Prior research has linked stigma associated with substance use (e.g., encounters with and anticipation of discrimination, internalization of negative stereotypes) to increased drug use problems, yet little work has examined protective factors that mitigate this association. The current study examined expressive flexibility (i.e., the ability to flexibly enhance and suppress one's emotional expression in accordance with situational demands), an important component of emotion regulation and psychological flexibility, as a buffer in the relation between substance use stigma and drug use problems among individuals with depression, a population disproportionately impacted by substance use disorder. A community sample of U.S. adults diagnosed with major depressive disorder (N = 112) completed self-report measures of substance use stigma, expressive flexibility, and drug use problems. Moderation analyses showed that substance use stigma was significantly associated with drug use problems, but the association was attenuated for participants with high levels of expressive flexibility. These findings underscored the potential utility of fostering expressive flexibility as a stigma coping resource in substance use prevention and treatment interventions.

Stigma acts as a barrier to the diagnosis and effective treatment of tuberculosis (TB). Individuals with TB who also use alcohol or drugs (AODs), including methamphetamine, may experience intersectional stigma. Further, the nature and intensity of these intersecting stigmas may be compounded by co-morbidities like HIV and marginalized social status. Despite this, AOD use stigma has rarely been studied in the context of TB and other co-occurring conditions. We examined the perceptions and experiences of AOD use-related stigma among individuals who were previously diagnosed with TB or were at increased risk of TB based on their close contacts, in a rural community in the Western Cape, South Africa. We analyzed qualitative data collected by two studies (study 1: five focus groups (n=34), study 2: ten focus groups (n=84)). Findings highlighted that study participants who use AODs experienced intersectional stigma from multiple sources. AOD use- and TB-related stigma were experienced from friends, family, healthcare providers, and the broader community, particularly for those who used illicit drugs. Participants discussed stigma's effects on their health and well-being. The negative effects of AOD use stigma were particularly salient among female participants. Findings indicate that intersecting stigmas exist at multiple levels for people who use AODs with/at risk of TB, and that these stigmas hinder healthcare utilization in this rural setting. Future interventions to improve TB service uptake need to address intersectional AOD use and TB stigma.