Date Published: January , 2012
Publisher: Blackwell Publishing Ltd
Author(s): James D Livingston, Teresa Milne, Mei Lan Fang, Erica Amari.
This study provides a systematic review of existing research that has empirically evaluated interventions designed to reduce stigma related to substance use disorders.
A comprehensive review of electronic databases was conducted to identify evaluations of substance use disorder related stigma interventions. Studies that met inclusion criteria were synthesized and assessed using systematic review methods.
Thirteen studies met the inclusion criteria. The methodological quality of the studies was moderately strong. Interventions of three studies (23%) focused on people with substance use disorders (self-stigma), three studies (23%) targeted the general public (social stigma) and seven studies (54%) focused on medical students and other professional groups (structural stigma). Nine interventions (69%) used approaches that included education and/or direct contact with people who have substance use disorders. All but one study indicated their interventions produced positive effects on at least one stigma outcome measure. None of the interventions have been evaluated across different settings or populations.
A range of interventions demonstrate promise for achieving meaningful improvements in stigma related to substance use disorders. The limited evidence indicates that self-stigma can be reduced through therapeutic interventions such as group-based acceptance and commitment therapy. Effective strategies for addressing social stigma include motivational interviewing and communicating positive stories of people with substance use disorders. For changing stigma at a structural level, contact-based training and education programs targeting medical students and professionals (e.g. police, counsellors) are effective.
Increasingly, governments and professional organizations are mobilizing resources towards preventing and managing health-related stigma. This coincides with a rapid expansion of research on stigma  which, until recently, has concentrated on documenting the magnitude of the problem and understanding its pernicious effects [2–4]. Researchers have been slow to turn their attention towards the question of how stigma associated with mental illness and substance use disorders can be reduced [5,6].
Seven electronic databases were selected for their ability to capture relevant literature across disciplines of interest (e.g. medicine, psychology, nursing and social science), including MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science, EBM Reviews and Cochrane Database of Systematic Reviews. A comprehensive review of these databases was conducted between November and December 2010 to identify English-language published studies, dissertations and conference proceedings. No restrictions were placed on publication year or methodological design. Combinations of keywords related to ‘stigma’ and ‘substance use disorder’ were entered into the above databases, and the ‘titles’ and ‘abstract’ fields were searched (Table S1; details of supporting information are given at the end). Additional publications were identified by scanning reference lists of articles and consulting with experts and key informants. We also hand-searched the content pages of nine journals that had published studies on the topic of substance use-related stigma (Table S2; details of supporting information are given at the end). Grey literature searches were also conducted by entering keywords into search engines, databases and content-relevant websites selected in consultation with experts in the field (Table S3; details of supporting information are given at the end).
This systematic review identified a small body of research, comprised of 13 studies, which have empirically evaluated interventions that target stigma related to substance use disorders. Overall, the studies were of moderate research quality, which indicates a risk of bias and confounding that may have affected the cumulative evidence. A major limitation of the included studies is that only three (23%) assessed stigma-related outcomes beyond the immediate post-intervention period. Therefore, the medium- to long-term effects of these interventions remain largely unknown. Another research gap is the absence of substance use-related stigma intervention studies aimed at child and youth populations, which have been identified as important target populations for preventing and reducing stigma . Moreover, research has yet to document whether changes in institutional policies and professional practices actually improve perceptions and experiences of stigma among people with substance use disorders.
This review has highlighted a number of interventions and strategies that have demonstrated some success for reducing stigma related to substance use disorders. The findings produced by the 13 included studies require replication, especially as many had small sample sizes, reported mixed results and used uncontrolled study designs. Until such time that there is a more robust body of evidence, it is recommended that these interventions be piloted and evaluated carefully to ascertain whether they are generalizable to different populations and contexts.