use disorders among mental health practitioners
Drake, C., Codd, R., & Terry, C. (2018) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2018.03.005 · Cited by 14 · see citing works
Mindfulness mediates the relationship between mental health self-stigma and psychological distress: A cross-sectional study
Martin, T. J., Spencer, S. D., & Masuda, A. (2020) · Current Psychology · doi:10.1007/s12144-020-01050-2 · Cited by 13 · see citing works
The social health domain of people bereaved by a drug-related death and associations with professional help: A cross-sectional study
Kalsås, Ø. R., Dyregrov, K., Fadnes, L. T., & Titlestad, K. B. (2022) · Death Studies · doi:10.1080/07481187.2022.2142329 · Cited by 13 · see citing works
Therapeutic Songwriting for Perceived Stigma and Perceived Social Support in Adults with Substance Use Disorder: A Cluster-Randomized Effectiveness Study
Silverman, M. J. (2019) · Substance Use & Misuse · doi:10.1080/10826084.2019.1701037 · Cited by 14 · see citing works
“Public stigma is the reaction the general public has toward the stigmatized group including stereotypes, discrimination, and judgments (Luoma et al., 2013).”
Background
Social Stigmatization of Drug Abusers in a Developing Country: A Cross-Sectional Study
Khalid, F., Jaan, A., ASLAM, M. M. S., Ahmed, Z., Raheem, A., Bodla, Z. H., Basit, A., Hussain, B., Iftikhar, A., Tayyeb, M., et al. (2020) · Cureus · doi:10.7759/cureus.10661 · Cited by 13 · see citing works
“Another study showed that about 70% of the respondents had feelings of self-stigma and worthlessness [14].”
Background
Prevalence and correlates of using opioids alone among individuals in a residential treatment program in Michigan: implications for overdose mortality prevention
Gicquelais, R. E., Genberg, B. L., Maksut, J. L., Bohnert, A. S. B., & Fernandez, A. C. (2022) · Harm Reduction Journal · doi:10.1186/s12954-022-00723-4 · Cited by 13 · see citing works
“First, self-stigma and anticipated stigma were measured using two subscales from the validated Substance Abuse Self-Stigma Scale [41].”
Method
Treatments, Perceived Stigma, and Employment Outcomes among Substance Abusers in China
Li, H., & Jia, C. X. (2022) · Healthcare · doi:10.3390/healthcare10010130 · Cited by 11 · see citing works
Identity Construction in Recovery from Substance Use Disorders
Chen, G. (2022) · Journal of Psychoactive Drugs · doi:10.1080/02791072.2022.2159592 · Cited by 12 · see citing works
“…interventions should include: (a) assessment of the client’s level of self-stigma as measured by the Substance Abuse Self-Stigma Scale (SASSS; see Luoma et al. 2013); (b) assessment of the individual’s RC (see Groshkova, Best, and White 2013); (c) targeting those who are highly stigmatized and…”
Stigma and ART initiation among people with HIV and a lifetime history of illicit drug use in Saint-Petersburg, Russia-A prospective cohort analysis
Vetrova, M., Lodi, S., Rateau, L., Patts, G., Blokhina, E., Palatkin, V., Yaroslavtseva, T., Toussova, O., Bushara, N., Bendiks, S., et al. (2022) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2022.103600 · Cited by 11 · see citing works
Self-compassion buffers the internalized alcohol stigma and depression link in women sexual assault survivors who drink to cope
Braun, T. D., Green, Z., Meshesha, L. Z., Sillice, M. A., Read, J. P., & Abrantes, A. M. (2022) · Addictive Behaviors · doi:10.1016/j.addbeh.2022.107562 · Cited by 10 · see citing works
Self-stigma, hope for future, and recovery
Anand, T., Kandasamy, A., & Suman, L. N. (2022) · Industrial Psychiatry Journal · doi:10.4103/ipj.ipj_52_21 · Cited by 11 · see citing works
Alcohol-Related Risky Behavior Patterns and Their Association With Alcohol Use and Perceived Alcohol Stigma in Moshi, Tanzania
Zhao, D., Vissoci, J. R. N., Mmbaga, B. T., Abdullah, A. S. M., & Staton, C. A. (2020) · Journal of Studies on Alcohol and Drugs · doi:10.15288/jsad.2020.81.614 · Cited by 10 · see citing works
“The PDD contains 12 six-point Likert scale questions and has shown good psychometric properties in various settings (Luoma et al., 2010, 2013; Ruan et al., 2008).”
