Abstract

The pervasiveness of substance use disorder (SUD) is a major concern in the United States. SUD

affects the lives of many lives. Defined as a disorder in which the abuse of one or more

substances leads to a clinically significant impairment or distress, SUD affects the lives of many

creating an epidemic of various health disparities from adolescents to adults. For example, the

2012 National. A survey on Drug Use and Health (NSDUH), an annual survey sponsored by the

Substance Abuse and Mental Health Services Administration (SAMHSA), reported that based on

the criteria specified in the DSM-IV, an estimated 8.5% of Americans aged 12 years or older

were diagnosed with substance dependence or abuse in the previous year. There have been

many studies that substantiate stigma as a significant barrier to substance abuse treatment

among the general population (Krieger, 1999; Link et al., 1997; Minior et al., 2003; Young et al.,

2005). Goffman (1963) defined mental illness stigma as a special kind of gap between virtual

social identity and actual social identity. Many studies indicate that minority communities,

especially African Americans, rarely receive or seek substance use disorder (SUD) treatment

due to stigmas toward the quality of care and lack of awareness about its detriments.

The focus of this research is to develop a more comprehensive understanding of whether

perceived stigma has a significant impact on the use of treatment services among African

American men. Also, to determine effective interventions as a solution to an ongoing health

disparity and ineffective policy decisions regarding SUD treatment services.

 INTRODUCTION
Background

There have been many studies that substantiate stigma as a significant barrier to

substance abuse treatment among the general population (Krieger, 1999; Link et al., 1997;

Minior et al., 2003; Young et al., 2005). In fact, recent studies have found that substance users

with substance use disorders (SUD) typically are met with greater stigmas than any other health

related condition, thus, supporting the idea that stigma is an integral component in the lack of

substance abuse treatment acceptance (Rao et al., 2009; Ronzani et al., 2009; Room, 2005;

Corrigan et al., 2005; Schomerus et al., 2011). Other studies have specifically identified stigma

as a perpetual barrier to substance abuse treatment and other health care mainly among

minority populations (Calsyn et al., 2004; Ojeda & McGuire, 2006; Reif et al., 2005). A literature

review conducted on treatment barriers attempted to rationalize minorities’ lack of treatment

acceptance of health care services by concluding that many minority groups such as African

Americans have negative ideas about the overall health care system and professionals in

general (Miller, Sheppard, Colenda, & Magen, 2001). These negative perceptions among African

Americans may have been formulated by their own negative beliefs about health care, previous

negative experiences, or inherent stereotypes developed within their socio-ethnic community

(Scheffer, 2003). However, more research on the origins of African Americans’ negative

perceptions toward health care and substance abuse treatment acceptance and a

comprehensive understanding of how stigmas impact treatment acceptance among this sub-

population is needed.

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Stigma’s Influence on Society

In the United States society views SUD as immoral, demeaning, or a weakness of some

sort (Room, 1983). Substance abusers are seen as a risk to society’s normal way of life and are

looked unfavorably upon (Ritsher et al., 2003). In a study that compared the general public’s

perspective of SUD to other illnesses SUD was viewed as a demoralizing characteristic and was

ranked significantly higher in the area of social disapproval and barriers to treatment services

(Baumohl et al., 2003). Previous research validates society’s perspective by proving that

individuals that have been diagnosed with a SUD have been regularly stigmatized by the

general public in the past at some point (Link & Phelan, 1999). Other studies show that stigmas

about substance abuse treatment and SUDs persist even in the absence of the substance or

during recovery and, as a result, has direct implications to additional symptoms of mental

illnesses acquired after treatment success (Link et al., 1997). For instance, additional symptoms

of mental illnesses may be due to the internalization of society’s negative perceptions toward

substance abusers (Link et al., 1987). Also, as a result, unhealthy coping strategies are formed,

such as evading health care all together in order to avoid discrimination or rejection that they

believe they may receive if treatment services are accepted (Link et al., 1987).

