The relationship between substance abuse-associated stigma and deficits in executive functioning

The relationship between substance abuse-associated stigma and deficits in executive functioning | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The relationship between substance abuse-associated stigma and deficits in executive functioning Leila Razeghian Jahromi, Safura Sadeghi Mazidi, Azade Moradi Bavi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2044725/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Substance abuse is a common problem worldwide. Among addicts, the perceived stigma of substance abuse harms their quality of life and represents a major treatment barrier. We explored the effect of executive dysfunction on the stigma perceived due to substance abuse. Methods: In this cross-sectional study, a validated questionnaire on executive dysfunction and stigma was distributed among eighty drug addicts admitted to Ostad Moharary Neuropsychiatric Hospital in March 2022. Demographic data were also collected. Statistical analyses were done using SPSS v. 25. Results: In this study, 80 drug users were evaluated, of which 28 (35%) were narcotic drug users, 7 (8.8%) were stimulant drug users, and 45 (56.3%) were multidrug users. Materials were simultaneous (multiple). The mean age of participants was 36.56 37 9.37. In this study, the total test obtained from the stigma questionnaire showed a significant and positive relationship with each of the time scales of self-management, self-organization, self-regulation of emotion, self-motivation, self-inhibition, and total executive performance defects. Conclusion: Self-perceived stigma is directly linked with executive dysfunction in drug users who are seeking to quit. Since stigma and executive function both play essential roles in addiction treatment success, interventions should be adjusted to reduce the self-perceived stigma and executive function deficits of substance addicts. Addiction Drugs Stimulants Stigma Executive Functioning Deficits Background Stigma is a set of negative beliefs that a group or society holds regarding an issue or a group of people ( 1 ). Stigma leads to prejudice, avoidance, rejection, and discrimination against people with a socially undesirable characteristic or a culturally marginalized behavior, such as substance abuse; the World Health Organization (WHO) states that this major cause of discrimination contributes to human rights violations ( 2 ). Stigma is often based on assumptions, preconceptions, and generalizations rather than facts, meaning that appropriate interventions can avert or minimize its negative impacts ( 2 ). Executive functions are a mental skill set that includes working memory, flexible thinking, and self-control. We use these daily skills to learn, work, manage daily life, and plan and organize multi-step tasks. Executive functions play an important role in everyday cognitive tasks, such as estimating time and distance, planning solutions, and implementing plans to solve problems. Impairment in executive function affects the quality of life and job performance due to harming concentration, task completion, and emotional regulation. Five areas of impairment are recognized: time management, emotion regulation, problem-solving, self-restraint, and self-motivation ( 3 ). Substance abuse may significantly impair emotional functioning, decision-making, and social behavior ( 4 ). In drug users, cognitive processes and executive functions affect the course of treatment and rehabilitation ( 5 ), resulting in less adherence to treatment ( 6 ), poor attendance at outpatient treatment sessions ( 7 ), low willingness to change ( 8 ), decreased self-insight ( 9 ), denial of substance abuse ( 10 ), increased impulsivity, and less abstinence from substances of abuse after treatment termination ( 11 ). Impairment in executive function links stigma caused by substance abuse with the problems caused by it ( 12 , 13 ). Executive functioning affects the individual's response to drugs' incentive and punishment effects ( 13 ). Among addicted people who have decreased executive function, the probability of feeling helpless and becoming homeless is higher ( 14 ). Also, improving executive function increases the probability of quitting ( 15 ). Despite the importance of executive function in drug users, the effect of stigma caused by substance abuse on executive function deficits has not been specifically investigated among substance addicts seeking to quit. In this study, we explored the effect of executive function impairment on the perceived stigma caused by substance abuse among addicts who were trying to quit. Methods This cross-sectional study was conducted using the questionnaire design between February and April 2022 at Ostad Moharary Neuropsychiatric Hospital, Shiraz, Iran, on substance abuse addicts who were hospitalized to quit. Inclusion criteria were age above 18 years, basic literacy, and the intention to quit substance abuse. Exclusion criteria were having any psychiatric disorder or a lack of willingness to participate. The study protocol was approved by the Ethics Committee of the School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran (IR.SUMS.MED.REC.1400.402). Participation was