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A Stigma or Negative Stereotype Related to Mental Illness or Substance Abuse

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Substance misuse and substance use disorders (SUDs) have great costs for users, their families, and society in general. The negative impacts for individuals with SUDs are further aggravated by the stigma complex (i.e., “the set of interrelated, heterogeneous system structures, from the individual to the society, and processes, from the molecular to the geographic and historical, that constructs, labels, and translates difference into ‘marks”. Of note, there has been a dearth of research on alcohol and drug use-related stigma compared to mental illness stigma.

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Public knowledge and norms about people with mental and substance use disorders have been captured through population-based surveys with components focused on the stigma of mental and substance use disorders as it is reflected in stereotypes, help- or treatment-seeking, and behavioral dispositions. Public perceptions and beliefs about mental and substance use disorders are influenced by knowledge about these disorders, the degree of contact or experience that one has had with people with mental and substance use disorders, and media portrayal of people with mental and substance use disorders, as well as media coverage of tragic events, notably gun violence and suicide. Public perceptions are also strongly influenced by social norms concerning the attribution of cause, or blame, for mental and substance use disorders, and the perceived dangerousness or unpredictability of people with these disorders. Race, ethnicity, and culture are embedded in social relationships and as such play a role in shaping attitudes, beliefs, and behaviors. Knowledge about mental and substance use disorders can positively influence public norms, yet there is evidence that reframing these disorders as brain diseases produces mixed results on people's attitudes and behavior toward people with mental and substance disorders. As noted above, public education campaigns that frame mental and substance use disorders as brain diseases can have unintended consequences, including increased perception of difference and disbelief in the likelihood of recovery. Several factors may explain why contact with people with mental and substance use disorders sometimes deepens stigma, including the affected individuals' symptom severity and stage of recovery; and, in the context of contact-based interventions, the quality of the intervention itself, the fidelity with which it was implemented, and the quality of the peer training that had been provided to the individuals offering the contact services.

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cholars and scientists have pointed to persistent stigma as a major barrier to the success of mental health reform. Stigma occurs and so needs to be addressed at multiple levels of society including the structural level of institutional practices, laws, and regulations; among both the general public and groups, such as health care providers, employers, and landlords; and as self-stigma, which reflects internalized negative stereotypes. The language that is used to discuss mental and substance use disorders, and to refer to people with these disorders, is often targeted for change as a strategy for reducing stigma. For example, many stakeholders prefer person-centered language, that is, language that describes a person as having a mental illness rather than as being mentally ill. The term “stigma” itself has been targeted for change by some stakeholder groups, and the Substance Abuse and Mental Health Services Administration (SAMHSA) is moving away from use of this term. In this report, the word stigma and its variants are used, except where the report discusses a more specific dimension of stigma such as prejudicial beliefs or discriminatory practices

We use patient-centered language throughout this report. “Prejudice” means to prejudge and generally implies prejudgment based on erroneous beliefs or incomplete information. Similarly, stigma against people with mental or substance use disorders can stem from erroneous beliefs about, for example, their dangerousness or the unpredictability of their behavior. Lack of information about the nature of these disorders (e.g., their causes) can lead to public attitudes of shame and blame. Discrimination is manifested as prejudice in behaviors that endorse differential treatment of people with mental and substance use disorders (Cummings et al., 2013). “Stereotyping” is the prejudicial characterization of an entire group, which blinds us to the differences among the people in that group. People with mental and substance use disorders are not a homogeneous group, and yet they are often referred to as such, for example, in discussions about background checks for firearm purchase.Mental and substance use disorders are prevalent and among the most highly stigmatized health conditions in the United States. Worldwide, mental and substance use disorders are leading causes of morbidity and mortality. The social and disease burden of these disorders increased by 37 percent between 1990 and 2010, primarily due to demographic trends in population growth and aging (Whiteford et al., 2013).

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To sum up, race had no main effect on perceiving stigma for either mental illness or drug addiction; however, many case managers mentioned specific racial groups having a negative view of mental health services. However, the case managers also specified that it was the men within these racial groups (particularly African American men and Latino men) who maintained these views

Similarly, while case managers agreed that clients were more likely to stigmatize mental illness treatment, the client survey found that only those in the Mental Health Court program perceived more stigmatization against mental illness whereas the drug program clients and standard probation clients perceived more stigmatization against drug addiction.

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Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, Charlson FJ, Norman RE, Flaxman AD, Johns N, Burstein R, Murray CJL, Vos T. Global burden of disease attributable to mental and substance use disorders: Findings from the Global Burden of Disease Study, 2010. The Lancet. 2013;382:1575–1586.

Cummings JR, Lucas SM, Druss BG. Addressing public stigma and disparities among persons with mental illness: The role of federal policy. American Journal of Public Health. 2013;103(5):781–785.

Pescosolido BA, Jensen PS, Martin JK, Perry BL, Olafsdottir S, Fettes D. Public knowledge and assessment of child mental health problems: Findings from the National Stigma Study-Children. Journal of the American Academy of Child & Adolescent Psychiatry. 2008a;

Colton CW, Manderscheid RW. Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Preventing Chronic Disease. 2006;3(2):A42.

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