Background
HIV, substance use, and intersectional stigma: Associations with mental health among persons living with HIV who inject drugs in Russia
Hook, K., Sereda, Y., Rossi, S. L., Koberna, S., Vetrova, M., Lodi, S., & Lunze, K. (2022) · AIDS and Behavior · doi:10.1007/s10461-022-03778-3 · Cited by 10 · see citing works
Analysis of YouTube content on substance use disorder treatment and recovery
Raj, S., Ghosh, A., Pandiyan, S., Chauhan, D., & Goel, S. (2023) · International Journal of Social Psychiatry · doi:10.1177/00207640231190304 · Cited by 11 · see citing works
“Stereotypes that may promote self-stigma portray persons with substance misuse as those who lack willpower, are secretive, have blameworthy personal responsibility, and are deval-ued for their failures (Luoma et al., 2013).”
Background
Exploring the Relationships Between Eating Disorders and Mental Health in Women Attending Residential Substance Use Treatment
Robinson, L. D., Kelly, P. J., Deane, F. P., & Reis, S. L. (2019) · Journal of Dual Diagnosis · doi:10.1080/15504263.2019.1660019 · Cited by 10 · see citing works
“This is not surprising as secrecy along with social withdrawal is common among individuals misusing substances as well as those who experience eating disorder symptoms (Ahern, Stuber, & Galea, 2007; Luoma et al., 2013).”
Background
Correlates of Intersectional HIV and Substance Use Stigma Affecting People with HIV and Substance Use in St. Petersburg, Russia
Lodi, S., Rossi, S. L., Bendiks, S., Gnatienko, N., Lloyd-Travaglini, C. A., Vetrova, M., Toussova, O., Bushara, N., Blokhina, E. A., Krupitsky, E. M., et al. (2022) · AIDS and Behavior · doi:10.1007/s10461-022-03781-8 · Cited by 12 · see citing works
“Second, although the Berger HIV stigma scale and the SASSS substance use stigma scale have been widely used, it is difficult to translate an observed magnitude of scores into a clinically meaningful effect.”
Method
Measuring Barriers to Mental Health Care in the Military: The RAND Barriers and Facilitators to Care Item Banks
Acosta, J., Huang, W., Edelen, M. O., Cerully, J., Soliman, S. H., & Chandra, A. (2018) · RAND Corporation eBooks · doi:10.7249/rr1762 · Cited by 9 · see citing works
The Peer to Career Pipeline: An Observational Study of Peer Worker Trainee Characteristics and Training Completion Likelihood
de Martell, S. C., Wilkerson, J. M., Howell, J., Brown, H. S., Ranjit, N., Steiker, L. H., & McCurdy, S. (2023) · Journal of Substance Use and Addiction Treatment · doi:10.1016/j.josat.2023.209287 · Cited by 7 · see citing works
Stigmatisation intériorisée et consommation de substances psychoactives : revue systématique de la littérature
Milan, L., & Varescon, I. (2021) · Psychologie Française · doi:10.1016/j.psfr.2021.02.006 · Cited by 7 · see citing works
Measuring psychological flexibility: The cultural adaptation and psychometric properties of the AAQ for substance abuse among Spanish speaking population in correctional and community settings