voluntary and individuals were free to withdraw at any time. Data were collected using a pre-designed form that included informed consent, demographic information (age, gender), urine toxicology test results, an executive function impairment questionnaire, and a perceived stigma questionnaire. Urine samples of the patients were collected at the time of entering the study and were analyzed by the HPLC method in the laboratory of the hospital. The 89-item Barkley Deficits in Executive Functioning Scale (BDEFS) was designed by Barkley in 2012. Answers are based on a four-point Likert scale (never to always). It includes five subscales: time management, self-organization/problem-solving, self-restraint, self-motivation, and emotion regulation ( 3 , 16 ). Higher scores indicate greater executive dysfunction. The factor structure, reliability, and validity of the Persian version of this questionnaire have been confirmed in Iran ( 17 ). The Stigma Scale was designed by Michael King et al. in 2007, consisting of 28 questions answered on a five-point Likert scale (0, completely disagree to 5, completely agree), with negative questions being scored in reverse. This questionnaire consists of three sub-scales: discrimination, disclosure, and positive aspects of stigma ( 18 ). Higher scores indicate increased perceived stigma. The English version of this scale has been approved in terms of reliability and validity ( 19 ), with this also being true regarding the Persian version ( 20 ). Data were analyzed using SPSS software v. 26. Quantitative data are displayed as mean (standard deviation) and qualitative data as number (percentage). We used the student t-test or its non-parametric equivalent (Mann-Whitney test) to compare means. The chi-squared test and its non-parametric equivalent (Fisher's exact test) were used to compare frequencies. Pearson's correlation coefficient test was used to determine the relationship between quantitative data. Logistic regression was used to investigate factors affecting the outcome. Two-sided P-values were considered significant when less than 0.05. Results We surveyed a total of 80 drug addicts, most of whom (56.3%) used multiple substances. The mean age was 36.56 ± 9.37, and the majority of the study population were men. A little over half of the participants had no family history of substance abuse (Table 1). Notably, addiction to stimulants was more common among women (33.3%) than men (4.4%) (P=0.005). Table 1 Demographic characteristics of the study participants, mean ± SD or n (%) Characteristic Value Age, years 36.56 ± 9.37 Sex, male 68 (85.0) Substance type - Narcotics - Stimulants - Multiple 28 (35.0) 7 (8.8) 45 (56.3) Family history of substance abuse, yes 36 (35.0) Descriptive statistics of executive dysfunction test scores are presented in Table 2. As seen, patients with substance abuse had the greatest deficits in self-organization/problem-solving, followed by time management and emotion regulation (Table 2). Table 2 Scores of participants on executive dysfunction and its components Parameter Mean SD Minimum Maximum Time management 49.73 9.37 35 70 Self-organization/problem-solving 53.95 15.62 27 93 Emotion regulation 45.08 7.95 31 64 Self-motivation 28.89 5.82 19 42 Self-restraint 30.98 8.36 15 52 Total 208.61 39.94 132 316 Table 3 summarizes the performance of our study subjects on the Stigma Scale (Table 3). Interestingly, the highest scores were seen in the positive aspects of stigma subscale. Table 3 Scores of participants on the Stigma Scale and its dimensions Parameter Mean SD Minimum Maximum Discrimination 34.00 7.60 11 51 Disclosure 11.37 3.86 4 20 Positive aspects 77.35 14.18 35 117 Total 31.97 8.68 16 54 Age did not correlate with neither stigma nor executive dysfunction, with the exception of a significant positive correlation between age and the executive dysfunction subscale of self-organization of excitement (r = 0.244, P0.05) In this study, the total test score obtained from the Stigma Scale showed a significant and positive relationship with each of the scales of time management, self-organization/problem-solving, emotion regulation, self-motivation, self-restraint, and total executive function deficit (Table 4). The discrimination dimension of stigma had a positive and significant relationship with time-management, emotion regulation, and the total score of executive dysfunction. Also, stigma disclosure showed a significant positive relationship with self-organization/problem-solving. In addition, the positive aspects of stigma had a positive and meaningful relationship with emotion regulation (Table 4). Table 4 Correlation between scales of executive dysfunction and stigma Characteristic Time-management Self-organization/ problem-solving Emotion regulation Self-motivation Self-restraint Total executive dysfunction Total stigma 0.223 * 0.273 * 0.257 * 0.238 * 0.308 ** 0.336 ** Discrimination 0.267 * 0.162 0.250 * 0.140 0.205 0.239 * Disclosure 0.171 0.235 * 0.143 0.140 0.218 0.230 * Positive aspects 0.175 0.143 0.271 * 0.57 0.125 0.191 * P<0.05 ** P<0.001 Discussion The present study explored the effect of executive function impairment on the perceived stigma caused by substance abuse among addicts trying to quit. In terms of executive