The cognitive, affective, and behavioral expression of self-stigma among people who use drugs in online substance use communities

Objectives: To develop a codebook for self-stigma across cognitive, affective, and behavioral domains, and to estimate the prevalence, co-occurrence, and temporal patterns of these indicators in Reddit posts by people who use drugs. Methods: We developed a ten-indicator codebook through consensus-based abductive coding spanning cognitive (self-labeling, pessimism/self-defeatism, deservingness/worthlessness), affective (shame, guilt/self-blame, despair/hopelessness), and behavioral (concealment, anticipated rejection, desire to quit, ambivalence) domains; two coders reached substantial agreement (Cohen's k = 0.72). We then scaled classification with a large language model validated against expert coding (k = 0.73, F1 = 0.80), analyzing 72,115 thread-initiating posts from 1,660 English-language users (2006-2025). Results: 3,838 posts (5.3%) from 1,228 users (74.0%) contained self-stigma; all ten indicators discriminated self-stigma posts (RR 3.6 to 86.2), led by self-labeling (56.0%) and despair/hopelessness (48.5%). Self-stigma was integrated: core and behavioral indicators were strongly associated at the user level (OR = 4.65, 95% CI 3.12-6.94, p < 0.001), and 87.0% of posts with behavioral indicators also contained a core indicator. Contrary to progressive models, behavioral indicators emerged earlier than core ones (desire to quit at median position 0.08 vs. shame at 0.38). Nine of ten indicators were stable across posting trajectories; only pessimism increased (OR = 1.62, 95% CI 1.25-2.10). Conclusion: Among people who use drugs online, self-stigma is an integrated phenomenon in which behavioral indicators rarely appear without internalized ones and often precede them. Most expressions remain stable over time, but pessimism about change deepens, marking a target for early digital intervention and showing that progressive stage models do not map directly onto textual disclosure.

On Identifying Points of Semantic Shift Across Domains

The semantics used for particular terms in an academic field organically evolve over time. Tracking this evolution through inspection of published literature has either been from the perspective of Linguistic scholars or has concentrated the focus of term evolution within a single domain of study. In this paper, we performed a case study to identify semantic evolution across different domains and identify examples of inter-domain semantic shifts. We initially used keywords as the basis of our search and executed an iterative process of following citations to find the initial mention of the concepts in the field. We found that a select set of keywords like ``semaphore'', ``polymorphism'', and ``ontology'' were mentioned within Computer Science literature and tracked the seminal study that borrowed those terms from original fields by citations. We marked these events as semantic evolution points. Through this manual investigation method, we can identify term evolution across different academic fields. This study reports our initial findings that will seed future automated and computational methods of incorporating concepts from additional academic fields.