Little attention has been paid to the examination and measurement of self-stigma in substance misuse. This paper aims to fill this gap by reporting on the development of a new scale to measure self-stigma experienced by people who are misusing substances, the Substance Abuse Self-Stigma Scale. Content validity and item refinement occurred through an iterative process involving a literature search, focus groups, and expert judges. Psychometric properties were examined in a cross-sectional study of individuals (n = 352) receiving treatment for substance misuse. Factor analyses resulted in a 40-item measure with self devaluation, fear of enacted stigma, stigma avoidance, and values disengagement subscales. The measure showed a strong factor structure and good reliability and validity overall, though the values disengagement subscale showed a mixed pattern. Results are discussed in terms of their implications for studies of stigma impact and intervention.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Ahern, J., Stuber, J., & Galea, S. (2007). Stigma, discrimination, and the health of illicit drug users. Drug and Alcohol Dependence, 88, 188–196.
Blascovich, J., & Tomaka, J. (1991). Measures of self-esteem. In J. P. Robinson, R. P. Shriver, & L. W. Wrightsman (Eds.), Measures of personality and social psychological attitudes (pp. 115–160). San Diego: Academic.
Bollen, K. A., & Stine, R. (1993). Bootstrapping goodness-of-fit measures in structural equation models. In K. A. Bollen & J. S. Long (Eds.), Testing structural equation models. Newbury Park: Sage.
Brodish, A. B., & Devine, P. G. (2009). The role of performance-avoidance goals and worry in mediating the relationship between stereotype threat and performance. Journal of Experimental Social Psychology, 45, 180–185.
Chawla, N., & Ostafin, B. D. (2007). Experiential avoidance as a functional dimensional approach to psychopathology: an empirical review. Journal of Clinical Psychology, 63, 871–890.
Clark, L. A., & Watson, D. (1995). Constructing validity: basic issues in objective scale development. Psychological Assessment, 7, 309–319.
Cook, D. R. (1996). Empirical studies of shame and guilt: The internalized shame scale. In D. L. Nathanson (Ed.), Knowing feeling: Affect, script, and psychotherapy (pp. 132–165). New York: Norton.
Corrigan, P. W. (2002). Adherence to anti-psychotic medications and health behavior theories. Journal of Mental Health, 11, 243–254.
Corrigan, P. W., Watson, A. C., & Barr, L. (2006). The self-stigma of mental illness: implications for self-esteem and self-efficacy. Journal of Social and Clinical Psychology, 25, 875–884.
Cortina, J. M. (1993). What is coefficient alpha? An examination of theory and applications. Journal of Applied Psychology, 78, 98–104.
Crisp, A. H., Gelder, M. G., Rix, S., Meltzer, H. I., & Rowlands, O. J. (2000). Stigmatization of people with mental illnesses. The British Journal of Psychiatry, 177, 4–7.
Cunningham, J. A., Sobell, L. C., Sobell, M. B., Agrawal, S., & Toneatto, T. (1993). Barriers to treatment – why alcohol and drug-abusers delay or never seek treatment. Addictive Behaviors, 18, 347–353.
Fung, K. M. T., Tsang, H. W. H., & Corrigan, P. W. (2008). Self-stigma of people with schizophrenia as predictor of their adherence to psychosocial treatment. Psychiatric Rehabilitation Journal, 32(2), 95–104.
Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and commitment therapy. New York: Springer.
Hayes, S. C., Barnes-Holmes, D., & Roche, B. (Eds.). (2001). Relational frame theory: A post-skinnerian account of human language and cognition. New York: Plenum Press.
Hayes, S. C., Strosahl, K., Wilson, K. G., Bisset, R. T., Pistorello, J., Toarmino, D., et al. (2004). Measuring experiential avoidance: a preliminary test of a working model. Psychological Record, 54, 553–578.
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: model, processes, and outcomes. Behavior Research and Therapy, 44, 1–25.
Hazlett-Stevens, H., Ullman, J. B., & Craske, M. G. (2004). Factor structure of the Penn State worry questionnaire: examination of a method factor. Assessment, 11(4), 361–370.
Larson, D. G., & Chastain, R. L. (1990). Self-concealment: conceptualization, measurement, and health implications. Journal of Social and Clinical Psychology, 9, 435–455.
Link, B. G., & Phelan, J. C. (2006). Stigma and its public health implications. Lancet, 367(9509), 528–528.
Link, B. G., Streuning, E. L., Neese-Todd, S., Asmussen, S., & Phelan, J. C. (2002). On describing and seeking to change the experience of stigma. Psychiatric Rehabilitation, 6, 201–231.
Livingston, J. D., & Boyd, J. E. (2010). Correlates and consequences of internalized stigma for people living with mental illness: a systematic review and meta-analysis. Social Science & Medicine, 71(12), 2150–2161.