dysfunction, our patients had the greatest deficits in self-organization/problem-solving, followed by time management and emotion regulation. Our key finding was that stigma had a significant and positive relationship with executive dysfunction and each of its subscales. Substance abuse is a global problem, considered one of the concerns of the governments in most countries. The stigma associated with substance abuse has behavioral, occupational, and legal implications; it is linked with poor psychological well-being and averts access to healthcare, screening, and treatment ( 1 , 21 , 22 ). Executive function is one thing that is impaired in drug users, with deficits in executive function also being associated with treatment failure ( 12 , 13 ). In this study, the total test score obtained from the stigma questionnaire showed a significant and positive relationship with each of the scales of time management, self-organization/problem-solving, emotion regulation, self-motivation, self-restraint, and total executive function deficit. Therefore, the stigma associated with substance abuse is linked with impaired executive function. While multiple studies confirm the negative impact of stigma on cognitive functions in psychiatric patients ( 23 – 25 ), less is known about the effect of executive functioning deficits on self-perceived stigma related to drug use. In a recent study by Wang et al., the link between executive functioning deficits, substance-use-related stigma, and substance use problems was explored among individuals exposed to trauma. The researchers confirmed a positive link between the stigma and executive functioning deficits, which in turn were associated with substance use problems ( 26 ). Our findings, among substance abusers seeking to quit, are consistent with the results of Wang et al., highlighting the possibility of achieving better treatment outcomes by addressing the stigma and executive functioning deficits that those who are trying to quit face. In this study, there was no significant relationship between gender and stigma. A recent systematic review by Meyers et al. found that while the quantitative literature indicates no disparity between the genders in the stigma associated with drug use, the qualitative literature shows that women experience more stigma ( 21 ). Our study, being quantitative in nature, agrees with the former. However, Meyers et al. note that, especially in healthcare settings, female drug users may experience greater stigma due to “societal expectations of women’s morality, cleanliness, and motherhood” ( 21 ). Such factors are quite prominent in Iran, with one study indicating that the stigmatization was so much for women that they were unwilling to participate ( 27 ). Hence, while our results do not draw a link between gender and drug use-associated stigma, qualitative work may lead to different findings and result in a clearer understanding of this issue. Given that our study was conducted in a specialized psychiatric referral center, we did not have a control group to compare executive function scores against, representing a slight limitation. However, among healthy young people in Mashhad, Iran, the average subscale scores for time management, self-organization/problem-solving, emotion regulation, self-motivation, and self-restraint deficits were reported as 36.39, 41.91, 34.07, 21.76, 25.88 with the BDEFS questionnaire ( 28 ). We found these values at 49.73, 53.95, 45.08, 28.89, and 30.98, respectively, indicating a much greater deficit in each of the areas of executive function in our study population of substance abusers who were seeking to quit. Our study adds valuable information to the literature regarding the link between the stigma associated with substance abuse and the deficits that substance abusers have in executive functioning. While it seems intuitive that these variables may have a cause-and-effect relationship, longitudinal studies are required to prove such a matter, representing a limitation of our cross-sectional study. Furthermore, our study sample was taken from patients admitted to our psychiatric hospital with the intention to quit, meaning that our results cannot be generalized to the general population of substance abusers. Nonetheless, our study is the first to shed light on the relationship between executive function and stigma caused by drug use in Iran, and may help in designing better interventions and achieving better outcomes for helping those who wish to quit. Conclusions Self-perceived stigma is directly linked with executive dysfunction in drug users who are seeking to quit. Since stigma and executive function both play essential roles in addiction treatment success, interventions should be adjusted to reduce the self-perceived stigma and executive function deficits of substance addicts. Abbreviations BDEFS, Barkley Deficits in Executive Functioning Scale Declarations Ethics approval and consent to participate: The study protocol was approved by the Ethics Committee of the School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran (IR.SUMS.MED.REC.1400.402). Participation was voluntary and individuals were free to withdraw at any time. Consent for publication . Not applicable as this work does not contain any individual