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Abstract

Background and Aim:

Opioid Use Disorder (OUD) is a major public health issue, exacerbated by public stigma that hinders treatment-seeking and social integration. This study aimed to adapt and validate a social-contact-based intervention to reduce public stigma against individuals with OUD in India, ensuring cultural relevance and feasibility.

Methods:

The study followed a two-phase approach: adaptation and validation using the ADAPT framework and Delphi method with 14 multi-disciplinary experts and people with lived experience (PWLE), and pre-experimental, open-label pilot study assessing feasibility, acceptability, and preliminary impact on stigma. Participants (n = 30) attended a 60- to 90-min session combining an educational component with direct social contact with PWLE. Stigma was assessed using a validated questionnaire at baseline, 48 hr, and 3 months. Correlation analysis was done between total stigma and domain-wise scores.

Results:

The intervention achieved a 90% session completion rate, with 69.2% of approached individuals consenting to participate. Acceptability measures indicated high engagement, with 90% of participants rating the session as useful, although 36.6% found it challenging to reconcile with pre-existing beliefs. Stigma scores significantly improved at 48 hr post-intervention in the Attribution Blame domain (p = .002) and Attribution Exoneration domain (p = .079, trend toward significance). Partial attenuation of stigma reduction effects was observed at 3 months. The Total Stigma Score was significantly correlated with Punishment (r = .733, p < .001), Social Threat (r = .681, p < .001), and Attribution Blame (r = .609, p < .001). Attribution Exoneration negatively correlated with Punishment (r = −.373, p < .05).

Conclusion:

This study demonstrates the feasibility and acceptability of a culturally adapted, social-contact-based intervention for reducing public stigma against OUD. Shifting blame perceptions may help reduce punitive attitudes.

Keywords

opioid use disorder public stigma social contact education intervention validation

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References

Ambekar

Agrawal

Rao

Mishra

A. K.

Khandelwal

S. K.

Chadda

R. K.

(2019). Magnitude of substance use in India. New Delhi: Ministry of Social Justice and Empowerment, Government of India. https://pib.gov.in/Pressreleaseshare.aspx?PRID=1565001

Ambekar

Murthy

Basu

Rao

G. P.

Mohan

(2017). Challenges in the scale-up of opioid substitution treatment in India. Indian Journal of Psychiatry, 59, 6–9. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_14_17

Ambekar

Rao

Agrawal

(2013). India’s National Narcotic Drugs and Psychotropic Substances policy, 2012: A 20th century document in the 21st century. The International Journal on Drug Policy, 24, 374–375. https://doi.org/10.1016/j.drugpo.2013.01.001

Avasthi

Basu

Subodh

B. N.

Gupta

P. K.

Sidhu

B. S.

Gargi

P. D.

Sharma

Ghosh

Rani

(2018). Epidemiology of substance use and dependence in the state of Punjab, India: Results of a household survey on a statewide representative sample. Asian Journal of Psychiatry, 33, 18–29. https://doi.org/10.1016/j.ajp.2018.02.017

Basu

Ghosh

Hazari

Parakh

(2016). Use of family CAGE-AID questionnaire to screen the family members for diagnosis of substance dependence. The Indian Journal of Medical Research, 143(6), 722–730. https://doi.org/10.4103/0971-5916.191931

Birnschein

A. M.

Paisley

C. A.

Tomeny

T. S.

(2021). Enhancing social interactions for youth with autism spectrum disorder through training programs for typically developing peers: A systematic review. Research in Autism Spectrum Disorders, 84, Article 101784. https://doi.org/10.1016/j.rasd.2021.101784

Can Gür

Yılmaz

(2023). Effectiveness of interventions in reducing substance-related stigma: A systematic review and meta-analysis of randomized controlled trials. Issues in Mental Health Nursing, 44(3), 162–175. https://doi.org/10.1080/01612840.2022.2163439

Carrara

B. S.

Fernandes

R. H. H.

Bobbili

S. J.

Ventura

C. A. A.

(2020). Health care providers and people with mental illness: An integrative review on anti-stigma interventions. International Journal of Social Psychiatry, 67(7), 840–853. https://doi.org/10.1177/0020764020985891

Cheetham

Picco

Barnett

Lubman

D. I.

Nielsen

(2022). The impact of stigma on people with opioid use disorder, opioid treatment, and policy. Substance Abuse and Rehabilitation, 13, 1–12. https://doi.org/10.2147/sar.s304566

10.

Clark

T. W.

(2020). Determinism and destigmatization: Mitigating blame for addiction. Neuroethics, 14(2), 219–230. https://doi.org/10.1007/s12152-020-09440-w

11.

