(PS1-A24) The Role of Stigma and Shame in Self-efficacy for Substance Use Treatment Adherence

According to the World Health Organization (WHO, 2018)), substance use disorders (SUDs) have been ranked by many countries as some of the most stigmatized conditions. Additionally, substance use disorders (SUDs) are largely overrepresented in the justice system (Tsai & Gu, 2019). Justice-involved individuals with SUDs are often court-mandated to receive substance use treatment and although studies have investigated treatment completion, self-efficacy in adhering to substance use treatment has yet to be examined among this sample (Coviello et al., 2013). The current study seeks to examine whether experiences and perceptions of stigma as well as shame are related to levels of treatment adherence self-efficacy among a sample court-mandated to receive substance use treatment. Participants (n=40) were recruited via social media to complete an online survey and were given a $10 gift-card for completing the survey. The majority of participants were men (60%), identified as white/Caucasian (77.5%) and the average age was 28.77 (SD=8.802). The HIV Treatment Self-Efficacy Scale (HIV-ASES; Johnson et al., 2007) was adapted to create the Treatment Adherence Self-Efficacy (T-ASES) measure that includes 13 items assessing participants’ confidence in their ability to adhere to substance use treatment. Stigma measures included the Criminal Record Stigma Mechanisms Scale (CR-SMS), Substance Use Stigma Mechanisms Scale (SU-SMS), Internalized Stigma of Individuals with Criminal Records scale (ISICR), Internalized Stigma of Individuals with Substance Use Disorders scale (ISISU), and the Internalized Shame Scale (ISS) (Cook, 2008; Moore et al., 2018).  Regression analyses were conducted to determine whether stigma and shame were significantly associated with participants’ self-efficacy for treatment adherence. Internalized shame explained a significant proportion of variance in self-efficacy for treatment adherence, R² = .217, F(1, 28) = 7.758, p = .009. Results suggest that individuals with higher levels of internalized shame will experience decreased self-efficacy for treatment adherence (b = -.961, p = .009); this aligns with previous literature which states that individuals with higher internalized shame and stigma will experience lower levels of self-efficacy in different settings (i.e. inpatient treatment). Scales measuring stigma did not significantly predict self-efficacy for treatment adherence. Further studies can explore the relationships among these variables to determine factors that may explain this disparity. These findings can contribute to substance use treatment programs to better help increase treatment adherence among court-mandated populations.