Internalized stigma as an independent risk factor for substance use problems among primary care patients: Rationale and preliminary support
Open accessAbstract
Background Little is known about internalized stigma among primary care patients, and whether the presence of internalized stigma is related to the severity of substance use problems independent of substance use-related variables. We sought to examine the relationship between internalized stigma and substance use problems among primary care patients with opioid or alcohol use disorders (OAUDs).Methods We present baseline data from 393 primary care patients who were enrolled in a study of collaborative care for OAUDs. Regression analyses examined the relationship between internalized stigma and substance use problems, controlling for demographics, psychiatric comorbidity, and quantity/frequency of use.Results The majority of participants reported thinking, at least sometimes, that they "have permanently screwed up" their lives (60%), and felt "ashamed" (60%), and "out of place in the world" (51%) as a result of their opioid or alcohol use. Higher internalized stigma was significantly related to more substance use problems (β=2.68, p<0.01), even after the effects of covariates were accounted for. Stigma added 22%, out of 51% total variance explained, leading to a significant improvement in prediction of substance use problems.Conclusions Among this group of primary care patients with OAUDs, rates of internalized stigma were comparable to those reported in specialty substance use treatment settings. Consistent with extant specialty care literature, our results suggest that internalized stigma may be a unique contributor that is associated with treatment outcomes, such as substance use problems, among primary care patients with OAUDs.
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Cultivating self-compassion is particularly important among people with SUD, for whom shame and self-criticism related to use, internalized stigma, and past traumas can fuel substance use.
“Cultivating self-compassion, meanwhile, is particularly important among people with SUD, for whom shame and self-criticism related to use, internalized stigma, and past traumas can fuel substance use 14,15.”
From Effects of a trauma-informed mindful recovery program on comorbid pain, anxiety, and substance use during primary care buprenorphine treatment: A proof-of-concept study (2023) · cites this paper as [15]
The Results and Discussion (page not available) report shame related to opioid or alcohol use and an association between internalized stigma and greater substance-use problems among primary care patients with opioid or alcohol use disorders. The paper measures problems arising from use, not whether shame or stigma fuels substance use itself, and it does not address past trauma or establish a benefit of self-compassion. (LLM, conf=0.87)
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- Authors
- Kulesza, M., Watkins, K. E., Ober, A. J., Osilla, K. C., & Ewing, B.
- Affiliations
- RAND Corporation (US)
- Corresponding author
- Watkins, Katherine E.
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2017-11
- Volume
- 180
- Pages
- 52-55
- ISSN
- 0376-8716 (ISSN-L)
- PMC
- PMC5648632
- OpenAlex
- W2751839148
- Cited by
- 73
- References
- 43
- Citations by year
- 2026: 8 · 2025: 7 · 2024: 7 · 2023: 13 · 2022: 9 · 2021: 16 · 2020: 7 · 2019: 6
- FWCI
- 2.78
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Drug and Alcohol Dependence (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (R01DA033953, R01DA034266)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- self-stigma, problematic substance use, opioid use disorder, alcoholism, primary care patients, collaborative care, shame, psychiatric comorbidity, treatment outcomes
- MeSH terms
- Alcoholism, Humans, Primary Health Care, Risk Factors, Comorbidity, Substance-Related Disorders, Social Stigma
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