Developing Communication Strategies to Reduce Addiction Stigma

Summary

Fifty-seven million people in the U.S. report nonmedical drug use in the past year, and eight million people over the age of 12 have a drug use disorder.¹ Drug use is highly stigmatized.^2,3 Stigma occurs when a group of people, such as those experiencing addiction, are labelled and stereotyped with negative attributes, resulting in loss of status and discrimination.⁴ For example, 90% of U.S. adults are unwilling to have someone with drug addiction marry into their family and 78% are unwilling to have a person with drug addiction work with them on a job. Stigmatizing attitudes are not limited to the public. Three-quarters of doctors are unwilling to have a person with opioid use disorder marry into their family and two-thirds view people with opioid use disorder as dangerous.⁵

While evidence-based interventions to support recovery and prevent overdose exist, they are severely under-implemented, in large part due to the stigma around addiction and lack of support among the public, some treatment providers, and policymakers.^3,6 Medication for opioid use disorder and overdose prevention sites are two examples of effective interventions to address addiction and overdose that are not widely implemented due to lack of public and key actor support.^3,6,7

To address addiction stigma and increase support for expanding evidence-based interventions, government agencies and advocacy groups have implemented messaging campaigns through television, radio, social media, billboards, and other channels. However, the evidence base for which communication strategies successfully reduce addiction stigma is extremely limited.² The Johns Hopkins Center for Mental Health and Addiction Policy launched the Stigma Lab research portfolio to address this gap.¹¹ The Stigma Lab conducts randomized experiments testing the effects of different communication strategies on addiction stigma, perceived effectiveness of evidence-based interventions, and support for policies to scale-up those interventions. 

Significance

Broader support among the public, policymakers, and people with substance use disorders is critical to scale up addiction prevention and treatment interventions. Support from these groups also increases the likelihood that policies and practices will be adopted and implemented as intended.^8,9 Reducing stigma can also enhance engagement in services by people with addiction and ultimately increase recovery.¹⁰ Stigma Lab research produces actionable findings that can inform the development of public health campaigns to reduce addiction stigma and increase support for evidence-based interventions led by government agencies, advocacy groups, healthcare systems, and others. The portfolio of Stigma Lab research has already been used by a wide range of actors, including state health departments, the Joe Biden Presidential Campaign, and the United Nations.

Stigma Lab is also working to address the compounding effects of stigma related to race, class, and other social factors when coupled with addiction stigma.^11–16 For example, one Stigma Lab experiment demonstrated that members of the public were more likely to stigmatize a low-socioeconomic status pregnant woman experiencing addiction than a high-socioeconomic status pregnant woman. The researchers also found that messages about systemic barriers to treatment faced by low-socioeconomic status pregnant women increased support for expanding insurance coverage for drug addiction treatment, a policy change that could significantly increase access to effective addiction care by this group.¹⁷ Addiction stigma reduction could also reduce support for ineffective punitive approaches to reduce substance use, such as arrest and incarceration, which are disproportionally experienced by Black people, despite similar rates of drug use among whites and Blacks.¹⁸

Benefits

Demonstrated benefits are those that have been observed and are verifiable.

Potential benefits are those logically expected with moderate to high confidence.

The National Institute on Drug Abuse used Stigma Lab research to develop guidelines for doctors on how reduce stigma when talking about addiction with pregnant women and mothers.¹⁹ demonstrated.

Clinical

Guidelines

Stigma Lab developed effective addiction-stigma reduction messages with the Johns Hopkins Health System that will be disseminated through multiple communication channels and made available to other health systems for broader dissemination.²⁰ demonstrated.

Community

Health education resources

Stigma Lab identified effective addiction-stigma reduction messages and collaborated on campaign design with the state of West Virginia. demonstrated.

Community

Health education resources

Campaigns informed by Stigma Lab research could reduce stigma and discriminatory practices among healthcare providers towards people with addiction. potential.

Community

Health care quality

Reductions in addiction stigma among healthcare providers could increase engagement in services and increase recovery by people with addiction. potential.

Community

Life expectancy & quality of life

Stigma Lab helped West Virginia develop the state’s strategic plan around addiction stigma reduction. demonstrated.