Stigma’s Influence on Health Care

Numerous studies have demonstrated that stigmas about SUD have a direct impact, not

only on mental health, but on physical health as well (Krieger, 1999; Link et al, 1997; Minior et

al., 2003). From a medical perspective SUD has been treated as a chronic disease similar to

other preventable chronic illnesses such as diabetes, hypertension, and obesity, yet studies

show that the general public, including health care professionals, have more negative attitudes

Page 3 of 46
about substance abusers than people who suffer from other preventable chronic illnesses (Ben-

Porath, 2002; Baumohl et al., 2003). In fact, an investigation on minority substance abusers’

experience with stigmatization) demonstrated that many minority substance abusers have, in

fact, experienced stigmatization from health care providers and inadequate health care services

due to providers’ negative attitudes toward SUD (Miller et al., 2001). These negative

interactions likely indirectly discourage treatment acceptance. Stigmas about health care

providers may cultivate negative coping methods within the substance abuser that include

concealing their substance use or withdrawing from society potentially exacerbating their

mental and physical health symptoms (Farina, 1981). A later study that investigated

inadequate coping skills acquired by substance abusers supported previous findings by

concluding that inadequate coping skills are directly linked to many physical and mental health

detriments (Kurtz et al., 2005).

Stigma’s Influence on Treatment Barriers

Researchers have attributed stigma’s influence on treatment acceptance to a particular

type of self-stigma termed “perceived stigma” (Link et al., 1989). Perceived stigma, in the

context of SUD, has been described by Link et al., (1989) as an individual’s belief that others,

mainly health care institutions and social networks, will discriminate, degrade, or ostracize

them because of their illness. Further research on perceived stigma identified three significant

components that include stereotypes, prejudices, and discrimination as a result (Corrigan 2000

& 2002). Negative coping methods such as isolation, secrecy, and/or withdrawal from

community or social networks among substance abusers emerge due to perceived stigmas (Link

et al., 1989; Link et al., 1987). Current research also suggests that in the African American (AA)

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community, perhaps more than other communities, SUD are viewed as a personal weakness or

character flaws and lead to rejection, prejudices, and discrimination amongst peers (Conner et

al., 2010). As a result of the AA community’s negative perspectives about SUD, African

Americans may be discouraged from disclosing their illnesses within their social networks or to

health care professionals, ultimately creating a cycle of negative coping methods that could

potentially create new mental and physical health treatment barriers (Alvidrez et al., 2008;

Anglin et al., 2006).

Stigma’s Influence on African American Men

Previous research suggests that stigmas about substance abuse treatment among

African American men may also have a socio-ethnic basis that is derived from inherent negative

perceptions about the quality of care received during treatment perpetuated by stereotypes

within their culture (Peña et al., 2000). These stereotypes may have derived from previous

experiences with discrimination or rejection of other types (Rusert, 2009). Additionally,

research implies African American male substance abusers may have also conceptualized a fear

of discrimination and rejection by their social networks due to their own stigmas about

substance abuse and, in turn, their expectation that discrimination or rejection may occur while

seeking substance abuse treatment indirectly discourages treatment acceptance (Peña & Koss-

Chioino, 1992). This same conceptualization of discrimination and rejection reinforces poor

coping abilities while indirectly increasing stressors and intensifying mental and/or physical

health symptoms (Wahl, 1999). Further, stigmas about substance abuse treatment among

minorities provoke substance abusers to project their own negative cultural views about SUD,

which are usually fostered by socio-ethnic backgrounds, onto health care professionals thereby

Page 5 of 46
hindering the health care process by concealing their substance use ultimately accelerating

their ailment (Link et al., 1987).

Significance of the Study

Much of the research on substance abuse treatment in comparison to the general

population demonstrate that African Americans men are less likely to accept substance abuse

treatment services when needed (Wells et al., 2001). For example, according to a current study

on substance abuse treatment acceptance among African American men, less than one-third of

the participants utilized treatment services even when diagnosed with a SUD (Fiscella et al.,

2002; Jackson et al., 2007). This indicates there is a significant need for effective intervention

methods to reduce stigma as a barrier to treatment services. Stigma reduction techniques have

not been shown to be ineffective among African American men, however re-evaluating possible

intervention techniques by gaining more insight into the basis of negative perceptions of

treatment services and their logic of rejecting services that are ultimately beneficial to their

health is essential. Focusing on both social and perceived stigmas as a barrier for SUD

treatment allows for the opportunity to gain more insight into specific perceptions of

individuals’ interpretations and understanding of substance use disorders and substance abuse

treatment services that may have been shaped by cultural stereotypes.

Purpose of the Study

A literature review conducted by Kushner & Sher (1991) found that most research on

substance abuse treatment acceptance and/or delay was correlated to stigmas about SUD.

