International Journal of Drug Policy Volume 133, November 2024, 104612 Rashmi Ghonasgi, Maria E. Paschke, Rachel P. Winograd, Catherine Wright, Eva Selph, Devin E. Banks
Highlights
This scoping review includes 22 peer-reviewed articles published 1999–2023, with discrepant findings based on method.
Qualitative findings suggest substance use stigma is a more common treatment barrier among Black than White people who use drugs.
Most quantitative findings suggest Black people face less substance use stigma than their White counterparts.
Racial prejudice was consistently linked with greater substance use stigma.
Gaps include a little attention to structural stigma and stigma toward interventions, and a focus on “race” rather than racism.
Abstract
Background
Substance use stigma poses a barrier to treatment and recovery from substance use disorder. Stigma is amplified when intersecting with other stigmatized identities, particularly Black racial identity. Despite increasing attention to the intersecting roles of racial and substance use stigma, it is unknown how these stigmas interact to impact treatment and health outcomes among Black people who use drugs. This scoping review examines empirical research documenting differential impacts of race and racism on substance use stigma.
Methods
We systematically searched PsychInfo and PubMed databases. Eligible studies were conducted in the U.S.; examined a Black sample, subsample, or experimental condition/variable (i.e., in a vignette); and measured substance use stigma (excluding alcohol or nicotine). Qualitative studies describing a theme related to substance use stigma were also included.
Results
Of 1431 unique results, 22 articles met inclusion criteria. The most measured substance use stigma type was interpersonal (e.g., discrimination). Most quantitative findings (n = 15) suggested that Black members of the general public endorse less substance use stigma and Black people who use drugs face less substance use stigma relative to their White counterparts. Qualitative studies (n = 7) suggested stigma was a more common and pernicious substance use treatment barrier for Black people compared to White. Across methods, racial prejudice was associated with substance use stigma, supporting hegemonic ideas that substance use is stereotypically characteristic of Black people.
Conclusions
The interaction between substance use stigma and race is complex and varies by in-group and out-group raters as a function of racial identity and identity as a person who uses drugs. Contradictory findings reflect methodological differences, emphasizing the need for more unified measurement of substance use stigma. More research is needed among Black people who use drugs to improve understanding of the impact of these intersecting stigmas on racial inequities in substance use treatment, morbidity, and mortality. To read more click here.