This study investigated stigma and discriminatory behavior toward drug addiction in a national sample of adults in Korea. We also explored factors related to demographic characteristics that may influence stigma and discriminatory behavior toward drug addicts. In this study, 88.3% (deny as family) and 72.0% (deny as colleague) of all participants reported that they agreed with the stigma toward drug addiction. Factors related to stigma included gender, age, household average monthly income, opioid analgesics misuse experience, alcohol consumption, and smoking. The factors that were found to have significant influences on stigma included gender, age, opioid analgesics misuse experience, smoking, agreement to medical treatment toward drug addiction, and disagreement to increase government support. However, factors related to discrimination appeared to be age, monthly income, and smoking, and only monthly income and smoking were identified as significant influencing factors.

Compared to the results of the studies on stigma and discrimination targeting American adults (USA: stigma 78%–90%, discrimination 54%–64%) [22], this study showed that the stigma score for Korea was lower than that of the United States, and the discrimination score was higher for Korean adults (KOR: stigma 72.0%–88.3%, discrimination 72.2%–78.0%). The general public’s attitude toward drug addiction is related to their demographic and social characteristics [26]. Since this study showed a high consent rate for discriminatory behavior, further research on “discrimination” is needed. In a previous study, 83% of participants reported experiencing some form of discrimination [27]. Discrimination can cause individuals to be isolated from their families, rejected by their coworkers, and excluded from the society [28]. The discrimination is positively correlated with suicide attempts among transgender people, and that intimidation from others has a greater impact on their social isolation [29]. As such, there are a few studies on discrimination, but studies comparing it with stigma are lacking. In this sense, it suggests that more research on discrimination is needed.

We identified several factors associated with stigma and discriminatory behavior toward drug addiction. Adults who had not abused opioids were more likely to stigmatize drug addiction in thoughts and behaviors. In addition, we found that participants who had no smoking history were more likely to form stigma and discrimination toward drug addiction. This phenomenon can be explained by the familiarity hypothesis [30]. We can expect that people who have experienced substance abuse will be able to increase their understanding of the addict’s situation and reduce stigma and discriminatory behavior through personal and secondhand experiences with drugs [14]. However, more research is needed to understand the role of familiarity on stigma and discrimination toward drug addiction. In a study with a large Asian American population, which includes Korean Americans, Asian Americans had the lowest rates of service use and help-seeking attempts for psychiatric problems among other racial groups in the United States; moreover, Asian Americans tend to delay seeking hospital care until their psychiatric symptoms become chronic and severe [21].

This study found that participants’ drug experiences were associated with stigma and discrimination toward drug addiction. This suggests that positive attitudes toward drug addicts can be regarded as having feelings of compassion for them, while negative attitudes have been associated with devaluation of the groups [19]. As data on stigma and discrimination can be expressed in various ways in different social situations and therapeutic settings, and these influences can also affect the treatment services patients receive [22], investigation on stigma and discrimination in the general public and the data from this study can help reduce bias in therapeutic interventions and health care.

There appears to be heterogeneity in stigma and discriminatory attitudes toward drug addicts. In this study, there were more factors affecting stigma than discrimination. Researchers have yet to come to any clear conclusions about how to measure and analyze stigma and discrimination separately and objectively [31,32]. Previous studies [33,34] conceptualized stigma as internalized, perceived, anticipated, or enacted stigma, and some studies [35-37] defined enacted stigma as discrimination. Stigma is sometimes classified as an internalized form, and discrimination also refers to unfair treatment based on one’s status, which is one aspect of stigma [38,39]. As defined in our study, stigma is defined as the perception of belonging to a group and the internalized aversion to and rejection of belonging to that same group, while discrimination is a conceptualization of an externalized attitude toward the expected poor and unfair treatment and consequences for the target.

One of the findings was that older people had greater stigma. Young people may have less experience of the harmful effects of drug addiction, while older generations, through direct and indirect experiences, already have negative views about drug addiction and hence support more discriminatory treatment [40]. Regarding the demographic data, gender had significant effects on stigma as well. Women had more negative thoughts about drug addiction than men. These results were consistent with previous studies reporting the effects of heightened vigilance due to women’s vulnerability to drug problems [41]; women disabled by drug use are physically more vulnerable than men and are more likely to be targeted when exposed to crime [42]; woman drug addicts are exposed to an exploitative environment [43], and the effects of drugs can affect women’s defensive behavior to protect themselves and their ability to actively express themselves [44].

