title: The vicious circle of perceived stigmatization, depressiveness, anxiety, and low quality of life in substituted heroin addicts.
abstract: BACKGROUND
  Perceived stigmatization of drug addicts may interact with negative mood states and thus may contribute to the maintenance of addictive behavior.
  
  
  METHODS
  Opiate maintenance patients (n = 106) and an unselected comparison group (n = 144) rated self-report questionnaires about perceived stigmatization, quality of life (QoL), depressiveness, anxiety, self-esteem, addiction characteristics, and social support.
  
  
  RESULTS
  63% of opiate maintenance patients felt discriminated in contrast to 16% of the comparison group. Perceived stigmatization was rated higher by opiate maintenance patients, and all domains of QoL were rated lower, even when statistically controlling depressiveness, anxiety and social factors. Perceived stigmatization was correlated to depressiveness, anxiety, low self-esteem and low QoL, but not addiction characteristics and social support. Structural equation models revealed anxiety and the pathway depressiveness enhancing feelings of being stigmatized resulting in low self-esteem to explain 74% of variance in mental QoL, whereas anxiety and a pathway stigmatization inducing depressiveness leading to low self-esteem explained 49% of variance in physical QoL.
  
  
  CONCLUSIONS
  A vicious circle of stigmatization, negative affective states and low QoL was confirmed. In addition to societal antistigma campaigns, antidepressive and anxiolytic therapy might have the potential to diminish feelings of being stigmatized and to improve QoL.
authors.affiliation: Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Mannheim, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Frischknecht
authors.forename: Bettina
authors.initials: B
authors.lastname: Beckmann
authors.forename: Milena
authors.initials: M
authors.lastname: Heinrich
authors.forename: Anja
authors.initials: A
authors.lastname: Kniest
authors.forename: Helmut
authors.initials: H
authors.lastname: Nakovics
authors.forename: Falk
authors.initials: F
authors.lastname: Kiefer
authors.forename: Karl
authors.initials: K
authors.lastname: Mann
authors.forename: Derik
authors.initials: D
authors.lastname: Hermann
mesh_terms: D000328:Adult; D001007:Anxiety / Q000150:complications / Q000523:psychology*; D016739:Behavior, Addictive / Q000523:psychology; D003863:Depression / Q000150:complications / Q000523:psychology*; D005260:Female; D006556:Heroin Dependence / Q000150:complications / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D008297:Male; D015233:Models, Statistical; D058850:Opiate Substitution Treatment / Q000379:methods / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D012649:Self Concept; D057566:Self Report; D012938:Social Perception; D012944:Social Support; D013240:Stereotyping