Internalized Stigma and Role Model Perception in Therapeutic Communities

Background and Purpose: This study examined the impact of substance use related self-stigma on perception of role model status within therapeutic communities (TCs). In TCs, the community is the method of treatment and more advanced residents are expected to be role models for members in lower phases. Studies have indicated an adverse effect of substance abuse self-stigma on social interactions. This suggests that residents with a higher level of self-stigma could be less likely to become role models. However, at this point no studies have investigated the effect of self-stigma on TC members’ role model status.

Methods: Data were collected in two central Ohio prison based therapeutic communities using pencil and paper surveys. Participants (N=162) included 87 male residents and 75 female residents. The average age was 36.46 years (SD=8.79). Self-stigma was measured using questions from the validated Substance Abuse Self Stigma Scale (Luoma, Nobles, & Drake, 2013). Role model scores were calculated based on the number of times a participant was listed as a role model by peers. For each resident, age, gender, and program phase in the TC were also collected. Data were analyzed using negative binomial regression models to explore the impact of self-stigma on perception as a role model.

Results: Two models were run. In first, average self-stigma predicted residents’ role model status (B = -.428, SE = .1523, p = .005). Age and gender were not significant predictors in the model. In the second model, current phase was added as an independent variable. Current TC phase predicted role model status (B = .556, SE = .1330, p < .001). Adding residents’ phase in the TC weakened the relationship between self-stigma score and role model score (B = -.290, SE = .1429, p = .043). Spearman’s rho revealed a weak negative correlation between self-stigma and current phase in the TC (r = -.171, p = .034). Program phase therefore partially mediates the relationship between self-stigma and role model status.

Conclusion and Implications: Results support the hypothesis that those with higher substance-abuse self-stigma are less likely to be rated as role models by peers. Self-stigma was also negatively correlated with the phase that residents achieve. This relationship appears to partially mediate the link between self-stigma and peer perception of role model status. Clinically, this suggests that it would be useful to address the issue of self-stigma in treatment groups. It also appears that progress through the phase system may ameliorate the adverse effects of self-stigma on residents’ willingness and ability to act as role models. However, this analysis does not fully clarify the causal relationship between self-stigma and phase, as it is also possible that residents with higher self-stigma are less likely to reach a high phase. Further research should aim to strengthen the understanding of any causal mechanisms involved.