Open Access Research article

Negative attributions towards people with substance use disorders in South Africa: Variation across substances and by gender

Katherine Sorsdahl1*, Dan J Stein1 and Bronwyn Myers12

Author Affiliations

1 Department of Psychiatry and Mental Health, University of Cape Town J-Block Groote Schuur Hospital Observatory, Cape Town, South Africa

2 Alcohol and Drug Abuse Research Unit, Medical Research Council, Cape Town, South Africa

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BMC Psychiatry 2012, 12:101  doi:10.1186/1471-244X-12-101

Published: 7 August 2012



Little research has examined attitudes towards people who use substances in low and middle income countries (LMIC). Therefore, the present study examined the attributions made by the general South African population about people who use substances and whether these attributions differ by the type of substance being used, the gender of the person using the substance, or the characteristics of the person making the attribution.


A convenience sample of 868 members of the general public was obtained through street-intercept methods. One of 8 vignettes portraying alcohol, cannabis, methamphetamine or heroin, with either a male or female as the protagonist was presented to each respondent. Respondents’ attitudes towards the specific cases were investigated.


Respondents held equally negative views of the presented substances, with the exception of the cannabis vignette which was considered significantly less “dangerous” than the alcohol vignette. Respondents were more likely to offer “help” to women who use alcohol, but more likely to suggest “coercion into treatment” for men. Individuals who scored higher on the ASSIST were more likely to hold negative attitudes towards substance users and black African respondents were more likely to offer help to individuals who use substances.


The stigma associated with substance use in South Africa is high and not necessarily dependent on the drug of choice. However, a range of factors, including gender of the substance user, and ethnicity of the rater, may impact on stigma. Interventions designed to strengthen mental health literacy and gender-focused anti-stigma campaigns may have the potential to increase treatment seeking behaviour.

Alcohol; Drugs; Stigma; South Africa; Gender