Medical Disease or Moral Defect? Stigma Attribution and Cultural Models of Addiction Causality in a University Population
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.
KeywordsAddiction Stigma Cultural models Cultural consensus analysis Residual agreement analysis
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.
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.
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 was obtained from all individual participants included in the study.
- Borgatti, Stephen P. 1996 ANTHROPAC 4.0 Reference Manual. Natick, MA: Analytic Technologies.Google Scholar
- 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
- 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
- Coulter, Angela. 1999 Paternalism or partnership? BMJ 319(7212):719–720.Google Scholar
- 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.
- Gaines, A. D. (Ed.). 1992 Ethnopsychiatry: the cultural construction of professional and folk psychiatries. Albany: State University of New York Press.Google Scholar
- Gaines, A. D. 2006 Ethnopsychiatry. In J. Birx (Ed.), Encyclopedia of Anthropology (Vol. 2, pp. 862–864). Thousand Oaks, CA: Sage Publications.Google Scholar
- Goffman, E. 1964 Stigma; notes on the management of spoiled identity. Englewood Cliffs: Prentice-Hall.Google Scholar
- 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
- 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
- MacInnes, Colin. 1966 People in search of dreams. Mental Health 25:24-25.Google Scholar
- Polak, Frederick. 2000 Thinking about drug law reform: some political dynamics of medicalization. Fordham Urban Law Journal 28:351.Google Scholar
- 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
- 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
- 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
- Valverde, Mariana 1998 Diseases of the Will: Alcohol and the Dilemmas of Freedom. Cambridge.Google Scholar