Although there have been numerous studies on barriers to substance abuse treatment,

research about stigma’s impact on substance abuse treatment acceptance among specific

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groups within the general population, such as African American men are extremely limited

(Kushner & Sher, 1991). The purpose of this study is to develop a more comprehensive

understanding of African American men’s perceptions about SUD and barriers to treatment

acceptance with consideration to their socio-ethnic perspectives, views, and beliefs. A

comprehensive understanding of perceived and social stigmas among African American men is

necessary in order to help reduce or prevent other potential barriers to substance abuse

treatment acceptance. Also, studies have shown that further insight into the perspectives and

viewpoints of African American men in regard to substance use can be successful in identifying

significant treatment barriers such as their use of informal social support systems (i.e. religious

leaders, friends, and family members) instead of seeking professional treatment services

(Mishra et al., 2009; Thompson et al., 2004).

Research Question

The research questions are as follows:

1. Is social stigma or perceived stigma a barrier for SUD treatment for African American men?

2. Are there differences in levels of perceived stigma versus social stigma among African

American men with SUD who have rejected treatment services?

3. Do African American men with substance use disorder report higher levels of perceived

stigmas or social stigmas?

Definition of Terms

Significant key terms to the proposed study will be operationally defined as follows. In

the present study, perceived stigma will be measured by the Perceived Stigma of Substance

Abuse Scale (PSAS; Luoma et al., 2010). The scale will provide a single total score ranging from

Page 7 of 46
8-32 with higher scores indicating greater perceived stigma toward those with SUD. Social

Stigma will be measured by the Stig-9 questionnaire (Gierk et al., 2013). The questionnaire

consists of nine items and one example item on a four-point Likert scale. Respondents indicate

the degree to which they expect negative societal beliefs, feelings, and behaviors towards

someone who has been treated for a SUD. The item responses are summarized in a sum score

ranging from 0-27 points with higher scores indicating negative societal beliefs, feelings, and

behaviors towards those with SUD.

Social stigma: Refers to the general public’s effect on barriers to treatment services.

“Disqualification from social acceptance, derogation, marginalization and ostracism

encountered by persons who abuse alcohol or other drugs as the result of societal negative

attitudes, feelings, perceptions, representations and acts of discrimination” (State of Wisconsin,

2003).

Perceived stigma: An individual’s belief that other’s, mainly health care institutions and

society, will discriminate, degrade, or ostracize them because of their illness (Link et al., 1989).

Further, perceived stigma includes three major components: Stereotypes, prejudice, and

discrimination (Corrigan, 2000 & 2002). Perceived stigma refers to beliefs that members of a

stigmatized group have about the prevalence of stigmatizing attitudes and actions in society (cf.

Link, 1987).

Socio-ethnic group: The cultural context of ethnic minority communities (Luborsky et al.,

1988).

Substance Use Disorder (SUD): Substance Use Disorder is defined, according to the

Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V), as a maladaptive

Page 8 of 46
pattern of substance use leading to clinically significant impairment or distress, as

demonstrated by 2 or more criterions occurring within a 12-month period such as; continued

substance use despite having persistent or recurrent social or interpersonal problems or the

substance use is continued despite knowledge of having a physical or psychological problem

that is likely to have been caused or exacerbated the substance. The DSM-V combines the DSM-

IV categories of substance abuse and substance dependence into a single disorder measured on

a continuum from mild to severe.

African American or black (AA): African-American and/or black will refer to a person

who identifies with African or Caribbean heritage and was either born in the United States or

has spent a minimum of 75% of their life years living in the United States. When not spelled out

in text, African American or black will be denoted as AA.

Social networks: are defined as a web of social ties that connect people to others, such

as family members, friends, community members, and religious leaders. Social networks

provide social support that may include emotional support that buffers individuals from poor

physical or mental health, information or instrumental help that can be used to maintain or

improve health. Persons living in large, urban high-rises with little social organization and

support or in rural areas may be at a disadvantage for developing supportive social networks.

Social networks also channel the diffusion of ideas and practices. They therefore may play a

vital role in community-based interventions that depend on the spread of new ideas for their

success.

