Reduction in substance use stigma following a peer-recovery specialist behavioral activation intervention

• Published in: The International journal of drug policy 2024-08, Vol.130, p.104511, Article 104511
• Main Authors: Kleinman, Mary B., Anvari, Morgan S., Felton, Julia W., Bradley, Valerie D., Belcher, Annabelle M., Abidogun, Tolulope M., Hines, Abigail C., Dean, Dwayne, Greenblatt, Aaron D., Wagner, Michael, Earnshaw, Valerie A., Magidson, Jessica F.
• Format: Article
• Language: English
• Subjects: Adult; Behavior Therapy - methods; Behavioral activation; Female; Humans; Male; Methadone; Methadone - administration & dosage; Methadone - therapeutic use; Middle Aged; Opiate Substitution Treatment; Opioid use disorder; Opioid-Related Disorders - rehabilitation; Peer Group; Peer recovery specialist; Pilot Projects; Social Stigma; Stigma; Substance-Related Disorders - rehabilitation; Treatment Outcome
• ISSN: 0955-3959; 1873-4758; 1873-4758
• DOI: 10.1016/j.drugpo.2024.104511

•Patient perceived stigma is a barrier to treatment of opioid use disorder.•Interventions led by peer recovery specialists (PRS) may shift stigma.•This study evaluated shift in stigma during a PRS-delivered intervention.•There was a decrease in substance use (SU) but not methadone treatment (MT) stigma.•Decreases in stigma may serve to improve MT and other SU-related outcomes. Patients’ perceptions and experiences of stigma related to substance use and methadone treatment are barriers to successful treatment of opioid use disorder, particularly among low-income and medically underserved populations. Interventions led by peer recovery specialists (PRSs) may shift stigma-related barriers. This study sought to evaluate shifts in substance use and methadone treatment stigma in the context of an evidence-based behavioral intervention adapted for PRS delivery to support methadone treatment outcomes. We recruited patients who had recently started methadone treatment or demonstrated difficulty with adherence from a community-based program (N = 37) for an open-label pilot study of a 12-session behavioral activation intervention led by a PRS interventionist. Participants completed substance use and methadone treatment stigma assessments and the SIP-R, a brief measure of problems related to substance use, at baseline, mid-point (approximately six weeks), and post-treatment (approximately 12 weeks). Generalized estimating equations assessed change in total stigma scores between baseline and post-treatment as well as change in stigma scores associated with change in SIP-R responses. There was a statistically significant decrease in substance use stigma (b(SE)=-0.0304 (0.0149); p = 0.042) from baseline to post-treatment, but not methadone treatment stigma (b(SE)=-0.00531 (0.0131); p = 0.68). Decreases in both substance use stigma (b(SE)=0.5564 (0.0842); p < 0.001) and methadone treatment stigma (b(SE)=0.3744 (0.1098); p < 0.001) were associated with a decrease in SIP-R scores. PRS-led interventions have potential to shift substance use stigma, which may be associated with decrease in problems related to substance use, and therefore merit further testing in the context of randomized controlled trials.