Improving healthcare for substance users: the moderating role of psychological flexibility on stigma, mental health, and quality of life

• Date: 24 November 2023
• Pages: 662-677
• DOI: https://doi.org/10.1108/IJHRH-08-2023-0072
• Published date: 24 November 2023
• Subject Matter: Health & social care,Vulnerable groups,Inequalities & diverse/minority groups,Sociology,Race & ethnic studies,Minorities,Multiculturalism,Racial identity,Work,economy & organizations
• Author: Mahvia Gull,Zartashia Kynat Javaid,Kamran Khan,Husnain Ali Chaudhry

Improving healthcare for substance users:

the moderating role of psychological

f‌lexibility on stigma, mental health, and

quality of life

Mahvia Gull, Zartashia Kynat Javaid, Kamran Khan and Husnain Ali Chaudhry

Abstract

Purpose –Stigma is a major impediment to human rights in health care that causes discrimination,

isolation and the exclusion of individuals from essential health-care services. It fosters fear, leading to

negative stereotypingof individuals based on their social, cultural or health status and underminestheir

dignity and respect, consequently violating their right to health.Therefore, the purpose of this study is to

evaluate the moderating role of psychological flexibility in the relationship between stigma (enacted,

anticipatedand internalized), mental healthand the quality of life of substanceusers.

Design/methodology/approach –This study was basedon a cross-sectional design and included 200

male patientswith an age range of 18–65 years from 23 rehabilitationcenters in four cities in Pakistan.The

purposive samplingtechnique was used, and the sample size ranged from 4 to 23 participants for each

site. Four scales were used to measure stigma, general mental health, quality of lifeand psychological

flexibilityin substance users.

Findings –The data were analyzed using SPSS and Smart PLS, which showed that stigma (enacted,

anticipated and internalized) had a detrimental effect on substance users’ mental health and qualityof

life. Additionally,psychological flexibilityacts as an efficient moderator betweenthem.

Originality/value –This research unveils the moderating role of psychological flexibility in mitigating

stigma’s adverse effects on individuals with substance use disorders. Future investigations should

prioritize interventions aimed at enhancing psychological flexibility to ameliorate the repercussions of

stigma,ultimately enhancing the well-beingand quality of life of substance users.

Keywords Stigma, Mental health, Quality of life, Psychological f‌lexibility, Substance use disorder

Paper type Research paper

Introduction

In accordance with the Universal Declaration of Human Rights, “all human beings are born

free and equal in dignity and rights”. The Department of Health explicitly states that human

rights are fundamental to health care in general (Cachat-Rosset and Klarsfeld, 2023;Dick,

2018;Qu, 2022). In its 2007 publication, Human Rights in Healthcare: A Framework for

Local Action, the Department of Health states that human rights should be viewed as “a

vehicle for making principles such as dignity, equality, respect, fairness, and autonomy

central to our lived human experience” (p. 13). Therefore, it is believed that fundamental

values such as respect and dignity support the rights that are explicitly stated in human

rights legislation (Riggirozzi, 2021;Md. Tahir et al.,2022). Establishing human rights “real”

in the experiences of those receiving medical care is the main goal. A significant turning

point in the emphasis on human rights for people receiving mental health services was the

incorporation of the perspective of human rights in the work of mental health. The central

Mahvia Gull is based at the

Department of Psychology,

Foundation University,

Rawalpindi Campus 2,

Rawalpindi, Pakistan.

Zartashia Kynat Javaid is

based at the Department of

Applied Psychology,

Government College

University Faisalabad,

Faisalabad, Pakistan.

Kamran Khan is based at

the Department of Business

Administration, COMSATS

University Islamabad, Wah

Cantt, Pakistan.

Husnain Ali Chaudhry is

based at the Department of

Business Administration,

Preston University, Kohat,

Pakistan.