person’s data. Availability of data and materials. The data that support the findings of this study are available from the corresponding author upon reasonable request. Competing interests. None declared by all authors. Funding. Research Vice-Chancellery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Project No. 24590. Authors' contributions. LRJ: Study conception, design, supervision, writing, revising. SSM: Data collection, interpretation, drafting. AMB: Data collection, data analysis, drafting, and revising. All authors read and approved the final manuscript. Acknowledgements. The present article was extracted from the thesis written by Azade Moradi Bavi and was financially supported by Shiraz University of Medical Sciences grant No. 24590. We thank Dr. Seyed Ali Hosseini for his significant contributions to the writing of this manuscript. References Kulesza M, Larimer ME, Rao D. Substance use related stigma: what we know and the way forward. Journal of addictive behaviors, therapy & rehabilitation. 2013;2(2). Link BG, Phelan JC. Conceptualizing stigma. Annual review of Sociology. 2001;27(1):363-85. Barkley RA. Barkley Adult ADHD Rating Scale-IV (BAARS-IV): Guilford Press; 2011. Bechara A. 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Stigma leads to prejudice, avoidance, rejection, and discrimination against people with a socially undesirable characteristic or a culturally marginalized behavior, such as substance abuse; the World Health Organization (WHO) states that this major cause of discrimination contributes to human rights violations (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Stigma is often based on assumptions, preconceptions, and generalizations rather than facts, meaning that appropriate interventions can avert or minimize its negative impacts (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eExecutive functions are a mental skill set that includes working memory, flexible thinking, and self-control. We use these daily skills to learn, work, manage daily life, and plan and organize multi-step tasks. Executive functions play an important role in everyday cognitive tasks, such as estimating time and distance, planning solutions, and implementing plans to solve problems. Impairment in executive function affects the quality of life and job performance due to harming concentration, task completion, and emotional regulation. Five areas of impairment are recognized: time management, emotion regulation, problem-solving, self-restraint, and self-motivation (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSubstance abuse may significantly impair emotional functioning, decision-making, and social behavior (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). In drug users, cognitive processes and executive functions affect the course of treatment and rehabilitation (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), resulting in less adherence to treatment (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), poor attendance at outpatient treatment sessions (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), low willingness to change (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), decreased self-insight (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), denial of substance abuse (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), increased impulsivity, and less abstinence from substances of abuse after treatment termination (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Impairment in executive function links stigma caused by substance abuse with the problems caused by it (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Executive functioning affects the individual's response to drugs' incentive and punishment effects (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Among addicted people who have decreased executive function, the probability of feeling helpless and becoming homeless is higher (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Also, improving executive function increases the probability of quitting (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite the importance of executive function in drug users, the effect of stigma caused by substance abuse on executive function deficits has not been specifically investigated among substance addicts seeking to quit. In this study, we explored the effect of executive function impairment on the perceived stigma caused by substance abuse among addicts who were trying to quit.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis cross-sectional study was conducted using the questionnaire design between February and April 2022 at Ostad Moharary Neuropsychiatric Hospital, Shiraz, Iran, on substance abuse addicts who were hospitalized to quit. Inclusion criteria were age above 18 years, basic literacy, and the intention to quit substance abuse. Exclusion criteria were having any psychiatric disorder or a lack of willingness to participate. The study protocol was approved by the Ethics Committee of the School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran (IR.SUMS.MED.REC.1400.402). Participation was voluntary and individuals were free to withdraw at any time.