Substance Use

Addressing Internalized Shame in Justice-Involved Women with Substance Use Disorders: Insights from a New Study 

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Internalized shame presents a significant challenge for people seeking recovery, particularly among justice-involved women with substance use disorders (SUD). Shame, compounded by societal stigma, often impedes the recovery process. For this population, mindfulness-based relapse prevention (MBRP) emerges as a promising approach to addressing internalized shame and fostering justice-involved women’s recovery. A recent study, co-authored by Dr. Jason Luoma, explores how internalized shame evolves during SUD treatment and highlights MBRP’s potential as a therapeutic intervention. 

Why Focus on Shame and Justice-Involved Women? 

Shame, a deeply personal emotion, can develop when people internalize stigmatizing beliefs about themselves. For justice-involved women, societal stigma can be especially pervasive, intersecting with gendered expectations around roles such as motherhood. Research highlights that internalized shame can impair treatment outcomes, reduce self-esteem, and lead to avoidance behaviors that hinder recovery. Studies have also shown a correlation between shame and relapse rates, making it crucial to address shame for long-term recovery success. 

Study Overview 

This secondary analysis focused on 105 women undergoing residential SUD treatment in a nonprofit facility in the Pacific Northwest. Participants, many of whom had faced incarceration or nonviolent substance-related charges, were randomized into two groups: one received MBRP, while the other received traditional relapse prevention (RP). Both interventions aimed to equip participants with strategies for managing cravings and high-risk situations. Mindfulness, a key component of MBRP, emphasized acceptance and non-judgment of present-moment experiences—a potential cornerstone for reducing internalized shame in substance use disorder (SUD) recovery. 

Key Findings 

The study identified significant reductions in internalized shame across both treatment groups from baseline to post-treatment. While participants in the MBRP group showed slightly greater reductions, the difference was not statistically significant. These findings suggest that both interventions, when delivered in a supportive group setting, can foster an environment that alleviates feelings of shame and isolation. 

Importantly, the study also confirmed the reliability of the Internalized Shame Scale (ISS) in this context, establishing that it accurately measures internalized shame across different treatment conditions and time points. This marks a critical step for future research into shame as a measurable construct within SUD treatment. 

Mindfulness and Its Role in Shame Reduction 

Mindfulness-based interventions have shown promise in addressing shame by encouraging people to observe their thoughts and feelings without criticism. Previous studies have linked increased mindfulness with improved self-esteem and reduced emotional distress. In this study, MBRP’s mindfulness practices appeared to help participants develop greater acceptance and reduce avoidance behaviors, potentially lessening the grip of shame over their self-perception. 

For justice-involved women, who often face unique societal and systemic pressures, these benefits are especially noteworthy. The structured group setting, shared experiences, and mindfulness techniques may collectively work to break the cycle of self-stigmatization and promote recovery. 

Implications for Practice 

This study provides valuable insights into the potential for addressing shame within SUD treatment settings. Here are some practical takeaways: 

Incorporating Mindfulness Practices: Whether through MBRP or integrated into traditional approaches, mindfulness can empower people to confront and accept their experiences, fostering resilience in recovery. 

Tailored Interventions for Justice-Involved Women: Treatment programs should consider the unique stigma-related challenges faced by this group, such as the societal judgment of mothers with SUD histories. 

Building Supportive Group Environments: The group dynamic in both MBRP and RP was identified as a key factor in reducing feelings of isolation, an emotion often intertwined with shame. 

Looking Ahead 

While this study offers promising insights, it also underscores the need for further research. Future studies could explore how specific components of MBRP, or other mindfulness-based interventions contribute to reducing shame. Additionally, expanding sample sizes and exploring long-term outcomes beyond 15 weeks post-treatment could provide a more comprehensive understanding of these interventions’ effectiveness. 

Conclusion 

This study highlights the complex interplay of shame, stigma, and recovery in justice-involved women with SUD. Mindfulness-based relapse prevention (MBRP) offers a promising approach to reducing internalized shame in substance use disorder (SUD) treatment. By integrating mindfulness techniques and fostering group support, MBRP can empower justice-involved women’s recovery, offering hope for those navigating the challenges of stigma and shame. As research continues to illuminate effective strategies, treatment programs can better address these barriers, paving the way for more compassionate and inclusive recovery pathways. 

Download a pre-print copy here 

Reducing Stigma Associated with Substance Use and Criminal Involvement

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Stigma creates significant barriers to accessing addiction treatment within the criminal legal system. New research led by Dr. Kelly Moore, and including Portland Psychotherapy’s Jason Luoma, PhD, aims to address this issue by testing a multi-level intervention called CSTARR (Combatting Stigma to Aid Reentry and Recovery). CSTARR involves training for criminal legal system staff to reduce stigmatizing attitudes and group therapy using Acceptance and Commitment Therapy (ACT) for clients to cope with self-stigma.  