Luoma, J. B. (2010). Substance use stigma as a barrier to treatment and recovery. In R. A. Bankole (Ed.), Addiction medicine: Science and practice (pp. 1195–1216). Springer New York.
Luoma, J. B., Twohig, M. P., Waltz, T., Hayes, S. C., Roget, N., Padilla, M., et al. (2007). An investigation of stigma in individuals receiving treatment for substance abuse. Addictive Behaviors, 32, 1331–1346.
Luoma, J. B., Kohlenberg, B. S., Hayes, S. C., Bunting, K., & Rye, A. K. (2008). Reducing self-stigma in substance abuse through acceptance and commitment therapy: model, manual development, and pilot outcomes. Addiction Research & Theory, 16(2), 149–165.
Luoma, J. B., O’Hair, A. K., Kohlenberg, B. S., Hayes, S. C., & Fletcher, L. (2010). The development and psychometric properties of a new measure of perceived stigma toward substance users. Substance Use & Misuse, 45(1–2), 47–57.
Luoma, J. B., Drake, C. E., Kohlenberg, B. S., & Hayes, S. C. (2011). Substance abuse and psychological flexibility: the development of a new measure. Addiction Research and Theory, 19(1), 3–13.
Luoma, J. B., & Kohlenberg, B.S., Hayes, S. C., & Fletcher, L. (2012). Slow and steady wins the race: A randomized clinical trial of acceptance and commitment therapy targeting shame in substance use disorders. Journal of Consulting and Clinical Psychology, 80, 43–53.
Major, B., Spencer, S., Schmader, T., Wolfe, C., & Crocker, J. (1998). Coping with negative stereotypes about intellectual performance: the role of psychological disengagement. Personality and Social Psychology Bulletin, 24(1), 34–50.
Masuda, A., Hayes, S. C., Lillis, J., Bunting, K., Herbst, S. A., & Fletcher, L. B. (2009). The relation between psychological flexibility and mental health stigma in acceptance and commitment therapy: a preliminary process investigation. Behavior and Social Issues, 18(1), 1–16.
Quinn, D. M., Kahng, S. K., & Crocker, J. (2004). Discreditable: stigma effects of revealing a mental illness history on test performance. Personality and Social Psychology Bulletin, 30, 803.
Ritsher, J. B., & Phelan, J. C. (2004). Internalized stigma predicts erosion of morale among psychiatric outpatients. Psychiatry Research, 129, 257–265.
Ritsher, J. B., Otilingam, P. G., & Grajales, M. (2003). Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Research, 121, 31–49.
Rosenberg, M. (1965). Society and the adolescent self-image. Princeton: Princeton University Press.
Rosenfeld, S. (1997). Labeling mental illness: the effects of received services and perceived stigma on life satisfaction. American Sociological Review, 62, 660–672.
Rusch, N., Holzer, A., Hermann, C., Schrramm, E., Jacob, G. A., Bohus, M., et al. (2006). Self-stigma in women with borderline personality disorder and women with social phobia. The Journal of Nervous and Mental Disease, 194, 766.
Scambler, G. (1998). Stigma and disease: changing paradigms. The Lancet, 352, 1054–1055.
Schmader, T., Johns, M., & Forbes, C. (2008). An integrated process model of stereotype threat effects on performance. Psychological Review, 115(2), 336–356.
Smart, L., & Wegner, D. M. (1999). Covering up what can’t be seen: concealable stigma and mental control. Journal of Personality and Social Psychology, 77(3), 474–486.
Steele, C. M. (1997). A threat in the air: how stereotypes shape intellectual identity and performance. American Psychologist, 52(6), 613.
Steele, C. M., Spencer, S. J., & Aronson, J. (2002). Contending with group image: the psychology of stereotype and social identity threat. Advances in Experimental Social Psychology, 34, 379–440.
Stuart, H. (2004). Stigma and work. Healthcare Papers, 5(2), 100–111.
Taylor, B., & Cert, B. (2001). HIV, stigma and health: integration of theoretical concepts and the lived experiences of individuals. Journal of Advanced Nursing, 35(5), 792.
Wahl, O. F. (1999). Mental health consumers’ experience with stigma. Schizophrenia Bulletin, 25, 467–478.
Wenzlaff, R. M., & Wegner, D. M. (2000). Thought suppression. Annual Review of Psychology, 51, 59–91.
Zimet, G. D., Powell, S. S., Farley, G. K., Werkman, S., & Berkoff, K. A. (1990). Psychometric characteristics of the multidimensional scale of perceived social support. Journal of Personality Assessment, 55, 610–617.
About this article
Cite this article
Luoma, J.B., Nobles, R.H., Drake, C.E. et al. Self-Stigma in Substance Abuse: Development of a New Measure. J Psychopathol Behav Assess 35, 223–234 (2013). https://doi.org/10.1007/s10862-012-9323-4
- Substance misuse
- Measure development