Comparing the Stigma of Substance Dependence Disorders in an Undergraduate Population Matthew D. Machnik University of Wisconsin-Green Bay

COMPARING SUBSTANCE DEPENDENCE STIGMA Abstract Stigma is a social phenomenon that involves the endorsement of negative attitudes toward certain groups, such as those diagnosed with mental illness. One such group that falls within the purview of mental illness is people diagnosed with substance dependence disorders. However, research into the stigma associated with these disorders is scarce, and even less work has been done on comparisons of the stigma associated with individual substance dependence disorders.


Thus, the aim of the current study was to expand the knowledge base on this topic by comparing the stigma associated with nicotine, alcohol, and cocaine dependence. This was accomplished by examining the stigmatizing beliefs held by a group of undergraduate students at a Midwestern university. Participants were asked to read one of three vignettes describing an individual diagnosed with one of the aforementioned conditions, after which they completed two measures regarding stigma, as well as one regarding familiarity with substance dependence disorders. Results indicate that cocaine and alcohol dependence were generally rated as having similar amounts of stigma associated with them, with nicotine dependence being rated as having the lowest ratings of stigma. Additional results, their potential implications, and limitations of the current study are included.

COMPARING SUBSTANCE DEPENDENCE STIGMA Comparing the Stigma of Substance Dependence Disorders in an Undergraduate Population Although the conceptualization of stigma is debated, it is proposed that the development of stigmatizing attitudes involves holding negative and prejudicial beliefs toward members of a specific group (Link & Phelan, 2001). This can occur based upon general acceptance of stereotypes held by large groups (Ben-Zeev, Young, & Corrigan, 2010), and can result in discrimination and status loss (Link & Phelan, 2001). Stigma carries with it a number of implications for mentally ill individuals, such as stereotyping and prejudice, loss of self-esteem,


and hesitance to seek treatment (Ben-Zeev et al., 2010). The impact of negative stigma on mental health is so great, advocacy groups, such as the National Alliance on Mental Illness [NAMI], have undertaken the responsibility of educating the public about mental illness in an attempt to reduce stigmatizing beliefs held by large groups (NAMI, 2011). Types of Stigma Ben-Zeev et al. (2010) take the conceptualization of stigma by Link and Phelan (2001) further by suggesting that stigma can occur in a number of ways. Specifically, they describe three different types, including public stigma, self-stigma, and label avoidance (Ben-Zeev et al., 2010). Public stigma involves the endorsement of stereotypes by large groups (Ben-Zeev et al., 2010), such as when one ethnic group holds disdainful attitudes about other ethnicities (Cockerham, 2003). These stereotypes and attitudes can also be applied to persons with mental illness, and can manifest themselves behaviorally as discrimination and prejudice (Ben-Zeev et al., 2010). The idea of public stigma can be broken down further, such that it may be perceived in two distinct ways. First, it can be the stigmatizing attitudes that a person holds about others (Palamar, Kiang, & Halkitis, 2011), such as when an individual believes that people with mental illness are inherently dangerous (Corrigan, Markowitz, Watson, Rowan, & Kubiak, 2003a).

COMPARING SUBSTANCE DEPENDENCE STIGMA Second, it can be thought of as how a person believes that others hold stigmatizing attitudes, such as when an individual perceives others as believing that drug users are not to be trusted (Palamar, et al., 2011). Self-stigma occurs when a person internalizes the stigmatizing beliefs held by the public (Ben-Zeev et al., 2010), which are then applied by the individual to a stigmatized characteristic


that he or she possesses (Bathje & Pryor, 2011). This internalization can lead to loss of both selfesteem and self-efficacy (Bathje & Pryor, 2011). As a result, self-stigmatizing individuals may experience decreased confidence regarding the completion of everyday tasks, as well as hesitance to seek treatment (Ben-Zeev et al., 2010). Finally, label avoidance occurs when a person engages in behavior aimed at avoiding the application of a stigmatized label applied to him or her (Ben-Zeev et al., 2010). For example, a person may choose to not seek treatment for his or her mental illness due to the impact of being labeled as a mental health patient (Ben-Zeev et al., 2010). Based on the conceptualizations provided by Ben-Zeev et al. (2010), label avoidance could be the product of either public or selfstigma. In other words, a person may want to avoid a label that was applied either by the public, or by him- or herself. Therefore, this type of stigma is focused upon the labels applied to mental illness, rather than the illness itself. Stigma and Mental Illness Stigma, as it pertains to mental illness, can negatively influence the quality of life for members of stigmatized groups (Link, Struening, Rahav, Phelan, & Nuttbrock, 1997; Ahern, Stuber, & Galea, 2007). This finding carries with it implications that extend across a variety of contexts. For example, stigmatized persons often experience discrimination in regards to employment, housing, and dealings with law enforcement (Corrigan et al., 2003b). Specifically,

Griffiths. & Brooks. create economic disadvantages..COMPARING SUBSTANCE DEPENDENCE STIGMA 5 employers may be hesitant to hire individuals diagnosed with mental illness. and lead to a lower quality of life among those diagnosed with mental illness. while landlords may not lease to them out of concern for tenant safety (Ben-Zeev et al. 2008). and receiving inadequate health care (González-Torres. it is apparent that developing an understanding of stigma is imperative. If these stigmatizing beliefs are internalized. Foster. leading to outright social avoidance (Ben-Zeev et al. Reddy. In addition.. However. 2010). Among persons diagnosed with depressive disorders. 2007).. it would seem. Arístegui. Asbury.. . they may be hesitant to engage in social situations. may result from the perception that persons with mental illness are inherently dangerous (Link & Phelan. and self-directed among diagnosed individuals (Kleim et al. Two of the most commonly studied disorders in regard to mental illness stigma are schizophrenia and depression. & Guimon. their results demonstrate the importance of understanding this phenomenon. The aforementioned studies provide only a small sample of the existing research pertaining to mental illness stigma. 2010). & Christensen. This. 2011). while self-stigma and public stigma were found to be associated with moderate degrees of embarrassment. 2001). as it can have a variety of detrimental effects for members of stigmatized groups. Studies have been conducted that suggest stigma associated with schizophrenia exists on a variety of levels. stigmatized individuals can experience a greater desire for social distance by others (Dietrich et al. Oraa. 2009). which can impair social relationships. including publically (Smith. self-stigma has been associated with lower quality of life (Yen et al. as stigma can discourage treatment. 2004). being perceived as dangerous. Thus. 2006). Fernández-Rivas. Jorm.. Interviews conducted with persons diagnosed with schizophrenia suggest that these stigmatizing beliefs can lead to social isolation and discrimination. and reluctance to seek treatment (Barney.

COMPARING SUBSTANCE DEPENDENCE STIGMA Stigma and Substance Use Stigmatizing beliefs have also been studied in regard to substance abuse disorders. cigarette smokers have been rated by . which may decrease the likelihood of treatment success. Stigma has also been examined regarding specific substance types and their related disorders. however. cigarette smoking in America has been labeled as a “public enemy. For example. has become an area of interest recently. 2010). As a result of anti-smoking legislation and campaigns. especially considering the widely noted adverse health effects of smoking. as well as limit the amount of potential harm to people exposed to second-hand smoke. In addition. Stigma associated with nicotine use. it can also encourage the stigmatization of individuals who smoke cigarettes (Kim & Shanahan. the stigma it creates has the potential to produce a number of problems. as legislation has begun to prohibit smoking in public areas (Kim & Shanahan. 2003). 2003). Thus. 2009). Although the objective of this process is to encourage current smokers to quit. 2003). Although the intentions of the anti-smoking movement seem honest. but it may also act as a source of discouragement after treatment has begun. since substance disorders are regarded as being highly destructive to the individual (Geppert & Bogenschutz. the results of a study conducted by Luoma et al. The desire to avoid labeling may discourage these individuals from seeking treatment (Ben-Zeev et al. cigarette smoking in particular.” leading to an increase in negative attitudes toward cigarette smokers (Kim & Shanahan.. This lack of attention may be a point of concern. although this particular group has received less attention than others. which can allow the destructive behavior to continue. not only is stigma a barrier to seeking treatment. 6 (2007) suggest that people who seek treatment for substance related disorders are often aware of their stigmatization.

