CONNECTIONS BETWEEN THE FOLK PSYCHIATRY OF ADDICTION AND LEVELS OF ...

194 Pages·2012·4.08 MB·English

CONNECTIONS BETWEEN THE FOLK PSYCHIATRY OF ADDICTION
AND LEVELS OF ATTRIBUTED STIGMA

by
NICOLE LYNN HENDERSON
WILLIAM W. DRESSLER, COMMITTEE CHAIR
JOHN H. BLITZ
CHRISTOPHER D. LYNN
STEPHEN J. THOMA

A THESIS

Submitted in partial fulfillment of the requirements
for the degree of Master of Arts
in the Department of Anthropology
in the Graduate School of
The University of Alabama

TUSCALOOSA, ALABAMA

2016
Copyright Nicole Lynn Henderson 2016
ALL RIGHTS RESERVED
ABSTRACT
Some serious health problems, such as addiction, can be highly stigmatized by
others. Through different learning experiences and life events, people develop varying
conceptions of the etiology of addiction. These sets of beliefs are referred to as “folk
psychiatry” and can be understood as a guiding force behind public opinion. This study
examines the knowledge individuals use to make judgments about individuals with
substance-use disorder by positing a shared cultural model of addiction causality. This
research was conducted among undergraduate students at the University of Alabama, as
college students in the 18-25 age range are especially at risk for developing substance-use
disorder due to binge drinking on college campus and other factors. As causes of addiction
are heavily intertwined with biological, social, and political issues, this model aids in
recognizing which realm of understanding maintains the highest saliency in laypeople’s
conceptions of the development of substance use-disorder. The model consists of 28 causes
distributed throughout five themes: Biomedical, Self-Medication, Familial, Social, and
Hedonistic. Cultural consensus was found along three dimensions of the model: overall
influence of causes, level of personal control over causes, and level of outsider influence on
causes. Differing knowledge and understandings of the model of addiction causality and
measures of political progressivism were shown to have significant effects on the level of
attributed stigma towards individuals with substance use disorder.

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LIST OF ABBREVATIONS AND SYMBOLS
AA Alcoholics Anonymous
AAWS Alcoholics Anonymous World Services
ABC Alcoholic Beverage Control Board
ACLU American Civil Liberty Union
ANT 101 Introduction to Anthropology
ANT 102 Introduction to Cultural Anthropology
APA American Psychiatric Association
ASAM American Society of Addiction Medicine
AUD Alcohol-Use Disorder
β beta, Standardized Coefficient
CASA National Center on Addiction and Substance Abuse at Columbia University
CBHSQ Center for Behavioral Health Statistics and Quality
CCA Cultural Consensus Analysis
CCT Cultural Consensus Theory
CDC Center for Disease Control and Prevention
CSR Campus Security Report
df Degrees of Freedom
DSM-IV Diagnostic and Statistical Manual of Mental Disorders – 5
HED Heavy Episodic Drinking
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HHE 270 Personal Health
IRB Institutional Review Board
M Mean
MDMA 3,4-methylenedioxy-methamphetamine
MDS Multi-dimensional Scaling
MFQ Moral Foundations Questionnaire
N, n Number, Sample Size
NDIC National Drug Intelligence Center
NIAAA National Institute on Alcohol Abuse and Alcoholism
NIDA National Institute on Drug Abuse
NSDUH National Survey on Drug Use and Health
ONDCP Office of National Drug Control Policy
p Probability of Results or Outcome
PPACA Patient Protection and Affordable Care Act
PROFIT Property Fitting Analysis
PY 355 General Experimental Psychology
r Pearson Product Moment Correlation
R2 Multiple Correlation Coefficient
RA Residual Agreement
REL 419 Myth, Ritual, and Magic
SAMHSA Substance Abuse and Mental Health Services Administration
SD Standard Deviation
SMART Self-Management and Recovery Training
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SUD Substance-Use Disorder
t Computed Value of t-test
UA University of Alabama
USDHHS United States Department of Health and Human Services
WCTU Women’s Christian Temperance Union
= Equal to
> Great than
≥ Greater than or equal to
< Less than
≤ Less than or equal to
± Plus or minus