\u003c/p\u003e \u003cp\u003eData were collected using a pre-designed form that included informed consent, demographic information (age, gender), urine toxicology test results, an executive function impairment questionnaire, and a perceived stigma questionnaire. Urine samples of the patients were collected at the time of entering the study and were analyzed by the HPLC method in the laboratory of the hospital.\u003c/p\u003e \u003cp\u003eThe 89-item Barkley Deficits in Executive Functioning Scale (BDEFS) was designed by Barkley in 2012. Answers are based on a four-point Likert scale (never to always). It includes five subscales: time management, self-organization/problem-solving, self-restraint, self-motivation, and emotion regulation (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Higher scores indicate greater executive dysfunction. The factor structure, reliability, and validity of the Persian version of this questionnaire have been confirmed in Iran (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe Stigma Scale was designed by Michael King et al. in 2007, consisting of 28 questions answered on a five-point Likert scale (0, completely disagree to 5, completely agree), with negative questions being scored in reverse. This questionnaire consists of three sub-scales: discrimination, disclosure, and positive aspects of stigma (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Higher scores indicate increased perceived stigma. The English version of this scale has been approved in terms of reliability and validity (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), with this also being true regarding the Persian version (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eData were analyzed using SPSS software v. 26. Quantitative data are displayed as mean (standard deviation) and qualitative data as number (percentage). We used the student t-test or its non-parametric equivalent (Mann-Whitney test) to compare means. The chi-squared test and its non-parametric equivalent (Fisher's exact test) were used to compare frequencies. Pearson's correlation coefficient test was used to determine the relationship between quantitative data. Logistic regression was used to investigate factors affecting the outcome. Two-sided P-values were considered significant when less than 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eWe surveyed a total of 80 drug addicts, most of whom (56.3%) used multiple substances. The mean age was 36.56 \u0026plusmn; 9.37, and the majority of the study population were men. A little over half of the participants had no family history of substance abuse (Table 1). Notably, addiction to stimulants was more common among women (33.3%) than men (4.4%) (P=0.005).\u003c/p\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n\u003cp style=\"text-align: center;\"\u003eDemographic characteristics of the study participants, mean \u0026plusmn; SD or n (%)\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eValue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36.56 \u0026plusmn; 9.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSex, male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e68 (85.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSubstance type\u003c/p\u003e\n \u003cp\u003e- Narcotics\u003c/p\u003e\n \u003cp\u003e- Stimulants\u003c/p\u003e\n \u003cp\u003e- Multiple\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e28 (35.0)\u003c/p\u003e\n \u003cp\u003e7 (8.8)\u003c/p\u003e\n \u003cp\u003e45 (56.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFamily history of substance abuse, yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36 (35.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eDescriptive statistics of executive dysfunction test scores are presented in Table 2. As seen, patients with substance abuse had the greatest deficits in self-organization/problem-solving, followed by time management and emotion regulation (Table 2).\u003c/p\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e\u003c/p\u003e\n\u003cp style=\"text-align: center;\"\u003e Scores of participants on executive dysfunction and its components\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMinimum\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaximum\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime management\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSelf-organization/problem-solving\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e53.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmotion regulation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e45.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSelf-motivation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSelf-restraint\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e208.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e39.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e316\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp; Table 3 summarizes the performance of our study subjects on the Stigma Scale (Table 3). Interestingly, the highest scores were seen in the positive aspects of stigma subscale.