& 7 Lowe. 2004). Therefore. and reluctance to discuss smoking habits with primary care physicians. the perceived shame resulting from stigma associated with seeking treatment for alcohol related disorders can deter individuals from finding care (Gray. Dawson. Fortney et al. Moreover.. A vignette study conducted by Piza Peluso and Blay (2008) found that participants perceived alcohol dependent persons as being more likely to commit violent acts. Another area that has received a considerable amount of attention is stigma associated with alcohol use. and felt that knowledge of the disorder leads to increased social distancing. while 79% would not allow an alcohol dependent person marry into their family. Additional research into alcohol-related stigma has made comparisons across racial and ethnic groups. a strong relationship was found between negative perceptions of the social acceptability of smoking. Additionally. the possibility exists that increases in stigma may actually deter smoking cessation efforts. when considering the impact of anti-smoking campaigns and legislation on stigma. (2010) found that 74% of respondents (N=630) would be unwilling to work closely with the individual. 2010). in a study conducted by Stuber & Galea (2009). a vignette study conducted by Pescosolido et al. Hannan. & Blay. and Grant (2010) examined . research has examined the public stigma associated with alcohol dependence. A study conducted by Smith. Studies have been conducted to confirm the presence of publically held stigmatizing beliefs about people who abuse alcohol across different cultures (Piza Peluso. 2008. Goldstein. The results of a study conducted by Fortney et al. Similar to other disorders. 1998). whether it is specialized or through primary care. Furthermore. (2004) suggest that these stigmatizing beliefs can occur regardless of treatment venue.COMPARING SUBSTANCE DEPENDENCE STIGMA work supervisors as being lower on job performance and dependability (Gilbert.

even though African-American individuals hold more stigmatizing beliefs about alcohol use (Smith et al. Higgins-Biddle. 2008. 2010). 2010. & Furtado. For the sake of comparison. it is difficult to infer what might cause this relationship. & Guillen. 2009). Comparisons of Stigma between Mental Illness and Substance Abuse . 2010). Fortney et al. they are less likely to feel stigmatized for seeking treatment (Fortney et al. All of the research located was determined to be outside of the focus of the present study. The results of the study indicate that White respondents reported holding fewer stigmatizing beliefs toward former alcoholics when compared with minority group members (Smith et al. 2000. Despite this..COMPARING SUBSTANCE DEPENDENCE STIGMA 8 racial differences in perceptions of former alcoholics. The results of the aforementioned studies provide interesting insight into the stigma held by different racial groups. Corrigan et al.. it seems that additional research is needed to explain these results.. Thus. Nevertheless.. A thorough search of the relevant literature yielded no information pertaining solely to the stigma associated with cocaine. other studies were located which compared the stigma of cocaine use and dependence to other mental and medical disorders (Crespo. as well as other street drugs. 2004). Interestingly.. Ronzani. Munoz. (2004) found that African-American individuals were less likely to feel stigmatized upon seeking treatment for alcohol abuse when compared to Caucasians.. such as crack or heroin. Although one can speculate on what might cause these seemingly paradoxical findings. Specifically. The inverse appears to be true for White/Caucasian individuals (Smith et al. is needed. a study conducted by Fortney et al. Therefore. 2004). Perez-Santos. both studies have provided information demonstrating the complex nature of stigma as it relates to substance abuse. it would seem that research regarding the stigma attached to cocaine use. information was also sought regarding other relatively serious street drugs.

(2010) found that alcohol dependence was a more stigmatized condition than schizophrenia. substance dependence may be considered more likely to be the result of bad character than other neurobiological causes. (1999) found that participants were less likely to rate cocaine or alcohol dependence as a mental illness when compared to depression or schizophrenia. specifically cocaine use. by associating substance disorders with character flaws and greater perceived controllability.. Stueve. 2010). in which results suggest that persons diagnosed with substance dependence disorders were perceived as being more likely to exhibit violent behavior when compared with persons diagnosed with depression. However. Furthermore. members of the public may be more likely to stigmatize them when compared to other mental illnesses.COMPARING SUBSTANCE DEPENDENCE STIGMA Currently. existing research does provide some insight into this issue. Phelan. and Pescosolido (1999). The results of Corrigan et al. although specific research into this area is rare. This perception may result from ideas about whether or not the person has control over his or her disorder. For instance. there is a lack of information in the literature pertaining to comparisons of 9 substance dependence and other mental illnesses. One explanation for these results involves examining other perceptions of mental illness and substance disorders. Thus. Therefore. (2008) made use of similar measures of stigma. it would appear that substance abuse is considered to be a more stigmatized condition than some other forms of mental illness. In addition. (2000) and Crespo et al. One potential explanation for this finding comes from a vignette study conducted by Link. studies conducted by Corrigan et al. a vignette study conducted by Pescosolido et al. Link et al. . For example. such as a chemical imbalance (Pescosolido et al. is considered to be under greater perceived control of the individual when compared to other forms of mental illness. and found that cocaine use was consistently rated as holding more stigma than psychosis and depression. (2000) would suggest that substance use. Bresnahan.

Attitudes about stigma were determined by gathering participants‟ perceptions of dangerousness. 1999).. the study conducted by Link et al. (1999) examined the stigmatizing attitudes toward a number of different psychiatric and medical conditions. as well as desire for social distance (Link et al.COMPARING SUBSTANCE DEPENDENCE STIGMA Comparison of Substance Related Stigma Another gap in our knowledge base pertains to comparisons of the stigma of individual substance disorders. 10 whereas others limited their inclusion to a single substance related disorder. For example. In addition. 1999).. In regard to dangerousness. However. or working with the individual described in the vignette (Link et al. it is unique in that it included multiple substance use disorders in its comparison.. Each vignette was written to represent an individual diagnosed with a specific condition. making friends. baseline measurements of stigma were derived from a vignette describing a troubled individual who was not diagnosed with any condition (Link et al. 1999). (1999) presented participants with a number of different vignettes. Therefore. or schizophrenia. Although this study was mentioned previously. Utilizing a nationwide.. alcohol dependence. such as cocaine dependence. 1999). the researchers asked participants a number of questions involving a variety of hypothetical social situations. . Link et al. representative sample of American adults (N=1444). (1999) is one of few that can provide information related to comparisons of substance use stigma. For social distance. Link et al. 1999).. with each disorder being representative of the diagnostic criteria in the DSM-IV (Link et al. such as socializing. the small amount of existing research on this topic can provide limited insight. participants were questioned as to how strongly they believed the individual in the vignette would be violent towards others (Link et al.

