الفهرس 
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Abstract
Substance use disorders (SUDs) is a global public health problem associated with
poor health outcomes and decreased productivity among the affected individuals. Stigma
of SUDs considers one of barriers to substance use treatment, and reason for lower
utilization of health services.
Individuals with substance use disorders face stigma and discrimination, which
may cause chronic stress and may lead to emotional and behavioral responses of
stigmatized individuals, such as feeling of anger, concealment of drug using status,
withdrawal from social interactions and isolation. The labeling of a person as a drug
addict triggers „„powerful expectations of rejection from others that in turn erode
confidence, disrupt social interaction, and impair social and occupational functioning‟‟.So
the more increase of the level of stigma of individuals with SUDs, the more decrease in
their social functioning.
Aim of the study:
This study aims to assess perceived, self-stigma and social functioning among
patients with substance use disorders, and to identify the relationship between both
perceived, self-stigma and social functioning.
The study followed a descriptive design. It was conducted at the outpatient clinic
of EL Maamoura Hospital for Psychiatric Medicine, in Alexandria. The sample of study
consisted of 300 patients with substance use disorders who have no physical disability or
disfigurement, and not hospitalized during the last three months.
Tools used to collect the data of the present study:
Four tools used to collect the data;
Tool ”1” Socio-demographics and Clinical Data Structured Interview Schedule:
The tool include data regarding socio-demographic characteristics, and the clinical
data such as type, method, frequency of using substances, numbers of substances used,
duration and causes of initiating substance use.
Tool ”2”: Perceived Stigma of Addiction Scale (PSAS):
This tool developed by Luoma et al., (2010). It measures perceptions of the
prevalence of stigmatizing beliefs toward substance use. It consists of 8 items self-report
scale. Higher scores indicating higher perceived stigma.
Tool ”3”: Substance Abuse Self-Stigma Scale (SASSS):
This scale developed by Luoma et al. (2013), to measure the components of a
functional contextual model of self-stigma among individuals with SUDs. It contained 40
items divided into three sections; self-devaluation, fear of enacted stigma, stigma
avoidance and values disengagement
Tool ”4”: Social Functioning Scale (SFS):
This scale was developed by Birchwood et al., (1990), designed to enable assessment
of social functioning, social skills and performance. SFS is a 79-item scale, it consists of
7 sub-scales.
The following are the main results of the present study.
Socio-demographic data:
- 86.7% studied individuals were males, 41.0 % were in age group ranging from
thirty years to less than forty years, and the mean age was 33.88 ± 7.20 years. 49.0%
of them were married.
- 30.7% of studied patients had basic education, 34.3% were Craft-worker, 17.7 % of
them not working. 91.3% were living in urban areas. 50.7% of them were living
with Original family, 42.7 % of subjects had three to four family members, 40.7%
were the middle member of the family
Clinical data:
- 76.0% of patients used tramadol followed by 37.7 % used hashish, 80.0% using the
substance by mouth, 43.7 % smoke the substances. 35% of the studied subjects were
using the substances more than three times daily. 58.0% used only” one” substance.
41.3 % of the subjects were using the substances for 5 – 9 years. 57.3% initiating
substance due to ”pressure of others, 41.7 % of patients motivated for treatment to
provide relieve for their parents.
- 77.7% of patients had relapsed. 35.2% of patients relapsed because of the
encouraging environment. 26.6% of patients relapsed five times or more. More than
two third of patients had smokers in their families. 35.0% of patients had relatives in
their family using substances and 60.0 % of them the brother was a substance user.
- Around two third of subjects their parents know that they used substances, 78.0% of
patients stated that; they already have people who support them during treatment
and 90.2% of them, their family was supporting them.
- A highest percentage of the studied patients (57.7%) obtained high level of
perceived stigma, while 39.7% of them obtained moderate level of perceived
stigma.
- 78.3% of individuals have moderate self-stigma of substance abuse, followed by
19.3% has high self-stigma. As related to levels of subscales of self-stigma, it was
found that 55.0 % of subjects had high level of Self-devaluation, followed by 62.7%
of them had high level of Fear of enacted stigma, and 76.7 % of them had moderate
level of Stigma avoidance and values disengagement.
- Regarding level of ”social functioning”, 62 % of subjects have low level of social
functioning, their highest percentages were in the subscales of ”pro-social activity”
(87.0%), ”recreational activity” (72.3%), and ”independence performance”(40.7%).
