Medicine, Nursing and Health Sciences

They tried to make me go to rehab

Self-stigma & social identity in recovery

Melinda Beckwith PhD Candidate

Turning Point Eastern Health Clinical School, Monash University

Melinda Beckwith PhD Candidate

Turning Point Eastern Health Clinical School, Monash University

Context §  Move towards recovery-oriented practice and systems of care in AOD

§  Recovery-oriented care focuses on improving quality of life

–  not just symptom reduction (ie reducing or stopping use) but also •  improved physical & mental wellbeing •  increased engagement with community

§  We don’t know a lot about HOW people recover from substance use issues

Yes, I’ve been black but when I come back you’ll know, know, know

Social Identity Model of Recovery

Stigma as a Barrier to Recovery §  If recovery is socially negotiated, societal stigma & discrimination

present barriers to recovery

–  Even in recovery, people are still subject to stigma for past use

§  Stigma re drug use (enacted, & perceived) has been linked to:

–  Poorer physical health

–  Poorer mental health

–  Poorer social outcomes

…all the areas we want to see improve in recovery

He said “I just think you’re depressed” This me “Yeah, baby, and the rest”

Stigma as a Barrier to Recovery

§  In many ways, society is not structured to support recovery

§  little research has been conducted on the effects of self-stigma (internalised stigma) – a measure only developed recently

§  Self-stigma results from internalisation of negative view of self as a function of identification with a stigmatised group (ie people who use drugs/drink heavily)

He said “I just think you’re depressed” This me “Yeah, baby, and the rest”

Research Questions

1.  Is self-stigma related to self-identification as a ‘user’/’drinker’?

2.  Does self-stigma impact wellbeing and other indicators of recovery (physical and mental wellbeing, quality of life, & ‘recovery capital’)?

Study design §  109 new residents of two Therapeutic Communities in Victoria

§  Interviewed approx 2-4 weeks after admission

§  Part of longitudinal study, at 5 TCs, involving large battery of measures

Demographics

Male 66.5%

Mean age at baseline interview 35.6 (range 18-67)

Mean age of problematic use 19.9 (range 9-56)

Sample Primary drug of concern % of sample

Amphetamine 36.1

Alcohol 28.4

Heroin 23.2

Other 12.3

Ever injected 59.4

Ever in jail 34.0

Any co-occurring mental health condition 77.4

Currently employed 17.1

Measures Internalised stigma related to substance use

Substance Abuse Self-Stigma Scale (SASSS)

• 4 subscales –  self-devaluation

»  “I feel ashamed of myself”–  fear of enacted stigma

»  “People would be scared of me if they knew about my substance use history”

–  stigma avoidance »  “I avoid situations that make me feel different”

–  values disengagement (reverse scored) »  “I do things that are good for me, even if I feel like I don’t deserve it”

Measures Social Identity

•  Identification with social category ‘drug user’/‘drinker’

Indicators of recovery

•  Physical ill-health (Maudsley Addiction Profile)

•  Psychological distress (K10)

•  Quality of Life (Personal Wellbeing Index)

•  Recovery Capital (Assessment of Recovery Capital)

Results

Self-stigma total score

Freq

uenc

y

Distribution of scores : Self-Stigma Substance Abuse Scale

Results

Domain Correlation strength ( r )

Identification as a User/Drinker .363

Psychological distress .536 Physical symptoms .325

Recovery capital - .405 Quality of life - .293

Correlates of self-stigma

all correlations significant at the level of p < .01

Results - correlates of self-stigma

psychological distress

physical symptoms

identification as a User

quality of life recovery capital

Discussion §  To move from identity linked to substance use to identity supportive of

recovery

–  some people may need to both convince society of their worth, but also themselves

It’s not just my pride, It’s just ‘til these tears have dried

Discussion §  Presents a challenge to creating truly recovery-oriented systems

§  We need to know:

–  how self-stigma changes in recovery –  impact on recovery outcomes

Currently following up participants: WATCH THIS SPACE

I ain’t got the time and if my daddy thinks I’m fine…

Acknowledgements §  Residents & staff of Odyssey House & Windana

§  SONAR project team

–  Prof Cath Haslam, Dr Genevieve Dingle, & Jock Mackenzie at UQ –  Prof Dan Lubman, Dr Michael Savic & Ramez Bathish at Turning

Point –  Prof David Best at Sheffield Hallam University & Turning Point –  Dr Ana-Maria Bliuc at Monash University

§  Australian Research Council for project funding

§  CREIDU for PhD funding

To get in touch: melindab@turningpoint.org.au