rather than basing the vignettes on DSM-IV criteria (Cunningham et al... Cunningham et al. 1993). marital. and . cocaine dependence as a diagnosed condition is more stigmatized than alcohol dependence. 1993).COMPARING SUBSTANCE DEPENDENCE STIGMA 11 A number of different results were obtained regarding the stigma of cocaine and alcohol dependence. or cocaine use (Cunningham et al. This was done while keeping the described amounts of consumption consistent across the different label types (Cunningham et al. In addition. 1999). 1993). legal. participants responded as desiring greater amounts of social distance from an individual diagnosed with cocaine dependence when compared to an individual diagnosed with alcohol dependence (Link et al. A more thorough approach to comparing stigmatizing beliefs about substance use was conducted by Cunningham. and Chow (1993). Sobell. respectively (Cunningham et al. 1999). The researchers utilized a participant pool of 606 adults. 1993). aged 19 to 76. who were recruited locally. Specifically. such as perceived work. the researchers described a male individual who engaged in one of three types of substance use. including cigarette smoking. with one question each for the work.. legal.. 1993). Similarly. persons described as being diagnosed with cocaine dependence were perceived as being more likely to be violent when compared with persons diagnosed with alcohol dependence (Link et al. in regard to alcohol use. (1993) conceptualized stigma as including a number of elements.. These four different elements were then used to construct a five-item assessment. The researchers departed from other research methods by using vignettes describing a general substance use scenario. For example. according to the results of Link et al. and interpersonal problems. (1999).. alcohol consumption.. one can conclude that. Therefore. In constructing the vignettes. two labels were applied to each substance user‟s level of dependence (Cunningham et al. the labels “alcoholic” or “heavy drinker” were used to designate high dependence and moderate dependence.

. 1993). Thus.. Finally.COMPARING SUBSTANCE DEPENDENCE STIGMA 12 marital aspects. 1993).. whether or not the individual could successfully cease substance use by abstaining. In addition.. The researchers reported a number of significant findings. 1993). cigarette smokers had a lower stigma rating attached to them when compared to both alcohol and cocaine users (Cunningham et al. Across all three substance types. the researchers collected information regarding substance abuse treatment. when making general assumptions about the findings obtained . individuals utilizing abstinence for cessation of use were rated as being more likely to succeed than those undertaking non-abstaining methods (Cunningham et al. and how it pertained to the individual in the vignette (Cunningham et al. and whether or not participants would believe the individual described if he admitted to successfully ceasing his substance use (Cunningham et al. which types of treatment programs they would suggest. Furthermore. particularly in regard to perceived legal problems (Cunningham et al. and two for interpersonal (Cunningham et al. A number of findings regarding stigma were also noted. which offered insight into whether a substance type was stigmatized more greatly in one area as opposed to another. 1993). 1993). In regard to treatment. the questions assessed impressions of likelihood of treatment success... 1993). cocaine and alcohol users were rated as being less likely to succeed in treatment when compared to cigarette smokers (Cunningham et al. 1993). cigarette smokers‟ admissions of cessation of use were more likely to be believed than those of alcohol or cocaine users (Cunningham et al. This allowed comparisons to be made across the different aspects of stigma. both cocaine and alcohol users were rated as having similar degrees of stigma attached to them. cigarette smokers were rated as being more likely to succeed in cessation of use without treatment when compared to cocaine and alcohol users (Cunningham et al... 1993). 1993). Specifically.. Finally. Across all four elements of stigma.

Therefore. (1993). This may be so.COMPARING SUBSTANCE DEPENDENCE STIGMA 13 by Cunningham et al. 1993). Specifically. the authors suggest that this finding may have originated from participants‟ belief that cigarette smoking is not a legitimate substance abuse problem (Cunningham et al. in regard to cigarette smoking being rated as less likely to cause problems across all elements of stigma. (1993) is that.. The researchers were surprised by the finding that cocaine and alcohol use were rated as having similar amounts of legal stigma (Cunningham et al. Even though a limited amount of research exists regarding the relative state of stigmatizing beliefs regarding substance use. 1993). In addition. it would appear that cigarette smokers are subjected to lower levels of stigma when compared to cocaine or alcohol users. 1993). comparisons can still be made. Though this certainly seems plausible. while certain . What is intriguing about the results of Link et al. They suggest that this perception may have come about by participants considering the legal ramifications associated with each. the finding obtained by Cunningham et al. such as drunk driving and arrests (Cunningham et al. The researchers provided a number of potential explanations for their results. when compared to legal status. the result also carries with it a potential implication for stigma and the legal status of a substance. this perception may also be supported by the notion that tobacco use is seemingly associated with fewer intoxicating and behavior influencing effects than the other two substance types used.. (1993) seems to suggest that. given the less stringent restrictions placed on tobacco when compared to cocaine or alcohol use.. It seems almost counterintuitive to suggest that an illicit substance would be perceived as carrying similar amounts of legal stigma compared to one that is legally obtainable. (1999) and Cunningham et al. participants may put greater emphasis on the negative legal consequences of substance use when forming impressions of users.

certain differences do as well. Specifically. but not others. (1993) was completed using adults recruited locally in Toronto. whereas cocaine dependence was associated with a higher degree of stigmatization than alcohol dependence in Link et al. cocaine users were ascribed a similar level of stigmatization when compared to alcohol users in Cunningham et al. it offers an interesting direction for present and future research. individuals using cocaine were rated as being highly stigmatized (Link et al. both studies made use of different populations. the participant pool used in Link et al. First. While this suggestion is certainly debatable. whereas the study conducted by Cunningham et al. the vignettes used in Link et al. The vignettes from the study conducted by . (1999). Specifically. (1999) were written to correspond with DSM-IV criteria for both alcohol and cocaine dependence. thus making such comparisons impossible. the vignettes used in both studies involved different methods of construction. in both studies. Second. the results of the two studies suggest that cocaine and alcohol use carry similar levels of stigma in some populations. However. (1993). one potential explanation for the different results regarding cocaine and alcohol related stigma is that they represent different culturally held beliefs. comparisons of culturally held stigmatizing beliefs may assist in understanding how these beliefs develop.. Observations of methodological differences between the two studies may provide a potential explanation for their differing results. For example. 1999. (1999) did not include the demographic composition of the participants used. Thus.. given the different countries of origin for both samples. Link et al. 1993). Canada.COMPARING SUBSTANCE DEPENDENCE STIGMA 14 similarities exist. (1999) was comprised of adults who participated in a survey that was administered throughout the United States. Therefore. Specifically. Although further comparisons of participant characteristics could provide insight into how the different results were achieved. Cunningham et al.