Clinton

A. J.

Pollini

R. A.

(2021). Using positive empathy interventions to reduce stigma toward people who inject drugs. Frontiers in Psychology, 12, Article 616729. https://doi.org/10.3389/fpsyg.2021.616729

12.

Corrigan

P. W.

(2011). Best practices: Strategic stigma change (SSC): Five principles for social Marketing campaigns to reduce stigma. Psychiatric Services, 62(8), 824–826. https://doi.org/10.1176/ps.62.8.pss6208_0824

13.

Corrigan

P. W.

Nieweglowski

(2018). Stigma and the public health agenda for the opioid crisis in America. International Journal of Drug Policy, 59, 44–49. https://doi.org/10.1016/j.drugpo.2018.06.015

14.

Corrigan

P. W.

Michaels

P. J.

Morris

(2015). Do the effects of antistigma programs persist over time? Findings from a meta-analysis. Psychiatric Services, 66(5), 543–546. https://doi.org/10.1176/appi.ps.201400291

15.

Council for International Organizations of Medical Sciences. (2016). International ethical guidelines for health-related research involving humans.

16.

Degenhardt

Grebely

Stone

Hickman

Vickerman

Marshall

B. D. L.

Bruneau

Altice

F. L.

Henderson

Rahimi-Movaghar

Larney

(2019). Global patterns of opioid use and dependence: Harms to populations, interventions, and future action. The Lancet, 394(10208), 1560–1579. https://doi.org/10.1016/S0140-6736(19)32229-9

17.

Earnshaw

V. A.

(2020). Stigma and substance use disorders: A clinical, research, and advocacy agenda. American Psychologist, 75(9), 1300–1311. https://doi.org/10.1037/amp0000744

18.

El Hayek

Foad

de Filippis

Ghosh

Koukach

Mahgoub Mohammed Khier

Pant

S. B.

Padilla

Ramalho

Tolba

Shalbafan

(2024). Stigma toward substance use disorders: A multinational perspective and call for action. Frontiers in Psychiatry, 15, Article 1295818. https://doi.org/10.3389/fpsyt.2024.1295818

19.

Ending discrimination against people with mental and substance use disorders. (2016). National Academies Press eBooks. https://doi.org/10.17226/23442

20.

Fetterhoff

(2023). Substance abuse stigma: Concept analysis. Journal of Addictions Nursing, 34(4), E195–E200. https://doi.org/10.1097/JAN.0000000000000531

21.

Gautham

M. S.

Gururaj

Varghese

Benegal

Rao

G. N.

Kokane

Chavan

B. S.

Dalal

P. K.

Ram

Pathak

Singh

R. K. L.

Singh

L. K.

Sharma

Saha

P. K.

Ramasubramanian

Mehta

R. Y.

Shibukumar

T. M.

Deuri

S. P.

Krishnatreya

. . . Majhi

(2020). The National Mental Health Survey of India (2016): Prevalence, socio-demographic correlates and treatment gap of mental morbidity. International Journal of Social Psychiatry, 66(4), 361–372. https://doi.org/10.1177/0020764020907941

22.

Ghosh

Sharma

Sood

Sharma

(2024). Unveiling the landscape of antistigma interventions for individuals with substance use disorders: A scoping review. Indian Journal of Psychiatry, 66(12), 1101–1123. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_770_24

23.

Goffman

(1963). Stigma: Notes on the management of spoiled identity. Prentice-Hall.

24.

Griffiths

K. M.

Carron-Arthur

Parsons

Reid

(2014). Effectiveness of programs for reducing the stigma associated with mental disorders. A meta-analysis of randomized controlled trials. World Psychiatry, 13(2), 161–175. https://doi.org/10.1002/wps.20129

25.

Hatzenbuehler

M. L.

Link

B. G.

(2014). Introduction to the special issue on structural stigma and health. Social Science & Medicine, 103, 1–6. https://doi.org/10.1016/j.socscimed.2013.12.017

26.

Humeniuk

Ali

Babor

T. F.

Farrell

Formigoni

M. L.

Jittiwutikarn

de Lacerda

R. B.

Ling

Marsden

Monteiro

Nhiwatiwa

Pal

Poznyak

Simon

(2008). Validation of the alcohol, smoking and substance involvement screening test (ASSIST). Addiction, 103(6), 1039–1047. https://doi.org/10.1111/j.1360-0443.2007.02114.x

27.

Kelly

J. F.

Saitz

Wakeman

(2016). Language, substance use disorders, and policy: The need to reach consensus on an “Addiction-ary.” Alcoholism Treatment Quarterly, 34(1), 116–123. https://doi.org/10.1080/07347324.2016.1113103

28.

