Perceived public stigma and stigmatization in explaining lifetime illicit drug use among emerging adults

Illicit drug use is often associated with adverse health and legal consequences, as well as stigma, or social disapproval. Stigma may be enacted as a preventive measure against drug use; however, research was needed to investigate its effects on use in an empirical manner. This cross-sectional study surveyed 1021 emerging adults (age 18-25) throughout Manhattan, New York. We investigated how two forms of stigma-perceived public stigma and personal stigmatization-along with religiosity and exposure to users, explained lifetime use of five drugs: marijuana, powder cocaine, ecstasy, and non-medical use of opioids and amphetamine. Odds ratios for lifetime use of each drug were estimated using age-adjusted stepwise logistic regression models. Results suggest that high levels of exposure to users increased the odds of lifetime use of each drug, and protective effects of religiosity and racial minority status often diminished when controlling for stigma. High levels of stigmatization toward users tended to decrease the odds of use, and perceived public stigma toward users did not explain use of any drug. In conclusion, although individuals who stigmatize users are protected from use, the perception of public stigma does not appear to be valuable in preventing use. Since stigma is associated with adverse psychological and social consequences in users, the efficacy of stigma as a public health tool against drug use is questionable. Public health efforts can deglamorize and discourage use while aiming to reduce stigma toward users by treating use as a health behavior and not a deviant or moral behavior.