Stigma in substance-based and behavioural addictions: A systematic review

Background and Aims: The study of stigma contributes greatly to our understanding of individuals' experiences of mental disorders. Addictive disorders are often associated with public misconceptions of the disorder, which can contribute to shame, discrimination, and reticence to seek help. This review aimed to: (1) evaluate the nature, frequency, and prevalence of addiction stigma; (2) identify the correlates of addiction stigma; and (3) examine the psychometric qualities of addiction stigma measures. Methods: A search of Web of Science, PubMed, Scopus, PsycINFO, and PsycNet, had 5,515 results which were screened for eligibility using Covidence. Eligible papers were quantitative, peer-reviewed studies, which reported an outcome variable of stigma related to an addiction. Results: A total of 99 studies were included in the review, including 70 studies of substance-based addictions, 19 studies of behavioral addictions, and 10 studies which examined both. Thirteen of the 20 studies examining the impact of familiarity with addiction reported that greater familiarity was associated with lower public stigma. Studies comparing substance and behavioral addictions (n = 5) typically reported greater public stigma towards vignettes depicting substance-based addictions than for behavioral addictions. Between 22% and 40% of individuals with an addictive disorder identified stigma as a significant barrier to seeking help; however, the relative importance of stigma among other barriers was unclear. Discussion and Conclusions: Evidence for countermeasures to prevent and/or reduce stigma is currently limited. Further research on the nature and prevalence of addiction stigma is needed to inform the development of effective clinical and public health countermeasures.