What leads a person to use drugs and alcohol?
Peer pressure? Depression? Genetics? Through various personal and educational experiences, we develop ideas about what does and does not lead to addiction. These beliefs are wide-ranging and rarely encompass only one facet of a person's life. In the research conducted for my master's thesis, I utilized cognitive anthropological methods to conceptualize and visualize how undergraduates at the University of Alabama think about the etiology of addiction. A group of undergraduate students participated in a free-listing exercise and identified 28 factors that they believed increased an individual's risk in developing a substance use disorder. These included factors that stemmed from a person's social or family life, as well as to psychological problems that could lead an individual to self-medicate with drugs/alcohol. Further, students identified innate, biological characteristics of the person or the substance and hedonistic causes that could influence an individual's likelihood of continuing to use drugs.
How do these beliefs relate to the tendency to stigmatize people with addiction?
This collection of ideas about the causes of a particular mental illness are referred to as "folk psychiatry" or "ethnopsychiatry," and these have been shown to be guiding factors behind public attitudes of individuals with mental illness. I found that among undergraduates at the University of Alabama, there are two guiding ideologies for understanding addiction: the Medical and the Moral. Those who adhered to the Medical model prioritized the Self-Medication and the Biological factors when explaining addiction, while those who adhered to the Moral model preferred the Social and Hedonistic causes for explaining why a person would develop substance use disorders. I found that those who adhered to the Medical model stigmatized significantly less than individual's with the Moral model.
Are there cross-cultural differences in these causal beliefs?
In the summer of 2017, I conducted pilot work in the city of Ribeirão Preto, SP, Brazil. Much like in the US, university students in Brazil are at extreme risk of developing problematic substance use behaviors, so I am particularly interested in how they think about and understand addiction. The sample consisted of students who attended either the University of São Paulo - Ribeirão Preto or Paulista University. Though I'm still in the process of data analysis, many of the factors identified by the American sample were present in the Brazilian sample, as you can see in the word cloud to the right.
Do individuals with substance use disorder interpret these factors in the same way?
How do these beliefs relate to the experience of self-stigma and the perception of societal stigma?
These are the questions that will guide the next few phases of my dissertation research. I am currently in the process of applying for grants to return to Ribeirão Preto to conduct fieldwork for my dissertation. I'm hoping to expand the pilot work that I began in the summer of 2017 to gain a more thorough understanding of folk psychiatric models of addiction and how they relate to the attribution of stigma towards individuals with substance use disorder. I will also be shifting focus to working with individuals currently receiving treatment for substance use disorders to investigate whether broader cultural ideas about substance use and abuse align with the illness experience of people with substance use disorders. I will also be expanding my study of stigma to include measures of perceived societal stigma and self-stigma. This multidimensional approach is one that is rarely utilized by global mental health researchers, but is critical to fully understanding the scope of public health crises like substance use in Brazil.