Predicting Willingness to Use MOUD: An Application of the Theory of Reasoned Action and Theory of Planned-Behavior

Abstract

This study applied the Theory of Reasoned Action (TRA) and Theory of Planned Behavior (TPB) to assess predictors of willingness to use three medications (methadone, buprenorphine, naltrexone) for opioid use disorder (MOUD), among people who use opioids (PWUOs). A single assessment survey, with measures aligned to the TRA/TPB were administered to 235, majority male, predominately White, PWUOs attending syringe services programs (SSPs) in the Southeastern United States. Hierarchical multiple regressions were used to analyze predictors of willingness to take each type of MOUD. Findings partially supported the TRA but not TPB, with positive attitudes associated with greater willingness to use all three types of MOUD: pinpointing to the value of SSPs as a low threshold hub for treatment engagement.

Keywords

people who use opioids medications for opioid use disorder theory of planned behavior theory of reasoned action

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References

Ajzen

(1985). From intentions to actions: A theory of planned behavior. In Kuhl

Beckmann

(Eds.), Action-control: From cognition to behavior (pp. 1–39). Springer.

Ajzen

(2012). Martin Fishbein’s legacy: The reasoned action approach. The Annals of the American Academy of Political and Social Science, 640(1), 11–27. https://doi.org/10.1177/0002716211423363

Alanis-Hirsch

Croff

Ford

J. H. I. I.

Johnson

Chalk

Schmidt

McCarty

(2016). Extended-release naltrexone: A qualitative analysis of barriers to routine use. Journal of Substance Abuse Treatment, 62, 68–73. https://doi.org/10.1016/j.jsat.2015.10.003

Altekruse

S. F.

Cosgrove

C. M.

Altekruse

W. C.

Jenkins

R. A.

Blanco

(2020). Socioeconomic risk factors for fatal opioid overdoses in the United States: Findings from the mortality disparities in American communities study (MDAC). PLoS One, 15(1), Article e0227966. https://doi.org/10.1371/journal.pone.0227966

Andraka-Christou

Capone

M. J.

(2018). A qualitative study comparing physician-reported barriers to treating addiction using buprenorphine and extended-release naltrexone in US office-based practices. International Journal of Drug Policy, 54, 9–17. https://doi.org/10.1016/j.drugpo.2017.11.021

Bagley

S. M.

Schoenberger

S. F.

dellaBitta

Lunze

Barron

Hadland

S. E.

Park

T. W.

(2023). Ambivalence and stigma beliefs about medication treatment among young adults with opioid use disorder: A qualitative exploration of young adults’ perspectives. Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 72(1), 105–110. https://doi.org/10.1016/j.jadohealth.2022.08.026

Bagozzi

R. P.

Wong

Abe

Bergami

(2000). Cultural and situational contingencies and the theory of reasoned action: Application to fast food restaurant consumption. Journal of Consumer Psychology, 9(2), 97–106. https://doi.org/10.1207/S15327663JCP0902_4

Baharom

Hassan

M. R.

Ali

Shah

S. A.

(2012). Improvement of quality of life following 6 months of methadone maintenance therapy in Malaysia. Substance Abuse Treatment, Prevention, and Policy, 7, 1–6. https://doi.org/10.1186/1747-597X-7-32

Biancarelli

D. L.

Biello

K. B.

Childs

Drainoni

Salhaney

Edeza

Mimiaga

M. J.

Saitz

Bazzi

A. R.

(2019). Strategies used by people who inject drugs to avoid stigma in healthcare settings. Drug and Alcohol Dependence, 198, 80–86. https://doi.org/10.1016/j.drugalcdep.2019.01.037

10.

Brooks

McHenry

(2024). A contemporary approach to substance use disorders and addiction counseling (3rd ed.). American Counseling Association.

11.

Cederbaum

J. A.

Lee

W. J.

Okine

Duan

Lee

J. O.

(2021). Using the theory of reasoned action to examine grandparent and maternal substance use on the cannabis use of children of teen mothers. Drug and Alcohol Dependence, 228, Article 109019. https://doi.org/10.1016/j.drugalcdep.2021.109019

12.

Center for Disease Control and Prevention . (2023). National center for health statistics: Provisional drug overdose death counts. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm#nature_sources_of_data

13.

Cioe

Biondi

B. E.

Easly

Zheng

Springer

S. A.

(2020). A systematic review of patients’ and providers’ perspectives of medications for treatment of opioid use disorder. Journal of Substance Abuse Treatment, 119, Article 108146. https://doi.org/10.1016/j.jsat.2020.108146

14.

