Addiction medicine education on massive open online course improves the stigma of substance use disorder patients: a randomized controlled trial_West China Medical Journal

Authors：

YU Liangming ¹ , ZHAO Chenyang ¹ , JIANG Pengfei ² , ZHANG Mingmin ³ , XU Jiajun ¹ , DONG Qianyu ¹ , FENG Qian ⁴ , JIANG Haoyan ⁴ , YANG Xia ¹ ,  LI Jing ¹

1. Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Meishan Detoxification Center, Meishan, Sichuan 620010, P. R. China;
3. The Institute of Cognitive Neuroscience, the School of Psychology and Cognitive Science, East China Normal University, Shanghai 201300, P. R. China;
4. West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LI Jing, Email: joana028@163.com

Keywords：

Addiction; substance use disorder; stigma; shame; massive open online course

DOI：

10.7507/1002-0179.202110051

Video：

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Objective To explore the relation between stigma and substance use of patients with substance use disorder and explore the impact of learning addiction medicine massive open online course (MOOC) on patients’ stigma, depression and anxiety. Methods Patients with substance use disorder in Meishan Detoxification Center from January 11 to 18, 2020 were selected. The patients were randomly divided into control group and teaching group. Both groups participated in regular labor reform while the teaching group attended extra MOOC course. The general demographic data and the duration and amount of substance use were collected before intervention. Before and after intervention, all the patients completed scales including Chinese Version of Substance Use Stigma Mechanisms Scale (SUSMS-C), Zung Self-Rating Depression Scale (SDS) and Zung Self-Rating Anxiety Scale (SAS). The correlation between stigma and depression, anxiety, substance use characteristics were analyzed, as well as the changes of stigma, depression and anxiety before and after MOOC intervention.Results A total of 78 patients were included, including 41 in the control group and 37 in the teaching group. There was no correlation between the scores of SUSMS-C and the duration or amount of substances use (P>0.05). SAS score and SDS score were positively correlated with the total score of stigma, internalized stigma, enacted stigma (family) and enacted stigma (healthcare providers) (P<0.05). SDS scores and SAS scores had no correlation with the anticipated stigma (P>0.05). After intervention, the total score of stigma, anticipated stigma (family) and anticipated stigma (healthcare providers) in the teaching group decreased (P<0.05). In the control group, only anticipated stigma (family) decreased (P=0.047). There was no significant difference in other SUSMS-C items, SAS scores, or SDS scores between the two groups before and after intervention (P>0.05). Conclusions Stigma may not be able to protect patients with substance use disorder from using substances. Instead, stigma may potentially cause negative emotional consequences like depression and anxiety. The addiction medicine MOOC can be used as an intervention to reduce the stigma of patients with substance use disorder.

Citation： YU Liangming, ZHAO Chenyang, JIANG Pengfei, ZHANG Mingmin, XU Jiajun, DONG Qianyu, FENG Qian, JIANG Haoyan, YANG Xia, LI Jing. Addiction medicine education on massive open online course improves the stigma of substance use disorder patients: a randomized controlled trial. West China Medical Journal, 2022, 37(2): 255-261. doi: 10.7507/1002-0179.202110051 Copy

