Skip to main content

Advertisement

SpringerLink
Log in

Gender identity, stimulant drug use, and criminal justice history on internalized stigma among a nationally representative sample of adults who misuse opioids

  • Research
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

The rise of fatal stimulant use among adults who use opioids is a public health problem. Internalized stigma is a barrier to substance use treatment, which is greater for women and populations with criminal justice involvement.

Methods

Using a nationally representative sample of adults in the United States from a probability-based survey on household opinions in 2021, we examined characteristics of women (n = 289) and men (n = 416) who misuse opioids. In gender-stratified multivariable linear regression, we investigated factors associated with internalized stigma, and tested for the interaction of stimulant use and criminal justice involvement.

Results

Compared to men, women reported greater mental health symptom severity (3.2 vs. 2.7 on a 1 to 6 scale, p < 0.001). Internalized stigma was similar between women (2.3 ± 1.1) and men (2.2 ± 0.1). Among women and not men, however, stimulant use was positively associated with internalized stigma (0.36, 95% CI [0.07, 0.65]; p = 0.02). Interaction between stimulant use and criminal justice involvement was negatively associated with internalized stigma among women (− 0.60, 95% CI [− 1.16, -0.04]; p = 0.04); among men, the interaction was not significant. Predictive margins illustrate among women, stimulant use eliminated the gap in internalized stigma such that women with no criminal justice involvement had a similar level of internalized stigma as women with criminal justice involvement.

Conclusion

Internalized stigma between women and men who misuse opioids differed based on stimulant use and criminal justice involvement. Future research should assess whether internalized stigma influences treatment utilization among women with criminal justice involvement.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ahmad FB, Cisewski JA, Rossen LM, Sutton P (2022) Provisional drug overdose death counts: national center for health statistics. Available from: https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm. Accessed 1 Dec 2022

  2. Glick SN, Klein KS, Tinsley J, Golden MR (2021) Increasing heroin-methamphetamine (goofball) use and related morbidity among seattle area people who inject drugs. Am J Addict 30(2):183–191

    Article  PubMed  Google Scholar 

  3. Goodwin RD, Moeller SJ, Zhu J, Yarden J, Ganzhorn S, Williams JM (2021) The potential role of cocaine and heroin co-use in the opioid epidemic in the United States. Addict Behav 113:106680

    Article  PubMed  Google Scholar 

  4. Ellis MS, Kasper ZA, Cicero TJ (2018) Twin epidemics: the surging rise of methamphetamine use in chronic opioid users. Drug Alcohol Depend 193:14–20

    Article  PubMed  Google Scholar 

  5. Arendt V, Guillorit L, Origer A, Sauvageot N, Vaillant M, Fischer A et al (2019) Injection of cocaine is associated with a recent HIV outbreak in people who inject drugs in Luxembourg. PLoS One 14(5):e0215570

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Chawarski MC, Hawk K, Edelman EJ, O’Connor P, Owens P, Martel S et al (2020) Use of amphetamine-type stimulants among emergency department patients with untreated opioid use disorder. Ann Emerg Med 76(6):782–787

    Article  PubMed  PubMed Central  Google Scholar 

  7. National Academies of Sciences E, and Medicine Medication for opioid use disorder saves lives 2019

  8. Ronsley C, Nolan S, Knight R, Hayashi K, Klimas J, Walley A et al (2020) Treatment of stimulant use disorder: a systematic review of reviews. PLoS One 15(6):e0234809

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Tsui JI, Mayfield J, Speaker EC, Yakup S, Ries R, Funai H et al (2020) Association between methamphetamine use and retention among patients with opioid use disorders treated with buprenorphine. J Subst Abuse Treat 109:80–85

    Article  PubMed  Google Scholar 

  10. Salehi M, Emadossadat A, Kheirabadi GR, Maracy MR, Sharbafchi MR (2015) The effect of buprenorphine on methamphetamine cravings. J Clin Psychopharmacol 35(6):724–727

    Article  CAS  PubMed  Google Scholar 

  11. Ciccarone D (2021) The rise of illicit fentanyls, stimulants and the fourth wave of the opioid overdose crisis. Curr Opin Psychiatry 34(4):344–350

    Article  PubMed  PubMed Central  Google Scholar 

  12. Nunn A, Zaller N, Dickman S, Trimbur C, Nijhawan A, Rich JD (2009) Methadone and buprenorphine prescribing and referral practices in US prison systems: results from a nationwide survey. Drug Alcohol Depend 105(1–2):83–88

