Advertisement

Culture, Medicine, and Psychiatry

, Volume 41, Issue 4, pp 480–498 | Cite as

Medical Disease or Moral Defect? Stigma Attribution and Cultural Models of Addiction Causality in a University Population

Original Paper

Abstract

This study examines the knowledge individuals use to make judgments about persons with substance use disorder. First, we show that there is a cultural model of addiction causality that is both shared and contested. Second, we examine how individuals’ understanding of that model is associated with stigma attribution. Research was conducted among undergraduate students at the University of Alabama. College students in the 18–25 age range are especially at risk for developing substance use disorder, and they are, perhaps more than any other population group, intensely targeted by drug education. The elicited cultural model includes different types of causes distributed across five distinct themes: Biological, Self-Medication, Familial, Social, and Hedonistic. Though there was cultural consensus among respondents overall, residual agreement analysis showed that the cultural model of addiction causality is a multicentric domain. Two centers of the model, the moral and the medical, were discovered. Differing adherence to these centers is associated with the level of stigma attributed towards individuals with substance use disorder. The results suggest that current approaches to substance use education could contribute to stigma attribution, which may or may not be inadvertent. The significance of these results for both theory and the treatment of addiction are discussed.

Keywords

Addiction Stigma Cultural models Cultural consensus analysis Residual agreement analysis 

Notes

Acknowledgements

The research reported here was supported by funds from the Graduate School, The University of Alabama. Members of the Medicine, Mind, Body, and Culture seminar at The University of Alabama, and especially Kathryn S. Oths, offered helpful comments on a previous draft of this paper. The authors are solely responsible for any errors.

Funding

This study was funded by The Graduate School at the University of Alabama.

