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

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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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“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
“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 13
Identity Construction in Recovery from Substance Use Disorders
Chen, G. (2022) · Journal of Psychoactive Drugs · doi:10.1080/02791072.2022.2159592 · Cited by 12
“…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
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 11
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
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 11
“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
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
“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 12
“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
“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
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
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 9
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 9
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
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
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 9
“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
“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 31
“…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
“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
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
“…(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
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
Disability among patients with opioid use disorders and its relationship with stigma toward substance use
Kumar, S., Singh, S., Sarkar, S., & Balhara, Y. P. S. (2018) · Indian Journal of Social Psychiatry · doi:10.4103/ijsp.ijsp_120_17 · Cited by 5
“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 6
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
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
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
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
“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
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. W., & Schomerus, G. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-06187-z · Cited by 5
“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
“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
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
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
“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
“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
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
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
“, 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 4
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
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
“Measures of internalized stigma about mental illness have been adapted to measure self-stigma about substance abuse (see Luoma et al., 2013).”
Background

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
Health Sciences › Medicine › Psychiatry and Mental health › 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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Self-Stigma in Substance Abuse: Development of a New Measure

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