Kelly

J. F.

Westerhoff

C. M.

(2010). Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms. The International Journal on Drug Policy, 21(3), 202–207. https://doi.org/10.1016/j.drugpo.2009.10.010

29.

Koschorke

Evans-Lacko

Sartorius

Thornicroft

(2017). Stigma in different cultures. In Gaebel

Rössler

Sartorius

(Eds.), The stigma of mental illness—End of the story? (pp. 67–82). Springer. https://doi.org/10.1007/978-3-319-27839-1_4

30.

Livingston

J. D.

Milne

Fang

M. L.

Amari

(2012). The effectiveness of interventions for reducing stigma related to substance use disorders: A systematic review. Addiction, 107(1), 39–50. https://doi.org/10.1111/j.1360-0443.2011.03601.x

31.

McManus

J. L.

Saucier

D. A.

Reid

J. E.

(2021). A meta-analytic review of interventions to improve children’s attitudes toward their peers with intellectual disabilities. Contemporary Educational Psychology, 65, Article 101948. https://doi.org/10.1016/j.cedpsych.2021.101948

32.

Ministry of Health and Family Welfare, Government of India. (2014). National Mental Health Programme (NMHP). Retrieved February 12, 2025, from https://mohfw.gov.in/?q=Major-Programmes/non-communicable-diseases-injury-trauma/National-Mental-Health-Programme-NMHP

33.

Moore

Campbell

Copeland

Craig

Movsisyan

Hoddinott

Littlecott

O’Cathain

Pfadenhauer

Rehfuess

Segrott

Hawe

Kee

Couturiaux

Hallingberg

Evans

(2021). Adapting interventions to new contexts—The ADAPT guidance. BMJ, 374, Article n1679. https://doi.org/10.1136/bmj.n1679

34.

Morris

O’Reilly

Nayyar

(2021). Classroom-based peer interventions targeting autism ignorance, prejudice and/or discrimination: A systematic PRISMA review. International Journal of Inclusive Education, 27(13), 1389–1433. https://doi.org/10.1080/13603116.2021.1900421

35.

National Institute on Drug Abuse. (n.d.) Drug misuse and addiction. Retrieved August 11, 2023, from https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/drug-misuse-addiction

36.

Rivera

K. J.

Zhang

J. Y.

Mohr

D. C.

Wescott

A. B.

Pederson

A. B.

(2021). A narrative review of mental illness stigma reduction interventions among African Americans in The United States. Journal of Mental Health & Clinical Psychology, 5(2), 20–31. https://doi.org/10.29245/2578-2959/2021/2.1235

37.

Sekhon

Cartwright

Francis

J. J.

(2017). Acceptability of healthcare interventions: An overview of reviews and development of a theoretical framework. BMC Health Services Research, 17(1), Article 88. https://doi.org/10.1186/s12913-017-2031-8

38.

Taylor

(2020). We agree, don’t we? The Delphi Method for Health Environments Research. HERD, 13(1), 11–23. https://doi.org/10.1177/1937586719887709

39.

Thornicroft

Sunkel

Alikhon Aliev

Baker

Brohan

El Chammay

Davies

Demissie

Duncan

Fekadu

Gronholm

P. C.

Guerrero

Gurung

Habtamu

Hanlon

Heim

Henderson

Hijazi

Hoffman

. . . Winkler

(2022). The Lancet Commission on ending stigma and discrimination in mental health. Lancet, 400(10361), 1438–1480. https://doi.org/10.1016/S0140-6736(22)01470-2

40.

Whitehead

A. L.

Julious

S. A.

Cooper

C. L.

Campbell

M. J.

(2016). Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable. Statistical Methods in Medical Research, 25(3), 1057–1073. https://doi.org/10.1177/0962280215588241

41.

United Nations Office on Drugs and Crime. (n.d.-a). World drug report 2022. Retrieved February 13, 2025, from https://www.unodc.org/unodc/data-and-analysis/world-drug-report-2022.html

42.

United Nations Office on Drugs and Crime. (n.d.-b). World drug report 2024. Retrieved February 13, 2025, from https://www.unodc.org/unodc/en/data-and-analysis/world-drug-report-2024.html

43.

Yang

L. H.

Wong

L. Y.

Grivel

M. M.

Hasin

D. S.

(2017). Stigma and substance use disorders: An international phenomenon. Current Opinion in Psychiatry, 30(5), 378–388. https://doi.org/10.1097/YCO.0000000000000351

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Acceptability and Feasibility of a Social Contact Based Intervention for Reduction of Public Stigma Against Persons With Opioid Use Disorder

Abstract

Background and Aim:

Methods:

Results:

Conclusion:

Keywords

Get full access to this article

References

Supplementary Material