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 LITERATURE REVIEW

Background

The concept of stigma, in regard to mental illness, was initially presented by Goffman in

1963 as an attempt to conceptualize the characteristics of individuals with mental illnesses and

were viewed as abnormal by society. Goffman’s (1963) goal was to understand why society

seemed to ostracize those who were suffering from mental illnesses. The concept of mental

illness stigma was later expanded and related to SUD (Stafford and Scott, 1986). Two types of

stigmas were identified: social and perceived (Stafford and Scott, 1986). At that time little was

known about perceived stigma, though social stigma was greatly focused on by researchers to

determine the general public’s impact on barriers to treatment services. For example, in a

study conducted by Nunnally (1961), Cohen and Struening (1962), and Taylor and Dear (1981),

participants were allowed to give self-reports about their perspectives on people who suffer

from SUD. It was later found in the study that the vast majority of the general public held

unfavorable views toward substance abusers and saw SUD as a character flaw (Nunnally, 1961;

Cohen & Struening 1962; Taylor & Dear 1981). A later study conducted by Fink and Tasman

(1992) used vignettes to measure the general public’s attitudes about people diagnosed with

SUD and also found unfavorable views toward substance abusers. It was later identified that

negative attitudes about substance use disorders by the general public are, in fact, significant

barriers to, not only health care services, but substance abuse treatment and recovery (Fink &

Tasman, 1992). Corrigan (2000 & 2002) explains that perceived stigma can be separated into

three components including: Stereotypes, prejudices, and discrimination. Corrigan (2002) goes

on to examine these components further suggesting that stereotypes about SUD are

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established among specific sub-cultures within a general population. Additionally, it is

suggested that prejudices about substance abusers are validated by those stereotypes that

were established by those sub-cultures, ultimately leading to social discrimination (Corrigan et

al., 1999).

Stigma’s Influence on Society

Similar research regarding the general public’s viewpoint on SUD conducted by

Yankelovich (1990), Beldon and Russonello (1996) relied on public opinion surveys and

statements about their attitudes toward substance abuse. There was a general consensus

among the research that the public still maintained unfavorable views toward SUD (Taylor &

Dear 1981; Yankelovich 1990; Beldon & Russonello, 1996). A comprehensive range of research

has found that there are many factors that influence treatment acceptance among substance

abusers including labeling (Goffman, 1963). Piner and Kahle (1984) found that labels contribute

to stigmas about mental illnesses even when symptoms are no longer present, and treatment

and recovery have been successful. In fact, these findings and others related studies contradict

previous research that suggested that people with mental illnesses are only stigmatized when

symptoms are obvious or visible (National Institute of Mental Health, 1980; Link et al, 1987).

(Socall & Holtgraves, 1992). Research states that stigma is a detriment to the treatment and

recovery process of substance abusers who experience it and is still a prominent factor even

after symptoms are in remission and abstinence has been maintained (Fulton, 1999).

A study conducted by Gelder (2001) suggests that negative perceptions towards people

with mental illnesses, including SUD, may be due to three factors including a belief that people

with SUD are impulsive, out of control, and a threat to society, poor decision makers, and a lack

Page 11 of 46
of awareness about SUD and its causes. Gelder’s 2001 study that focused primarily on SUD

derived from a 1998 study which surveyed public opinions about SUD and compared them to

the opinions of other mental illnesses such as schizophrenia and found that the general public

held more negative opinions toward people with SUD than people with other mental illnesses

(Gelder, 1998 & 2001). Later studies by numerous investigators supported Gelder’s findings by

demonstrating that SUD are much more stigmatized than other health conditions, preventing

substance abuse treatment acceptance (Rao et al., 2009; Ronzani et al., 2009; Room, 2005;

Corrigan et al., 2005; Schomerus et al., 2011).

In 1999 a report by the U.S. Surgeon General also acknowledged that stigma is a

significant barrier to mental health and substance abuse treatment (U.S. Surgeon General

Report, 1999). The report further states:

“It is important to underline that the challenge is as much about compelling people to

change their attitudes towards and/or be more understanding of those who struggle

with a mental illness as it is to move them to recognize and acknowledge their own

mental health problems, and those of their families, friends and employees. It is no

wonder that negative attitudes towards mental illness sustain estimates are that two-

thirds of people who require treatment for a mental illness don’t seek help, either

because of a lack of understanding of the symptoms or because of the stigma associated

with the illness and its treatments. If people don’t acknowledge their own mental health

problems, how can we expect them to be accepting and supportive of others” (p. 6-8).

A 2001 study conducted in Great Britain by Gelder (2001) validated the U.S. Surgeon General’s

statement by reporting that half of the participants in a public survey admitted to personally

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knowing someone with a SUD, yet this knowledge had no impact on their negative views about

SUD. Several studies on the attitudes within the social networks of substance abusers found

that family members, employers, prospective landlords, and even mental health professionals

had unfavorable attitudes about substance abusers and have previously discriminated against

them in some way (Farina & Feller 1973; Struening et al., 2001).

