At least three conceptually distinct forms of stigma can be identified (Luoma et al., 2007). Enacted stigma refers to directly experienced discrimination based on membership in a stigmatized group, for example difficulty in obtaining employment, reduced access to housing, poor support for treatment, or interpersonal rejection. Perceived stigma refers to beliefs that members of a stigmatized group have about the prevalence of stigmatizing attitudes and actions in society (cf. Link, 1987). Self-stigma refers to negative thoughts and feelings (e.g., shame, negative self-evaluative thoughts, fear) that emerge from identification with a stigmatized group and their resulting behavioral impact—avoidance of treatment, failure to seek employment, and avoidance of intimate contact with others (Luoma et al., 2007). Several instruments exist for use with a mentally ill population measuring experiences with enacted stigma, perceived stigma, and internalized stigma (Link, Yang, Phelan, and Collins, 2004). However, the experiences of stigma in substance using populations are not as well researched. New measures of stigma specific to substance misuse are needed if research on this area is going to progress.
