Internalized Stigma as an Independent Risk Factor for Substance Use Problems Among Primary Care Patients

Rationale and Preliminary Support

Published in: Drug and Alcohol Dependence, Volume 180, Supplement C (November 2017), Pages 52-55. doi: 10.1016/j.drugalcdep.2017.08.002

Posted on on September 19, 2017

by Magdalena Kulesza, Katherine E. Watkins, Allison J. Ober, Karen Chan Osilla, Brett Ewing

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Research Question

  1. What is the relationship between internalized stigma and substance use problems among primary care patients diagnosed with opioid and/or alcohol use disorders?


Little is known about internalized stigma among primary care patients, and whether the presence of internalized stigma is related to the severity of substance use problems independent of substance use-related variables. We sought to examine the relationship between internalized stigma and substance use problems among primary care patients with opioid or alcohol use disorders (OAUDs).


We present baseline data from 393 primary care patients who were enrolled in a study of collaborative care for OAUDs. Regression analyses examined the relationship between internalized stigma and substance use problems, controlling for demographics, psychiatric comorbidity, and quantity/frequency of use.


The majority of participants reported thinking, at least sometimes, that they "have permanently screwed up" their lives (60%), and felt "ashamed" (60%), and "out of place in the world" (51%) as a result of their opioid or alcohol use. Higher internalized stigma was significantly related to more substance use problems (β = 2.68, p < 0.01), even after the effects of covariates were accounted for. Stigma added 22%, out of 51% total variance explained, leading to a significant improvement in prediction of substance use problems.


Among this group of primary care patients with OAUDs, rates of internalized stigma were comparable to those reported in specialty substance use treatment settings. Consistent with extant specialty care literature, our results suggest that internalized stigma may be a unique contributor that is associated with treatment outcomes, such as substance use problems, among primary care patients with OAUDs.

Key Findings

  • Internalized stigma was common among this sample of primary care patients diagnosed with opioid and/or alcohol use disorders (OUADs).
  • A significant association between internalized stigma and substance use problems was found in this sample, even after controlling for factors such as psychiatric comorbidity, OUAD-related variables, and demographics.
  • Among the covariates analyzed, internalized stigma was the strongest predictor of substance use problems.


Future research should investigate whether stigma interventions could help lower the incidence of substance use problems and enhance emotional well-being and quality of life.

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