Self-Stigma in Substance Abuse: Development of a New Measure
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Self-Stigma in Substance Abuse: Development of a New Measure Jason B. Luoma & Richard H. Nobles & Chad E. Drake & Steven C. Hayes & Alyssa O’Hair & Lindsay Fletcher & Barbara S. Kohlenberg
Published online: 9 October 2012 # Springer Science+Business Media New York 2012
Abstract 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 SelfStigma 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 (n0 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.
J. B. Luoma (*) : R. H. Nobles : C. E. Drake Portland Psychotherapy Clinic, Research, and Training Center, 1830 NE Grand Ave., Portland, OR 97211, USA e-mail: [email protected] S. C. Hayes : A. O’Hair : L. Fletcher University of Nevada, N. Virginia St., Reno, NV 1664, USA S. C. Hayes : A. O’Hair : L. Fletcher Department of Psychology/296, University of Nevada, Reno, NV 89557, USA B. S. Kohlenberg Department of Psychiatry and Behavioral Sciences, University of Nevada School of Medicine, Mail Stop 0354, Reno, NV 89557-0354, USA
Keywords Stigma . Substance misuse . Psychometric . Measure development
Stigma refers to a social process in which a perceived attribute marks an individual to be socially sanctioned and devalued (Luoma 2010). Stigma may be divided into at least two domains: public stigma and self-stigma (Corrigan 2002). Public stigma refers to the reaction the general public has toward the stigmatized group and includes stereotypes, judgments, and discrimination. Self-stigma refers to the selfdevaluation and fear of enacted stigma resulting from identification with a stigmatized group that serves as a barrier to the pursuit of valued life goals (Luoma et al. 2008). Studies of individuals with serious mental illness and co-occurring disorders (Link and Phelan 2006) have shown that selfstigma is associated with delays in treatment seeking or avoidance of treatment (Fung et al. 2008; Livingston and Boyd 2010), diminished self-esteem/self-efficacy (Corrigan et al. 2006), increased mental health symptoms (Ritsher and Phelan 2004), and lower quality of life (Rosenfeld 1997). Data on self-stigma in addiction are sparse, and few measures exist to examine this construct (Luoma et al. 2010). Interventions for self-stigma in substance dependence have begun to be evaluated (Luoma et al. 2008; Luoma
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