Stigma’s Influence on Mental Health Professionals

A study conducted by Wahl (1999) that included obtaining the opinions of mental health

illustrating health care professionals’ discriminative attitudes toward diagnosed patients.

Additionally, Wahl’s (1999) interviews of over one hundred mental health care professionals

found that many of them were just as likely to embody negative attitudes toward people with

SUD ultimately helping to perpetuate stigmas among substance abusers. In his study Wahl

(1999) suggested that their contributions to stigmas toward SUD were not only due to negative

attitudes, which can lead to discouraging behaviors by professionals, but also due to degrading

comments and discriminative behavior toward their patients. Those kind of negative behaviors

deter substance abusers from seeking additional treatment or lead to premature treatment

withdrawal (Fulton, 1999). Wahl (1999) goes on to explain the potential detrimental

consequences of this kind of inadequate care by health care professionals which include

exacerbation of anxiety, depression, and SUD symptoms. Further, Wahl’s study (1999)

correlates stigma toward substance abusers with disinclinations to apply for jobs, seek further

education, or pursue other components that could improve the quality of life such as health

care and treatment.

Stigma’s Influence on Community

Page 13 of 46
 Stigmas toward substance abusers not only affect treatment acceptance, but it also

influences policy aspects of treatment and funding on a federal and state level (Fulton 1999).

Research further implies that stigmas at the federal and state level could influence stigmas at

community levels (i.e. organizations, social service agencies, employers, health care providers,

and educational institutions) by effecting how the community responds to individuals with SUD

(Pescosolido et al., 1999). Additionally, it was later acknowledged that stigma is often used to

demoralize and marginalize sub-cultures or socio-ethnic groups (Bayer, 2008; Buchanan &

Young, 2000; Stuber, 2008). Consequences of this type of stigmatization invoke discrimination

and rejection within the communities of substance abusers, primarily minority communities

(Link et al., 1997; Ritsher et al., 2003). In addition to being stigmatized, individuals with SUD are

regularly seen by the community as criminal issue and not a legitimate health concern that

should be funded by taxpayers’ dollars (Conyers et al., 2003). As a result of these types of

negative attitudes, limitations to treatment services in minority communities, especially within

the African American community remains a constant barrier (Barksdale & Molock, 2009;

Wallace & Constantine, 2005). Other issues that persist in the African American community

and perpetuate stigmatization of individuals with SUD are lack of knowledge about the disorder

and how and where to obtain services (Ward et al., 2009).

Stigma’s Influence on Culture

It is extremely important to consider ethnicity among African Americans when

addressing stigma as a barrier to substance abuse treatment because there are substantial

historical implications and race related stigmas may be significant factors in understanding their

reluctance to seek treatment. (Masuda et al., 2009). For example, catastrophes such as the

Page 14 of 46
Tuskegee Experiments have direct implications toward the mistrust of health professionals and

negative attitudes toward seeking treatment (Rusert, 2009; Whaley, 2001). Additionally,

culturally incompetent professionals contribute to underused treatment services by offending

African American clients causing them to become less likely to seek treatment services again

(Alvidrez et al., 2010; Snowden, 2001). Also, past and present experiences with discrimination,

prejudices, and rejection play important roles in the reluctance of African Americans to seek

out treatment services for mental health or physical health care (Terrell & Terrell, 1981). Anglin,

Alberti, Link, and Phelan (2008) stated in a study about barriers to treatment that “Moreover,

many African Americans believe that mental disorders improve on their own, without

treatment.” Further, studies have illustrated that older African Americans use church, prayer,

and family as coping strategies with SUD instead of professional services (Conner et al., 2010;

Snowden, 2001; Ward et al., 2009; Ward & Heidrich, 2009).

Nonetheless, a study conducted by Silva de Crane and Spielberger in 1981 showed that

African Americans have more stigmas toward other African Americans with SUD when

compared to other ethnic minority groups. Later research found that negative perceptions

toward substance abusers among African Americans have not improved (Diala, 2000). Further,

other studies show that African Americans are more likely than Caucasian Americans to display

degrading behaviors toward friends and family members who have sought substance abuse

treatment services (Alvidrez, 1999; Sirey et al., 2001).

In general, African American’s are reluctant to seek treatment services because they

tend to have negative attitudes about the quality of care that they may receive during

treatment and fear rejection and discrimination which could be attributed to perceived stigmas

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about health care providers and a general belief that health care professionals have

discriminatory views regarding SUD and their race.

