Recent and Current Research
Exploring the Public Stigma of Addiction through Stakeholder Focus Groups
Katherine N., Tyas..., Anastasia , Rachel D., Lorenzo W, Pat C.
Problem or Purpose: The National Academy of Science reported that research on the stigma of addiction is scarce in comparison to that on the stigma of mental illness (National Academy of Science, Engineering & Medicine, 2016). The stigma of addiction differs from the stigma of mental illness in three main ways: (1) discrimination against people with addictions is legally sanctioned, (2) stigma is used as a tactic in public health campaigns to promote drug use prevention, and (3) some addiction interventions facilitate self-stigma through their focus on wrongdoing by the addict (Corrigan et al., in press). The purpose of the current study was to gather all possible forms of public stigma against addiction to inform the literature and pave the way for quantitative studies on the harmful impacts of the stigma of addiction as well as strategies to reduce the stigma against addicts. Illinois Institute of Technology
Procedure: Twelve focus groups were conducted with a population of current addicts, former addicts, family members of addicts, and substance use treatment providers. Focus groups lasted 90 minutes with questions focusing on stereotypes, prejudice, and discrimination perpetrated by the public against addicts. The conceptualization of these three items is based on a social-cognitive model of stigma where stereotypes are negative beliefs, prejudices are negative emotional reactions, and discrimination is the resulting negative behavior against the stigmatized group (Link & Phelan, 2001). Additional questions measured what is shameful and embarrassing about addiction to gather more forms of stigma that may have been missed by the conceptualization of the social cognitive model.
Results: A total of 99 individuals participated in the focus groups with 16.2% identifying as current addicts, 54.5% identifying as former addicts, 22.2% identifying as family members, and 23.2% identifying as treatment providers. Qualitative coding identified stigma candidates in five main categories: stereotypes, prejudice, discrimination, shame, and embarrassment. Sub-categories under each main category further describe the stigma experienced by addicts.
Conclusions/Implications: These results can help inform more supportive services for individuals with addiction and will pave the way for quantitative research on the effects of addiction stigma.
Mental Health Journalism Fellowship Evaluation
Patrick W. Corrigan and Karina J. Powell
The purpose of this research study was to evaluate the effects of representative media pieces created by a Mental Health Journalism Fellowship. The mission of the journalism fellowship is to develop materials for consumption by the general public that do not use stigmatizing images of people with mental illness. The primary research objective was to assess the impact that these media pieces have on the public stigma of mental illness through quantitative assessment in an intervention and a control group. Two hundred study participants were randomly assigned to one of four conditions, two written journalism pieces from the MHJF (one chosen to represent a highly stigmatizing article and the other chosen to represent a low stigmatizing article), one outside journalism article (selected for its journalistic sensitivity), and a no-intervention control condition. Stigmatizing and affirming attitudes were assessed pre-intervention, post-intervention, and at one week follow-up. Results indicated a statistically significant difference on a measure of coercion between the highly stigmatizing fellowship article and the outside journalism article, with the group exposed to the former scoring worse. With regard to goal orientation, recovery, and empowerment, the outside journalism article condition showed significantly better attitudes than the MHJF highly stigmatizing condition.
WRAP, Self-Determination and Adherence
Patrick W. Corrigan, Nev Jones, Janice Parker and Drexler James
Background: Wellness Action Recovery Plan (WRAP) initiatives have been established in many states and significant impacts on symptoms, hope, and recovery have been documented through both quasi-experimental evaluations and a rigorous randomized control trial. No existing studies, however, have examined the impact of WRAP on treatment engagement or investigated WRAP’s impact using qualitative methods.
Methods: Five focus groups were held around the state of Illinois with a diverse group of WRAP facilitators and program participants. Focus group participants were asked a series of open-ended questions regarding their past and present treatment experiences, understanding of the terms self-determination and adherence, and the ways in which they thought WRAP had affected their lives in general as well as their relationships with providers and attitudes toward mental health services.
Results: Analysis of the focus group transcripts revealed a number of consistent themes. With regard to past experiences of treatment engagement and disengagement, participants emphasized two themes: first, the importance of self-determined motivation, and second the importance of caring and egalitarian relationships with providers. With respect to the terms self-determination and adherence, provocative differences emerged, with some participants arguing that adherence and self-determination were conceptually opposed terms, and others arguing that they could be complementary. Finally, with respect to the impact of WRAP, participants focused on the ways in which WRAP increased both honesty and self-advocacy with providers and awareness of their symptoms and the role of medications and other supports. These gains seemed to be mediated by increases in hope, self-confidence, and self-determination, as well as positive interactions with peers and peer facilitators.
