TPC Journal-Vol 10- Issue 2-FULL ISSUE

228 The Professional Counselor | Volume 10, Issue 2 Discussion Research has indicated the importance of decreasing stigma surrounding substance use treatment in order to address the public health issue of so many individuals lacking treatment in the United States (Bose et al., 2016; Clement et al., 2015). Although the effects of self-stigma on help-seeking behaviors (Crowe et al., 2016; Mullen & Crowe, 2017), attitudes toward seeking psychological help (Cheng et al., 2018), and AOD use (Luoma et al., 2008) have been well documented, there remains a gap in the counseling literature explicating the relationship between the above constructs. In this study, the proposed theoretical causal model (see Figure 1) suggested that self-stigma of mental illness and self-stigma of help seeking would have a direct effect on attitudes toward help seeking and a positive indirect effect on drug and alcohol use mediated by attitudes toward help seeking; moreover, it suggested that attitudes toward help seeking would have a negative direct effect on AOD use. By using the online platform MTurk for a community sample of 406 participants, the results from a path analysis indicated an excellent fit model with significant standardized regression coefficients that revealed a complex relationship between self-stigma of mental illness, self-stigma of help-seeking, attitudes toward psychological help seeking, AOD use, and age. Although the results of the present study did not support all three initial hypotheses, the findings did show a statistically significant indirect relationship among the six variables. The first hypothesis was not supported by data because self-stigma of mental illness did not have a direct effect on attitudes toward help seeking or an indirect effect on AOD use. However, self-stigma of mental illness did correlate with self-stigma of help seeking, which included a large effect size that indicated a strong relationship between these variables. The lack of direct effect between self-stigma of mental illness and attitudes toward help seeking may have resulted from a moderating influence caused by the direct effect of self-stigma of help seeking on attitudes toward help seeking. Based on these findings, we concluded that self-stigma of help seeking is a stronger predictor of attitudes toward help seeking when paired with self-stigma of mental illness. However, more research is needed to replicate these findings, and specifically the potential moderating effect of self-stigma of help seeking on self-stigma of mental illness. In contrast, the results from the path analysis provided evidence for our second hypothesis. Specifically, participants who reported high levels of self-stigma of help seeking had less positive attitudes toward seeking psychological help as well as higher alcohol use or drug use. This finding is consistent with findings from prior research that revealed participants who reported high levels of stigma had decreased adaptive coping skills such as help-seeking behaviors (Crowe et al., 2016) and increased maladaptive coping skills such as drug use (Etesam et al., 2014). It is possible that participants turned to drinking or drug use as a method of coping rather than seeking formal support. However, we cannot determine if that is the case from the current study. The direct relationship of an individual’s reported stigma of help seeking with less positive attitudes toward seeking psychological help also confirms previous theoretical descriptions of the relationship between self-stigma of help seeking and attitudes toward help seeking (Tucker et al., 2013; Vogel et al., 2007; Wade et al., 2011). Lastly, participants who reported more positive attitudes toward help seeking had significantly lower AOD use, which provided support for our third hypothesis. These findings suggest that regardless of age, participants who had a positive attitude toward seeking help reported significantly lower AOD use. In addition to the unique findings uncovered through mediation analysis, this study