title: Towards greater understanding of addiction stigma: Intersectionality with race/ethnicity and gender.
abstract: In spite of the significant burden associated with substance use disorders, especially among persons who inject drugs (PWIDs), most affected individuals do not engage with any type of formal or informal treatment. Addiction stigma, which is represented by negative social attitudes toward individuals who use alcohol and/or other drugs, is one of the barriers to care that is poorly understood. The current study: a) assessed implicit (indirect and difficult to consciously control) and explicit (consciously controlled) beliefs about PWIDs among visitors to a public web site; and b) experimentally investigated the effects of ethnicity/race and gender on those implicit and explicit beliefs.
  
  
  
  N=899 predominantly White (70%) and women (62%) were randomly assigned to one of six target PWIDs conditions: gender (man/woman) x race/ethnicity (White, Black, Latino/a). Participants completed an Implicit Association Test and explicit assessment of addiction stigma.
  
  
  
  Participants implicitly associated PWIDs (especially Latino/a vs. White PWIDs) with deserving punishment as opposed to help (p=0.003, d=0.31), indicating presence of addiction stigma-related implicit beliefs. However, this bias was not evident on the explicit measure (p=0.89). Gender did not predict differential implicit or explicit addiction stigma (p=0.18).
  
  
  
  Contrary to explicit egalitarian views towards PWIDs, participants' implicit beliefs were more in line with addiction stigma. If replicated and clearer ties to behavior are established, results suggest the potential importance of identifying conditions under which implicit bias might influence behavior (even despite explicit egalitarian views) and increase the likelihood of discrimination towards PWIDs.
authors: RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA. Electronic address: mkulesza@rand.org.
authors: Magdalena
authors: M
authors: Kulesza
authors: RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA. Electronic address: mmatsuda@rand.org.
authors: Mauri
authors: M
authors: Matsuda
authors: University of Washington, Department of Psychiatry, 1100 NE 45th Street, Seattle, WA, 98105, USA. Electronic address: jjramirz@uw.edu.
authors: Jason J
authors: JJ
authors: Ramirez
authors: University of Virginia, Department of Psychology, 102 Gilmer Hall, Charlottesville, VA, 22904, USA. Electronic address: ajw3x@virginia.edu.
authors: Alexandra J
authors: AJ
authors: Werntz
authors: University of Virginia, Department of Psychology, 102 Gilmer Hall, Charlottesville, VA, 22904, USA. Electronic address: bteachman@virginia.edu.
authors: Bethany A
authors: BA
authors: Teachman
authors: University of Washington, Department of Psychiatry, 1100 NE 45th Street, Seattle, WA, 98105, USA. Electronic address: KPL9716@uw.edu.
authors: Kristen P
authors: KP
authors: Lindgren
mesh_terms: D000328:Adult; D001741:Black or African American / Q000208:ethnology / Q000523:psychology; D016739:Behavior, Addictive / Q000208:ethnology / Q000523:psychology; D044383:Black People / Q000208:ethnology / Q000523:psychology; D003430:Cross-Sectional Studies; D005006:Ethnicity / Q000523:psychology*; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D044469:Racial Groups / Q000208:ethnology* / Q000523:psychology*; D011897:Random Allocation; D012737:Sex Factors; D057545:Social Stigma; D019966:Substance-Related Disorders / Q000208:ethnology* / Q000523:psychology*; D044465:White People / Q000208:ethnology / Q000523:psychology; D055815:Young Adult
keywords: Addiction stigma; Gender bias; Implicit association test; Intersectionality framework; Persons who inject drugs; Racial/ethnic bias