A Randomized Study to Examine Substance Use-Related Stigma Among Master of Social Work Students

Overview: We use a randomized-controlled design to survey MSW students' attitudes of substance use-related stigma. Students were randomly assigned to read one of two vignettes, which used different terms to describe the main character’s substance-use condition. The result reveals that MSW students perceive less social threat when using person-first language.Proposal text: Introduction
Social workers often engage individuals with substance use disorders. Person-first language is known to be a form of linguistic expression which could reduce stigma and prejudice on mental illness, yet little research exists on master-level social work (MSW) students' attitudes toward substance use. This study evaluated MSW students' attitudes toward punishment and personal comfort with individuals struggling with problematic substance use. 
Methods
We use a randomized-controlled design to survey MSW students (n=225) in a mid-sized Midwestern public university. Students were randomly assigned to read one of two vignettes, which were identical except for the terminology used to describe the main character’s substance-use (with substance use disorder v. substance abuser). Two Likert-style scales (1 = strongly disagree to 6 = strongly agree) measured punishment-related [i.e., perpetrator punishment scale (α=.83)] (e.g., need for punitive conditions) and personal comfort attitudes [(i.e., social threat scale (α=.91)] (e.g., willing to be their co-worker/neighbor) regarding substance use. We used independent sample t-tests (one sided p) to test the mean difference in scores among those randomized to the two conditions.  Few data were missing, so we used listwise deletion.  

Results
On average, independent samples t-tests revealed that MSW students (82% female) exposed to the substance abuse terminology perceived significantly lower personal comfort (M = 3.66, SD =1.25) with the character relative to those who saw the substance use disorder vignette (M = 3.94, SD = 1.06), t (223) =1.795, p=.037.  This represented a small, yet meaningful effect (Cohen’s d = 0.24).  However, there were no significant differences on the perpetrator-punishment scale among the two conditions. 

Discussion
This study’s findings are consistent with other studies that have found the phrase “substance abuse” to be associated with higher stigma.  Unlike Kelly and Westerhoff (2010), social work students did not have higher punishment-related attitudes, which may be due to changes in attitudes during the time that has elapsed since that study. That is, the public-health framing of the opioid crisis or social workers’ general orientation toward treatment versus punishment may account for this finding. However, it is concerning that, on a personal level, social workers experiencing a single exposure to “substance abuse” are more likely to perceive individuals struggling with substance use as less desirable neighbors, employees and co-workers. 

Conclusion
With a high likelihood that social workers will interact with patients with SUDs, it appears that the choice of language does influence MSW students’ attitudes on substance use. Therefore, this finding suggests that social work educators need additional training on how language influences stigmatizing attitudes. Additional research is needed on how to best reduce stigmatizing attitudes among social work students.

Reference
Kelly, J. F., & Westerhoff, C. M. (2010). Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms. International Journal of Drug Policy, 21(3), 202-207.