Conclusions: Self-determination, including perceived control over treatment choices, and autonomous motivation, appear to be crucial not only to recovery but to sustained and meaningful treatment engagement. Peer-run interventions like WRAP that promote self-determination are thus not only building blocks of subjective recovery but also for meaningful engagement with traditional mental health services, including medications. Future quantitative research investigating these themes with a larger sample is suggested.
Patrick W. Corrigan, Karina J. Powell, J. Konado Fokuo and Kristin A. Kosyluk
Background: Public stigma is frequently a barrier to many personal goals for people with mentalillness including job opportunities, housing, and quality health care. A number of anti-sigma programs have been developed with the intention of reducing stigma’s harmful effects. Humor, though often associated with the promulgation of negative stereotypes, may have the potential to decrease stigmatizing attitudes in the context of disclosure. Research suggests the effects of humor are impacted by personal differences in humor style.
Methods: Research participants completed pre-tests of stigmatizing attitudes and humor style and were then randomized to one of three conditions (a comedy sketch where the comic discloses his mental illness, the same sketch where all allusion to the comic’s mental illness is omitted, and a control comedy sketch). Research participants then repeated the measure of stigmatizing attitudes and provided perceptions of the comic.
Results: Humor styles and perceptions of the comic significantly interacted with sketch type to diminish stigma. Perceptions of the comic when he self-disclosed as having a mental illness, were associated with reduced stigma from pre to post when the comic was viewed as humorous, having a mental illness, “like me,” and sincere. The self-disclosed comic who was viewed as less aggressive also showed significantly better change in stigma on the AQ. People with affiliative humor style significantly decreased stigma after participating in either mental health comedy sketch compared to the control.
Conclusions: People who seem to enjoy humor and making people laugh were shown to have significantly larger changes in the disclosed comic condition compared to the nondisclosed and control condition. An affiliative style was also found to interact with the nondisclosed comic condition which suggests comedy about mental health in general might reduce stigma in a person who enjoys laughing. An aggressive humor style was not found to interact with either comic condition, a notable finding that suggests offense at a comic’s statement about mental illness does not seem to impede attitude change. These findings suggest people exposed to comedy about mental health are not empty vessels. Person-level variables need to be considered in crafting these approaches. We began with humor styles here as natural mediators of the way comedy routines are experienced.
The California Contact-Based Anti-Stigma Program
Patrick W. Corrigan and Patrick J. Michaels
Research shows contact-based anti-stigma programs are among the most effective. Such findings call for clarity to define the components of consumer-directed anti-stigma programs. Using Community Based Participatory Research (CBPR) was a first step of a mixed methods design to describe the active ingredients comprising these kinds of programs. CBPR investigators developed an interview guide and subsequently facilitated four focus groups to identify key components. Included participants were anti-stigma experts with lived experience.
Using grounded theory, two independent raters identified discrete themes. Two additional coders then sorted themes into constructs representing key ingredients of contact-based programs. Coders agreed upon constructs then grouped them into a hierarchical model of key ingredients in consumer-directed stigma change. Two major model categories emerging from the focus groups were problem and solution to stigma; diversity and family were also compelling categories. The problem was described by: forms, impacts, qualities, and protective factors. Solutions were described by: principles, targets, messages, unintended consequences, empowerment, program support, evaluation, and needs assessment/organizational engagement.
Overall, five criteria represent indicators of successful consumer-directed programs: program design, targeting, staffing, messaging, and follow-up and evaluation. Obtained data from Solutions were used to populate a fidelity measure for consumer-directed anti-stigma programs. This new instrument is entitled the California Quality Improvement, Fidelity, Assessment, and Implementation Ratings for Stigma and Discrimination Reduction Programs (CQI-FAIR). The second step in this mixed method design is a cross-validation study. The purpose is to collect data from an independent sample of mental health advocates familiar with consumer-based anti-stigma programming to rate the importance of items comprising the CQI-FAIR as it pertains to public stigma, self-stigma, and label avoidance.
One hundred people who are mental health advocates with lived experience will be recruited for this online Qualtrics-based survey. Eligible participants will be advocates or consumers familiar with contact-based anti-stigma programming conducted in California. For this study, participants will complete also questionnaires assessing stigma and affirming attitudes as well as review the CQI-FAIR. Analyses will be conducted to evaluate which items within the 5 criterions are most important to elimination of public stigma, self-stigma, and label avoidance.
