Table 1 Applying the Health Stigma and Discrimination Framework to this review

Drivers and Facilitators

Drivers

• Fear

• Poor knowledge/awareness

• Prejudice

• Stereotypes

Facilitators

• Social, gender, religious and cultural norms and beliefs which determine whether alcohol consumption or illicit drug use are acceptable in particular settings

• Laws and policies

Health condition related stigma

Intersecting fields of stigma

• Ethnicity, gender, sexual identity, citizenship status, socio-economic status, age, other health conditions

Stigma manifestations

Experiences

• Internalised stigma (people feeling shame and personally taking on the negative labels associated with AOD use and mental health conditions)

• Experienced stigma (verbal abuse, vilification)

• Anticipated stigma (expectation or fear of bias if others discover their AOD use or mental health condition)

• Secondary stigma (negative labels applied to family and friends)

• Experienced discrimination (unfair treatment or constrained opportunities)

Practices

• Being stereotyped by members of the public or service providers

• Stigmatising behaviours (exclusion, avoidance, rejection, gossip)

• Discriminatory attitudes

• Expressions of prejudice

Outcomes

Individual

• Concealment or non-disclosure

• Increase in risk behaviours

• Limited ability to seek and obtain access to appropriate mental health and AOD services

• Informal help-seeking

• Resilience and advocacy through rejection of stereotypes

Organisations and institutions

• Responses or interventions that can be implemented at an organisational or institutional level to address stigma

Impacts

Impacts

• Reduced quality of life

• Increased isolation and loneliness

• Decreased participation in employment and housing

• Increased contact with the criminal justice system

• Exacerbation of existing mental health conditions

• Increase in depression, anxiety and social isolation

• Long-term break down in relationships