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Matusow H, Dickman SL, Rich JD, Fong C, Dumont DM, Hardin C et al (2013) Medication assisted treatment in US drug courts: results from a nationwide survey of availability, barriers and attitudes. J Subst Abuse Treat 44(5):473–480

    Article  PubMed  Google Scholar 

  14. Scott CK, Dennis ML, Grella CE, Mischel AF, Carnevale J (2021) The impact of the opioid crisis on US state prison systems. Health Justice 9(1):17

    Article  PubMed  PubMed Central  Google Scholar 

  15. Livingston JD, Boyd JE (2010) Correlates and consequences of internalized stigma for people living with mental illness: a systematic review and meta-analysis. Soc Sci Med 71(12):2150–2161

    Article  PubMed  Google Scholar 

  16. Hatzenbuehler ML, Phelan JC, Link BG (2013) Stigma as a fundamental cause of population health inequalities. Am J Public Health 103(5):813–821

    Article  PubMed  PubMed Central  Google Scholar 

  17. Brener L, Caruana T, Broady T, Cama E, Ezard N, Madden A et al (2022) Addressing injecting related risks among people who inject both opioids and stimulants: findings from an Australian survey of people who inject drugs. Addict Behav Rep 15:100398

    CAS  PubMed  Google Scholar 

  18. Kulesza M, Watkins KE, Ober AJ, Osilla KC, Ewing B (2017) Internalized stigma as an independent risk factor for substance use problems among primary care patients: rationale and preliminary support. Drug Alcohol Depend 180:52–55

    Article  PubMed  PubMed Central  Google Scholar 

  19. Birtel MD, Wood L, Kempa NJ (2017) Stigma and social support in substance abuse: implications for mental health and well-being. Psychiatry Res 252:1–8

    Article  PubMed  Google Scholar 

  20. LeBel TP (2012) If one doesn’t get you another one will: formerly incarcerated persons’ perceptions of discrimination. Prison J 92(1):63–87

    Article  ADS  Google Scholar 

  21. Howell BA, Earnshaw VA, Garcia M, Taylor A, Martin K, Fox AD (2022) The stigma of criminal legal involvement and health: a conceptual framework. J Urban Health 99(1):92–101

    Article  PubMed  PubMed Central  Google Scholar 

  22. Major B, O’Brien LT (2005) The social psychology of stigma. Annu Rev Psychol 56:393–421

    Article  PubMed  Google Scholar 

  23. Crocker J, Major B (1989) Social stigma and self-esteem: the self-protective properties of stigma. Psychol Rev 96:608–630

    Article  Google Scholar 

  24. Meyers SA, Earnshaw VA, D’Ambrosio B, Courchesne N, Werb D, Smith LR (2021) The intersection of gender and drug use-related stigma: a mixed methods systematic review and synthesis of the literature. Drug Alcohol Depend 223:108706

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Edelman NL, Patel H, Glasper A, Bogen-Johnston L (2014) Sexual health risks and health-seeking behaviours among substance-misusing women. J Adv Nurs 70(12):2861–2870

    Article  PubMed  Google Scholar 

  26. Syvertsen JL, Toneff H, Howard H, Spadola C, Madden D, Clapp J (2021) Conceptualizing stigma in contexts of pregnancy and opioid misuse: a qualitative study with women and healthcare providers in Ohio. Drug Alcohol Depend 222:108677

    Article  PubMed  Google Scholar 

  27. Fazel S, Yoon IA, Hayes AJ (2017) Substance use disorders in prisoners: an updated systematic review and meta-regression analysis in recently incarcerated men and women. Addiction 112(10):1725–1739

    Article  PubMed  PubMed Central  Google Scholar 

  28. Sawyer W, Wagner P (2023) Mass incarceration: the whole pie 2023. Prison policy initiative. https://www.prisonpolicy.org/reports/pie2023.html. Accessed 8 June 2023

    Google Scholar 

  29. Statistics BoJ (1986) Historical Corrections Statistics in the United States 1850–1984. In: Justice USDo, editor

  30. Statistics BoJ (2021) Prison and Jail Inmates at Midyear Series (1997–2020), Prisoners Series (1980–2020). In: Justice USDo, editor. Washington, DC

  31. Taylor BG, Lamuda PA, Flanagan E, Watts E, Pollack H, Schneider J (2021) Social stigma toward persons with opioid use disorder: results from a nationally representative survey of US adults. Subst Use Misuse 56(12):1752–1764