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ACKNOWLEDGEMENTS
First, I would like to thank Bill Dressler, who continuously pushed me to do more
than I thought I could - your endless enthusiasm about my work kept me going (and going
and going). I’m especially grateful for your patience, as I slowly worked my way towards
realizing you’re always right. I would like to thank the other members of my committee –
Dr. Chris Lynn, Dr. John Blitz, and Dr. Steve Thoma – who provided invaluable comments
and direction throughout the process. A special thanks to Dr. Jo Weaver, Dr. Cameron
Lacquement, Dr. Steven Jacobs, Wanda Burton, and Michael LaRocca for letting me recruit
from their classes and offering extra credit for participation. Without their generosity, this
project would not have been possible. I am also indebted to Dr. Jo Weaver for letting me ask
every question she both could and could not answer and for constantly reminding me that
I’m not an idiot. I would also like to thank the Department of Anthropology and Graduate
School at the University of Alabama for their generous financial support.
I would like to express my gratitude to LuAnn Nix and my girls at Tuscaloosa
Tumbling Tides. They’ve given me a home away from home and a safe haven from stress.
Thanks to my family, who may not always understand what I’m doing, but always make
sure I understand that I’m loved. To the blonde and the redhead: I don’t know what I’m
going to do without you guys, but I know we’ll always be connected through the wind. I
can’t think of the word to describe how much I love y’all. It’s a lot, but more? Like unending,
but not? Inestimable. Thanks to all my thesauri, both in living and book form.
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CONTENTS
ABSTRACT ............................................................................................................................................................ii
LIST OF ABBREVIATIONS AND SYMBOLS ............................................................................................iii
ACKNOWLEDGEMENTS .................................................................................................................................vi
LIST OF TABLES ................................................................................................................................................xi
LIST OF FIGURES...............................................................................................................................................xii
1. INTRODUCTION ............................................................................................................................................1
1.1. Outline of the Thesis .......................................................................................................................5
2. STATEMENT OF THE PROBLEM...........................................................................................................7
2.1. Introduction ........................................................................................................................................7
2.2. The Criminalization of Addiction ..............................................................................................8
2.3. Social Factors of Addiction ...........................................................................................................15
2.4. Conclusion ............................................................................................................................................19
3. RESEARCH POPULATION AND SETTING .........................................................................................21
3.1. Introduction ........................................................................................................................................21
3.2. Increasing Substance Use .............................................................................................................21
3.3. Rates of Substance Abuse on Campus ....................................................................................23
3.4. Ethnography of College Life.........................................................................................................26
3.5. University of Alabama College Life ..........................................................................................30
3.6. Conclusion ............................................................................................................................................33
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4. THEORETICAL APPROACH .....................................................................................................................34
4.1. Introduction ........................................................................................................................................34
4.2. Cognitive Anthropology.................................................................................................................34
4.3. Biocultural Theory ...........................................................................................................................37
4.3.1. Addiction as Biological........................................................................................................38
4.3.2. Addiction as Cultural ...........................................................................................................40
4.3.3. Addiction as Biocultural .....................................................................................................42
4.4. Stigmatization of Addiction ........................................................................................................43
4.4.1. What is Stigma? ......................................................................................................................45
4.4.2. Attribution Theory................................................................................................................48
4.5. Moral Foundations Theory ..........................................................................................................49
4.6. Conclusion ............................................................................................................................................53
5. METHODS ........................................................................................................................................................55
5.1. Introduction ........................................................................................................................................55
5.2. Phases I & II: Freelisting and Pile-sorting .............................................................................56
5.3. Phase III .................................................................................................................................................59
5.3.1. Rating Tasks .............................................................................................................................60
5.3.2. Moral Foundations Questionnaire ................................................................................62
5.3.3. Stigma Attributions Questionnaire ...............................................................................63
6. RESULTS ...........................................................................................................................................................65
6.1. Freelisting Results ............................................................................................................................65
6.2. Pile-Sorting Results .........................................................................................................................67
6.3. Phase III Descriptive Statistics ...................................................................................................73
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6.4. Rating Task Results .........................................................................................................................74
6.4.1. Cultural Consensus Analysis Results for Influence ...............................................75
6.4.2. Residual Agreement Analysis for Influence ..............................................................78
6.4.3. Cultural Consensus Analysis Results for Personal Control ...............................83
6.4.4. Residual Agreement Analysis for Personal Control ..............................................86
6.4.5. Cultural Consensus Analysis Results for Network Influence ...........................92
6.4.6. Residual Agreement Analysis for Network Influence ..........................................94
6.5. Property Fitting (PROFIT) Analysis Results ........................................................................100
6.6. Moral Foundations Questionnaire Results ...........................................................................104
6.7. Stigma Attributions Questionnaire Results .........................................................................104
6.8. Conclusion ............................................................................................................................................109
7. DISCUSSION AND CONCLUSION ...........................................................................................................111
7.1. Introduction ........................................................................................................................................111
7.2. The Cultural Model of Addiction Causality ...........................................................................111
7.2.1. The Universality of the Model .......................................................................................116
7.2.2. Addiction as a Hybrid Medical-Moral-Legal Issue ...............................................117
7.3. Relating the Cultural Model to Stigma Attribution ...........................................................121
7.3.1. Moral Model of Addiction: Social and Hedonistic Causes ..................................121
7.3.2. Medical Model of Addiction: Biomedical and Self-Medication Causes ........125
7.3.3. Familial Causes .......................................................................................................................128
7.4. Moral Foundations Questionnaire and Attributed Stigma ...........................................130
7.5. Future Directions ..............................................................................................................................133
7.5.1. Gateway Drug Theory and the Cultural Model ......................................................133
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