Although significant methodological differences exist. (1993) focused on the social consequences of substance use. as well as desire for social distance. and may account for the differences present. This is because. First. (1993) were constructed to describe patterns of substance use not corresponding to a diagnosed condition. it is possible that public attitudes toward alcohol. Second. and interpersonal issues.COMPARING SUBSTANCE DEPENDENCE STIGMA Cunningham et al. and nicotine users may have since changed. For example. legal. the measure used in Cunningham et al. by utilizing a different population. it may be prudent to suggest that researchers hoping to make comparisons between obtained and previous results use similar criteria for presenting behaviors. the findings of the current study expand upon the results of Cunningham et al. alcohol. Thus. However. (1993). a significant amount of time has passed the since the study conducted by Cunningham et al. Therefore. (1993). the intention was to assess any potential differences in participants‟ stigmatizing attitudes held toward nicotine. and cocaine users. A final difference is present in the types of measurements used. (1999) assessed perceptions of dangerousness. The Current Study The current investigation served as a partial conceptual replication of the study conducted by Cunningham et al. similar to Cunningham et al. differences in the aspects of stigma that were assessed in the two studies may have contributed to the differences in the results. Thus. The presentation of different behaviors in both studies 15 may play a role in affecting how participants view the individuals described in the vignettes. such as problems in regard to work. (1993) in a number of ways. marital. (1993) was published. the current investigation increased the generalizability of the results obtained by Cunningham et . the measure used in Link et al. cocaine.

the results of the current investigation will be more generalizable to college undergraduate populations. research into the topic of stigma has shown that it is a complex construct (e. it would . all of the participants will have attained some level of college education.1 (SD=9. the population used in the current research was more representative of undergraduate students. 2010). it was comprised entirely of undergraduate students at a local university. For example. 2010). For example.3). was located in a different country and state of origin. For example. (1993) was the types of participant attitudes assessed. the measure of stigma used in the study by Cunningham et al. For example. It was hypothesized that these differences would have a cumulative effect that influenced the results obtained. A third difference between the current investigation and the work of Cunningham et al. (1993) was reported as having an average age of 29. (1993).66 (SD=3. Ben-Zeev et al. Specifically. certain limitations exist. (1993) reported having acquired some college education. Although this method did provide insight into the topic.1% (N=579) of the population in Cunningham et al. and drinking and driving in the United States (WDHS. (1993) consisted of five questions designed to measure four proposed elements of stigma. In addition. binge drinking.COMPARING SUBSTANCE DEPENDENCE STIGMA 16 al. it was proposed that stigmatizing attitudes about alcohol use may be lower due to the seemingly high social acceptability of this behavior. Furthermore... Link & Phelan. average participant age was 19. whereas the population used in Cunningham et al.05). whereas only 58. As previously noted. 2001). Therefore. and had a distinct prevalence rate of substance use (Wisconsin Department of Health Services [WDHS]. given the high prevalence of alcohol consumption in this region. as well as younger adults in general. Therefore. Wisconsin has the highest rates of overall alcohol consumption. 2010. The population used in the current research contained a number of distinct differences when compared to the original study.g.

(1999) by including assessments for two different types of public stigma. alcohol. For example. and nicotine dependence. (1993) and Link et al. researchers have proposed that different types of stigma may exist. in that it does not address the different facets of stigma that have been proposed. (1999). including the specific beliefs held by the participants. These types of stigma can be broken down further to include concepts such as dangerousness.. who limited their assessment of stigma to perceptions of dangerousness and desire for social distance. as well as how participants believe others view mentally ill persons. (1999). an advantage to the vignettes used in the current study is that they not only present specific substance dependence behaviors. In addition. the vignettes expand upon those used in Link et al. the types of behavior they present are not consistent.. Thus. advances in the understanding of stigma have seemingly rendered the measure used by Cunningham et al. This stands in contrast to Cunningham et al. Therefore. (1993) is adequate in forming a clear understanding of stigma. but also address the attitudes participants may have toward substance abuse as a mental illness. (1993) inadequate. helping or rejection behaviors. as well as label avoidance (Ben-Zeev et al. These same limitations could be applied to the measure used in Link et al. the current study attempted to overcome the limitations of both Cunningham et al. 2010). the vignette describing cocaine dependence implied that the individual was stealing to support his or her drug . and ideas regarding segregation of the mentally ill (Corrigan et al. since three of the four 17 elements were assessed using only a single question. Although the vignettes used in Link et al. Therefore. who described general substance use scenarios without the inclusion of mental illness diagnoses.COMPARING SUBSTANCE DEPENDENCE STIGMA seem unlikely that the brief questionnaire used in Cunningham et al. This may be especially true. In addition. (1993). Finally. the current study utilized vignettes derived from the DSM-IV-TR criteria for cocaine. (1999) were also written based upon DSMIV criteria. 2003a). including public and self-stigma.

The present study tested three different hypotheses.5%).COMPARING SUBSTANCE DEPENDENCE STIGMA use. whereas this behavior is not present in the vignette for alcohol dependence (Link et al. such as theft. This is based upon the notion that participants may associate nicotine use with fewer intoxicating effects and legal ramifications. Therefore. SD=3. it was hypothesized that alcohol dependence would be rated as having more stigma than nicotine dependence. it was proposed that participants‟ ratings would be more indicative of the attitudes held toward the different substance dependence disorders rather than the behaviors described. as opposed to the disorder described. it was proposed that the characteristics of the population being used will contribute to decreased amounts of stigma associated with alcohol. 1999). It was comprised of 124 women (76. Finally.8%). it was hypothesized that cocaine dependence would be associated with the highest level of stigma.05). By doing so. and had an age range of 18 to 45 (M=19. it was hypothesized that nicotine dependence would carry with it the lowest ratings of stigma. and one individual identifying as other (0. Second.66. Method Participants The sample consisted of 162 undergraduate students from a mid-size public university in the upper Midwest.. Although this stands in contrast to the results obtained by Cunningham et al. One important consideration is that 87. 37 men (22.5% (N=140) of the sample was aged below the legal limit for alcohol consumption in the state where the study was conducted. .6%).3%. Thus. but less stigma than cocaine dependence. (1993). it is possible that participants‟ ratings of stigma may have been influenced by the behaviors presented. First. Most participants (88. the current study attempted to overcome this limitation by keeping the descriptions of behavior consistent 18 throughout each of the vignettes.

Hispanic/Mexican/Puerto Rican (N=3. Participation in these experiences is part of the requirements for both of the aforementioned courses. 6.8%).2%). and Human Development (N=11. the vast majority of the population identified as White/Caucasian (N=145. only 160 students signed up in advance to participate in the study. Black/AfricanAmerican (N=2. and alternatives to research participation. such as writing research summaries or attending presentations. 89.‟ and 7 (4. and 2 participants (1. The program is used with students enrolled in introductory Psychology and Human Development courses. 1. including Asian/Pacific Islander (N=7. Nursing (N=12. 7. one was eliminated from data analysis for reporting an age less than 18 years.5%). Native American (N=3. 19 1.2%) responding „undecided. 32 different undergraduate majors were represented. All of the participants were recruited using the Experiential Research Learning Program [ERLP]. Ethnically.3%). though the amount of credit needed to be earned is small compared to the requirements for course completion. Furthermore. a computer-based program designed at the university where the study took place. Students can choose studies in which to participate based on provided descriptions. Although the total number of respondents was 163 individuals.COMPARING SUBSTANCE DEPENDENCE STIGMA N=143) were in their first or second year of undergraduate schooling.3%) providing no information regarding their majors.2%) identifying as other. However. The three most commonly represented majors in the sample were Human Biology (N=19. That means some may have taken the surveys twice.9%).9%). with 44 participants (27.7%). which resulted in the final sample size of 162. other ethnicities were represented. 11. 4. are available. which was the only way to receive the web link to the surveys. 1. Finally.4%). Procedure .

