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

  • Nicole L. HendersonEmail author
  • William W. Dressler
Original Paper


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.


Addiction 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.

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.


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Department of AnthropologyThe University of AlabamaTuscaloosaUSA

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