\u003c/p\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e\u003c/p\u003e\n\u003cp style=\"text-align: center;\"\u003eScores of participants on the Stigma Scale and its dimensions\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMinimum\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaximum\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiscrimination\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e34.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDisclosure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePositive aspects\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e77.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e117\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;Age did not correlate with neither stigma nor executive dysfunction, with the exception of a significant positive correlation between age and the executive dysfunction subscale of self-organization of excitement (r = 0.244, P\u0026lt;0.05). The sex, type of substance used, and family history of substance abuse had no relationship with neither stigma nor executive dysfunction (P\u0026gt;0.05)\u003c/p\u003e\n\u003cp\u003eIn this study, the total test score obtained from the Stigma Scale showed a significant and positive relationship with each of the scales of time management, self-organization/problem-solving, emotion regulation, self-motivation, self-restraint, and total executive function deficit (Table 4). The discrimination dimension of stigma had a positive and significant relationship with time-management, emotion regulation, and the total score of executive dysfunction. Also, stigma disclosure showed a significant positive relationship with self-organization/problem-solving. In addition, the positive aspects of stigma had a positive and meaningful relationship with emotion regulation (Table 4).\u0026nbsp;\u003c/p\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cstrong\u003eTable 4\u003c/strong\u003e\u003c/p\u003e\n\u003cp style=\"text-align: center;\"\u003eCorrelation between scales of executive dysfunction and stigma\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" style=\"border-collapse: collapse; margin: 0px auto;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime-management\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSelf-organization/\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eproblem-solving\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmotion regulation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSelf-motivation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSelf-restraint\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal executive dysfunction\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal stigma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.223\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.273\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.257\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.238\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.308\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.336\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiscrimination\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.267\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.250\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.239\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDisclosure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.235\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.230\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePositive aspects\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.271\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.191\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style=\"text-align: center;\"\u003e* P\u0026lt;0.05 ** P\u0026lt;0.001\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study explored the effect of executive function impairment on the perceived stigma caused by substance abuse among addicts trying to quit. In terms of executive dysfunction, our patients had the greatest deficits in self-organization/problem-solving, followed by time management and emotion regulation. Our key finding was that stigma had a significant and positive relationship with executive dysfunction and each of its subscales.\u003c/p\u003e \u003cp\u003eSubstance abuse is a global problem, considered one of the concerns of the governments in most countries. The stigma associated with substance abuse has behavioral, occupational, and legal implications; it is linked with poor psychological well-being and averts access to healthcare, screening, and treatment (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Executive function is one thing that is impaired in drug users, with deficits in executive function also being associated with treatment failure (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this study, the total test score obtained from the stigma questionnaire showed a significant and positive relationship with each of the scales of time management, self-organization/problem-solving, emotion regulation, self-motivation, self-restraint, and total executive function deficit. Therefore, the stigma associated with substance abuse is linked with impaired executive function. While multiple studies confirm the negative impact of stigma on cognitive functions in psychiatric patients (\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), less is known about the effect of executive functioning deficits on self-perceived stigma related to drug use. In a recent study by Wang et al., the link between executive functioning deficits, substance-use-related stigma, and substance use problems was explored among individuals exposed to trauma. The researchers confirmed a positive link between the stigma and executive functioning deficits, which in turn were associated with substance use problems (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Our findings, among substance abusers seeking to quit, are consistent with the results of Wang et al., highlighting the possibility of achieving better treatment outcomes by addressing the stigma and executive functioning deficits that those who are trying to quit face.