1.	李兴富, 张琼, 淤泽溥. 385 例海洛因依赖者脱毒治疗康复期心理渴求程度调查分析. 中国药物依赖性杂志, 2001, 10(2): 135-137.
2.	Koob GF. Negative reinforcement in drug addiction: the darkness within. Curr Opin Neurobiol, 2013, 23(4): 559-563.
3.	Corrigan PW, River LP, Lundin RK, et al. Stigmatizing attributions about mental illness. J Rural Community Psychol, 2000, 28(1): 91-102.
4.	Earnshaw VA. Stigma and substance use disorders: a clinical, research, and advocacy agenda. Am Psychol, 2020, 75(9): 1300-1311.
5.	Can G, Tanrıverdi D. Social functioning and internalized stigma in individuals diagnosed with substance use disorder. Arch Psychiatr Nurs, 2015, 29(6): 441-446.
6.	Woodhead EL, Timko C, Han X, et al. Stigma, treatment, and health among stimulant users: Life stage as a moderator. J Appl Dev Psychol, 2019, 60: 96-104.
7.	Wakeman SE, Rich JD. Barriers to medications for addiction treatment: How stigma kills. Subst Use Misuse, 2018, 53(2): 330-333.
8.	Luoma JB, Twohig MP, Waltz T, et al. An investigation of stigma in individuals receiving treatment for substance abuse. Addict behav, 2007, 32(7): 1331-1346.
9.	Ashford RD, Brown AM, Canode B, et al. A mixed-methods exploration of the role and impact of stigma and advocacy on substance use disorder recovery. Alcoholism Treatment Quarterly, 2019, 37(4): 462-480.
10.	Ross MW, Timpson SC, Williams ML, et al. Stigma consciousness concerns related to drug use and sexuality in a sample of street-based male sex workers. Int J Sex Health, 2007, 19(2): 57-67.
11.	Luoma JB, Kulesza M, Hayes SC, et al. Stigma predicts residential treatment length for substance use disorder. Am J Drug Alcohol Abuse, 2014, 40(3): 206-212.
12.	Sheehy K, Noureen A, Khaliq A, et al. An examination of the relationship between shame, guilt and self-harm: a systematic review and meta-analysis. Clin Psycho Rev, 2019, 73: 101779.
13.	Cameron AY, Shea MT, Randall AB. Acute shame predicts urges for suicide but not for substance use in a veteran population. Suicide Life Threat Behav, 2020, 50(1): 292-299.
14.	马月娇, 王东方, 袁明, 等. 物质使用患者病耻感量表中文版(SUSMS-C)的信度和效度研究. 中国药物依赖性杂志, 2018, 27(5): 339-343,348.
15.	杨玲, 付亚南. “污名化”对戒毒人员回归社会具有消极影响. 大众心理学, 2017(7): 41-42.
16.	赵天虹. 人文、开放与精准: 强制隔离戒毒教育矫治质量的提升路径. 司法警官职业教育研究, 2020, 1(4): 14-19.
17.	刘雪蕾, 刘辉. 探究监狱法学新教法的发展—以慕课教学为例. 理论观察, 2017(9): 138-140.
18.	AMORIM P. Mini International Neuropsychiatric Interview (MINI): validation of a short structured diagnostic psychiatric interview. Braz J Psychiatry, 2000, 22(3): 106-115.
19.	王汝展, 刘兰芬, 崔开艳, 等. ZUNG 氏抑郁自评量表作为内科住院患者抑郁障碍筛查工具的可行性研究. 中国健康心理学杂志, 2009, 17(8): 923-925.
20.	陶明, 高静芳. 修订焦虑自评量表的信度及效度. 中国神经精神疾病杂志, 1994, 20(5): 301-303.
21.	Gignac GE, Szodorai ET. Effect size guidelines for individual differences researchers. Pers Individ Dif, 2016, 102: 74-78.
22.	De France K, Lanteigne D, Glozman J, et al. A new measure of the expression of shame: the shame code. J Child Fam Stud, 2017, 26(3): 769-780.
23.	高隽, 钱铭怡. 羞耻情绪的两面性: 功能与病理作用. 中国心理卫生杂志, 2009, 23(6): 451-456.
24.	Palamar JJ, Halkitis PN, Kiang MV. Perceived public stigma and stigmatization in explaining lifetime illicit drug use among emerging adults. Addict Res Theory, 2013, 21(6): 516-525.
25.	Magnet M. Modern sex: liberation and its discontents. Ivan R. Dee, 2001.
26.	Sales JM, DiClemente RJ, Rose ES, et al. Relationship of STD-related shame and stigma to female adolescents’ condom-protected intercourse. J Adolesc Health, 2007, 40(6): 573.e1-e6.
27.	Bennett DS, Hersh J, Herres J, et al. HIV-related stigma, shame, and avoidant coping: risk factors for internalizing symptoms among youth living with HIV?. Child Psychiatry Hum Dev, 2016, 47(4): 657-664.
28.	Kelly JF, Dow SJ, Westerhoff C. Does our choice of substance related terms influence perceptions of treatment need? An empirical investigation with two commonly used terms. J Drug Issues, 2010, 40(4): 805-818.
29.	Moyers TB, Miller WR. Is low therapist empathy toxic?. Psychol Addict Behav, 2013, 27(3): 878-884.
30.	Zaki J, Ochsner KN. The neuroscience of empathy: progress, pitfalls and promise. Nat Neurosci, 2012, 15(5): 675-680.
31.	Lamm C, Batson CD, Decety J. The neural substrate of human empathy: effects of perspective-taking and cognitive appraisal. J Cogn Neurosci, 2007, 19(1): 42-58.
32.	Dekeseredy P, Sedney CL, Razzaq B, et al. Tweeting stigma: an exploration of twitter discourse regarding medications used for both opioid use disorder and chronic pain. J Drug Issues, 2021, 51(2): 340-357.

