Skip to main content

Advertisement

Log in

The Relationship between Drug User Stigma and Depression among Inner-City Drug Users in Baltimore, MD

  • Published:
Journal of Urban Health Aims and scope Submit manuscript

Abstract

There is growing awareness of the role of stigma and discrimination in HIV prevention, testing, and medical care. Yet, few studies have examined the stigma associated with using illicit drugs. In the present study, we examined the relationship between social network characteristics, drug user stigma, and depression. Study participants were comprised of 340 individuals who reported cocaine, crack, and/or heroin use in the prior 6 months and were involved in an HIV prevention study. They were recruited through street outreach, referrals, and word of mouth in inner-city Baltimore, MD, USA. The stigma scale was comprised of eight items, such as “how much do you feel ashamed of using drugs?” Depression was assessed with the Center for Epidemiological Studies Depression Scale, using cutoffs of 16 and 20 or greater. In the bivariate analyses, gender, homelessness in the past 6 months, drug user stigma, larger size of drug network, and current use of heroin, cocaine, and crack were all significantly associated with high levels of depression, whereas in the multivariate analyses, only drug user stigma remained significantly associated with depression. The results of this study suggest that drug treatment providers and other professionals who provide services to drug users should consider developing trainings to address drug user stigma. These programs should focus on the attitudes and behaviors of health and service providers toward drug users, among drug users themselves, and among family members and others who provide social support to drug users.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Rounsaville BJ. Treatment of cocaine dependence and depression. Biol Psychiatry. 2004; 56(10): 803–809.

    Article  PubMed  CAS  Google Scholar 

  2. Reissner V, Kokkevi A, Schifano F, et al. Differences in drug consumption, comorbidity and health service use of opioid addicts across six European urban regions (TREAT-project). Eur Psychiatry. 2012; 27: 455–62.

    Article  PubMed  CAS  Google Scholar 

  3. Mason BJ, Kocsis JH, Melia D, et al. Psychiatric comorbidity in methadone maintained patients. J Addict Dis. 1998; 17(3): 75–89.

    Article  PubMed  CAS  Google Scholar 

  4. Ross J, Teesson M, Darke S, et al. The characteristics of heroin users entering treatment: findings from the Australian Treatment Outcome Study (ATOS). Drug Alcohol Rev. 2005; 24(5): 411–418.

    Article  PubMed  Google Scholar 

  5. Ford JD, Gelernter J, DeVoe JS, et al. Association of psychiatric and substance use disorder comorbidity with cocaine dependence severity and treatment utilization in cocaine-dependent individuals. Drug Alcohol Depend. 2009; 99(1–3): 193–203.

    Article  PubMed  Google Scholar 

  6. Hser YI, Huang D, Chou CP, Anglin MD. Trajectories of heroin addiction: growth mixture modeling results based on a 33-year follow-up study. Eval Rev. 2007; 31(6): 548–563.

    Article  PubMed  Google Scholar 

  7. Brown RA, Monti PM, Myers MG, et al. Depression among cocaine abusers in treatment: relation to cocaine and alcohol use and treatment outcome. Am J Psychiatry. 1998; 155(2): 220–225.

    PubMed  CAS  Google Scholar 

  8. Hasin D, Liu X, Nunes E, McCloud S, Samet S, Endicott J. Effects of major depression on remission and relapse of substance dependence. Arch Gen Psychiatry. 2002; 59(4): 375–380.

    Article  PubMed  Google Scholar 

  9. McKay JR, Pettinati HM, Morrison R, Feeley M, Mulvaney FD, Gallop R. Relation of depression diagnoses to 2-year outcomes in cocaine-dependent patients in a randomized continuing care study. Psychol Addict Behav. 2002; 16(3): 225–235.

    Article  PubMed  Google Scholar 

  10. Poling J, Kosten TR, Sofuoglu M. Treatment outcome predictors for cocaine dependence. Am J Drug Alcohol Abuse. 2007; 33(2): 191–206.

