A US national randomized study to guide how best to reduce stigma when describing drug‐related impairment in practice and policy

Abstract

Drug‐related impairment is persistently stigmatized delaying and preventing treatment engagement. To reduce stigma, various medical terms (e.g. ‘chronically relapsing brain disease’, ‘disorder’) have been promoted in diagnostic systems and among national health agencies, yet some argue that over‐medicalization of drug‐related impairment lowers prognostic optimism and reduces personal agency. While intensely debated, rigorous empirical study is lacking. This study investigated whether random exposure to one of six common ways of describing drug‐related impairment induces systematically different judgments.

Design, Setting and Participants

Cross‐sectional survey, US general population, among a nationally representative non‐institutionalized sample (n = 3635; 61% response rate; December 2019–January 2020).

Intervention

Twelve vignettes (six terms × gender) describing someone treated for opioid‐related impairment depicted in one of six ways as a(n): ‘chronically relapsing brain disease’, ‘brain disease’, ‘disease’, ‘illness’, ‘disorder’ or ‘problem’.

Measurements

Multi‐dimensional stigma scale assessing: blame; social exclusion; prognostic optimism, continuing care, and danger (a = 0.70–0.83).

Findings

US adults [mean age = 47.81, confidence interval (CI) = 47.18–48.44; 52.4% female; 63.14% white] rated the same opioid‐impaired person differently across four of five stigma dimensions depending on which of six terms they were exposed to. ‘Chronically relapsing brain disease’ induced the lowest stigmatizing blame attributions (P < 0.05); at the same time, this term decreased prognostic optimism [mean difference (MD) = 0.18, 95% CI = 0.05, 0.30] and increased perceived need for continuing care (MD = –0.26, 95% CI = –0.43, –0.09) and danger (MD = –0.13, 95% CI = –0.25, –0.02) when compared with ‘problem’. Compared with a man, a woman was blamed more for opioid‐related impairment (MD = –0.08, 95% CI = –0.15, –0.01); men were viewed as more dangerous (MD = 0.13, 95% CI = 0.06, 0.19) and to be socially excluded (MD = 0.16, 95% CI = 0.09, 0.23).

Conclusions

There does not appear to be one single medical term for opioid‐related impairment that can meet all desirable clinical and public health goals. To reduce stigmatizing blame, biomedical ‘chronically relapsing brain disease’ terminology may be optimal; to increase prognostic optimism and decrease perceived danger/social exclusion use of non‐medical terminology (e.g. ‘opioid problem’) may be optimal.