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Attitudes toward people who are addicted to opioids: The intersection of race, social class, and gender
AuthorWood, Emily Fisher
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Opioid addiction is one of the largest social and public health issues the United States is currently facing. Overdose deaths are now the leading cause of preventable deaths in the United States, having surpassed deaths from motor vehicle accidents (Rudd, Aleshire, Zibbell, & Gladde, 2016). Drug addiction is one of the most stigmatized conditions in the Western world and stigma is a major barrier to combatting the opioid epidemic (Surgeon General Report, 2016). Stigma prevents people from seeking and completing treatment, results in poor quality of care, and is related to negative mental, physical, and societal outcomes (Ahern, Stuber, & Galea, 2007l; Link & Phelan, 2001). Despite the recognition that addiction stigma is pervasive, harmful, and a barrier to combatting the opioid epidemic, research on addiction stigma is lacking and not empirically sophisticated, especially compared to research on mental illness stigma (National Academy of Sciences, 2016). Using a between subjects experimental design, this dissertation research investigated opioid addiction stigma and support for public health-oriented policies and programs among White undergraduate students at a university in the western United States. An intersectionality framework was used to investigate how the race, social class, and gender of a fictional opioid user depicted in a vignette relate to stigma, support for punishing the person via the criminal justice system (criminalization), and support for helping the person via medical treatment (medicalization). To test intergroup relations hypotheses, this research investigated how characteristics of participants interact with characteristics of the opioid user. In general, more negative attitudes were reported toward the White and working-class opioid user compared to the Black and middle-class opioid user. Higher social class participants and participants higher in system-justifying beliefs reported more negative attitudes. Results for participant gender were mixed and opioid user gender was only related to medicalization with participants being more likely to indicate the male opioid user should be medicalized. Attributions about the cause of addiction were tested as mediators between the race and social class of the opioid user and the stigma, medicalization, and criminalization dependent variables. Attributing the opioid user’s addiction to his or her bad character partially mediated the relationships between opioid user race and the dependent variables and opioid user social class and the dependent variables. Attributing the cause of addiction to disease/genetics did not mediate these relationships. This research also investigated how contact with addiction as well as the nature, quality, and outcomes related to contact relate to stigma, criminalization, and medicalization. In general, participants who indicated they had been addicted to drugs or alcohol reported lower stigmatizing attitudes. Participants who knew someone close to them who was addicted reported less negative attitudes toward the vignette opioid user but only on the social distance, disease/genetic attributions, medicalization, and criminalization measures. Participants who indicated that their relationship with the addicted person they know had become weaker because of the addiction reported more stigmatizing attitudes compared to participants who indicate the relationship got stronger. Finally, participants who indicated the addicted person they knew was their romantic partner were less likely to support criminalization compared to participants who knew an extended family member, parent, or friend who is addicted.