Perceptions of Substance Use Disorder and Associated Sanctions: A Factorial Vignette Experiment

• Author: Benjamin T. Kuettel
• DOI: http://doi.org/10.1177/07340168221105002
• Published date: 01 June 2023
• Date: 01 June 2023
• Subject Matter: Articles

Perceptions of Substance

Use Disorder and Associated

Sanctions: A Factorial

Vignette Experiment

Benjamin T. Kuettel

1

Abstract

This study examines whether characteristics of people who use drugs (PWUD) inf‌luence public per-

ceptions of substance use disorder (SUD) and punitiveness. Using a full-factorial vignette experi-

ment, a nationwide sample (N =448), and a series of regression models, I estimate the causal

effect of characteristics of PWUD on substance use evaluations and punitiveness. Results reveal

that drug type and prior criminal drug record affected both SUD and punitive judgements, implying

a prosocial punitiveness, where punishments are intended to rehabilitate. Demographics of PWUD

(e.g., race, sex, etc.) mattered little. However, racial resentment moderated the relationship

between SUD and punitiveness, suggesting aggressive punitiveness. These f‌indings imply that SUD

evaluations and punitiveness are linked in the public mind, suggesting that citizens may see punish-

ments as a way to address SUD by helping PWUD recover. This is not true for racially resentful

respondents, who appear to want to punish PWUD for punishment’s sake.

Keywords

factorial vignette experiment, perceptions, punishment, stigma, substance use disorder

Introduction

The United States continues to grapple with drug-related overdose mortalities. According to the

Centers for Disease Control and Prevention (CDC), there were approximately 70,630 drug overdose

deaths in 2019, with about 49,860 of those deaths involving opioids such as heroin, fentanyl, and

prescription opioids (Mattson et al., 2021). In 2019, opioids were responsible for 70.6% of all

drug overdose deaths in the United States (Mattson et al., 2021). Age-adjusted rates of drug overdose

deaths in 2019 were 21.6 per 100,000 compared to just 6.1 per 100,000 in 1999 (Hedegaard et al.,

2020; Mattson et al., 2021). Drug-related mortalities increased by 4.3% from 2018 to 2019 (Mattson

et al., 2021), and preliminary evidence suggests that overdose deaths have continued to increase

1

School of Criminal Justice, University at Albany, State University of New York, Albany, NY, USA

Corresponding Author:

Benjamin T. Kuettel, School of Criminal Justice, University at Albany, State University of New York, 135 Western Avenue,

Albany, NY 12222, USA.

Email: bkuettel@albany.edu

Article

Criminal Justice Review

2023, Vol. 48(2) 203-231

© 2022 Georgia State University

Article reuse guidelines:

sagepub.com/journals-permissions

DOI: 10.1177/07340168221105002

journals.sagepub.com/home/cjr

throughout 2020 partially due to the COVID-19 pandemic (Haley & Saitz, 2020; Slavova et al.,

2020). This swift rise in opioid-related drug overdose deaths across the United States beginning in

the late 1990s and continuing since has been called the “opioid crisis”, with the increase in

drug-related mortalities being referred to by academics as “deaths of despair”(Case & Deaton, 2020).

As policymakers, emergency service personnel, and the general populace continue to seek ways

of alleviating this drug overdose crisis, one key factor concerns who is perceived to have a substance

use disorder (SUD). “What we think about addiction very much depends on who is addicted”

(Courtwright, 1982, p. 4). The broader academic literature on public opinion, including attitudes

on spending for drug treatment, f‌inds that support for public health and harm reduction strategies

to combat drug overdose mortalities are contingent on positive attitudes and perceptions (Barry

et al., 2014; Kennedy-Hendricks et al., 2017; Kulesza et al., 2015; Matheson et al., 2014). Public

perceptions of SUD are often driven by drug scares and intertwined with historical drug stereotypes

(Earnshaw et al., 2013; Murakawa, 2011; Reinarman, 1994; Reinarman & Levine, 2004), including

implicit acts of stigmatization that serve to discourage drug use but instead act as barriers for those

seeking drug treatment (Ahern et al., 2007; Livingston et al., 2012). Moreover, stereotypes associated

with drug use may not ref‌lect real demographic changes in drug use or rates of drug overdose deaths

among different groups within the United States (Courtwright, 1982; Kolodny et al., 2015).

When ref‌lecting on the opioid crisis, some scholars argue that opioid overdose victims have been

disproportionately portrayed as working-class rural Whites, to which the response has been a sym-

pathetic public health approach (Beckett & Brydolf-Horwitz, 2020; Hansen & Netherland, 2016;

Netherland & Hansen, 2017). This response is in stark contrast to punitive war on drugs policies rem-

iniscent of prior drug epidemics that unfairly punished racial/ethnic minority individuals and com-

munities (Beckett & Brydolf-Horwitz, 2020; James & Jordan, 2018). Research has begun

exploring public perceptions and subsequent stereotypes concerning who is believed to have an

opioid use disorder in context of the opioid crisis. Sobotka & Stewart (2020) f‌ind the likelihood

of being identif‌ied as a person who has an opioid use disorder is greater when the individual is por-

trayed as White or unemployed. Although stereotypes concerning who uses opioids during the opioid

crisis has been studied, questions remain concerning whether historical drug stereotypes are relevant

or have changed alongside stereotypes of opioid use, what factors inf‌luence the likelihood of labeling

someone as having a SUD, and what factors drive punitive public responses regarding people who

use drugs (PWUD), including opioids.

The present study attempts to clarify contemporary public perceptions of SUD, as well as identify

what factors inf‌luence punitiveness concerning PWUD. To accomplish this, I use a factorial vignette

experimental design to see how respondents perceive SUD based on descriptions of PWUD. This

approach can reveal how manipulating characteristics of PWUD inf‌luence respondent judgements

of SUD, while also measuring support for punitive sanctions against PWUD. Findings from this

study can reveal interaction effects, or whether being labeled as having a SUD or receiving

greater punitive judgements by respondents is contingent on specif‌ic characteristics of PWUD

(e.g., race, sex, criminal record, etc.). These f‌indings can provide a better understanding of public

perceptions of SUD during the opioid crisis which can improve access to drug treatment, support

for harm reduction policies, and treatment of individuals with SUD in the criminal justice system.

Race, Drug Stereotypes, and Drug Enforcement in the United States

There is a long history of problems related to drugs and subsequent legislation attempting to combat

problematic drug use in the United States (Beckett & Brydolf-Horwitz, 2020; Lock et al., 2002;

Meier, 1992; Reinarman, 1994; Reinarman & Levine, 2004). These legislative decisions are

rooted in public perceptions that historically ref‌lected popular prejudices against a variety of

social and racial/ethnic minority groups (Alexander, 2010; Chambers, 2011; Nielsen, 2010). From

204 Criminal Justice Review 48(2)