    Article  PubMed  PubMed Central  Google Scholar 

  32. Dennis JM (2019) AmeriSpeak Omnibus Field Report.

  33. Bilgen I, Dennis JM, Ganesh N (2018) Nonresponse Follow-up Impact on AmeriSpeak Panel Sample Composition and Representativeness. In: NORC, editor. Chicago, IL

  34. Montgomery R, Dennis JM, Ganesh N (2018) Response rate calculation methodology for recruitment of a two-phase probability-based panel: The Case of AmeriSpeak. In: Chicago NatUo, editor

  35. Luoma JB, Nobles RH, Drake CE, Hayes SC, O’Hair A, Fletcher L et al (2013) Self-stigma in substance abuse: development of a new measure. J Psychopathol Behav Assess 35(2):223–234

    Article  PubMed  Google Scholar 

  36. Veit CT, Ware JE Jr (1983) The structure of psychological distress and well-being in general populations. J Consult Clin Psychol 51(5):730–742

    Article  CAS  PubMed  Google Scholar 

  37. Berwick DM, Murphy JM, Goldman PA, Ware JE Jr, Barsky AJ, Weinstein MC (1991) Performance of a five-item mental health screening test. Med Care 29(2):169–176

    Article  CAS  PubMed  Google Scholar 

  38. Ware J, Snow K, Kosinski M, Gandek B (1993) SF36 Health Survey: Manual and Interpretation Guide. In: The Health Institute NEMC, editor

  39. StataCorp (2019) Stata statistical software: release 16. StataCorp LLC, College Station

    Google Scholar 

  40. Grella CE, Lovinger K (2012) Gender differences in physical and mental health outcomes among an aging cohort of individuals with a history of heroin dependence. Addict Behav 37(3):306–312

    Article  PubMed  Google Scholar 

  41. Grella CE (2008) From generic to gender-responsive treatment: changes in social policies, treatment services, and outcomes of women in substance abuse treatment. J Psychoactive Drugs (Suppl 5):327–343

  42. Greenfield SF, Grella CE (2009) What is “women-focused” treatment for substance use disorders? Psychiatr Serv 60(7):880–882

    Article  PubMed  PubMed Central  Google Scholar 

  43. Binswanger IA, Merrill JO, Krueger PM, White MC, Booth RE, Elmore JG (2010) Gender differences in chronic medical, psychiatric, and substance-dependence disorders among jail inmates. Am J Public Health 100(3):476–482

    Article  PubMed  PubMed Central  Google Scholar 

  44. Bello JK, Hearing C, Salas J, Weinstock J, Linhorst D (2020) Trends in substance use by gender among participants in a jail-based substance use disorder treatment program: 1998–2016. J Forensic Sci 65(1):97–102

    Article  PubMed  Google Scholar 

  45. Herrman H, Stewart DE, Diaz-Granados N, Berger EL, Jackson B, Yuen T (2011) What is resilience? Can J Psychiatry 56(5):258–265

    Article  PubMed  Google Scholar 

  46. Li X, Qiao S, Yang X, Harrison SE, Tam CC, Shen Z et al (2022) A Resilience-based intervention to mitigate the effect of HIV-related stigma: protocol for a stepped wedge cluster randomized trial. Front Public Health 10:857635

    Article  PubMed  PubMed Central  Google Scholar 

  47. Sedić B, Štrkalj Ivezić S, Petrak O, Ilić B (2021) Differences in resilience, self-stigma and mental health recovery between patients with schizophrenia and depression. Psychiatr Danub 33(Suppl 4):518–528

    PubMed  Google Scholar 

  48. Webster LR (2017) Risk factors for opioid-use disorder and overdose. Anesth Analg 125(5):1741–1748

    Article  PubMed  Google Scholar 

  49. Novak P, Feder KA, Ali MM, Chen J (2019) Behavioral health treatment utilization among individuals with co-occurring opioid use disorder and mental illness: evidence from a national survey. J Subst Abuse Treat 98:47–52

    Article  PubMed  Google Scholar 

  50. Mauritz MW, Goossens PJ, Draijer N, van Achterberg T (2013) Prevalence of interpersonal trauma exposure and trauma-related disorders in severe mental illness. Eur J Psychotraumatol. https://doi.org/10.3402/ejpt.v4i0.19985

    Article  PubMed  PubMed Central  Google Scholar 

  51. McKay MT, Cannon M, Chambers D, Conroy RM, Coughlan H, Dodd P et al (2021) Childhood trauma and adult mental disorder: a systematic review and meta-analysis of longitudinal cohort studies. Acta Psychiatr Scand 143(3):189–205