the responses were saved. After reading the vignette. and participants were directed to a page which allowed them to provide their name. each participant was provided with a link to the study website. would not allow students to progress past this point. participants were randomly assigned to read one of three vignettes developed by the researcher. After completing each of the surveys. and year in school (see Appendix B). including age. After providing their name. following a between-subjects design. The purpose of the name collection was to ensure that each student was properly awarded credit for their participation. Randomization was accomplished using a setting within the Qualtrics survey software.COMPARING SUBSTANCE DEPENDENCE STIGMA Data collection was completed over the Internet using Qualtrics survey software. so the names provided could not be linked to the individual results. gender. Upon 20 signing up for the study in ERLP. participants were directed to a debriefing form (see Appendix C). if not checked. ethnicity. Use of this method allowed each participant to complete the survey at a time and place of his or her choosing. Materials Vignettes. If they consented. Each of the three vignettes was a written representation of an individual who was described as being diagnosed with one of three different substance dependence disorders . Once at the study website. major. as well as their familiarity with substance dependence disorders. Next. Consent was obtained on this form using a forced-choice checkbox which. which allowed each vignette to be distributed a proportionate number of times throughout the entire participant pool. participants were asked to complete three different questionnaires regarding their attitudes toward the person in the vignette. they were then asked to provide demographic information. Participants‟ names and survey results were stored in different data files within the Qualtrics server. each of the participants was asked to read a consent form (see Appendix A).

coercion-segregation (4 items). Each subscale was assessed individually. The final number of participants exposed to each vignette was as follows: cocaine dependence (N=53). with a score of one representing the minimum. 2003a). fear (4 items). with the majority of participants identifying as White and female (Corrigan et al. This measure was developed by Corrigan et al. including personal responsibility beliefs (3 items). Each of the 21 items was scored using a nine-point Likert scale. pity (3 items). Within the nicotine dependence vignette. and the manipulation was the type of substance dependence with which the person was diagnosed. The three disorders used were derived from the Diagnostic and Statistical 21 Manual of Mental Disorders. alcohol dependence (N=55). anger (3 items). 2000). cigarette smoking was described as the preferred means of nicotine administration. 2003a). and a score of nine representing the maximum as it related to each item (Corrigan et al.74. 2003a). cocaine dependence.. . The reliability of each subscale was assessed. Questionnaires. 4th Edition. 2003a).70. anger = . and the following alpha coefficients were obtained: personal responsibility = . The psychometric properties of the instrument were assessed using a sample of 542 students from a Midwestern community college. and dividing the sum by the total number of items (score range = 1 to 9) (Corrigan et al. Attribution Questionnaire. pity = . (2003a). and nicotine dependence (N=54). The questionnaire included six different subscales which were designed to assess a number of different components of stigma. and was used in the current research to assess the stigmatizing attitudes held by each participant (see Appendix E). Each of the vignettes contained similar descriptions of behavior... and nicotine dependence (American Psychiatric Association. Text Revision [DSM-IV-TR].COMPARING SUBSTANCE DEPENDENCE STIGMA (see Appendix D). and consisted of alcohol dependence.89.. Scores were determined by summing the responses for the items in each subscale. and willingness to help (4 items) (Corrigan et al.

94). 2011). SD=1. 2003a).9). the mean score of perceived public stigma of cocaine users obtained during scale development was 3.88. Palamar et al. (2003a). including dangerousness. DUSS. and coercion/segregation = .. Palamar et al.68. The 10 items in the DUSS were designed to measure several different facets of public stigma. Participants were asked to rate how much they agreed with each item using a five-point Likert scale (Palamar et al. the DUSS addressed the possibility that participants may be more comfortable ascribing stigmatizing beliefs to others. and likelihood of finding employment (Palamar et al. anger (M=3.89 (Corrigan et al. The psychometric properties of the DUSS were assessed using a sample of 1. helping = .. A third questionnaire was used to assess the familiarity of the participant with individuals having substance dependence disorders (see Appendix G).55.6% identified as White. pity (M=5... SD=2. and was originally designed to assess an individual‟s familiarity with mental illness. 2011). SD=2.19). 2011).. trust. Palamar et al.14). (2011). The DUSS was developed by Palamar et al. However. and dividing the sum by the total number of items (score range = 1 to 5.66 (SD=0. SD=2. The specific set of items that was used was derived from Corrigan et al. Reliability of the DUSS as a measure of stigma associated with cocaine was found to be high (α = .4% had some college education.COMPARING SUBSTANCE DEPENDENCE STIGMA 22 fear = .49).048 adults [mean age=20. 2011). Palamar et al. and was used to assess participants‟ beliefs regarding perceptions of stigma held by others (see Appendix F). 2011]. In addition to providing a measure of public stigma. For the purposes of this study. 2011)..31 (SD=1. .32.. 2011). 46. Familiarity Questionnaire. Normative data was provided for four of the six subscales: personal responsibility (M=4. the only psychometric information obtained was in regard to the measure of stigma associated with cocaine (Palamar et al.96. fear (M=5.. 43. Additionally.79.07. An overall score of stigma was formed by adding the responses.77.

Responses were summed together.. statistically significant differences were found within the fear (p < . which was then used to examine the differences between the six subscales of the Attribution Questionnaire. Before the dependent variables were analyzed. Corrigan et al. the demographic distribution of each experimental condition was examined. Specifically. A one-way ANOVA was then used to compare participants‟ average ratings on each of the measures of stigma by substance type. with a mean score of familiarity being reported as 2. 2003a).17 (SD=1. a ChiSquare analysis was performed to determine if the distribution of gender and ethnicity were different across the experimental conditions as well. This measure was found to have acceptable reliability (α = . with “yes” responses adding one point to the overall total. 2003a). No statistically significant differences were found between experimental groups in regard to the aforementioned demographic variables. 2003a). to reflect familiarity with substance 23 dependence disorders. The demographic distribution between groups is provided in Tables 1 and 2. Between conditions. DUSS. and familiarity questionnaire.001). and was normed using the same sample as the Attribution Questionnaire.62). helping (p < .. with the author‟s permission. each vignette was coded with a unique identifier within SPSS. Participants were asked to provide a yes or no response.63. Furthermore. and “no” responses being marked as zero (Corrigan et al. Results Data were analyzed using IBM SPSS 19 Statistics software.COMPARING SUBSTANCE DEPENDENCE STIGMA the 7 items were modified. and each of the demographic variables was relatively equally distributed throughout each condition. A one-way ANOVA was used to determine the means and standard deviations for the age and year in school variables across the three experimental conditions. to a maximum of seven (Corrigan et al.. This method produced a familiarity index that ranged from a minimum of zero points.

as well as on the DUSS (p < . However.86) reported higher familiarity with substance dependence disorders than males (M=2. A bivariate correlation analysis was run to determine the relationships between the summed scores for the six subscales of the Attribution Questionnaire. as well as the familiarity questionnaire. a post hoc Tukey HSD Comparison was run to further examine differences between conditions on scores of stigma and familiarity. With the exception of the personal responsibility subscale. Numerous statistically significant relationships emerged. p < . all other measures of stigma were significantly correlated with familiarity in such a way that overall stigmatizing beliefs were reduced as familiarity increased. A one-way ANOVA was run to compare the gender. DUSS. females (M=3. and personal responsibility (p < .67. The correlation matrix associated with this analysis is provided in Table 4. The only significant difference to emerge from this analysis pertained to gender and familiarity. Specifically. SD=1. coercion-segregation (p < . it is not likely that the relationship between gender and familiarity had an effect on comparisons of mean scores of stigma.COMPARING SUBSTANCE DEPENDENCE STIGMA . Differences between conditions on the pity and anger subscales of the Attribution Questionnaire. SD=1.01) subscales of the 24 Attribution Questionnaire. major. a bivariate correlation . In addition. no significant differences were noted in the distribution of females between each of the three conditions. were not statistically significant.22. In addition. analyses were run to determine whether any significant differences were present between the demographic variables and scores on each of the measures. but perhaps the most noteworthy are the relationships found between familiarity scores and the measures of stigma. and ethnicity variables with mean scores on the stigma and familiarity questionnaires. Finally.001). and a number of significant results were obtained (see Table 3). and familiarity questionnaire.46.05).001). Thus.001).

