Substance use stigma mechanisms associated with greater depressive symptoms, substance use-related problems, and lower behavioral activation.

OBJECTIVE

Stigma is a well-recognized barrier to substance use (SU) treatment initiation and retention. It is theorized to operate through three distinct mechanisms: internalized, enacted, and anticipated. The unique associations between these specific stigma mechanisms and key psychosocial factors - such as engagement in reinforcing activities (i.e., behavioral activation), depression, and SU-related problems (e.g., social, financial) - remain unexplored, particularly among historically underserved populations. The current study examined how SU stigma in total and each mechanism is associated with these outcomes among individuals in an urban methadone clinic serving a historically underserved community.

METHOD: This cross-sectional study utilized baseline data from a peer-delivered behavioral intervention trial to examine how SU stigma mechanisms are associated with behavioral activation (BA), depressive symptoms, and SU-related problems among a predominantly low-income sample in methadone treatment (N = 212).

RESULTS

Linear regression analyses revealed that overall SU stigma was associated with lower BA, higher depressive symptoms, and greater SU-related problems. In multiple linear regression models controlling for relevant covariates and stigma mechanisms, higher internalized SU stigma remained significantly associated with worse outcomes across all domains. Following multiple-testing correction, associations for anticipated stigma (with lower BA and higher depressive symptoms) and enacted stigma (with greater SU-related problems) were marginally significant.

CONCLUSIONS

Findings highlight differential associations of stigma mechanisms in psychosocial functioning, and may point to a need to address internalized stigma in SU interventions. Future longitudinal research is needed to assess causal and mechanistic relationships between stigma, SU and psychosocial outcomes to inform targeted intervention development.