Perceived Self-Stigma as a Barrier to Healthcare Service Utilization Among People with Substance Use Disorders
Abstract
Objectives: To assess the frequency of perceived stigma and utilization of healthcare
services for detoxification or its medical complications among people with Substance Use
Disorder
Study Design: This is a descriptive, cross-sectional study and 131 patients with SUD were
included via non probability consecutive sampling technique.
Place and Duration of study: It was conducted at Jinnah Postgraduate Medical Center,
Department of Psychiatry and Behavioral Sciences from June 2024 to June 2025.
Methods: Informed consent was taken from the patients. Patients with known medical
comorbidities were excluded. A self-reported measure, ‘Perceived Stigma of Substance
Abuse Scale (PSAS)’ was utilized to assess perceived stigma. Healthcare utilization was self
reported. Data was analyzed using Statistical Package for the Social Sciences (SPSS Version
23). Linear regression analysis was used to determine associations.
Results: The mean age of the patients was 30.99±9.49 years. Most of the patients
112(85.5%) were male, and 47(35.9%) unemployed. Over half of the patients, 77(58.8%)
were poly-substance users. Mean PSAS score was 21.62±3.59. Prevalence of perceived
stigma among substance users was 93(71%). Patients with a history of utilizing healthcare
services reported relatively higher perceived stigma compared to those who had not utilized
healthcare services.
Conclusion: In conclusion, individuals with substance use disorders had a higher prevalence
71% of perceived stigma with notable differences across clinical and demographic
subgroups. On further evaluation, it was observed that patients with a history of utilizing
healthcare services reported relatively higher but insignificant perceived stigma compared
to those who had not utilized healthcare services.
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References
Coping Strategies and Factors Related to Problematic Substance Use and Behavioral
Addictions Among Adolescents and Young Adults with Cancer. Journal of adolescent and
young adult oncology. 2020;9(6):639-50.
2. Santangelo OE, Provenzano S, Firenze A. Risk Factors for Addictive Behaviors: A
General Overview. International journal of environmental research and public health.
2022;19(11).
3. Ghazal P. Rising trend of substance abuse in Pakistan: a study of sociodemographic
profiles of patients admitted to rehabilitation centres. Public health. 2019;167:34-7.
4. Hammarlund R, Crapanzano KA, Luce L, Mulligan L, Ward KM. Review of the effects
of self-stigma and perceived social stigma on the treatment-seeking decisions of individuals
with drug- and alcohol-use disorders. Substance abuse and rehabilitation. 2018;9:115-36.
5. Clement S, Schauman O, Graham T, Maggioni F, Evans-Lacko S, Bezborodovs N, et al.
What is the impact of mental health-related stigma on help-seeking? A systematic review of
quantitative and qualitative studies. Psychological medicine. 2015;45(1):11-27.
6. Stringer KL, Baker EH. Stigma as a Barrier to Substance Abuse Treatment Among
Those With Unmet Need: An Analysis of Parenthood and Marital Status. Journal of family
issues. 2018;39(1):3-27.
7. Abbas S IS, Washdev W, Hashmi S. The Loneliness due to Stigmatization among Male
Patients with Substance Use Disorder. Ann Punjab Med Coll. 2021;15(4):255-8.
8. Yangyuen S, Kanato M, Mahaweerawat C, Mahaweerawat U. The Perceived Stigma of
Addiction and Treatment Utilization among Cannabis Addicts in Thailand. Indian journal of
community medicine : official publication of Indian Association of Preventive & Social
Medicine. 2020;45(4):492-6.
9. Sarfaraz Y, Jafri L, Majid H, Khan NU, Sadiqa A, Khan AH, et al. Exploring landscape of
drug abuse trends in Pakistan: A decade and a half of clinical laboratory big data analysis.
PLOS Glob Public Health. 2025 May 5;5(5):e0004424. doi:10.1371/journal.pgph.0004424.
10. Luoma JB, O'Hair AK, Kohlenberg BS, Hayes SC, Fletcher L. The development and
psychometric properties of a new measure of perceived stigma toward substance users.
Substance use & misuse. 2010;45(1-2):47-57.
11. Shahzad S, Ali M, Begum N. Urdu Translation and Psychometric Properties of
Perceived Stigma of Substance Abuse Scale (PSAS) in Patients With Substance Use Disorders
in Pakistan [Internet]. NIDA International Forum Abstracts; 2021 [cited 2026 Apr 19].
Available from: https://nida.nih.gov/international/abstracts/urdu-translationpsychometric-properties-perceived-stigma-substance-abuse-scale-psas-in-patients
12. Elkalla IHR, El-Gilany AH, Baklola M, Terra M, Aboeldahab M, Sayed SE, et al. Assessing
self-stigma levels and associated factors among substance use disorder patients at two
selected psychiatric hospitals in Egypt: a cross-sectional study. BMC psychiatry.
2023;23(1):592.
13. Belete H, Ali T, Mekonen T, Fekadu W, Belete T. Perceived stigma and associated
factors among adults with problematic substance use in Northwest Ethiopia. Psychology
research and behavior management. 2021;14:637-44.
14. Hadera E, Salelew E, Girma E, Dehning S, Adorjan K, Tesfaye M. Magnitude and
Associated Factors of Perceived Stigma among Adults with Mental Illness in Ethiopia.
Psychiatry journal. 2019;2019:8427561.
13
15. Scioli GA, Carmona-Torres JA, Paniccia A, Battista A, Cavicchia I, Bishar RM. A study
on the perception of the stigma related to drug use in a sample of Italians and Belgians.
Psychol Soc Educ. 2015;7(1):1–8.
16. Mackenzie CS, Heath PJ, Vogel DL, Chekay R. Age differences in public stigma, selfstigma, and attitudes toward seeking help: A moderated mediation model. Journal of clinical
psychology. 2019;75(12):2259-72.
17. Sattler S, Zolala F, Baneshi MR, Ghasemi J, Amirzadeh Googhari S. Public Stigma
Toward Female and Male Opium and Heroin Users. An Experimental Test of Attribution
Theory and the Familiarity Hypothesis. Frontiers in public health. 2021;9:652876.
18. Reid M. A qualitative review of cannabis stigmas at the twilight of prohibition. Journal
of cannabis research. 2020;2(1):46.
19. Douglass CH, Win TM, Goutzamanis S, Lim MSC, Block K, Onsando G, et al. Stigma
Associated with Alcohol and Other Drug Use Among People from Migrant and Ethnic
Minority Groups: Results from a Systematic Review of Qualitative Studies. Journal of
Immigrant and Minority Health. 2023;25(6):1402-25.
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