Injection Drug Use Increases Internalized and Anticipated Stigma Among Justice-Involved Individuals

Abstract

Research Question: Are there differing levels of anticipated and/or internalized stigma based on demographic categories such as marital status, education level, and IV drug use for individuals with substance use history and recent involvement with the criminal-legal system?

Background and Significance: Individuals with criminal-legal system involvement comprise a population that is more vulnerable than the general population to higher rates of opioid use disorder (OUD) and substance use disorder (SUD) more broadly, as well as associated infectious diseases such as HIV. For this reason, it is pertinent to have intervention early after release from the criminal legal system. Despite the effort of early intervention with mobile health unit (MHU) and patient navigators (PN) in this research study, many individuals may refuse social and health support due to substance abuse and HIV-related anticipated and internalized stigma. Anticipated stigma is the expectation that one might experience discrimination, while internalized stigma is the internalization of negative views of specific characteristics such as substance use disorder.

Materials and Methods: The current research is being conducted as part of a larger National Institute on Drug Abuse (NIDA) funded project entitled “Addressing Risk Through Community Treatment for Infectious Disease and Opioid Use Disorder Now Among Justice-Involved Populations” (ACTION) research study. The ACTION project is a collaboration between Texas Christian University (TCU) Institute of Behavioral Research (IRB), University of Texas Southwestern (UTSW), and Yale University School of Medicine. Participants are being recruited from Dallas and Tarrant County communities in Texas as well as New London and Windham/Tolland Counties in Connecticut. Participants’ levels of anticipated and internalized stigma were determined using a questionnaire of demographics and perceived stigma that given to participants during the baseline study visit. Stigma scores were evaluated in relation to subject’s education level and marital status and correlation analysis was performed testing if history of injection drug use was related to self-reported stigma.

Results: All study subjects were included after undergoing a two-step screening process and consisted of 356 subjects that were 77.0% male. Evaluation of the stigma questionnaire demonstrated that education level and marital status were unrelated to stigma (p = 0.05). However, among persons with a history of injection drug use, the frequency of injection drug use was positively associated with internalized stigma, r = 0.34, p < 0.01, R2 = 11.6%, and anticipated stigma, r = 0.26, p = 0.02, R2 = 6.8%.

Conclusion: The stigma results suggest that as injection drug use becomes more frequent, so does a person’s internalized and anticipated stigma. I anticipate that results from the main study will show that criminal justice involved individuals will have higher rates of both anticipated and internalized stigma compared to the general population, but anticipated will be higher than internalized. There will be higher scores of stigma for IV drug users, individuals with lower levels of education, and married participants. By examining the differing demographics by marital status, education level, and IV drug use, we can better understand the stigma experienced by each group.