lower scores of perceived stigmatizing beliefs of others. as opposed to actual drug addiction. Since the average age was relatively similar between each of the three conditions. and the inability to stop using it may be a lack of willpower. nicotine dependence was associated with lesser degrees of fear and coercion-segregation beliefs.16. One potential explanation for this result may be a public misperception that nicotine is not a drug. people may be more likely to assume that its use is purely within the control of the user. Discussion The purpose of the current study was to compare ratings of stigma associated with cocaine. Without the knowledge that nicotine is a drug. year in school. and nicotine dependence disorders. suggesting that perceptions of personal responsibility tended to decrease as age increased. Results of the data analysis supported the hypothesis that nicotine dependence would. The only significant relationship to emerge was between age and the personal responsibility subscale (r = -. in relation to the other substance types. nicotine dependence was rated as having a higher degree of personal responsibility. it is not likely that this relationship had a significant effect on comparisons of mean ratings of personal responsibility between conditions. suggesting that participants believed the person described in the nicotine dependence vignette was more responsible for his condition than the persons described in the alcohol or cocaine vignettes.05). and an increased willingness to help. Specifically. and summed scores on the stigma and familiarity questionnaires. p < . The lower levels of stigma associated with nicotine dependence may have an unintended side effect. Specifically.COMPARING SUBSTANCE DEPENDENCE STIGMA 25 analysis was run to examine any potential relationships between age. alcohol. the relatively lower levels of stigma associated with nicotine . carry the lowest levels of stigma within the population studied. However.

This. as it had been proposed that the increased prevalence of alcohol consumption in the geographic region of the study would result in overall decreased levels of stigma regarding alcohol dependence.COMPARING SUBSTANCE DEPENDENCE STIGMA dependence may suggest social acceptability of the behavior. These results were particularly intriguing. while the differences could . but more stigmatized than nicotine dependence. it may be the case that individuals with less stigmatized conditions may perceive less social pressure to seek treatment for cessation of use. while alcohol dependence would be less stigmatized than cocaine dependence. However. in turn. while support was obtained for hypotheses two and three. relatively similar ratings of stigma for cocaine and alcohol dependence were found in regard to helping. could create a situation in which nicotine dependent persons feel less social pressure to cease nicotine use. One potential direction for future research may be to examine the relationship between a lack of perceived stigma in regard to substance dependence and willingness to cease substance use. This notion was based on a comparison with Cunningham et al. Thus.. while stigma has been noted to have the effect of creating hesitance to seek mental health treatment (Ben-Zeev et al. the methodological differences that exist between the current study and Cunningham et al. 26 Thus. who found that cocaine and alcohol use were rated as having similar degrees of stigma. The results regarding the second and third hypotheses were mixed. coercion-segregation beliefs. It was proposed that cocaine dependence would be associated with the highest ratings of stigma. (1993) make recognizing the cause of these differences difficult. 2010). alcohol dependence was less stigmatized than cocaine dependence in regard to fear and personal responsibility. While cocaine dependence was associated with higher levels of stigma in regard to fear and personal responsibility. In the current study. this support is fairly limited. Thus. and the perceived beliefs of others. (1993).

One result that was particularly troublesome was the strong negative correlation between helping behaviors and the perceived stigmatizing beliefs of others. One suggestion for future research would be to perform studies of substance dependence stigma using similar methodologies. it would seem research . Thus. This carries the important implication that an individual‟s willingness to engage in helping behaviors (e. However. The items in the familiarity questionnaire shared a commonality. familiarity was based upon participants‟ own personal interactions and observations rather than general knowledge of the disorders described. While this result could potentially suggest a new method to be used in anti-stigma efforts. sharing a car pool or offering a job interview) toward persons diagnosed with substance dependence disorders may be influenced by the stigmatizing attitudes that he or she believes others hold. they were statistically significant.. and in different geographic locations. and demonstrate that increased exposure to persons with substance dependence disorders can possibly reduce stigmatizing beliefs. stigmatizing beliefs were reduced as increased familiarity was reported. Specifically.g. in that they all examined participants‟ own personal experiences with substance dependent individuals. The results would suggest that familiarity based on this mode of exposure has the possibility to decrease stigmatizing attitudes. it could be determined if a region‟s prevalence of substance use could affect stigmatizing attitudes. a number of studies done using the same measures. a more positive result was found when comparing familiarity with substance dependence disorders and scores of stigma. For example. could then be compared to determine whether the differences in scores of stigma could be attributed to population differences. Thus. From this.COMPARING SUBSTANCE DEPENDENCE STIGMA potentially be attributed to the increased prevalence of alcohol consumption in the current 27 sample. it cannot be known for certain. while the correlations were not particularly strong in this regard.

one way to possibly increase familiarity could be through live lectures or videos of personal testimonials. in that the mean responses for each deviated from the trends present in the remaining four subscales. One particularly intriguing result was in regard to the pity and anger subscales of the Attribution Questionnaire. the pity and anger subscales were the only measures of stigma whose results were not statistically significant different from nicotine. . One suggestion for future research is that these two beliefs be examined further to better understand their contribution to stigmatizing attitudes. are different from the examples of exposure described in the familiarity questionnaire. and more anger toward. however. as well as the DUSS. with alcohol dependence having slightly lower ratings of stigma on two scales. participants reported feeling more sympathy for. In addition. as the results of this study would suggest. future research may want to examine these methods as a potential means of increasing familiarity with persons diagnosed with substance dependence disorders. which makes their ability to increase familiarity questionable. Nevertheless. Specifically. In other words.COMPARING SUBSTANCE DEPENDENCE STIGMA is needed to determine how to effectively increase familiarity with substance dependent 28 individuals. In deviating from this trend. the trend involved cocaine and alcohol dependence being rated as having relatively similar levels of stigma on three scales. alcohol dependence was rated as having higher mean scores of pity and anger than both cocaine and nicotine dependence. This result poses an interesting question about what makes feelings of pity and anger directed at alcohol dependent individuals different from the other beliefs examined in this study. the person described in the alcohol dependence vignette when compared with the person described in cocaine and nicotine dependence vignettes. since. For example. These methods. increasing familiarity could reduce stigmatizing attitudes.

could result in different ratings of stigma within each of the substance types used. (2003a) used the Attribution Questionnaire to obtain participants‟ attitudes regarding an individual diagnosed with schizophrenia. due to ethical reasons. but lower degrees of pity and fear. One could assume that if. such as binge drinking or heavy consumption. the participant‟s own habits of drug use were not recorded. Although it is possible that the current research may provide some insight into this issue. When comparing their results with those obtained in the current research. One such variable is the influence of the legal status of a substance.COMPARING SUBSTANCE DEPENDENCE STIGMA 29 While the measures used in this study were intended to provide a thorough measurement of stigma. it should be noted that no tests of statistical significance were run to . and examine patterns of use rather than amounts used. participants with different patterns of substance use. it would seem that researchers hoping to develop a better understanding of stigma may want to pursue this specific topic of inquiry. cocaine is currently an illicit substance. there are additional variables not accounted for which could have affected scores. For example. In their study. while alcohol and nicotine products are legally obtainable. the three substance dependence disorders represented were regarded as being associated with higher degrees of personal responsibility and anger. Furthermore. it is suggested that any future research on the subject of substance dependence stigma include measures of personal substance use. he or she may be less likely to give higher ratings of stigma. (2003a) to examine the stigmatization of substance dependence as a mental illness. Additionally. However. Thus. The results of the current study can be compared to Corrigan et al. the methodology of the study makes it difficult to understand directly the contributions of legal status to stigma. Corrigan et al. for example. one of the participants was a frequent user of any of the substances mentioned in this study. For this reason.