    Article  PubMed  Google Scholar 

  11. Tate SR, Brown SA, Unrod M, Ramo DE. Context of relapse for substance-dependent adults with and without comorbid psychiatric disorders. Addict Behav. 2004; 29(9): 1707–1724.

    Article  PubMed  Google Scholar 

  12. Rubin E, Aharonovich E, Bisaga A, Levin FR, Raby WN, Nunes EV. Early abstinence in cocaine dependence: influence of comorbid major depression. Am J Addict. 2007; 16(4): 283–290.

    Article  PubMed  Google Scholar 

  13. Crisp AH, Gelder MG, Rix S, Meltzer HI, Rowlands OJ. Stigmatisation of people with mental illnesses. Br J Psychiatry. 2000; 177: 4–7.

    Article  PubMed  CAS  Google Scholar 

  14. Keyes KM, Hatzenbuehler ML, McLaughlin KA, et al. Stigma and treatment for alcohol disorders in the United States. Am J Epidemiol. 2010; 172(12): 1364–1372.

    Article  PubMed  CAS  Google Scholar 

  15. Schomerus G, Lucht M, Holzinger A, Matschinger H, Carta MG, Angermeyer MC. The stigma of alcohol dependence compared with other mental disorders: a review of population studies. Alcohol Alcohol. 2011; 46(2): 105–112.

    Article  PubMed  CAS  Google Scholar 

  16. Logie C, Gadalla TM. Meta-analysis of health and demographic correlates of stigma towards people living with HIV. AIDS Care. 2009; 21(6): 742–753.

    Article  PubMed  CAS  Google Scholar 

  17. Earnshaw VA, Chaudoir SR. From conceptualizing to measuring HIV stigma: a review of HIV stigma mechanism measures. AIDS Behav. 2009; 13(6): 1160–1177.

    Article  PubMed  Google Scholar 

  18. Mahajan AP, Sayles JN, Patel VA, et al. Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward. AIDS. 2008; 22(Suppl 2): S67–79.

    Article  PubMed  Google Scholar 

  19. Sales JM, DiClemente RJ, Rose ES, Wingood GM, Klein JD, Woods ER. Relationship of STD-related shame and stigma to female adolescents' condom-protected intercourse. J Adolesc Health. 2007; 40(6): 573.e1–573.e6.

    Article  Google Scholar 

  20. Riley GA, Baah-Odoom D. Do stigma, blame and stereotyping contribute to unsafe sexual behaviour? A test of claims about the spread of HIV/AIDS arising from social representation theory and the AIDS risk reduction model. Soc Sci Med. 2010; 71(3): 600–607.

    Article  PubMed  Google Scholar 

  21. Worthington C, Myers T. Factors underlying anxiety in HIV testing: risk perceptions, stigma, and the patient-provider power dynamic. Qual Health Res. 2003; 13(5): 636–655.

    Article  PubMed  Google Scholar 

  22. Ronzani TM, Higgins-Biddle J, Furtado EF. Stigmatization of alcohol and other drug users by primary care providers in southeast Brazil. Soc Sci Med. 2009; 69(7): 1080–1084.

    Article  PubMed  Google Scholar 

  23. Shah S, Diwan S. Methadone: does stigma play a role as a barrier to treatment of chronic pain? Pain Physician. 2010; 13(3): 289–293.

    PubMed  Google Scholar 

  24. Brener L, von Hippel W, Kippax S. Prejudice among health care workers toward injecting drug users with hepatitis C: does greater contact lead to less prejudice? Int J Drug Policy. 2007; 18(5): 381–387.

    Article  PubMed  Google Scholar 

  25. Latkin C, Srikrishnan AK, Yang C, et al. The relationship between drug use stigma and HIV injection risk behaviors among injection drug users in Chennai, India. Drug Alcohol Depend. 2010; 110: 221–7.

    Article  PubMed  Google Scholar 

  26. Ahern J, Stuber J, Galea S. Stigma, discrimination and the health of illicit drug users. Drug Alcohol Depend. 2007; 88(2–3): 188–196.

