Stigma and Secrecy Coping in Individuals in Treatment for Substance Dependence in Macedonia and Slovenia

Abstract

INTRODUCTION: At least three conceptually distinct forms of stigma can be identified (Luoma et al.,2007). Enacted stigma refers to directly experienced discrimination based on membership in a stigmatized group, for example difficulty in obtaining employment, poor support for treatment, or interpersonal rejection. Perceived stigma refers to beliefs that members of a stigmatized group have about the prevalence of stigmatizing attitudes and actions in society (cf.Link, 1987). Self-stigma refers to negative thoughts and feelings that emerge from identification with a stigmatized group and their resulting behavioral impact. (Luoma et al., 2007). Little evidence exists whether it is generally helpful or hurtful to conceal substance abuse as a method of regulating stigma, but secrecy is a common method of coping with stigma in substance using populations. The presence of stigma in substance using population negatively affects early detection and intervention, treatment, and recovery and fight against it can contribute to a better outcome of treatment and recovery. The aim of this study is to examine to what extent the enacted stigma, perceived stigma and secrecy as a method of coping with stigma in substance using populations are present and whether there is a differences related to patient and treatment characteristics. METHODS: A crosssection, a randomized study was conducted in the centers for treatment of drug dependence in Skopje and Ljubljana. A total number of 100 patients of both sexes and different age groups (50 clients from each center), being treated for drug dependence were included in this study. A written informative consent was presented to all participants before the start of the research. They filled in a non-standardized questionnaire with demographic data, data on drug use and treatment as well as 5 "yes" - "no" questions about the experienced stigma and other instruments for stigma and secrecy cooping: Stigma-Related Rejection Scale; Perceived Stigma Scale; Secrecy Coping Scale. RESULTS: Drug using population experiencing stigma in high extent. Stigma is more presence in female that in male patients and more in patients on methadone than on buprenorphine. Secrecy is a common method of coping with stigma in substance using populations but that is not a case in front of health staff for vast majority. Secrecy coping is present equally regardless of sex and the type of treatment program. CONCLUSION: Regarding high presence of stigma in substance using populations it is of crucial importance to raise awareness of the presence of stigma towards this population and fight against it in order to ease the recovery process.