Received 29 August 2023

Revised 22 October 2023

Accepted 28 October 2023

PAGE 662 jINTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTHCARE jVOL. 17 NO. 5 2024, pp. 662-677, ©Emerald Publishing Limited, ISSN 2056-4902DOI 10.1108/IJHRH-08-2023-0072

claim of Mann et al.’s (1994) mental health and human rights perspective is that promoting

human rights and promoting health are inextricably linked and are both necessary for

human well-being (Kola et al.,2021). Priority must be placed on the state’s responsibility to

recognize the varied impacts of specific mental health problems on a marginalized or

stigmatized group (Parsons et al.,2019;Gatenio Gabel and Mapp, 2020). This study begins

by emphasizing the need to consider stigma and discrimination as violations of the human

rights and dignity of individuals with substance use disorders (SUDs). It examines the

impact of stigma on the mental health and quality of life of substance users and the role of

psychological flexibility in health care. Recognizing that a great deal of research is being

conducted from a variety of perspectives on the notion of human rights, few consider

stigma among substance users to be the illicit coreproblem for human rights.

In the international context of humanrights, they are regarded as intrinsic to every individual

and the foundation for equal and undisputable rights (Sæteren and Na

˚den, 2021).

According to Goffman’s analysis, this explains why we instinctively label as offensive,

perilous or weak those we consider to be different from us in some way (Gull et al.,2022).

Additionally, stigmatizing a person who is different invalidates herentire being and reduces

her to a lower status (Zandy, 2019). As a result, someone who is stigmatized might believe

that he is not accepted or treated equally, which can lead to feelings of worthlessness,

shame and self-hatred (Wakeman, 2019). Therefore, individuals who struggle with both

mental health and substanceuse issues are exposed to a variety of stigmatizing factorsthat

work together to jeopardize their mentalhealth (Gostin et al.,2020).

Investigations into the stigmatization of people with SUDs have been conducted from a

variety of perspectives, including those of the general public, health-care providers, family

and patients receiving substance abuse treatment. There is a lot of evidence that health

workers have stigmatizing attitudes and practices (Corrigan, 2004,Schulze, 2007), and

clients of mental health services have said that both general practitioners and psychiatrists

treated them in a stigmatizing way (Thornicroft et al., 2007). According to Stuart et al.

(2011), coercive treatment threats, inadequate information, the perception of a lack of

capacity for responsible action and patronizing or humiliating behavior are examples of

discrimination and stigma in health-caresettings.

Furthermore, stigma exerts a profound and multifaceted impact on individuals grappling

with SUDs. This negative societal perception and discrimination engender a pervasive

sense of shame and self-blame, further compounding the already formidable challenges of

addiction (Chang et al.,2023). Stigmatizing attitudes can lead to social isolation, eroding

vital support networks preciselywhen they are needed most. Moreover, the internalization of

stigma can erode self-esteem and self-efficacy, undermining one’s belief in their ability to

overcome addiction. The constant fear of judgment and discrimination can lead to

heightened stress, anxietyand depression, exacerbating the burden of SUDs (Chang et al.,

2022;Saffari et al.,2022). This cumulative toll not only impedes recovery but also

perpetuates a cycle of poor mental health, ultimately diminishing the quality of life for those

already struggling with SUDs (Funget al., 2022).

To comprehend the comprehensive impact of stigma on individuals with SUDs and their

mental health-related health-care rights, it is crucial to delineate how stigma operates at

various societal levels and within individuals (Buribayev et al., 2020;Gul and Aqeel, 2021).

Furthermore, drug use can influence the extent and strength of stigma manifestation

(Williamson, 2022). Stigma can be categorized into three distinct types, including self-

stigma, enacted stigma and anticipated stigma. Enacted stigma, also known as perceived

discrimination, refers to individuals’ beliefs regarding past experiences of discrimination

(Wakeman, 2019;Chang et al.,2020). Compared to individuals suffering from other forms of

mental illness, people with SUDs are more likely to encounter stigma and discrimination

from the public. Moreover, those actively engaged in SUDs may experience greater public

stigma than those in recovery(Conklin, 2021).

VOL. 17 NO. 5 2024 jINTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTHCARE jPAGE 663