The before–after study by Luoma et al. [62] found that group-based ACT resulted in significantly decreased shame [g = 1.33, standard error (SE) = 0.35, P < 0.001] and internalized stigma (g = 1.14, SE = 0.57, P < 0.05) among people with substance use disorders. Scores of perceived stigma and stigma-related rejection remained unchanged. The randomized control trial study by the National Institute on Drug Abuse (NIDA) [67] found that employment skills training with people receiving substance use treatment moderately improved participants' view of society (g = 0.49, SE = 0.19, P < 0.01) and significantly decreased feelings of social alienation (g = 0.50, SE = 0.19, P < 0.01). The intervention did not lead to significantly improved self-image. Shuster & Lewin's [69] non-comparative, observational study suggested that surgically removing needle track-marks may be beneficial for injection drug users in recovery.
