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Factor structure, internal reliability and construct validity of the Methadone Maintenance Treatment Stigma

Laramie R Smith1, Maria Luisa Mittal1, Karla Wagner2

  • 1Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA.

Addiction (Abingdon, England)
|September 4, 2019
PubMed
Abstract

Insights

The Methadone Maintenance Treatment Stigma Mechanisms Scale (MMT-SMS) is a valid and reliable tool for measuring stigma experienced by individuals undergoing opioid use disorder treatment. This scale helps identify barriers to methadone maintenance treatment (MMT).

Area of Science:

  • Psychiatry and Behavioral Sciences
  • Addiction Medicine
  • Psychometrics

Background:

  • Stigma associated with methadone maintenance treatment (MMT) can deter individuals with opioid use disorder (OUD) from seeking or adhering to treatment.
  • Existing stigma measures may not adequately capture the nuances of MMT-specific stigma experiences.

Purpose of the Study:

  • To evaluate the factor structure, internal reliability, construct validity, and criterion validity of the Methadone Maintenance Treatment Stigma Mechanisms Scale (MMT-SMS).
  • To compare the MMT-SMS with the Substance Use Stigma Mechanism Scale (SU-SMS) in a population receiving MMT.

Main Methods:

  • A prospective study involving 93 participants receiving MMT at a community clinic in the Northeastern USA.
  • The MMT-SMS, a theory-based self-report questionnaire, was used to assess anticipated, enacted, and internalized stigma related to MMT and its sources (family, employers, healthcare workers).
  • Data collection included surveys at baseline and end-of-study, alongside records of drug use and treatment attendance.

Main Results:

  • The MMT-SMS demonstrated good internal reliability (α = 0.806–0.952) and supported a seven-factor structure via confirmatory factor analysis (RMSEA = 0.076, CFI = 0.974, TLI = 0.971).
  • Construct validity confirmed the MMT-SMS's ability to differentiate MMT-specific stigma from general substance use stigma.
  • Criterion validity showed associations between MMT stigma, substance use experiences (e.g., heroin injection), and MMT dose, suggesting predictive utility for treatment success.

Conclusions:

  • The MMT-SMS is a reliable and valid psychometric instrument for assessing stigma among individuals receiving MMT.
  • This scale can aid in understanding and addressing stigma as a barrier to effective treatment for opioid use disorder.
Keywords:
Medication-assisted treatmentmethadone maintenance treatmentopioid agonist treatmentopioid substitution therapyopioid use disorderpeople who inject drugsstigma

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