On the other hand 38.0% of patients have high social functioning, their highest
percentage were found at the subscales of ”independence-competence” (99.30%),
”employment /occupation” (91.0%), ”interpersonal communication” (85.7%), and
”withdrawal / social engagement” (66.3 %).
- There was a highly statistical significant positive correlation between Perceived
Stigma, and Self stigma (r = 0.565, p <0.001), and social functioning was
significantly, negatively correlated with both perceived stigma and self-stigma,
where (r = – 0.264, p<0.001), (r = – 0.314, p<0.001) respectively.
- It was found a statistical significant relationship between perceived stigma with sex,
education level, and occupation where (t= 2.730, p=0.007), (F = 2.552, p= 0.039),
(F = 2.374, p=0.030) respectively.
- A significant statistical relationship was found between self-stigma with birth order
where F = 6.212, p=0.002.
There was a statistical significant relationship between social functioning with
marital status and educational level where (F = 4.131, p = 0.017), (F = 2.746, p =
0.029) respectively.
- It was found a statistical significant relationship between perceived stigma with
duration of substance abuse, persons who know patients’ history of substance abuse
where (F = 2.449, p = 0.046), (F= 3.106, p= 0.046) respectively.
- There was a statistical significant relationship between self-stigma with frequency
of using substances per day where F= 2.857, p= 0.015. There was also a statistical
significant relationship between self-stigma with duration of substance abuse where
F=3.049, p= 0.017.
- It was found a statistical significant relationship between social functioning with
duration of substance abuse F= 3.055, p = 0.017.
-
Conclusion and recommendation
It can be concluded that a highest percentage of studied subjects obtained high
level of perceived stigma, while the majority of them had moderate self-stigma, and
low level of social functioning. The high the perceived stigma and self-stigma they
have, the poor their social functioning are.
The following recommendations are suggested:
Recommendation for health care providers
They should teach individuals with SUDs effective methods for coping with stigma.
Health care providers are recommended to provide training for patients that increase
patients’ levels of self-esteem, decrease stigma and increase their social functioning.
Health care professional training and educational programs to increase their
awareness, knowledge to reduce stigmatizing attitudes toward patients with SUDs.
Provide health education to individuals with SUDs and their family to increase
knowledge, understanding, and awareness of SUDs.
Psychiatric nurses should be included in integrated care plans to ensure appropriate
therapeutic interventions to cope with stigmatization and improve patients‟ social
functioning.
Efforts should be made to increase patients‟ social functioning, decrease perceived,
and self-stigma toward individuals with SUDs.
Effective ways for health care providers working with patients with SUDs include:
Offering compassionate support.
Displaying kindness to people in vulnerable situations.
Listening while withholding judgment.
Seeing a person for who they are, not what drugs they use.
Treating people with SUDs with dignity and respect.
Avoiding hurtful labels.
language modification toward individuals with SUDs, using terms such as; person
with SUDs, or person with AUDs instead of addict, substance abuser, or alcoholic,
this will raise stronger positive attitudes and decrease the negative and stigmatizing
attitudes.
Replacing negative attitudes with evidence-based facts.
Recommendation for the community
The need to develop specialized treatment services for women, emphasizing on the need for gender sensitive treatment
services, development of rehabilitation programs, and appropriate prevention strategies especially for
women.
Substance use stigma reduction should be integrated into public health efforts,
Programs to reduce both public and self-stigma are recommended.
Policies and procedures could be examined for the possibility of their contributing
to stigma towards clients.
Increase outpatient services in the community that help in developing aftercare
plans, exploring employment opportunities, focus on reintegrate individuals into
society and prevent social withdrawal.
Training and educating targeted populations like clinicians, nurses, health care
providers and raising awareness of general population that in turn reduce the stigma
towards individuals with SUDs.
Recommendation for further researches
There is a need to develop special measurement for social functioning designed
specifically for individuals with SUDs.
Stigma related to Substance use is needed to be examined and addressed substance
by substance, rather than as a group of substances.
More studies are needed to examine the stigma among women with SUDs.
Further researches are required to investigate the impact of different programs on
reducing perceived and self-stigma and enhancing social functioning of patients
with SUDs
Further researches are required to examine the relationship between different types
of stigma and quality of life.