Sánchez-Millán, H. A., Alicea-Cruz, A. J., & Pérez-Pedrogo, C. (2021) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2021.11.002 · Cited by 7 · see citing works
Addressing intersectional stigma as a care barrier for HIV-positive people who inject drugs: Design of an RCT in St. Petersburg, Russia
Rossi, S. L., Sereda, Y., Luoma, J. B., Pavlov, N., Toussova, O., Vasileva, J., Abramova, K., Bendiks, S., Kiriazova, T. K., Vetrova, M., et al. (2021) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2021.100861 · Cited by 8 · see citing works
Brief acceptance and commitment therapy added to medication management during acute alcohol detoxification: A pilot randomized controlled effectiveness trial
Weststrate, T. R., Briggs, C. A., Miller, A. J., Shuster, A. E., & Gaynor, S. T. (2023) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2023.06.002 · Cited by 7 · see citing works
Normative Feedback and Adolescent Readiness to Change
Smith, D. C., Davis, J. P., Ureche, D. J., & Tabb, K. M. (2014) · Research on Social Work Practice · doi:10.1177/1049731514535851 · Cited by 7 · see citing works
“It could be that public stigma and stereotypes for people with multiple stigmatized identities (e.g., African American substance users; Luoma et al., 2013) may have influenced the reactions of minority youth to questions about their RTC. Finally, we must consider the possibility that pretreatment…”
Background
Vocational identity of veterans with co-occurring mental health and substance use disorders
Stevenson, B. J., Thrower, S. J., Mueller, L. N., & Kelly, M. M. (2021) · Journal of Vocational Rehabilitation · doi:10.3233/jvr-211153 · Cited by 7 · see citing works
“We also know that individuals with substance use disorders experience social stigma related to their addiction (Luoma et al., 2013).”
Internalized stigma measurement in substance use treatment settings: a narrative review
Joseph, V. W., Pearson, M. R., & Witkiewitz, K. A. (2023) · Addiction Research & Theory · doi:10.1080/16066359.2023.2227090 · Cited by 30 · see citing works
“…and implemented to measure internalized stigma in substance use treatment settings including the Internalized Stigma of Mental Illness Scale (ISMI) (Boyd et al. 2014), the Substance Abuse Self-Stigma Scale (SASSS, Luoma et al. 2013 (Fong et al. 2021), and the Brief Opioid Scale (Yang et al. 2019).”
BackgroundMethodInfluential
Effects of media campaign videos on stigma and attitudes towards treatment seeking for alcohol use disorder: a randomized controlled study
Finn, S. W., Mejldal, A., Baskaran, R., & Nielsen, A. S. (2023) · BMC Public Health · doi:10.1186/s12889-023-16811-4 · Cited by 6 · see citing works
“Participants who endorsed ongoing or previous concern for their alcohol use were presented a questionnaire measuring self-stigma, the Self-Devaluation Subscale, of the Substance Abuse Stigma Scale [43].”