\u003c/p\u003e \u003cp\u003eIn this study, there was no significant relationship between gender and stigma. A recent systematic review by Meyers et al. found that while the quantitative literature indicates no disparity between the genders in the stigma associated with drug use, the qualitative literature shows that women experience more stigma (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Our study, being quantitative in nature, agrees with the former. However, Meyers et al. note that, especially in healthcare settings, female drug users may experience greater stigma due to \u0026ldquo;societal expectations of women\u0026rsquo;s morality, cleanliness, and motherhood\u0026rdquo; (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Such factors are quite prominent in Iran, with one study indicating that the stigmatization was so much for women that they were unwilling to participate (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Hence, while our results do not draw a link between gender and drug use-associated stigma, qualitative work may lead to different findings and result in a clearer understanding of this issue.\u003c/p\u003e \u003cp\u003eGiven that our study was conducted in a specialized psychiatric referral center, we did not have a control group to compare executive function scores against, representing a slight limitation. However, among healthy young people in Mashhad, Iran, the average subscale scores for time management, self-organization/problem-solving, emotion regulation, self-motivation, and self-restraint deficits were reported as 36.39, 41.91, 34.07, 21.76, 25.88 with the BDEFS questionnaire (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). We found these values at 49.73, 53.95, 45.08, 28.89, and 30.98, respectively, indicating a much greater deficit in each of the areas of executive function in our study population of substance abusers who were seeking to quit.\u003c/p\u003e \u003cp\u003eOur study adds valuable information to the literature regarding the link between the stigma associated with substance abuse and the deficits that substance abusers have in executive functioning. While it seems intuitive that these variables may have a cause-and-effect relationship, longitudinal studies are required to prove such a matter, representing a limitation of our cross-sectional study. Furthermore, our study sample was taken from patients admitted to our psychiatric hospital with the intention to quit, meaning that our results cannot be generalized to the general population of substance abusers. Nonetheless, our study is the first to shed light on the relationship between executive function and stigma caused by drug use in Iran, and may help in designing better interventions and achieving better outcomes for helping those who wish to quit.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eSelf-perceived stigma is directly linked with executive dysfunction in drug users who are seeking to quit. Since stigma and executive function both play essential roles in addiction treatment success, interventions should be adjusted to reduce the self-perceived stigma and executive function deficits of substance addicts.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBDEFS, Barkley Deficits in Executive Functioning Scale\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThe study protocol was approved by the Ethics Committee of the School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran (IR.SUMS.MED.REC.1400.402). Participation was voluntary and individuals were free to withdraw at any time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e. Not applicable as this work does not contain any individual person\u0026rsquo;s data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials.\u0026nbsp;\u003c/strong\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests.\u003c/strong\u003e None declared by all authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding.\u0026nbsp;\u003c/strong\u003eResearch Vice-Chancellery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Project No. 24590.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions.\u003c/strong\u003e LRJ: Study conception, design, supervision, writing, revising. SSM: Data collection, interpretation, drafting. AMB: Data collection, data analysis, drafting, and revising. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements.\u003c/strong\u003e The present article was extracted from the thesis written by Azade Moradi Bavi and was financially supported by Shiraz University of Medical Sciences grant No. 24590. We thank Dr. Seyed Ali Hosseini for his significant contributions to the writing of this manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKulesza M, Larimer ME, Rao D. Substance use related stigma: what we know and the way forward. Journal of addictive behaviors, therapy \u0026amp; rehabilitation. 2013;2(2).\u003c/li\u003e\n\u003cli\u003eLink BG, Phelan JC. Conceptualizing stigma. Annual review of Sociology. 2001;27(1):363-85.\u003c/li\u003e\n\u003cli\u003eBarkley RA. Barkley Adult ADHD Rating Scale-IV (BAARS-IV): Guilford Press; 2011.\u003c/li\u003e\n\u003cli\u003eBechara A. 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Social psychiatry and psychiatric epidemiology. 2014;49(9):1401-25.\u003c/li\u003e\n\u003cli\u003eKim-Spoon J, Kahn RE, Lauharatanahirun N, Deater-Deckard K, Bickel WK, Chiu PH, et al. Executive functioning and substance use in adolescence: Neurobiological and behavioral perspectives. Neuropsychologia. 2017;100:79-92.\u003c/li\u003e\n\u003cli\u003eRaphael‐Greenfield E. Assessing executive and community functioning among homeless persons with substance use disorders using the executive function performance test. Occupational Therapy International. 2012;19(3):135-43.\u003c/li\u003e\n\u003cli\u003eButler K, Le Foll B. Impact of substance use disorder pharmacotherapy on executive function: a narrative review. Frontiers in Psychiatry. 2019;10:98.\u003c/li\u003e\n\u003cli\u003eBarkley RA. Barkley deficits in executive functioning scale--children and adolescents (BDEFS-CA): Guilford Press; 2012.\u003c/li\u003e\n\u003cli\u003eMashhadi A, Mirdoraghi F, Hosainzadeh-Maleki Z, Hasani J, Hamzeloo M. Factor structure, reliability and validity of Persian version of Barkley Deficits in Executive Functioning Scale (BDEFS)-Adult version. Journal of Clinical Psychology. 2015;7(1):51-62.\u003c/li\u003e\n\u003cli\u003eKing M, Dinos S, Shaw J, Watson R, Stevens S, Passetti F, et al. The Stigma Scale: development of a standardised measure of the stigma of mental illness. The British Journal of Psychiatry. 2007;190(3):248-54.\u003c/li\u003e\n\u003cli\u003eCorrigan PW, Michaels PJ, Vega E, Gause M, Watson AC, R\u0026uuml;sch N. Self-stigma of mental illness scale\u0026mdash;short form: reliability and validity. Psychiatry research. 2012;199(1):65-9.\u003c/li\u003e\n\u003cli\u003eKarshaki H, MeshkinYazd A, Soudmand P. 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Addiction. 2007;102(9):1472-82.\u003c/li\u003e\n\u003cli\u003eTaliban Sharif J. Comparison of executive functions in normal and visually impaired youth in Mashhad. Journal of Psychology New Ideas. 2018;2(6):1-17.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Addiction, Drugs, Stimulants, Stigma, Executive Functioning Deficits","lastPublishedDoi":"10.21203/rs.3.rs-2044725/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2044725/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Substance abuse is a common problem worldwide. Among addicts, the perceived stigma of substance abuse harms their quality of life and represents a major treatment barrier. We explored the effect of executive dysfunction on the stigma perceived due to substance abuse.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e In this cross-sectional study, a validated questionnaire on executive dysfunction and stigma was distributed among eighty drug addicts admitted to Ostad Moharary Neuropsychiatric Hospital in March 2022. Demographic data were also collected. Statistical analyses were done using SPSS v. 25.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e In this study, 80 drug users were evaluated, of which 28 (35%) were narcotic drug users, 7 (8.8%) were stimulant drug users, and 45 (56.3%) were multidrug users. Materials were simultaneous (multiple). The mean age of participants was 36.56 37 9.37. In this study, the total test obtained from the stigma questionnaire showed a significant and positive relationship with each of the time scales of self-management, self-organization, self-regulation of emotion, self-motivation, self-inhibition, and total executive performance defects.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eSelf-perceived stigma is directly linked with executive dysfunction in drug users who are seeking to quit. Since stigma and executive function both play essential roles in addiction treatment success, interventions should be adjusted to reduce the self-perceived stigma and executive function deficits of substance addicts.\u003c/p\u003e","manuscriptTitle":"The relationship between substance abuse-associated stigma and deficits in executive functioning","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-09-20 15:25:37","doi":"10.21203/rs.3.rs-2044725/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fd1be597-f80e-41ac-b304-5474077d56ba","owner":[],"postedDate":"September 20th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-10-30T21:29:14+00:00","versionOfRecord":[],"versionCreatedAt":"2022-09-20 15:25:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2044725","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2044725","identity":"rs-2044725","version":["v1"]},"buildId":"-HB7Z8yhvgn0wM9Nzuekk","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}