Dr. Kelli Scott recently hosted the Addiction Science Journal Club’s first Twitter Chat discussing her manuscript, “Health Professional Stigma as a Barrier to Contingency Management Implementation in Opioid Treatment Programs” on Friday, March 12th. The study was funded by an Opioids COBRE awarded to Dr. Sara Becker to evaluate opioid treatment provider contingency management preferences. This article features highlights from Dr. Scott's Twitter Chat Q&A.
When asked what motivated her to write this paper, Dr. Scott responded with background on the project itself, funded by Opioids COBRE, that interviewed treatment providers and leadership at opioid treatment programs (OTPs) here in Rhode Island. They were surprised by the frequency of stigmatizing language and number stigmatizing themes that came up in discussions and felt that stigma was a potential barrier to implementation of evidence-based treatments, contingency management in particular. As a result, the team decided to "dig into the data" and code stigmatizing language and themes.
When addressing what addiction scientists should be doing to reduce stigma in the community as well as self-stigma, Dr. Scott mentioned a four pronged approach. First, both provider and client stigma should be considered in studies, either qualitatively or quantitatively, to help identify whether stigma may be a barrier. Second, involving community partners, treatment agencies, persons in recovery, and those who use drugs can be crucial for understanding how stigma works and it's impact. Third, scientists should consider participating in initiatives such as anti-stigma campaigns or connecting with Departments of Health regarding their substance use messaging as a way to get involved in their communities. Finally, self-reflecting on their own beliefs, assumptions, or experiences and how that may impact how they conduct studies focused on substance use should be considered by scientists.
The next question asked what surprised her most about the results. Dr. Scott's responded, "We were surprised how prevalent the stigmatizing language and beliefs were in our interviews! 86% of the interviews contained stigmatizing language and nearly half included both stigmatizing language and other stigma themes. To understand these findings, we invited Dr. Linda Hurley, CEO of one of our agency partners, to be a co-author. She helped us understand that the stigmatizing beliefs were not ill-intentioned, but often part of the agency norms. As clinicians, we are often trained to meet clients where they are and use their language, which may explain why providers commonly use these terms. Providers who are also members of the recovery community may use this language as well. However, not all clients may be receptive to a provider using language like “addict” in counseling. We often have a brief window to engage people in treatment, and using person-centered, non-stigmatizing language can be beneficial."
When posed with the questions on how qualitative methods can continue to help understand and address substance use disorder stigma, Dr. Scott first responded with her enthusiasm toward qualitivate methods. She explained that they never would have identified stigma as a potential barrier to contingency management (CM) without qualititative work and those interviews provide rich elaboration on quantitative surveys. While they do use a survey to assess provider attitudes about CM, it was helpful to them to get a sense of the specific lanugage and themes that providers discussed in the interviews. Dr. Becker also chimed into the narrative to mention that knowledge about the common stigma themes guided thier CM implementaion, for example, use of person-centered language and education to address assumptions about CM incentives was incorporated into their CM trainings.
Givent that CM has recently been receiving press coverage, Dr. Scott was asked her opinions on if this media attention may help to reduce stigmatizing views about CM in the community. She expressed that this is an important first step to reducing stigma and the lanugage used to discuss substance use, overdoses, treatment, and recovery in the media can set a standard for how we all talk about them, but it doesn't end there. Dr. Scott emphasized the need for a multifaceted approach to combat stigma in a variety of settings including, but not limited to: medical education, counseling education, continuing education requirements, and in communities. The need for studies on strategies for reducting stigma to identify effective ways to shift norms and beliefs that are stigmatizing.
The last question Dr. Scott addressed in the Q&A session was about the main takeaway from her finding that she'd like people to remember. The overarching message she conveyed is that it is important to consider and measure stigma when studying substance use treatment. While the treatment may be effective, it may not get off the groud if stigma is present and there isn't buy in from providers. "We talk a lot about addressing barriers and facilitators in implementation science, and stigma may be an important, but understudied, barrier to CM and other treatments for substance use. Would love to see more scientists assessing/addressing stigma" said Scott.
To access the full series of questions and responses, visit The Addiction Science Journal Club (@AddictionSciJC) on Twitter.