Substance Use and Mental Health Stigma in Veterans With Co-Occurring Disorders

ABSTRACT

Objective: This pilot study examined whether substance use or mental illness was more stigmatizing among individuals with co-occurring mental health and substance abuse problems. Methods: This study included 48 individuals with co-occurring substance use and mental health problems enrolled in a Substance Abuse and Mental Health Services funded treatment program. Subjects received a baseline assessment that included addiction, mental health, and stigma measures. Results: The sample consisted primarily of White males with an average age of 38 years. Substance abuse was found to be more stigmatizing than mental illness, F(1, 47) = 14.213, p < .001, and stigma varied across four different levels of stigma (Aware, Agree, Apply, and Harm), F(2.099, 98.675) = 117.883, p < .001. The interaction between type and level of stigma was also significant, F(2.41, 113.284) = 20.250, p < .001, indicating that differences in reported stigma between types varied across levels of stigma. Post hoc tests found a significant difference between all levels of stigma except for the comparison between Apply and Harm. Reported stigma was significantly higher for substance abuse than mental illness at the Aware and Agree levels. In addition, pairwise comparisons found significant differences between all levels of stigma with the exception of the comparison between Apply and Harm, indicating a pattern whereby reported stigma generally decreased from the first level (Aware stage) to subsequent levels. Conclusions: These results have important implications for treatment, suggesting the need to incorporate anti-stigma interventions for individuals with co-occurring disorders with a greater focus on substance abuse.

KEYWORDS:

• Co-occurring disorders
• stigma
• mental illness
• substance abuse

Acknowledgments

The authors wish to thank the following partners whose work, support, and collaborations were invaluable to making this project feasible: The Department of Veterans Affairs, University of Massachusetts Medical School, University of Massachusetts Boston, the Massachusetts Trial Court District Court Department, the Massachusetts Office of the Commissioner of Correction, the Committee for Public Counsel Services, and the district attorneys in the counties where services were provided, as well as Soldier On and Community Healthlink. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government, the Massachusetts Department of Mental Health, or SAMHSA.

Disclosures

The authors report no financial relationships with commercial interests.

Funding

The funding for this program was derived from a 2008 Jail Diversion and Trauma Recovery Program grant from SAMHSA (grant #SM 58804-01), awarded to the Massachusetts Department of Mental Health.