Honest, Open, Proud (Formerly: Coming Out Proud program)
Patrick W. Corrigan and Blythe Buchholz
Buchholz et al., Qualitative Results Table
Click Here to view table
Self-stigma is one of the egregious impacts of mental illness stigma, a diminished sense of self-esteem and self-efficacy leading to a “why try” effect in many people: “why try get a regular job, someone like me doesn’t deserve it.” Recently, innovative programs have emerged to challenge self-stigma, programs based in part on psychoeducation and cognitive reframing skills meant to challenge stigmatizing self-statements. An interesting result has emerged out of research by our group that informs an alternative program for dealing with self-stigma: the Coming Out Proud program (COPp). Research shows those who have disclosed aspects of their mental illness frequently report a sense of personal empowerment that enhances self-esteem and promotes confidence to seek and achieve individual goals. In this light, a group of people with lived experience and stigma researchers developed the Coming Out Proud program, now being used in beta research in the United States, Europe, Australia, and China. COPp is a three-session group program run usually by pairs of trained leaders with lived experiences. COPp has a comprehensive, user-friendly manual; step-by-step workbook and corresponding worksheets; fidelity measure; and leader training program which can be obtained from NCSE1.ORG. The three lessons include:
1. Considering the Pros and Cons of Disclosing:
- My identity and mental illness.
- Secrets are part of life.
- Weighing the costs and benefits of disclosing.
2. Different ways to Disclose:
- Five ways to come out.
- Testing a person for disclosure.
- How might others respond to my disclosure?
3. Telling your Story:
- How to tell a personally meaningful story.
- Who are peers that might help me with coming out?
- Review how telling my story felt.
- Putting it all together to move forward.
The program is designed to aid in the facilitation of disclosure of certain aspects of lived experience with the objective of reducing the self-stigma associated with mental illness.
Click here to download the COPp Manual.
Click here to download the COPp Workbook.
Click here to download the COPp Workbook Fidelity Measure.
Testing the Efficacy of the Coming Out Proud Program: a Randomized Controlled Trial
Approximately 100 individuals with the lived experience of mental illness will be recruited to participate in the trial. After a brief phone screening, potential participants will be fully informed of the study and if interested, informed consent will be obtained. Participants will then be randomized to either the COPp (intervention group) or be wait-listed for the program (control group). For those in the COPp group, the program will be provided at a time and place convenient to participants, usually three days or nights within a single week. The program will be facilitated by two trained leaders with lived experience, in groups of approximately 6-10 participants. During this time, facilitators will thoroughly cover each lesson of the COPp program workbook (one lesson per each session). Participants in both the control and intervention groups will be administered measures at baseline (one week window before starting COPp or the control), post-test (one week window after COPp or the control) and follow-up (one month after COPp or control). Measures will include standardized instruments that assess self-stigma, disclosure, personal empowerment, self-esteem, self-efficacy, and recovery. The protocol aims to determine if the COPp reduces secrecy- and disclosure-related distress, self-stigma, shame, secrecy, social withdrawal, stigma-related stress and stigma as a barrier to seek help as compared to the control group. Additionally, it aims to determine if the intervention increases empowerment, self-esteem, disclosure-related self-efficacy and quality of life as compared to the control group.
The Impact of Active Minds Speakers Bureau: A Contact-Based Anti-Stigma Program
Patrick W. Corrigan and Patrick J. Michaels
Three main stigma reduction strategies have been used with members of the general public: protest, education, and contact. Yet interactions with people with mental health challenges have been shown to have a stronger and longer lasting impact. One high profile intervention among college students is Active Minds Speakers Bureau. Presentations use personal experiences to counteract stigma’s consequences, and promote mental health awareness and treatment. A qualitative study of Active Minds Speakers Bureau was conducted as a data-driven basis for a subsequent quantitative study. Community Based Participatory Research (CBPR) was a first step of a mixed methods design to decipher the active ingredients of Active Minds Speakers Bureau presentations. CBPR investigators collaboratively developed an interview guide and subsequently facilitated three focus groups. Focus groups included participants who recently viewed a presentation including college students, community members, and Active Minds National Organization staff.
Two independent raters separately analyzed qualitative data. Distinct themes were then categorized into 15 conceptual frameworks including Active Minds intentions, attitudinal and cognitive reactions, awareness of consequences, awareness of public stigma, awareness of self-stigma, community advocacy, community intentions, general awareness, interpersonal advocacy, mental health knowledge, mental health maintenance, recovery, self-advocacy, societal acceptance, and treatment availability. The next intermediate step in this mixed method design is a cross-validation study. The purpose is to collect data from an independent sample of people who are leaders in Active Minds communities to determine the importance of these 15 different conceptual frameworks. Study results will guide measurement tool selection and design of a quantitative study of Active Minds Speakers Bureau.
One hundred people who are leaders in Active Minds communities will be recruited for this online Qualtrics-based cross-validation study. Eligible participants will be Active Minds staff and board members as well as student leaders. For this study, participants will rate the importance of each of the 15 frameworks considering Active Minds’ mission and mental health agenda. Analyses will be conducted to evaluate which of the 15 frameworks are most important to the leadership of Active Minds.
Exploring the Public Stigma of Addiction through Stakeholder Focus Groups