Community

Public health practices

Dr. McGinty, one of the Stigma Lab core faculty, serves on the United Nations Technical Consultation Panel on Stigma Reduction and Drug Use.²¹ demonstrated.

Policy

Committee participation

The U.N. Technical Consultation Panel on Stigma Reduction and Drug Use is developing a final report, informed by Stigma Lab research, to serve as a blueprint for stigma reduction policies and practices in U.N. member states.²¹ potential.

Policy

Scientific research reports

Stigma Lab research directly informed the terminology used in city legislation to legalize facilities in which people can safely use pre-obtained drugs under medical supervision. This intervention has been shown to prevent infectious disease transmission and fatal overdose.²² demonstrated.

Policy

Legislation

As a member of the Joe Biden campaign/transition team behavioral health committee, Dr. McGinty led the development of a draft executive order detailing actions the federal government could take to reduce addiction stigma. potential.

Policy

Policies

This research has clinical, community, and policy implications. The framework for these implications was derived from the Translational Science Benefits Model created by the Institute of Clinical & Translational Sciences at Washington University in St. Louis.

Clinical

The National Institute on Drug Abuse used Stigma Lab research to develop health education for doctors on how to reduce stigma when discussing addiction with pregnant women and mothers.¹⁹ Stigma Lab’s research has the potential to improve the quality of care, including addiction treatment, received by people with addiction.

Community

Stigma Lab researchers developed and tested addiction stigma reduction campaigns for health systems and community settings. Using a large national sample of health professionals, Stigma Lab showed that several strategies reduced addiction stigma among health professionals: combining images and text, including messages about the importance of non-stigmatizing language and the value of medications to treat opioid use disorder, and delivering messages from the perspective of a patient with addiction or a health system administrator (unpublished data, 2021). The campaign will be disseminated in 2021-2022 in the Johns Hopkins Health System through electronic bulletin boards, screensavers, and the Johns Hopkins website. The campaign will also be made available to other health systems for broader dissemination.

Stigma Lab also worked with the West Virginia Governor’s Council Public Education & Stigma Awareness Action Group to develop the state’s strategic plan on reducing addiction stigma. Researchers also helped West Virginia develop and disseminate stigma reduction campaigns, including a campaign to decrease the stigma surrounding medication for opioid use disorder.²⁴ Disseminating Stigma Lab research through statewide media campaigns can reduce addiction stigma in communities, which can increase support for and use of evidence-based addiction interventions in community settings.

Policy

Stigma Lab research has informed local, federal, and international stigma reduction policy. For example, Stigma Lab researchers found that using the term “overdose prevention site” instead of “safe consumption site” increased public support for this politically controversial but evidence-based intervention by more than 15 percent.²³ As a result, Baltimore updated legislation to legalize facilities where people can safely use pre-obtained drugs under medical supervision. At the time of the experiment, “safe consumption site” (or sometimes the similar “safe injection site”) was commonly used by the harm reduction community, including in previous versions of the Baltimore proposal.^22,24

Stigma Lab Core researcher Dr. Beth McGinty also served on the Joe Biden campaign/transition team to develop an executive order detailing actions the federal government could take to reduce addiction stigma, including requiring that all federal agencies use non-stigmatizing, person-centered language in all internal and external-facing documents, websites, policies, and other materials, and replacing the term “addict,” which has been shown to be stigmatizing, with the clinically correct “person with substance use disorder.” The executive order has been fully drafted and could be implemented during the Biden Administration. Dr. McGinty also serves on the United Nations Technical Consultation Panel on Stigma Reduction and Drug Use, which is developing a final report for U.N. member states on policies and practices to reduce addiction stigma, including messages emphasizing treatment effectiveness.²¹

Lessons Learned

Committing to partnership opportunities was critical to achieve impact.  This included devoting significant time and effort to planned partnerships, in which community and policy partners were involved in the project from the outset, but it also involved seizing new partnership opportunities as they arose. The unexpected partnerships, which often came to be through organic interactions with decisionmakers – sometimes designed to be about a totally different topic – proved to be really critical in facilitating the reach and impact of the research.