Objective: The current study sought to examine the relationships among mental health/substance use severity, self-esteem, and components of self-stigma among individuals with co-occurring schizophrenia-spectrum and substance use disorders. Stereotype concurrence, or the internalization of negative preconceptions associated with membership in a stigmatized group, was hypothesized as a mediator.

Methods: Forty-nine subjects with co-occurring schizophrenia-spectrum and substance use disorders completed self-stigma, mental health, substance use, and self-esteem assessments. A multiple regression was employed to identify direct effects. Bootstrap mediator analyses were used to identify indirect effects through the hypothesized mediator: stereotype concurrence.

Results: Aside from polysubstance dependence (49%), most subjects had a diagnosed co-occurring alcohol use disorder (43%). Dysphoria and alcohol severity were negatively related to self-esteem. Stereotype concurrence mediated the relationship between autistic preoccupation and self-esteem.

Conclusions: Self-stigma was related to decreased self-esteem in individuals with a diagnosed co-occurring schizophrenia-spectrum and substance use disorder, which is consistent with previous findings that have linked self-stigma to decreased self-esteem in individuals with either disorder alone. Decreased self-esteem has been linked to treatment noncompliance and relapses, impeding recovery, while improvements in self-esteem have been shown to be an important consequence of stigma reduction. Treatment implications are discussed.