SUBSTANCE USE – MOVING BEYOND STIGMA AND STIGMATIZING LANGUAGE TO INTEGRATIVE HEALTHCARE
Creators: name: Davis, April D
Publisher: name: Washington State University
Year: 2024
Subjects: Integrative Healthcare
Interprofessional Education
Stigmatizing Language
Student Healthcare Programs
Substance Use Disorder
Behavioral psychology

description: Objective Substance use disorder (SUD) is stigmatized unlike almost any other type of modern-day disease, which adds significant burden for individuals to receive optimal, integrative, and equitable healthcare. The use of stigmatizing language toward patients with SUD or using cannabis-based medicine can pose a significant barrier to treatment related to structural and professional stigma in the healthcare setting. Study one aimed to a) explore healthcare students’ awareness of SUD-related stigma and reported likelihood of using stigmatizing language; b) examine whether there is a connection between program type and stigma awareness prior to any intervention; and c) identify factors that correlate with attenuation in reported use of stigmatizing language, post educational activity. Study two aimed to learn how an interprofessional educational activity that provides knowledge about and exposure to a standardized patient at risk for substance misuse a) impacts healthcare students’ awareness and knowledge of stigma and stigmatizing language surrounding SUD; and b) impacts attitudes and intentions toward people with SUD when applying the cognitive behavior therapy (CBT) framework. This study also sought to discover whether program type or year in a professional degree were contributing factors to reported changes in awareness, knowledge, attitudes, or intentions. The third manuscript was a state of the field on cannabis-based medicine and the professional stigma impacts surrounding its integration into the healthcare setting.
description: Methods A cross-sectional correlational study was undertaken among 131 healthcare students from four professional programs on a university campus for studies one and two. The participants engaged in an educational activity related to screening, brief intervention, and referral to treatment (SBIRT) for SUD, with a pre-activity focused on stigma education related to substance use and examples of stigmatizing versus non-stigmatizing language. The author conducted secondary analysis of data for two studies through: multiple regression to assess potential prediction of program type and/or reported prior awareness of and/or reported use of SUD-related stigmatizing language on post-intervention reported use of SUD-related stigmatizing language (study one); post hoc analysis on program type and potential associations with pre-activity awareness of and likeliness to use stigmatizing language (study one); and, secondary thematic analysis of responses to open ended items using inductive and deductive approaches to progressively code and organize data (study two).
description: Results Study one: The regression model forecasted a moderate percentage of reported likelihood in using SUD-related stigmatizing language post educational activity, which served as the intervention in this study [R2 = 0.675, R2adj = 0.668, F(3,127) = 88.07, p &lt; 0.001]. Two variables (reported pre-awareness and reported pre-likeliness of use) out of three significantly contributed to the model. Program type differences were significant for pre-activity awareness of SUD-related stigmatizing language [F(3, 127)=6.46, p&lt;0.001, partial η2=0.13]. Differences in pre-activity likeliness of using SUD-related stigmatizing language were not significant between program types [F(3, 127)=1.29, p=0.28, partial η2=0.03]. Post hoc analysis revealed that Athletic Training students’ pre-activity awareness of SUD-related stigmatizing language differed significantly from Doctor of Nursing Practice and Pharmacy students, but not from Medicine students.
description: Study two: Major themes were identified for each of the two open-ended questions posed from student participant responses. The qualitative data revealed that most student participants who submitted responses reported a change in learning and understanding overall, either through newly gained knowledge, awareness, or empathy or through reiteration and further honing of previously learned concepts or skills. Additionally, many student participants identified the importance of interprofessional experiential learning opportunities directed towards how to effectively treat patients who present with a potential SUD in a non-stigmatizing manner.
description: State of the field: There are specific conditions and situations where cannabinoid therapy has been found to be effective and where cannabis-based medicine should be embraced and taught in medical schools as a beneficial and often lower risk intervention for midlife and older adults with epilepsy, chronic pain, dementia, inflammatory bowel disease, multiple sclerosis, and palliative medicine.
description: Conclusions The results imply a need to assess students’ awareness of stigma for SUD in professional healthcare programs and offer educational interventions to curb likeliness to use stigmatizing language and increase awareness and knowledge of stigma surrounding SUD and empathy in healthcare students toward people with a SUD. Anti-stigma-based interventions and comprehensive, current publications aimed at reducing SUD- and cannabis-based medicine stigma in healthcare students and providers can further contribute to creating a more inclusive and integrative healthcare environment.