    Article  PubMed  Google Scholar 

  27. Young M, Stuber J, Ahern J, Galea S. Interpersonal discrimination and the health of illicit drug users. Am J Drug Alcohol Abuse. 2005; 31(3): 371–391.

    Article  PubMed  Google Scholar 

  28. Ross MW, Darke S. Mad, bad and dangerous to know: dimensions and measurement of attitudes toward injecting drug users. Drug Alcohol Depend. 1992; 30(1): 71–74.

    Article  PubMed  CAS  Google Scholar 

  29. Room R. Stigma, social inequality and alcohol and drug use. Drug Alcohol Rev. 2005; 24(2): 143–155.

    Article  PubMed  Google Scholar 

  30. Palamar JJ, Kiang MV, Halkitis PN. Development and psychometric evaluation of scales that assess stigma associated with illicit drug users. Subst Use Misuse. 2011; 46(12): 1457–1467.

    Article  PubMed  Google Scholar 

  31. Luoma JB, O’Hair AK, Kohlenberg BS, Hayes SC, Fletcher L. The development and psychometric properties of a new measure of perceived stigma toward substance users. Subst Use Misuse. 2010; 45(1–2): 47–57.

    Article  PubMed  Google Scholar 

  32. Luoma JB, Twohig MP, Waltz T, et al. An investigation of stigma in individuals receiving treatment for substance abuse. Addict Behav. 2007; 32(7): 1331–1346.

    Article  PubMed  Google Scholar 

  33. Phelan JC, Link BG, Dovidio JF. Stigma and prejudice: one animal or two? Soc Sci Med. 2008; 67(3): 358–367.

    Article  PubMed  Google Scholar 

  34. Link BG, Phelan JC. Conceptualizing stigma. Annu Rev Sociol. 2001; 27: 363–385.

    Article  Google Scholar 

  35. Link BG, Struening EL, Rahav M, Phelan JC, Nuttbrock L. On stigma and its consequences: evidence from a longitudinal study of men with dual diagnoses of mental illness and substance abuse. J Health Soc Behav. 1997; 38(2): 177–190.

    Article  PubMed  CAS  Google Scholar 

  36. Link BG, Phelan JC. Stigma and its public health implications. Lancet. 2006; 367(9509): 528–529.

    Article  PubMed  Google Scholar 

  37. Maulik PK, Eaton WW, Bradshaw CP. The effect of social networks and social support on mental health services use, following a life event, among the Baltimore epidemiologic catchment area cohort. J Behav Health Serv Res. 2011; 38(1): 29–50.

    Article  PubMed  Google Scholar 

  38. Wasserman DA, Weinstein MG, Havassy BE, Hall SM. Factors associated with lapses to heroin use during methadone maintenance. Drug Alcohol Depend. 1998; 52(3): 183–192.

    Article  PubMed  CAS  Google Scholar 

  39. Davey-Rothwell MA, Tobin K, Yang C, Sun CJ, Latkin CA. Results of a randomized controlled trial of a peer mentor HIV/STI prevention intervention for women over an 18 month follow-up. AIDS Behav. 2011 Nov; 15(8): 1654–63

  40. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977; 1(3): 385–401.

    Article  Google Scholar 

  41. Costenbader EC, Astone NM, Latkin CA. The dynamics of injection drug users' personal networks and HIV risk behaviors. Addiction. 2006; 101(7): 1003–1013.

    Article  PubMed  Google Scholar 

  42. Stuber J, Galea S, Link BG. Smoking and the emergence of a stigmatized social status. Soc Sci Med. 2008; 67(3): 420–430.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Carl Latkin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Latkin, C., Davey-Rothwell, M., Yang, Jy. et al. The Relationship between Drug User Stigma and Depression among Inner-City Drug Users in Baltimore, MD. J Urban Health 90, 147–156 (2013). https://doi.org/10.1007/s11524-012-9753-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11524-012-9753-z

Keywords

Navigation