Method
Policies for recovery from drug use: Differences between public stigma and perceived stigma and associated factors
Luo, T., Xu, S., & Zhang, K. (2024) · Drug and Alcohol Review · doi:10.1111/dar.13818 · Cited by 5 · see citing works
Methadone Patient Access to Collaborative Treatment: Protocol for a Pilot and a Randomized Controlled Trial to Establish Feasibility of Adoption and Impact on Methadone Treatment Delivery and Patient Outcomes
Meyerson, B. E., Davis, A., Crosby, R. A., Linde-Krieger, L. B., Brady, B. R., Carter, G. A., Mahoney, A. N., Frank, D., Rothers, J., Coffee, Z. H., et al. (2025) · JMIR Research Protocols · doi:10.2196/69829 · Cited by 5 · see citing works
“…(3) empowerment using a 5-item empowerment scale [49]; (4) stigma—toward people with OUD with a 9-item scale [50], self-stigma with a 9-item scale [51], and fear of enacted stigma through a 9-item scale [52]; (5) beliefs—about trauma-informed care measured by the attitudes toward trauma-informed…”
The Internalized Stigma and Self-Esteem in Individuals with Alcohol and Risky Substance Use Disorder
Akhan, L. U., & Yazıcı, H. G. (2022) · Alcoholism Treatment Quarterly · doi:10.1080/07347324.2022.2107968 · Cited by 5 · see citing works
Stigma and Substance Use Disorder in Pakistan: A Comparison Over Drug Taking Duration
Abbas, S., Iqbal, S., Sher, A., & Waseem, A. (2022) · Journal of Pakistan Psychiatric Society · doi:10.63050/jpps.19.01.110 · Cited by 5 · see citing works
Disability among patients with opioid use disorders and its relationship with stigma toward substance use
Kumar, S., Singh, S., Sarkar, S., & Balhara, Y. S. S. (2018) · Indian Journal of Social Psychiatry · doi:10.4103/ijsp.ijsp_120_17 · Cited by 5 · see citing works
“The members of the society who does not misuse substance tend to stereotype individuals suffering from SUD in extremely pejorative and negative categories, as a result of which the person comes to see him or herself as part of the conceptual group resulting in internalization of stigma.[35] Researchers have proposed a…”
Background
Stigma and Quality of Life in Substance Users: Methods and Applications
Fung, X. C. C., Chang, K., Chang, C., & Lin, C. (2022) · Springer eBooks · doi:10.1007/978-3-030-67928-6_179-1 · Cited by 5 · see citing works
Cultural adaptation and psychometric properties of the Substance Abuse Self-Stigma Scale among Latinos with substance use disorders: An effective screening tool for correctional and community settings.
Pérez-Pedrogo, C., Planas-García, B. Y., Ortega-Guzmán, J., Rivera-Suazo, S., Caraballo, J. N., & Albizu‐García, C. E. (2022) · Stigma and Health · doi:10.1037/sah0000383 · Cited by 5 · see citing works
An Acceptance-Based, Intersectional Stigma Coping Intervention for People with HIV Who Inject Drugs – an Open-Label RCT in St. Petersburg, RussiaPreprint
Luoma, J. B., Rossi, S. L., Sereda, Y., Pavlov, N., Toussova, O., Vetrova, M., Bendiks, S., Kiriazova, T. K., Krupitsky, E. M., Lioznov, D. A., et al. (2022) · SSRN Electronic Journal · doi:10.2139/ssrn.4182419 · Cited by 5 · see citing works
Patient Satisfaction with Substance Use Disorder Rehabilitation Services: a Qualitative Study
Dhumal, T., Giannetti, V. J., Kamal, K. M., Freyder, P. J., Kulkarni, A., Desai, G. V., & Covvey, J. R. (2020) · The Journal of Behavioral Health Services & Research · doi:10.1007/s11414-020-09705-5 · Cited by 4 · see citing works
An Integrative Review of Measurement Instruments Used to Assess the Stigma That Affects People Who Use Drugs
Semegni, C. K. E., Phetlhu, D. R., & Modeste, R. R. M. (2021) · SAGE Open · doi:10.1177/2158244020963067 · Cited by 4 · see citing works
“In the selected studies for this review, Ha et al. (2012); Luoma et al. (2010, 2013); Palamar et al. (2011); and Smith et al. (2016) reported having their instrument reviewed by experts.”
BackgroundMethodInfluential
Factors associated with integration of people recovering from alcohol dependence syndrome with their family: An exploratory study
Rathee, A., Devi, Y. S., Gupta, S., & Mandal, P. (2024) · Industrial Psychiatry Journal · doi:10.4103/ipj.ipj_344_23 · Cited by 4 · see citing works
Self-stigma in alcohol dependence scale: development and validity of the short form
Rieckhof, S., Leonhard, A., Schindler, S., Lüders, J., Tschentscher, N., Speerforck, S., Corrigan, P., & Schomerus, G. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-06187-z · Cited by 3 · see citing works
“Depict-ing this entire process in one scale distinguish the SSMI, SSAD and SSAD-SF from other measures of self-stigma (e.g. ISMI [36], ; SASSS [47], ; SU-SMS [48]).”