Treatment Reluctance among African American Men

Numerous studies on treatment barriers among African Americans have been

conducted, but there is limited research and understanding about African American men’s

reluctance to seek substance abuse treatment (Barksdale & Molock, 2009; Wallace &

Constantine, 2005). Although African American men have been considered to have more

stressors than any other ethnic minority groups, they are the least likely to receive assistance

even when services are offered to them (Kearney et al., 2005; Masuda et al., 2009). Many

African American men seek support from people within their social network including

clergymen, friends, and family members instead of professional services (Ayalon & Young,

2009). However, studies also show that social networks can become barriers to treatment if

negative attitudes about s SUD are being conveyed by their social network (Ward et al., 2009).

A significant factor for researchers to consider is addressing specific groups within the

subcultures in order to develop a greater understanding of individual perceptions. (Foulks &

Peña, 1995; Foulks et al., 1995; Peña & Koss-Chioino, 1992; Trimble, 1990; Trimble & Bolek,

1988; Tucker, 1985). A scale created by Cristancho, Garces, Peters, and Mueller (2008)

attempted to assess whether interpersonal or intrapersonal aspects of African American men

influenced substance abuse treatment stigma. The study’s purpose was to identify substance

abuse treatment barriers specific to this socio-ethnic group. The scale used two types of

barriers including “system-level” barriers, which are created by mental health care systems to

provide treatment services, and “individual-level barriers, which attempts to understand the

Page 16 of 46
individuals’ perspective and experiences with the mental health care systems (Neufeld et al.,

2008). It was concluded by the U.S. Department of Health and Human Services (DHHS) that

interpersonal stigma or perceived stigma was the primary barrier toward substance abuse

treatment.

Professionals, clinicians and researchers, agree that stigma reduction is absolutely

necessary in substance abuse interventions among African Americans, however, those

interventions should be more practical and relatable to specific groups within the race in order

to be effective (National Institutes of Health, Office of Extramural Research, 1993; American

Psychiatric Association, 1995; Rowe & Grills, 1993; Takeuchi et al., 1995; Foulks & Peña, 1995;

Foulks et al., 1995; Peña & Koss-Chioino, 1992; Trimble, 1990; Trimble & Bolek, 1988; Tucker,

1985; Hanson, 1985). For instance, research shows that developing a better understanding of

an individual’s perceived identity allows for greater insight on individualized treatment

methods which impacts treatment outcomes and effectiveness significantly among African

American men (Luborsky et al, 1988). In a study conducted by Helms and Parham (1996) the

Racial Identity Attitude Scale (RIAS) was used to strengthen empirical data about substance

abuse treatment barriers among African American men.

Implications on Stigma Reduction

Community organizations, federally funded substance abuse programs, and other

institutions assisting substance abusers have used a number of strategies to reduce SUD

stigmas (Corrigan & Penn, 1999). The primary approach is to reduce the influence on perceived

stigma so that treatment services can be accepted (Penn & Corrigan, 2002). Many strategies

that have been used in the past, include raising awareness and endorsing community outreach

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have been ineffective (Kurzban & Leary, 2001). However, researchers agree that ethnicity is a

significant component when using these approaches because, if not properly implemented,

these strategies can create the opposite effect (Hayes, Bissett et al., 2004; Hayes et al., 2006;

Hayes et al., 1996). Further research by Corrigan & Penn (1999) discussed developing a

systematic method of reducing stigmas that includes developing supportive policy from federal

and state level governments. Additional components of this method include social marketing

through the media, further research on perceived stigma as a barrier to substance abuse

treatment, and training specific to socio-ethnic groups within minority communities.

Current legislative policies on substance abuse treatment and barriers to access are

ineffective in reducing stigmas among African American men. New approaches to research

addressing stigma as a treatment barrier for substance abuse needs to be evaluated and

developed from a multicultural perspective (Corrigan & Penn, 1999). Stigma competent training

among the mental health professional population is necessary in order to help recognize

stigmatizing behaviors among themselves and patients. Training will help professionals to

encourage treatment acceptance by providing quality care (Corrigan et al., 2001 & 2002).

Lastly, social marketing campaigns through the media that encourage treatment acceptance,

raise awareness about SUD, and inspire stigma reduction among the general public is necessary

to be effective in such a resilient epidemic due to underuse services and poor quality of care

(Corrigan & Watson, 2002; Hayes, Niccolls et al., 2002).

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