Cultural models of substance misuse risk and stigma among individuals seeking treatment for substance use disorders in Ribeirão Preto, Brazil

• Ano de defesa: 2022
• Autor(a) principal: Henderson, Nicole Lynn
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: eng
• Instituição de defesa: Biblioteca Digitais de Teses e Dissertações da USP
• Palavras-chave em Português: Antropologia cultural; Cultural anthropology; Estigma social; Social stigma; Substance-related disorders; Transtornos por uso de substâncias psicoativas
• Link de acesso: https://www.teses.usp.br/teses/disponiveis/22/22131/tde-03092024-123433/

To address the effects of stigma adequately, we must first understand the underlying factors that lead to the development, expression, and internalization of that stigma. This study examined the cultural construction of substance misuse risk in Brazil, as these disorders are more stigmatized than other physical/mental illnesses and the associated stigma is often accepted as natural. This mixed-methods project utilized traditional ethnographic methods, quantitative methods specific to cognitive anthropology, and multivariate statistical analyses. The project is divided into two distinct studies that focus on two distinct populations. The first study focused on the elicitation of a cultural model of substance misuse risk and the operationalization of variation in community member\'s knowledge of this model to predict attributional stigma. Persons who emphasized the risk associated with selfmedication or familial stressors were more likely to stigmatize the user, while persons who saw substance use as principally a social experience were less likely to stigmatize the user. The second study explored how this model has been internalized by individuals undergoing treatment for substance dependence and, further, how differences in the experience of risk factors affected the perception of social stigma and the degree of self-stigma. Unlike the students, who rated the risk factors according to the causal types identified in earlier phases, patients organized their thinking around a unique subset of risk factors that emphasized aspects of one\'s social and familial environment, comorbid mental health problems or stressors, and the addictive properties of substances. And the more that individuals interpreted substance use in terms of this patient-specific configuration of stressors, the more likely they were to perceive public stigma, stigmatize themselves, and experience depressive symptoms. Despite this internal variation, both the young adults and the patients share a single cultural model and there is little evidence that the internal contention is leading to a subcultural split. Instead, some patients are moving away from the cultural model and its connection to stigma, thus forming their own idiosyncratic interpretations of substance misuse risk.