<b>Social Isolation, Perceived Stigma, Avoidance Behaviour And Sucidial Ideation Among Individuals With Substance Use Disorder: A Cross Sectional Study</b>

Substance Use Disorder (SUD) is linked to several psychosocial issues, including social isolation, perceived stigma, avoidance behavior, and suicidal ideation. Individuals with SUD often experience social rejection and internalize negative societal attitudes, leading to emotional distress and withdrawal from support systems. To cope, many engage in avoidance behaviors, which further isolate them and increase the risk of suicidal thoughts. These interconnected factors create a cycle of psychological pain that worsens over time. Despite their significance, these variables are not well studied together, especially in culturally sensitive contexts like Pakistan. Understanding these relationships is essential for developing effective interventions to reduce suicide risk and support recovery in individuals with SUD. The purpose of this study is to investigate the relationship between social isolation, perceived stigma, avoidance behavior, and suicidal ideation in adults undergoing treatment for substance use disorder (SUD). A cross-sectional design used with a sample of 120 adults participating in admitted in SUD treatment centers. Standardized scales, such as the University of California, Los Angeles   Loneliness Scale, Substance Use Stigma Mechanisms Scale,  Brief  Experiential Avoidance Questionnaire and Suicidal Behaviors Questionnaire-Revised (SBQ-R), will be utilized to assess core variables. Pearson correlations revealed that suicidal ideation was positively and significantly associated with social isolation (r = .35, p < .01), perceived stigma (r = .33, p < .01), and avoidance behavior (r = .41, p < .01), with avoidance behavior showing the strongest relationship. Results showed that all three predictors were positively and significantly correlated with suicidal ideation, and the regression model accounted for 46% of the variability in suicidal ideation scores. The findings are significant theoretically as well as practically for suicide prevention. The findings show avoidance behavior to have the strongest correlation with suicidal Ideation (β = 1.34, p < .001). Results showed that avoidance behavior mediates the effect of stigma on suicidal ideation. Findings also revealed that perceived stigma is a stronger predictor of suicidal ideation. It is concluded that these results highlight the importance of avoidance behavior and perceived stigma in the development of suicidal ideation among those with SUD. Interventions focus on these psychosocial constructs might thus substantially strengthen suicide prevention with patients in this population.