The CSTARR staff training focuses on substance use and criminal involvement stigma. It teaches skills for interacting with clients in a more validating way and facilitates contact with a person in recovery who shares their experiences. This is meant to improve staff attitudes and behaviors that can undermine treatment. The ACT groups help clients accept difficult thoughts and feelings stemming from stigma and build skills for staying engaged in meaningful activities despite stigma stressors. 

CSTARR is being tested in Tennessee across court, probation, and treatment staff working with shared clients in a drug recovery court program. Around 70 staff will complete the training and 70 of their mutual clients will engage in the ACT groups. The study will look at how feasible it is to implement CSTARR in real-world legal settings. It will also gather initial data on whether CSTARR impacts important outcomes.   

For staff, the research will analyze if the training changes stigmatizing attitudes, beliefs about treatment, and social distancing from people with criminal records. For clients, it will evaluate whether ACT reduces self-stigma, shame, and isolation while improving efficacy and coping skills. At the systems level, the study will look at impacts on client retention in mandated treatment and legal infractions during the program. 

The results will inform revisions to the CSTARR manual and survey measures. They will also provide key insights into implementing multi-level stigma reduction in criminal legal settings. This research addresses an important gap, as most existing interventions have not focused on substance use and criminal involvement stigma simultaneously or been designed for legal contexts.  

The criminal legal system presents unique challenges for stigma reduction that require creative solutions. People involved in the criminal legal system often face compounded stigma, yet legal settings have historically perpetuated stigmatizing attitudes. Initiatives like CSTARR that recognize the harm of stigma and include contact with people who have lived experience have promise for making these systems more just.  

We are eager to see the results of this groundbreaking work by Dr. Moore and our colleague Dr. Luoma. Findings will elucidate strategies for reducing stigma among staff and clients in incarceration diversion programs. They will also demonstrate whether multi-level approaches that target stigma at public and self-levels can improve legal and recovery outcomes. We hope this spurs broader interest in dismantling unjust societal stigma and increasing access to unbiased, compassionate addiction care. 

Read the full article Here

The Newest Study Supported by Portland Psychotherapy: Helping People with the Stigma of Injection Drug Use and HIV in Russia

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Stigma is a pervasive problem that can negatively impact healthcare outcomes for those affected by it. Stigmatized groups, such as people living with HIV who inject drugs, can face many barriers to care that stem from societal attitudes toward their condition. HIV and substance use stigma, when combined, can lead to further avoidance of care and poor health outcomes.

The findings from the SCRIPT (Stigma Coping to Reduce HIV Risks and Improve substance use Prevention and Treatment) study were recently published. This study was conducted by Karsten Lunze, MD, of Boston University Medical School, in collaboration with Jason Luoma, the CEO of Portland Psychotherapy. This study aimed to test an intervention developed by Dr. Luoma to help people cope with intersectional HIV and substance use stigma. The research studied people with HIV who inject drugs, who often face significant barriers to accessing care due to both HIV and substance use stigma.

To develop the intervention, the research team modified an Acceptance and Commitment Therapy (ACT) approach to target people with HIV who inject drugs. ACT is a type of cognitive-behavioral therapy that focuses on accepting difficult emotions and thoughts rather than trying to eliminate them. By teaching people how to cope with stigma through acceptance-based approaches, the study aims to reduce the link between internalized attitudes, fears, and shame, and healthcare avoidance behaviors.

The SCRIPT study aimed to evaluate the intervention’s effects on HIV and substance use stigma, care engagement, and injection drug use frequency. The study will also assess the intervention’s implementation by looking at participant satisfaction, intervention fidelity, and uptake.

The study found that people who received the intervention were more likely to start HIV and substance use treatment than those who did not receive the intervention. The increase in care engagement may be due to the fact that the intervention helped people to cope with stigma and reduced their avoidance of healthcare settings. The intervention was not designed to directly reduce shame and fears related to stigma, but rather focused on helping people to cope with stigma and improve their behavior and care seeking.

The implications for practice are that acceptance-based approaches can be effective in reducing stigma and improving care engagement in people with HIV who inject drugs. Healthcare providers should be trained to recognize and address intersectional stigma in their patients and use interventions that incorporate acceptance-based approaches to reduce stigma’s negative impact.

Portland Psychotherapy’s involvement in this study exemplifies the organization’s commitment to using its resources to address societal problems. By supporting research that aims to improve healthcare outcomes for stigmatized populations, Portland Psychotherapy is helping to make a positive impact on the community.

Shame and substance use are not related: Surprising results from the first ever meta-analysis of this relationship

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Many researchers and theorists discuss shame as an inherently negative emotion that is always problematic. In this view, shame involves negatively evaluating one’s self and is often contrasted with guilt, which involves negatively evaluating one’s behavior. According to this view, shame motivates people to avoid situations and withdraw from others so that they can protect … Read more

Quit Drinking to Create Better Relationships

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Many people drink as part of socializing with others and feel it helps them loosen up, have a better time, and overcome any social anxiety they may feel. They may think alcohol helps them stay connected with people and have better relationships.  Yet, after reflection, some people find that alcohol use actually interferes with their … Read more

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