Consolidated Appropriations Act . (2023). Public law No 117-328. https://www.govinfo.gov/app/details/PLAW-117publ328

15.

DeFlavio

J. R.

Rolin

S. A.

Nordstrom

B. R.

Kazal

L. A.

(2015). Analysis of barriers to adoption of buprenorphine maintenance therapy by family physicians. Rural and Remote Health, 15(1), 93–103. https://doi.org/10.3316/informit.197379083164565

16.

Filiatreau

L. M.

Szlyk

H. S.

Kasson

Dickson

M. F.

Banks

Winograd

Marotta

Cavazos-Rehg

(2025). Attitudes and subjective norms regarding medication for opioid use disorder among individuals in treatment for opioid use disorder in the greater St. Louis area. Journal of Drug Issues, 55(3), 401–419. https://doi.org/10.1177/00220426241229972

17.

Fishbein

Ajzen

(1975). Belief; attitude, intention, and behavior: An introduction to theory and research. Addison-Wesley.

18.

Hamilton

C. M.

Strader

L. C.

Pratt

J. G.

Maiese

Hendershot

Kwok

R. K.

Hammond

J. A.

Huggins

Jackman

Pan

Nettles

D. S.

Beaty

T. H.

Farrer

L. A.

Kraft

Marazita

M. L.

Ordovas

J. M.

Pato

C. N.

Spitz

M. R.

Wagener

Haines

(2011). The PhenX toolkit: Get the Most from your measures. American Journal of Epidemiology, 174(3), 253–260. https://doi.org/10.1093/aje/kwr193

19.

Hatch

M. A.

Laschober

T. C.

Paschen-Wolff

Ertl

M. M.

Nelson

C. M.

Wright

Lancaster

Feaster

D. J.

Forrest

Hankey

Monger

Fegley

J. P.

Irving

Young

Rose

Spector

Dresser

Moran

Jelstrom

Tross

(2024). PrEP for people who use opioids: A NIDA clinical trials network survey study in Southern U.S. cities where HIV incidence is high. Drug and Alcohol Dependence, 257, 111133. https://doi.org/10.1016/j/drugalcdep.2024.111133

20.

Ibragimov

Cooper

K. E.

Batty

Ballard

A. M.

Fadanelli

Gross

S. B.

Klein

E. M.

Lockard

Young

A. M.

Cooper

H. L. F.

(2021). Factors that influence enrollment in syringe services programs in rural areas: A qualitative study among program clients in appalachian Kentucky. Harm Reduction Journal, 18(1), 68. https://doi.org/10.1186/s12954-021-00518-z

21.

Jones

B. L. H.

Geier

Neuhaus

Coffin

P. O.

Snyder

H. R.

Soran

C. S.

Knight

K. R.

Suen

L. W.

(2024). Withdrawal during outpatient low dose buprenorphine initiation in people who use fentanyl: A retrospective cohort study. Harm Reduction Journal, 21(1), 80. https://doi.org/10.1186/s12954-024-00998-9

22.

Krawczyk

Rivera

B. D.

Jent

Keyes

K. M.

Jones

C. M.

Cerdá

(2022). Has the treatment gap for opioid use disorder narrowed in the US? A yearly assessment from 2010 to 2019. International Journal of Drug Policy, 110, Article 103786. https://doi.org/10.1016/j.drugpo.2022.103786

23.

Krawczyk

Rivera

B. D.

Levin

Dooling

B. C. E.

(2023). Synthesizing evidence of the effects of COVID-19 regulatory changes on methadone treatment for opioid use disorder: Implications for policy. The Lancet Public Health, 8(3), e238–e246. https://doi.org/10.1016/S2468-2667(23)00004-0

24.

Litchfield

White

(2006). Young adults’ willingness and intentions to use amphetamines: An application of the theory of reasoned action. E-Journal of Applied Psychology, 2(1), 45–51. https://eprints.qut.edu.au/225008/

25.

Mackey

Veazie

Anderson

Bourne

Peterson

(2020). Barriers and facilitators to the use of medications for opioid use disorder: A rapid review. Journal of General Internal Medicine, 35(Suppl 3), 954–963. https://doi.org/10.1007/s11606-020-06257-4

26.

McKellar

M. S.

Des Marais

A. C.

Chen

Choi

Lilly

Ayers

Bennett

Kestner

Perry

Poley

Corneli

Meade

C. S.

Sachdeva

(2024). Providing medication for opioid use disorder and HIV pre-exposure prophylaxis at syringe services programs via telemedicine: A pilot study. Harm Reduction Journal, 21(1), 69. https://doi.org/10.1186/s12954-024-00983-2

27.