Second. 30 Several limitations are present within the current study. Developing a better understanding of this topic seems crucial.COMPARING SUBSTANCE DEPENDENCE STIGMA make these comparisons. as it may serve as a powerful measure of stigma directed toward users of non-illicit substances. the possibility exists that some participants may have taken the surveys twice. Nevertheless. In conclusion. (2011) was designed specifically to assess stigmatizing attitudes toward people who use illicit substances. future studies of this type should include both male and female characters in vignettes to determine any differences that may exist based on gender. Finally. Furthermore. as any differences that are found could have implications for both mental health professionals and the population they serve. although reliability and validity information was available regarding its use measuring the stigma of cocaine dependence. Third. (2011) be investigated further. few comparisons have been made regarding the stigma associated with different substance types. Thus. the results may not be generalizable to undergraduate populations with greater amounts of diversity. its ability to measure the stigma of both nicotine and alcohol dependence is questionable. Therefore. additional comparative research could provide further insight into how stigmatizing . It is suggested the psychometric properties of the scale developed by Palamar et al. the measure developed by Palamar et al. although this number was very small. the measurements obtained regarding nicotine and alcohol dependence may not be entirely accurate. although studies have examined the stigma related to substance use. this brief and informal comparison is able to provide some insight into where substance dependence stands in regard to mental illness stigma. the vignettes that were used only addressed stigmatizing attitudes directed toward males with substance dependence disorders. the sample used in the study was predominantly White/Caucasian. so it is likely that the effect on scores was negligible. Therefore. First. Therefore.

It is hoped that this study will inspire others to follow suit. in that comparisons of stigma across populations with different characteristics. can possibly identify factors that contribute to increased or decreased stigma. and help build a better understanding of public stigma. .COMPARING SUBSTANCE DEPENDENCE STIGMA beliefs develop. 31 such as substance use prevalence rates.

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Informed Consent* Please read the following information carefully: Title: College Students‟ Attitudes about Substance Dependence Principal Investigator: Dr. at or (920) 465-2230. ID . if at any point you should experience any discomfort while completing the research materials. and there should be no way to identify your individual survey responses. Risks: The only foreseeable risks involved with this study will be the minimal risk typically associated with survey research that encountering survey items on a topic that somehow relates to your own background could potentially. Two questionnaires will ask about personal and public perceptions related to substance dependence disorders. a faculty member in Human Development and Psychology.COMPARING SUBSTANCE DEPENDENCE STIGMA Appendix A Please print this form for your records. lead you to think more about that background as a result. Your name will. current Chair of the Institutional Review Board. Kristin Vespia. which should take about 15 minutes in total. *Some information borrowed from the sample consent form provided on the UWGB IRB website (http://www. and is part of an Honors Project being conducted by Matthew D.uwgb. please contact Dr. or any other information that would personally identify you on the survey instruments Benefits: Participants will receive 1 ERLP point for their participation. including age. be stored separately from your survey. ethnicity. for example. major. You will not be asked to provide your name. as well as to choose not to answer specific survey items. and you have the right to cease participation at any time without penalty. vespiak@uwgb. Kristin Vespia. Although your name will be collected to ensure proper awarding of credit. All materials used in the study have been reviewed by the University of Wisconsin-Green Bay Institutional Review Board. If you have questions regarding the study. please stop and contact the principal investigator. Safeguards: All survey information provided will be anonymous and will be kept confidential. gender. The first survey will collect demographic information. This research is taking place under the supervision of Dr. Machnik. Please stop your participation and contact the research supervisor if you experience any distress. and year in school. therefore. Machnik 37 Purpose of Research: To gain knowledge pertaining to students‟ attitudes toward persons diagnosed with substance dependence disorders. A final measure will include items about participants‟ familiarity with substance dependence disorders. You can also contact the campus Health and Counseling Center at 465-2380. Although it is not anticipated. Kristin Vespia using the information provided above. Your participation in this study is purely voluntary. Participation: Participation will involve reading a vignette and completing four brief surveys. (920) 465-2746 Research Assistant: Matthew D. a UWGB student. it will be collected using a different electronic link and process than the one for completing the surveys. please contact James Marker. If you have any questions regarding research participant rights.

COMPARING SUBSTANCE DEPENDENCE STIGMA Appendix B 1. Current major: ____________________________ 5. Year in school: (Please check one) ___ Freshman ___ Sophomore ___ Junior ___ Senior ___ Super-Senior ___ Other: ___________________ . Age ______ 38 2. Gender: (Please circle one) Male Female 3. Which of the following best describes your ethnic affiliation: (Please check one) ___ Asian/Pacific Islander ___ Black/African-American ___ Hispanic/Mexican/Puerto Rican ___ Native American ___ White/Caucasian 4.

and is part of an Honors Project being conducted by Matthew D. Machnik. If you have questions regarding the study. or would like to be notified about the results individually. Posting of Results: The results of the study will be posted on the ERLP website once data collection is complete. . Kristin Vespia. Kristin Vespia. If you have any questions regarding research participant rights. Thank you for participating in the study! The following information reiterates the purpose of the study in which you just participated. please take this opportunity to print the following information for your records. (920) 4652746. a UWGB student. please contact James Marker. vespiak@uwgb. and provides the contact information for the researchers involved should you have any questions. Title: College Students‟ Attitudes about Substance Dependence Purpose of Research: To gain knowledge pertaining to students‟ attitudes toward persons diagnosed with substance dependence disorders. This research is taking place under the supervision of Dr. at markerj@uwgb.COMPARING SUBSTANCE DEPENDENCE STIGMA Appendix C 39 If you did not already print the consent form. a faculty member in Human Development and Psychology. current Chair of the Institutional Review or (920) 465-2230. please contact

Over the past 12 months. but has been unsuccessful. he has needed to increase the amount of alcohol he drinks in order to achieve the desired effect.COMPARING SUBSTANCE DEPENDENCE STIGMA Appendix D Cocaine Dependence: Thomas has been using cocaine for the past 18 months. He finds that when he is unable to use cocaine. Even though he is aware of the effects his cocaine use is having on his life. As a result. he has 40 needed to increase the amount of cocaine he uses in order to achieve the desired effect. and has all but given up the recreational activities he used to enjoy. he continues to drink. He has noticed a marked decline in his overall health. During the past 12 months. He finds that when he is unable to drink alcohol. and has all but given up the recreational activities he used to enjoy. Thomas has been diagnosed by a Psychologist as having alcohol dependence. Over the past 12 months. he feels he needs to drink alcohol on a continual basis. but has been unsuccessful. Thomas has been diagnosed by a Psychologist as having cocaine dependence. he continues to use it. he has tried to quit drinking alcohol several times. he has tried to quit using cocaine several times. As a result. In order to overcome the withdrawal. he feels he needs to use cocaine on a continual basis. In order to overcome the withdrawal. Alcohol Dependence: Thomas has been drinking alcohol for the past 18 months. Even though he is aware of the effects his alcohol use is having on his life. he experiences significant cocaine withdrawal symptoms. He has noticed a marked decline in his overall health. he experiences significant alcohol withdrawal symptoms. During the past 12 months. .