    Article  PubMed  Google Scholar 

  52. Rosic T, Au VYO, Worster A, Marsh DC, Thabane L, Samaan Z (2021) Trauma and post-traumatic stress disorder in patients treated for opioid use disorder: findings from a 12-month cohort study. BJPsych Open 7(4):e138

    Article  PubMed  PubMed Central  Google Scholar 

  53. Van Denend J, Harris JI, Fuehrlein B, Edens EL (2022) Moral injury in the context of substance use disorders: a narrative review. Curr Treat Options Psychiatry 9(4):321–330

    Article  PubMed  PubMed Central  Google Scholar 

  54. Lewer D, Freer J, King E, Larney S, Degenhardt L, Tweed EJ et al (2020) Frequency of health-care utilization by adults who use illicit drugs: a systematic review and meta-analysis. Addiction 115(6):1011–1023

    Article  PubMed  PubMed Central  Google Scholar 

  55. Cohen A, Vakharia SP, Netherland J, Frederique K (2022) How the war on drugs impacts social determinants of health beyond the criminal legal system. Ann Med 54(1):2024–2038

    Article  PubMed  PubMed Central  Google Scholar 

  56. Binswanger IA, Blatchford PJ, Mueller SR, Stern MF (2013) Mortality after prison release: opioid overdose and other causes of death, risk factors, and time trends from 1999 to 2009. Ann Intern Med 159(9):592–600

    Article  PubMed  PubMed Central  Google Scholar 

  57. Tourangeau R, Yan T (2007) Sensitive questions in surveys. Psychol Bull 133(5):859–883

    Article  PubMed  Google Scholar 

  58. Khalili P, Nadimi AE, Baradaran HR, Janani L, Rahimi-Movaghar A, Rajabi Z et al (2021) Validity of self-reported substance use: research setting versus primary health care setting. Subst Abuse Treat Prev Policy 16(1):66

    Article  PubMed  PubMed Central  Google Scholar 

  59. National Academies of Sciences E (2022) Medicine. In: Bates N, Chin M, Becker T (eds) Measuring sex, gender identity, and sexual orientation. The National Academies Press, Washington, p 200

    Google Scholar 

  60. Paschen-Wolff MM, Kidd JD, Paine EA (2023) The state of the research on opioid outcomes among lesbian, gay, bisexual, transgender, queer, and other sexuality- and gender-diverse populations: a scoping review. LGBT Health 10(1):1–17

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This work was supported by Grant 1U2CDA050098-01 via a subcontract, AWD100228, with the University of Chicago and by Grant 1UG1DA050067-01 (MassJCOIN). Funding came from the National Institute of Health’s (NIH) National Institute on Drug Abuse (NIDA), Justice Community Opioid Innovation Network (JCOIN), protocol approval number JCOIN 027. The funder had no role in the study design, collection, analysis, or interpretation of data, manuscript preparation, or manuscript submission.

Author information

Authors and Affiliations

  1. Department of Behavioral and Social Sciences, School of Public Health, School of Public Health, Brown University, Box G-S121-3, Providence, RI, 02912, USA

    Amelia Bailey

  2. Public Health Department, NORC at the University of Chicago, Chicago, IL, USA

    Bruce G. Taylor

  3. Crown Family School of Social Work, Policy, and Practice, The University of Chicago, Chicago, IL, USA

    Harold A. Pollack

  4. Department of Medicine, Unviersity of Chicago, Chicago, IL, USA

    John A. Schneider

  5. Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 715 N. Pleasant St., Arnold House, Amherst, MA, 01003, USA

    Amelia Bailey & Elizabeth A. Evans

Authors
  1. Amelia Bailey
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bruce G. Taylor
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Harold A. Pollack
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. John A. Schneider
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elizabeth A. Evans
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AB, BG, and EE contributed to study conceptualization and methodology. BG and EE provided supervision. AB conducted data analysis and data visualization. AB and BG drafted the manuscript. AB, BG, HP, JS, and EE provided comments and finalized and approved the submitted version.

Corresponding author

Correspondence to Amelia Bailey.

Ethics declarations

Conflict of interest

The authors have no competing interests to declare.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bailey, A., Taylor, B.G., Pollack, H.A. et al. Gender identity, stimulant drug use, and criminal justice history on internalized stigma among a nationally representative sample of adults who misuse opioids. Soc Psychiatry Psychiatr Epidemiol 59, 305–313 (2024). https://doi.org/10.1007/s00127-023-02500-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-023-02500-5

Keywords

Search

Navigation