Self-Stigma and Shame in Substance Addiction

The treatment manual attached below was originally developed through an iterative process as described in:

Luoma, J.B., Kohlenberg, B. S., Hayes, S. C., Bunting, K., & Rye, A.K., (2008). Reducing the Self Stigma of Substance Abuse through Acceptance and Commitment Therapy: Model, Manual Development, and Pilot Outcomes. Addiction Research and Theory, 16(2), 149-165.

The intervention was then tested in a randomized  clinical trial, the results of which are published here:

Luoma, J. B., Kohlenberg, B. S., Hayes, S. C. & Fletcher, L. (2012). Slow and steady wins the race: A randomized clinical trial of Acceptance and Commitment Therapy targeting shame in substance use disorders. Journal of Consulting and Clinical Psychology, 80, 43-51.

Abstract   

Objective: Shame has long been seen as relevant to substance use disorders, but interventions have not been tested in randomized trials. This study examined a group-based intervention for shame based on the principles of Acceptance and Commitment Therapy (ACT) in patients (N = 133; 61% female; M = 34 years old; 86% Caucasian) in a 28-day residential addictions treatment program. Method: Consecutive cohort pairs were assigned in a pair-wise random fashion to receive treatment as usual (TAU) or the ACT intervention in place of six hours of treatment that would have occurred at that same time. The ACT intervention consisted of three, two-hour group sessions scheduled during a single week. Results: Intent-to-treat analyses demonstrated that the ACT intervention resulted in smaller immediate gains in shame, but larger reductions at four month follow up. Those attending the ACT group also evidenced fewer days of substance use and higher treatment attendance at follow up. Effects of the ACT intervention on treatment utilization at follow up were statistically mediated by post treatment levels of shame, in that those evidencing higher levels of shame at post treatment were more likely to be attending treatment at follow up. Intervention effects on substance use at follow up were mediated by treatment utilization at follow up, suggesting that the intervention may have had its effects, at least in part, through improving treatment attendance. Conclusions: These results demonstrate that an approach to shame based on mindfulness and acceptance appears to produce better treatment attendance and reduced substance use.

You can get both of the articles here.

The fidelity coding system used in the JCCP article is also below. Please contact Jason Luoma for consultation if you choose to use this treatment manual to replicate these findings or need help with the fidelity coding system. We'd also appreciate any input from people who choose to use this protocol in research or in treatment settings. Let us know how it goes or provide feedback to improve it.

As part of a newer study in Russia, our team created a revised version of the manual and then translated it to Russian. The newer manual is more detailed and more structured than the original and probably easier to use for most clinicians. This manual is currently being tested and results will be listed here when we know the results. In the meantime, the English version of the newer manual is also attached below (you need to be logged into see it) and free to use for research and clinical purposes. We also developed an updated fidelity coding system that is available upon request.

If you are interested in helping with the research on self-stigma, consider contacting the Self-Stigma Research Collaborative.