. Thomas has been diagnosed by a Psychologist as having nicotine dependence. He finds that when he is unable to smoke cigarettes. He has noticed a marked decline in his overall health. he experiences significant nicotine withdrawal symptoms. he has tried to quit smoking cigarettes several times.COMPARING SUBSTANCE DEPENDENCE STIGMA Appendix D (continued) Nicotine Dependence: 41 Thomas has been smoking cigarettes for the past 18 months. and has all but given up the recreational activities he used to enjoy. In order to overcome the withdrawal. As a result. During the past 12 months. Over the past 12 months. Even though he is aware of the effects his cigarette smoking is having on his life. but has been unsuccessful. he feels he needs to smoke cigarettes on a continual basis. he continues to smoke. he has needed to increase the number of cigarettes he smokes in order to achieve the desired effect.

How much concern would you feel for Thomas? (1 = None at all. 9 = Very much) 2. 9 = Very much) 4. How dangerous would you feel Thomas is? (1 = None at all. (1 = None at all. 9 = Very much responsible) Pity 1. 9 = Yes. not at all. 9 = Very much) 3. 9 = Very much) . (1 = No. 9 = Very much) 2. 9 = Completely under personal control) 3. How frightened of Thomas would you feel? (1 = None at all. absolutely so) 2. 9 = Very much) Anger 1. How controllable. I would feel pity for Thomas. How scared of Thomas would you feel? (1 = None at all. is Thomas for his present condition? (1 = Not at all responsible. I would feel aggravated by Thomas. I would think that it were Thomas‟s own fault that he is in the present condition. not at all.COMPARING SUBSTANCE DEPENDENCE STIGMA Appendix E Personal Responsibility Beliefs 42 1. 9 = Very much) Fear 1. How irritated would feel by Thomas? (1 = None at all. I would feel threatened by Thomas? (1 = No. 9 = Very much) 3. is the cause of Thomas‟s present condition? (1 = Not at all under personal control. very much) 3. 9 = Very much) 2. How responsible. 9 = Yes. How much sympathy would you feel for Thomas? (1 = None at all. do you think. How angry would you feel at Thomas? (1 = None at all. do you think. (1 = None at all.

9 = Very much) 3. I would share a car pool with Thomas each day. If I were a landlord. If I were in charge of Thomas‟s treatment. 9 = Very likely) 3. (1 = Not likely. 9 = Very much) 4.COMPARING SUBSTANCE DEPENDENCE STIGMA Appendix E (continued) Helping 1. How much do you think an asylum. I think it would be best for Thomas‟s community if he were put away in a psychiatric hospital. How certain would you feel that you would help Thomas? (1 = Not at all certain. (1 = Not likely. If I were an employer. I think Thomas poses a risk to his neighbors unless he is hospitalized. I probably would rent an apartment to Thomas. (1 = Not at all. is best? (1 = Not at all. (1 = Not likely. 9 = Very much) 2. where Thomas can be kept away from his neighbors. I would interview Thomas for a job. 9 = Absolutely certain) 43 4. (1 = Not at all. 9 = Very likely) 2. 9 = Very much) . I would force him to live in a group home. (1 = Not at all. 9 = Very likely) Coercion-Segregation 1.

9. Most people would take Thomas‟s opinion less seriously. Most people would believe that Thomas is dangerous. 5. Most people would treat Thomas just as they would treat anyone else. Most people would not accept Thomas as a teacher of young children in public schools. 2. 5 = Strongly agree 1. 44 . 3. 10. Most young women would not date Thomas. 7. Most people would believe Thomas cannot be trusted. Most people would not accept Thomas as a close friend. 4. Most people think less of Thomas. Most employers would not hire Thomas. 6.COMPARING SUBSTANCE DEPENDENCE STIGMA Appendix F For all items. 1 = Strongly disagree. Most people feel that Thomas‟s drug use is a sign of personal failure. 8.

I have worked with a person who had a substance dependence disorder at my place of employment. I have observed persons with substance dependence disorders on a frequent basis.COMPARING SUBSTANCE DEPENDENCE STIGMA Appendix G 1. (Yes/No) 45 2. (Yes/No) 4. My job involves providing services/treatment for persons with substance dependence disorders. (Yes/No) . I have a relative who has a substance dependence disorder. I live with a person who has a substance dependence disorder. I have observed. a person I believe may have had a substance dependence disorder. (Yes/No) 5. A friend of the family has a substance dependence disorder. in passing. (Yes/No) 3. (Yes/No) 7. (Yes/No) 6.

79 46 Note.51 SD 4.53 1.51 1.04 1. No statistically significant differences were found between conditions.61 0.COMPARING SUBSTANCE DEPENDENCE STIGMA Table 1 Age and Year in School Distribution between Conditions Cocaine M Age Year in School 20.05 M 19.07 M 19. .39 Nicotine SD 1.58 Alcohol SD 2.23 1.42 1.

COMPARING SUBSTANCE DEPENDENCE STIGMA Table 2 Gender and Ethnicity Distribution between Conditions Cocaine N Gender Male Female Other Ethnicity Asian/Pacific Islander Black/African-American Hispanic/Mexican/Puerto Rican Native American White/Caucasian Other 2 0 1 2 47 1 4 0 2 0 48 1 1 1 0 1 50 1 12 40 1 12 43 0 13 41 0 Alcohol N Nicotine N 47 Note. . No statistically significant differences were found between conditions.

68 0.74 2. * 3.82 4. ** 2.1 3.05. ** = p < .** b.13 1. ** 2. ** b.78 1.32 c.7 1.65 1.46 1. ** 3. ** b.99 c.15 1. * 6.18 5.08 1. ** 4.59 1.96 c. ** b.75 a.77 4.62 2. = compared to cocaine dependence.14 c.58 4. a. ** 3. * 6.42 1. ** 3.COMPARING SUBSTANCE DEPENDENCE STIGMA 48 Table 3 Means and Standard Deviations of Measures with Tukey HSD Comparison Significance Levels Cocaine Measures Attribution Questionnaire Pity Anger Fear Helping Coercion-Segregation Personal Responsibility DUSS Familiarity Questionnaire 4.39 c.51 c.66 5.67 1.13 c. ** 3.28 4.4 a. = compared to nicotine dependence.42 1. ** 2. * 3.39 0.52 1.17 0. = compared to alcohol dependence.76 c.6 2.001 .08 a.42 1.48 a.74 1.71 1.73 a.46 1. ** 5.49 1.77 4. * = p < . b. ** 2. Only statistically significant relationships are reported. c.76 2.14 1.98 c.78 M SD M Alcohol SD M Nicotine SD Note.

23 --- 49 6 . *** = p < .01 ***.16 --4 .36 --5 *-.001 1 --2 ***-.17 ***.11 .12 **-.23 --- .26 **-.13 *.44 ***-.COMPARING SUBSTANCE DEPENDENCE STIGMA Table 4 Correlations between Summed Scores on all Measures Measures 1 Personal Responsibility 2 Pity 3 Anger 4 Fear 5 Helping 6 Coercion-Segregation 7 DUSS 8 Familiarity Note.40 --- 8 -.17 *-.31 ***.30 -.50 ***.03 . ** = p < .18 *. * = p < .10 *-.18 ***-.63 **-.01 -.16 ***.17 *-.21 --- 7 -.37 *-.05.34 --3 ***.14 ***.01.

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