In this study, it was found that those who thought that they should receive active counseling or hospital treatment when suffering from opioids and drug abuse were more likely to agree to stigmatization than those who tried to solve it personally. Moreover, people who are reluctant to see governments increasing support and investment toward drug addiction are more likely to agree to stigmatization. According to previous studies, experts have pointed out the stigma and discriminatory medical services toward drug addiction. Efforts to explain drug addiction as a brain disease can potentially increase the negative stigma effect in the perspective and perception toward drug addiction and show that it can lower expectations about people’s chances of recovery [45]. Stigma and discrimination toward drug addiction has side effects such as denying and blaming of individuals with drug addiction, and exempting government from their responsibility in drug addiction [46-48].

As a study confirming this negative effect of stigma and discrimination, previous studies conducted on HIV patients found that stigma reduced clinical intervention for individuals suffering from depression [49]. In a questionnaire among Indian HIV clinicians, 62% of participants were neutral or agreed with the statement that “depression is a sign of personal weakness,” and 53% of participants felt it was difficult to work with someone who was depressed [50]. Other studies have shown that specialized approaches, subject to stigma and discrimination, impede the exercise of the rights of drug addicts and hinder their access to health care services [51,52]. Many people choose not to seek help from treatment services as a way to deal with stigma and discrimination and to avoid being “labeled” owing to possible negative consequences. Not having access to treatment services can actually exacerbate substance abuse problems, which can create a false perception that drug addiction treatment services are unnecessary, resulting in the devaluation of treatment services [53].

Economic status was one of the characteristic factors related to discrimination. In this study, people with middle or higher economic status agreed more to discriminatory behavior. In line with these results, there is a study that suggests stigma and discriminatory behavior increase with socioeconomic status [40]. In contrast, a study reported that the probability of wealthy people having a discriminatory attitude is lower than that of the very poor people because wealthy people have free access to various communications such as mass media and social media, and may obtain knowledge and information on drug addiction easily [26]. However, in these studies, the concepts of stigma and discrimination are used interchangeably. Regarding these differences, this study distinguished the concepts of stigma and discrimination more clearly, and in particular, the items for discrimination were contents that related to “economic loss.” Therefore, it seems that wealthy people honestly expressed their conservative position in protecting their property rights as “landlords” and “employees.”

In this sense, as a way to prevent stigma and successfully reduce discrimination, it is suggested that experts who treat drug addiction and the institutions in charge of their education should include appropriate evidence-based materials in the educational curriculum [18,54]. It suggests that these efforts should be made with the general public to help change their attitude toward drug addicts in a more positive way. It is also worth mentioning that there is a lack of information about the impact of stigma and discrimination on drug addiction and the factors that impede appropriate medical intervention. In developing future addiction prevention policies and plans, it is also important to consider how this information will be used in future data-driven planning, through assessing stigma and discriminatory attitudes toward addicts and obtaining feedback from patients.

Our study had some limitations. Although it is common to use cross-sectional analysis in public views toward drug addiction, it is difficult to derive cause-and-effect relationships from the present findings. We used a few simple questions when evaluating stigma and discrimination to be consistent with Barry et al. [22]; however, questions were not specific about the types of drugs (e.g., alcohol, smoking, or opioids) or standardized like the Devaluation-Discrimination Scale [55]. Therefore, this study cannot address differences in stigma or discrimination toward those addicted to alcohol versus those addicted to opioids. We also took cognizance of the limitation that the concepts of stigma and discrimination were not fully captured in the items used in present study. So it is unclear how clearly the participants understood and answered substance abuse, stigma, and discrimination.

Despite these limitations, this study went further than previous research and conducted a nationwide survey to understand the factors that affect stigma and discrimination in the general public in Korea. We suggested a better understanding of how individual and clinical characteristics may influence stigma and discrimination toward drug addiction, and emphasize the need to expand research to reduce stigma and discrimination. Further research is needed to better differentiate and address stigma and discrimination, especially as the need to explore factors that may directly or indirectly affect stigma as well as discrimination grows.

In conclusion, these findings suggest that a vast majority of Korean adults hold moderate levels of stigma and discrimination toward drug addiction. People who are women; over 40 years of age; with no history of opioid analgesic misuse; nonsmoking; agree to hospital treatment for addicts; and disagree to increase government support were more likely to stigmatize drug addicts. Meanwhile, those with higher incomes and are non-smoking were more likely to agree to discriminatory treatment for drug addicts. This study provides insight into factors influencing stigma and discrimination, hence it is essential to introduce drug addicts are guided to seek appropriate medical services and treatment institutions under positive social awareness and are encouraged to regain their health.