Compliance with Ethical Standards

Conflict of interest

Nicole Henderson declares that she has no conflict of interest. Dr. William Dressler declares that he has no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. Ahern, Jennifer, Jennifer Stuber, and Sandro Galea. 2007 Stigma, discrimination and the health of illicit drug users. Drug and alcohol dependence 88(2):188–196.CrossRefGoogle Scholar
  2. Bandura, Albert. 1989 Regulation of cognitive processes through perceived self-efficacy. Developmental Psychology 25(5):729–735.CrossRefGoogle Scholar
  3. Barry, Colleen L., Emma E. McGinty, Bernice A. Pescosolido, and Howard H. Goldman. 2014 Stigma, Discrimination, Treatment Effectiveness, and Policy: Public Views About Drug Addiction and Mental Illness. Psychiatric Services 65(10):1269-1272.CrossRefGoogle Scholar
  4. Borgatti, Stephen P. 1996 ANTHROPAC 4.0 Reference Manual. Natick, MA: Analytic Technologies.Google Scholar
  5. Borgatti, Stephen P. 1999 Elicitation Techniques for Cultural Domain Analysis. In Enhanced Ethnographic Methods: Audiovisual Techniques, Focused Group Interviews, and Elicitation Techniques, edited by J. Schensul pp. 115-151. Altamira Press, Thousand Oaks, CAGoogle Scholar
  6. Caulkins, Douglas and Susan B. Hyatt. 1999 Using consensus analysis to measure cultural diversity in organizations and social movements. Field Methods 11(1):5–26.CrossRefGoogle Scholar
  7. Conrad, Peter 1992 Medicalization and Social Control. Annual Review of Sociology 18:209–232.CrossRefGoogle Scholar
  8. Corrigan, Patrick W. 1998 The Impact of Stigma on Severe Mental Illness. Cognitive and Behavioral Practice 5:201–222.CrossRefGoogle Scholar
  9. Corrigan, Patrick W. 2000 Mental Health Stigma as Social Attribution: Implications for Research Methods and Attitude Change. Clinical Psychology: Science and Practice 7(1):48–67.Google Scholar
  10. Corrigan, Patrick W., David Rowan, Amy Green, Robert Lundin, Philip River, Kyle Uphoff-Wasowski, Kurt White, and Mary Anne Kubiak. 2002 Challenging Two Mental Illness Stigmas: Personal Responsibility and Dangerousness. Schizophrenia Bulletin 28(2):293–309.CrossRefGoogle Scholar
  11. Coulter, Angela. 1999 Paternalism or partnership? BMJ 319(7212):719–720.Google Scholar
  12. Dressler, William W., Mauro C. Balieiro, and José Ernesto Santos. 2015 Finding Culture Change in the Second Factor Stability and Change in Cultural Consensus and Residual Agreement. Field Methods 27(1):22–38.CrossRefGoogle Scholar
  13. Drug Abuse Resistance Education 2014 Empowering Children to Lead Safe and Healthy Lives: 2014 Annual Report. Electronic Document, http://www.dare.org/wp-content/uploads/2016/03/D.A.R.E.-Annual-Report-2014.pdf, accessed March 5, 2016.
  14. Gaines, A. D. (Ed.). 1992 Ethnopsychiatry: the cultural construction of professional and folk psychiatries. Albany: State University of New York Press.Google Scholar
  15. Gaines, A. D. 2006 Ethnopsychiatry. In J. Birx (Ed.), Encyclopedia of Anthropology (Vol. 2, pp. 862–864). Thousand Oaks, CA: Sage Publications.Google Scholar
  16. Goffman, E. 1964 Stigma; notes on the management of spoiled identity. Englewood Cliffs: Prentice-Hall.Google Scholar
  17. Hartzler, Bryan and Kim Fromme. 2003 Heavy episodic drinking and college entrance. Journal of Drug Education 33(3):259-274.CrossRefGoogle Scholar
  18. Haslam, Nick 2005 Dimensions of Folk Psychiatry. Review of General Psychology 9(1):35-47.CrossRefGoogle Scholar
  19. Johnston, Lloyd D., Patrick M. O’Malley, Jerald G. Bachman, John E. Schulenberg, and Richard A. Miech 2015 Monitoring the Future National Survey Results on Drug Use, 1975–2014: Volume 2, College Students and Adults Ages 19–55. Institute for Social Research, The University of Michigan, Ann Arbor.Google Scholar
  20. Keeler, Martin H. 1968 Motivation for marihuana use: a correlate of adverse reaction. American Journal of Psychiatry 125(3):386-390.CrossRefGoogle Scholar
  21. Kleinman, Arthur and Byron Good. 1985 Culture and depression: studies in the anthropology and cross-cultural psychiatry of affect and disorder. Berkeley: University of California Press.Google Scholar
  22. Lende, Daniel H. 2005 Wanting and drug use: A biocultural approach to the analysis of addiction. Ethos, 33(1):100-124.CrossRefGoogle Scholar
  23. Link, Bruce G., Francis T. Cullen, James Frank, and John F. Wozniak. 1987 The Social Rejection of Former Mental Patients: Why Labels Matter. American Journal of Sociology 92(6):1461-1500.CrossRefGoogle Scholar
  24. Link, B. G., J. C. Phelan, M. Bresnahan, A. Stueve, and B. A. Pescosolido. 1999 Public Conceptions of Mental Illness: Labels, Causes, Dangerousness, and Social Distance. American Journal of Public Health, 89(9), 1328–1333.CrossRefGoogle Scholar
  25. MacInnes, Colin. 1966 People in search of dreams. Mental Health 25:24-25.Google Scholar
  26. Martin, Jack K., Bernice A. Pescosolido, and Steven A. Tuch. 2000 Of Fear and Loathing: The Role of “Disturbing Behavior,” Labels, and Causal Attributions in Shaping Public Attitudes toward People with Mental Illness. Journal of Health and Social Behavior 41(2):208–223.CrossRefGoogle Scholar
  27. Polak, Frederick. 2000 Thinking about drug law reform: some political dynamics of medicalization. Fordham Urban Law Journal 28:351.Google Scholar
  28. Regier, Darrel A., William E. Narrow, Donald S. Rae, Ronald W. Manderscheid, Ben Z. Locke, and Frederick K. Goodwin. 1993 The de facto U.S. mental and addictive disorders service system: Epidemiological Catchement Area prospective 1-year prevalence rates of disorders and services. Archives of General Psychiatry 50:85-94.CrossRefGoogle Scholar
  29. Romney, A. Kimball, Susan C. Weller, William H. Batchelder. 1986 Culture as Consensus: A Theory of Culture and Informant Accuracy. American Anthropologist 88(2):313-338.CrossRefGoogle Scholar
  30. Singer, Merrill. 2001 Toward a bio-cultural and political economic integration of alcohol, tobacco, and drug studies in the coming century. Social Science and Medicine 53(2):199-213.CrossRefGoogle Scholar
  31. Singer, Merrill and J. Bryan Page. 2014 The Social Value of Drug Addicts: Uses of the Useless. Walnut Creek, CA: Left Coast Press.Google Scholar
  32. Strauss, Claudia and Naomi Quinn. 1994 A cognitive/cultural anthropology. In Assessing Cultural Anthropology, edited by R. Borofsky pp. 284-299. McGraw-Hill, New York.Google Scholar
  33. Sturrock, Kenneth and Jorge Rocha. 2000 A multidimensional scaling stress evaluation table. Field methods 12(1):49-60.CrossRefGoogle Scholar
  34. Valverde, Mariana 1998 Diseases of the Will: Alcohol and the Dilemmas of Freedom. Cambridge.Google Scholar
  35. Wechsler, Henry, George W. Dowdall, Andrea Davenport, and Sonia Castillo. 1995 Correlates of college student binge drinking. American Journal of Public Health 85(7):921-926.CrossRefGoogle Scholar
  36. Wright, Eric R., William P. Gronfein, and Timothy J. Owens. 2000 Deinstitutionalization, Social Rejection, and the Self-Esteem of Former Mental Patients. Journal of Health and Social Behavior 41(1):68-90.CrossRefGoogle Scholar
  37. Wu, Li-Tzy, Daniel J. Pilowsky, William E. Schlenger, and Deborah Hasin. 2007 Alcohol use disorders and the use of treatment services among college-age young adults. Psychiatric Services 58(2):192-200CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Department of AnthropologyThe University of AlabamaTuscaloosaUSA

Personalised recommendations