Gavriel-Fried Belle, Rabayov Tal
Bob Shapell School of Social Work, Tel Aviv UniversityTel Aviv, Israel.
Front Psychol. 2017 Jun 9;8:957. doi: 10.3389/fpsyg.2017.00957. eCollection 2017.
People with gambling as well as substance use problems who are exposed to public stigmatization may internalize and apply it to themselves through a mechanism known as self-stigma. This study implemented the Progressive Model for Self-Stigma which consists four sequential interrelated stages: awareness, agreement, application and harm on three groups of individuals with gambling, alcohol and other substance use problems. It explored whether the two guiding assumptions of this model (each stage is precondition for the following stage which are trickle-down in nature, and correlations between proximal stages should be larger than correlations between more distant stages) would differentiate people with gambling problems from those with alcohol and other substance use problems in terms of their patterns of self-stigma and in terms of the stages in the model. 37 individuals with gambling problems, 60 with alcohol problems and 51 with drug problems who applied for treatment in rehabilitation centers in Israel in 2015-2016 were recruited. They completed the Self-stigma of Mental Illness Scale-Short Form which was adapted by changing the term "mental health" to gambling, alcohol or drugs, and the DSM-5-diagnostic criteria for gambling, alcohol or drug disorder. The assumptions of the model were broadly confirmed: a repeated measures ANCOVA revealed that in all three groups there was a difference between first two stages (aware and agree) and the latter stages (apply and harm). In addition, the gambling group differed from the drug use and alcohol groups on the awareness stage: individuals with gambling problems were less likely to be aware of stigma than people with substance use or alcohol problems. The internalization of stigma among individuals with gambling problems tends to work in a similar way as for those with alcohol or drug problems. The differences between the gambling group and the alcohol and other substance groups at the aware stage may suggest that public stigma with regard to any given addictive disorder may be a function of the type of addiction (substance versus behavioral).
患有赌博问题以及物质使用问题的人若遭受公众污名化，可能会通过一种称为自我污名化的机制将其内化并加诸自身。本研究实施了自我污名化渐进模型，该模型由四个连续且相互关联的阶段组成：认知、认同、应用和伤害，研究对象为三组分别患有赌博、酒精及其他物质使用问题的个体。研究探讨了该模型的两个指导性假设（每个阶段是下一阶段的前提条件，且具有本质上的逐次递减性，相邻阶段之间的相关性应大于相隔较远阶段之间的相关性）在自我污名化模式以及模型阶段方面，是否能区分患有赌博问题的人与患有酒精及其他物质使用问题的人。招募了2015 - 2016年在以色列康复中心申请治疗的37名患有赌博问题的个体、60名患有酒精问题的个体和51名患有药物问题的个体。他们完成了《精神疾病自我污名量表简版》，该量表通过将“心理健康”一词改为赌博、酒精或药物进行了改编，同时完成了针对赌博、酒精或药物障碍的DSM - 5诊断标准。该模型的假设得到了广泛证实：重复测量协方差分析显示，在所有三组中，前两个阶段（认知和认同）与后两个阶段（应用和伤害）之间存在差异。此外，赌博组在认知阶段与药物使用组和酒精组不同：患有赌博问题的个体比患有物质使用或酒精问题的个体更不容易意识到污名。患有赌博问题的个体中的污名内化倾向与患有酒精或药物问题的个体相似。赌博组与酒精及其他物质组在认知阶段的差异可能表明，针对任何特定成瘾障碍的公众污名可能是成瘾类型（物质成瘾与行为成瘾）的函数。