Method
Qualitative exploration of the psychological dimensions of telehealth shared medical appointments (SMAs) for buprenorphine prescribing
Greenberg, B., Oft, A. C., Lucitt, L., Haug, N. A., & Lembke, A. (2022) · Journal of Addictive Diseases · doi:10.1080/10550887.2022.2123669 · Cited by 4 · see citing works
“12 This self-stigma is particularly salient among opioid users and often leads to isolation, low self-efficacy, self-devaluation, depression and reduced access to care.”
Background
Journal of Addictive Behaviors,Therapy & Rehabilitation
Sumanasekera, W. K., Nethery, W. J., & Nguyen, S. (2016) · Journal of Addictive Behaviors Therapy & Rehabilitation · doi:10.4172/2324-9005.1000154 · Cited by 4 · see citing works
Emergency department staff compassion is associated with lower fear of enacted stigma among patients with opioid use disorder
Steinhauser, S. F., Haroz, R., Jones, I., Skelton, W., Fuller, B. M., Roberts, M., Jones, C. W., Trzeciak, S., & Roberts, B. W. (2024) · Academic Emergency Medicine · doi:10.1111/acem.14970 · Cited by 3 · see citing works
An Automated Text Messaging Intervention to Reduce Substance Use Self-Stigma (Project RESTART): Protocol for a Feasibility and Acceptability Pilot Study
Sibley, A. L., Noar, S. M., Muessig, K. E., Gottfredson, N. C., Paquette, C. E., Spears, A. G., Miller, W. C., & Go, V. F.-L. (2024) · JMIR Research Protocols · doi:10.2196/59224 · Cited by 3 · see citing works
“Self-stigma includes self-devaluation (i.e., internalized stigma), the fear of encountering public stigma, avoidance of difficult thoughts and experiences, and disengagement from pursuing valued life goals [25].”
Understanding the Effects of Digital Storytelling on OUD Stigma Reduction: Exploring Character and the Recovery Plot
Smith, R. A., Osoro, R. A., & Sterner, G. (2025) · Health Communication · doi:10.1080/10410236.2025.2463535 · Cited by 2 · see citing works
“Thirteen items (adapted from Cuddy et al., 2007, 2008; Luoma et al., 2013; Nieweglowski et al., 2019) were used to assess the degree to which participants associated people living with OUD with negative stereotypes of danger (e.g., violent and criminal ) and incompetence (e.g., irresponsible and…”
Self-stigma in Opioid Use Disorder: The roles of depression, hopelessness, anxiety, stress, and resilience
İspir, G. Z., Varlı, M. R., Danışman, M., Katar, K. S., Hasanlı, Z. U., & Kurtoğlu, M. B. (2025) · Heroin addiction and related clinical problems · doi:10.62401/2531-4122-2025-8 · Cited by 3 · see citing works
The Effect of a Self-Forgiveness Model on Self-Stigma in Individuals Diagnosed with Substance Use Disorders
Verona, M. P., & Branthoover, H. (2022) · Counseling and Values · doi:10.1163/2161007x-67020004 · Cited by 3 · see citing works
How Anti-Substance Abuse Campaigns Influence Substance Abusers’ Psychological Health in Chinese Communities: The Mediating Role of Perceived Stigma
Zeng, Y., Li, H., Cheng, Y., & Jia, C. X. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19116687 · Cited by 3 · see citing works
“, stereotypes) shaped by public discourse, substance abusers will gradually see themselves as being part of the stereotyped inferior group and will consistently enact stigma experiences [27], subsequently leading to possible experiential avoidance [28].”