1. 李兴富, 张琼, 淤泽溥. 385 例海洛因依赖者脱毒治疗康复期心理渴求程度调查分析. 中国药物依赖性杂志, 2001, 10(2): 135-137.
2. Koob GF. Negative reinforcement in drug addiction: the darkness within. Curr Opin Neurobiol, 2013, 23(4): 559-563.
3. Corrigan PW, River LP, Lundin RK, et al. Stigmatizing attributions about mental illness. J Rural Community Psychol, 2000, 28(1): 91-102.
4. Earnshaw VA. Stigma and substance use disorders: a clinical, research, and advocacy agenda. Am Psychol, 2020, 75(9): 1300-1311.
5. Can G, Tanrıverdi D. Social functioning and internalized stigma in individuals diagnosed with substance use disorder. Arch Psychiatr Nurs, 2015, 29(6): 441-446.
6. Woodhead EL, Timko C, Han X, et al. Stigma, treatment, and health among stimulant users: Life stage as a moderator. J Appl Dev Psychol, 2019, 60: 96-104.
7. Wakeman SE, Rich JD. Barriers to medications for addiction treatment: How stigma kills. Subst Use Misuse, 2018, 53(2): 330-333.
8. Luoma JB, Twohig MP, Waltz T, et al. An investigation of stigma in individuals receiving treatment for substance abuse. Addict behav, 2007, 32(7): 1331-1346.
9. Ashford RD, Brown AM, Canode B, et al. A mixed-methods exploration of the role and impact of stigma and advocacy on substance use disorder recovery. Alcoholism Treatment Quarterly, 2019, 37(4): 462-480.
10. Ross MW, Timpson SC, Williams ML, et al. Stigma consciousness concerns related to drug use and sexuality in a sample of street-based male sex workers. Int J Sex Health, 2007, 19(2): 57-67.
11. Luoma JB, Kulesza M, Hayes SC, et al. Stigma predicts residential treatment length for substance use disorder. Am J Drug Alcohol Abuse, 2014, 40(3): 206-212.
12. Sheehy K, Noureen A, Khaliq A, et al. An examination of the relationship between shame, guilt and self-harm: a systematic review and meta-analysis. Clin Psycho Rev, 2019, 73: 101779.
13. Cameron AY, Shea MT, Randall AB. Acute shame predicts urges for suicide but not for substance use in a veteran population. Suicide Life Threat Behav, 2020, 50(1): 292-299.
14. 马月娇, 王东方, 袁明, 等. 物质使用患者病耻感量表中文版(SUSMS-C)的信度和效度研究. 中国药物依赖性杂志, 2018, 27(5): 339-343,348.
15. 杨玲, 付亚南. “污名化”对戒毒人员回归社会具有消极影响. 大众心理学, 2017(7): 41-42.
16. 赵天虹. 人文、开放与精准: 强制隔离戒毒教育矫治质量的提升路径. 司法警官职业教育研究, 2020, 1(4): 14-19.
17. 刘雪蕾, 刘辉. 探究监狱法学新教法的发展—以慕课教学为例. 理论观察, 2017(9): 138-140.
18. AMORIM P. Mini International Neuropsychiatric Interview (MINI): validation of a short structured diagnostic psychiatric interview. Braz J Psychiatry, 2000, 22(3): 106-115.
19. 王汝展, 刘兰芬, 崔开艳, 等. ZUNG 氏抑郁自评量表作为内科住院患者抑郁障碍筛查工具的可行性研究. 中国健康心理学杂志, 2009, 17(8): 923-925.
20. 陶明, 高静芳. 修订焦虑自评量表的信度及效度. 中国神经精神疾病杂志, 1994, 20(5): 301-303.
21. Gignac GE, Szodorai ET. Effect size guidelines for individual differences researchers. Pers Individ Dif, 2016, 102: 74-78.
22. De France K, Lanteigne D, Glozman J, et al. A new measure of the expression of shame: the shame code. J Child Fam Stud, 2017, 26(3): 769-780.
23. 高隽, 钱铭怡. 羞耻情绪的两面性: 功能与病理作用. 中国心理卫生杂志, 2009, 23(6): 451-456.
24. Palamar JJ, Halkitis PN, Kiang MV. Perceived public stigma and stigmatization in explaining lifetime illicit drug use among emerging adults. Addict Res Theory, 2013, 21(6): 516-525.
25. Magnet M. Modern sex: liberation and its discontents. Ivan R. Dee, 2001.
26. Sales JM, DiClemente RJ, Rose ES, et al. Relationship of STD-related shame and stigma to female adolescents’ condom-protected intercourse. J Adolesc Health, 2007, 40(6): 573.e1-e6.
27. Bennett DS, Hersh J, Herres J, et al. HIV-related stigma, shame, and avoidant coping: risk factors for internalizing symptoms among youth living with HIV?. Child Psychiatry Hum Dev, 2016, 47(4): 657-664.
28. Kelly JF, Dow SJ, Westerhoff C. Does our choice of substance related terms influence perceptions of treatment need? An empirical investigation with two commonly used terms. J Drug Issues, 2010, 40(4): 805-818.
29. Moyers TB, Miller WR. Is low therapist empathy toxic?. Psychol Addict Behav, 2013, 27(3): 878-884.
30. Zaki J, Ochsner KN. The neuroscience of empathy: progress, pitfalls and promise. Nat Neurosci, 2012, 15(5): 675-680.
31. Lamm C, Batson CD, Decety J. The neural substrate of human empathy: effects of perspective-taking and cognitive appraisal. J Cogn Neurosci, 2007, 19(1): 42-58.
32. Dekeseredy P, Sedney CL, Razzaq B, et al. Tweeting stigma: an exploration of twitter discourse regarding medications used for both opioid use disorder and chronic pain. J Drug Issues, 2021, 51(2): 340-357.

West China Medical Journal

Addiction medicine education on massive open online course improves the stigma of substance use disorder patients: a randomized controlled trial

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