Background
A Review on Mental Illness and Stigma
ÇİLEK, N. Z., & Akkaya, C. (2022) · Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry · doi:10.18863/pgy.1069845 · Cited by 3 · see citing works
Stigma and Quality of Life in Substance Users: Methods and Applications
Fung, X. C. C., Chang, K., Chang, C., & Lin, C. (2022) · Springer eBooks · doi:10.1007/978-3-030-92392-1_179 · Cited by 3 · see citing works
Stigma Related to Substance Use and Addiction: The Long Journey Ahead—Commentary on Krendl and Perry (2023)
Hinshaw, S. P. (2023) · Gothic.net · doi:10.1177/15291006231202775 · Cited by 3 · see citing works
“Measures of internalized stigma about mental illness have been adapted to measure self-stigma about substance abuse (see Luoma et al., 2013).”
Background

The Development and Psychometric Properties of a New Measure of Perceived Stigma Toward Substance Users
Luoma, J. B., O’Hair, A., Kohlenberg, B. S., Hayes, S. C., & Fletcher, L. B. (2009) · Substance Use & Misuse · doi:10.3109/10826080902864712 · Cited by 201 · see citing works
Cultural adaptation and psychometric properties of the Substance Abuse Self-Stigma Scale among Latinos with substance use disorders: An effective screening tool for correctional and community settings.
Pérez-Pedrogo, C., Planas-García, B. Y., Ortega-Guzmán, J., Rivera-Suazo, S., Caraballo, J. N., & Albizu‐García, C. E. (2022) · Stigma and Health · doi:10.1037/sah0000383 · Cited by 5 · see citing works
Substance use stigma: Reliability and validity of a theory-based scale for substance-using populations
Smith, L. R., Earnshaw, V. A., Copenhaver, M. M., & Cunningham, C. O. (2016) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2016.02.019 · Cited by 210 · see citing works
Psychometric Properties of the Turkish Version of the Substance Abuse Self-Stigma Scale
Sükut, Ö., & Buzlu, S. (2022) · Addicta The Turkish Journal on Addictions · doi:10.5152/addicta.2022.21086 · Cited by 3 · see citing works
Substance use stigma: A systematic review of measures and their psychometric properties
Spata, A., Gupta, I., Lear, M. K., Lunze, K., & Luoma, J. B. (2024) · Drug and Alcohol Dependence Reports · doi:10.1016/j.dadr.2024.100237 · Cited by 24 · see citing works

Authors: Luoma, J. B., Nobles, R. H., Drake, C. E., Hayes, S. C., O’Hair, A., Fletcher, L., & Kohlenberg, B. S.
Affiliations: University of Nevada, Reno (US)
Corresponding author: Luoma, Jason B.
ORCID: Luoma, Jason B.
Drake, Chad E.
Hayes, Steven C.
Venue: Journal of Psychopathology and Behavioral Assessment
Publisher: Springer Science and Business Media LLC
Published: 2012-10-09
Volume: 35
Issue: 2
Pages: 223-234
ISSN: 0164-0305 (ISSN-L)
0882-2689
1573-3505
DOI: 10.1007/s10862-012-9323-4
PMC: PMC3680138
OpenAlex: W1985432220
Cited by: 150
References: 68
Citations by year: 2026: 9 · 2025: 18 · 2024: 19 · 2023: 21 · 2022: 23 · 2021: 12 · 2020: 8 · 2019: 10 · 2018: 11 · 2017: 7 · 2016: 6 · 2015: 2 · 2014: 4
FWCI: 1.44
Type: journal article
Language: en
Open access: green
europepmc.org
Licence: www.springer.com/tdm (tdm)
Locations: Journal of Psychopathology and Behavioral Assessment (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute on Drug Abuse (R21DA017644)
Topics: Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Keywords: self-stigma, substance abuse, scale development, stigma measurement, self-devaluation, stigma avoidance, addiction treatment

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