Menold

(2020). How do reverse-keyed items in inventories affect measurement quality and information processing. Field Methods, 32(2), 140–158. https://doi.org/10.1177/1525822X198908

28.

Molloy

B. K.

Stock

M. L.

Dodge

Aspelund

J. G.

(2019). Predicting future academic willingness, intentions, and nonmedical prescription stimulant (NPS) use with the theory of reasoned action and prototype/willingness model. Substance Use & Misuse, 54(14), 2251–2263. https://doi.org/10.1080/10826084.2019.1645175

29.

Mutter

Ali

M. M.

Smith

Strashny

(2015). Factors associated with substance use treatment completion in residential facilities. Drug and Alcohol Dependence, 154, 291–295. https://doi.org/10.1016/j.drugalcdep.2015.07.004

30.

National Academies of Sciences, Engineering, and Medicine . (2019). Medications for opioid use disorder save lives. National Academies Press. https://doi.org/10.17226/25310

31.

Paquette

C. E.

Syvertsen

J. L.

Pollini

R. A.

(2018). Stigma at every turn: Health services experiences among people who inject drugs. International Journal of Drug Policy, 57, 104–110. https://doi.org/10.1016/j.drugpo.2018.04.004

32.

Rigg

K. K.

(2024). Attitudes toward extended-release naltrexone treatment for opioid use disorder among African Americans. Drug and Alcohol Dependence, 257, Article 111260. https://doi.org/10.1016/j.drugalcdep.2024.111260

33.

Roberto

A. J.

Shafer

M. S.

Marmo

(2014). Predicting substance-abuse treatment providers' communication with clients about medication-assisted treatment: A test of the theories of reasoned action and planned behavior. Journal of Substance Abuse Treatment, 47(5), 307–313. https://doi.org/10.1016/j.jsat.2014.06.002

34.

Romero

Friedman

J. R.

Goodman-Meza

Shover

C. L.

(2023). US drug overdose mortality rose faster among hispanics than non-Hispanics from 2010 to 2021. Drug and Alcohol Dependence, 246, Article 109859. https://doi.org/10.1016/j.drugalcdep.2023.10985

35.

Schuckit

M. A.

(2016). Treatment of opioid-use disorders. New England Journal of Medicine, 375(4), 357–368. https://doi.org/10.1056/NEJMra1604339

36.

Schwartz

R. P.

Kelly

S. M.

O'Grady

K. E.

Mitchell

S. G.

Peterson

J. A.

Reisinger

H. S.

Agar

M. H.

Brown

B. S.

(2008). Attitudes toward buprenorphine and methadone among opioid-dependent individuals. American Journal on Addictions, 17(5), 396–401. https://doi.org/10.1080/10550490802268835

37.

Shah

P. A.

Sohler

N. L.

López

Fox

A. D.

Cunningham

C. O.

(2013). Awareness of, experience with, and attitudes toward buprenorphine among opioid users visiting a New York City syringe exchange program. Journal of Opioid Management, 9(6), 407–413. https://doi.org/10.5055/jom.2013.0183

38.

Substance Abuse and Mental Health Services Administration (SAMHSA) . (nd). Methadone take-home flexibilities extension guidance. https://tinyurl.com/3p7uf4zm

39.

Substance Abuse & Mental Health Services Association (SAMHSA) . (2018). Medicaid coverage of medication-assisted treatment for alcohol and opioid use disorders and of medication for the reversal of opioid overdose. https://tinyurl.com/khk6chhs

40.

Ude

Behrends

C. N.

Kelly

Schackman

B. R.

Clear

Goldberg

Gelberg

Kapadia

S. N.

(2023). The effects of COVID-19 on New York State’s drug user health hubs and syringe service programs: A qualitative study. Harm Reduction Journal, 20(1), 12. https://doi.org/10.1186/s12954-023-00742-9

41.

Uebelacker

L. A.

Bailey

Herman

Anderson

Stein

(2016). Patients’ beliefs about medications are associated with stated preference for methadone, buprenorphine, naltrexone, or no medication-assisted therapy following inpatient opioid detoxification. Journal of Substance Abuse Treatment, 66, 48–53. https://doi.org/10.1016/j.jsat.2016.02.009

42.

Volkow

N. D.

Blanco

(2020). The drug overdose epidemic: A public health emergency. New England Journal of Medicine, 383(23), Article e130. https://doi.org/10.1056/NEJMp2027201

43.

Wheeler

P. B.

Miller-Roenigk

Jester

Stevens-Watkins

(2024). Knowledge, experiences, and perceptions of medications for opioid use disorder among black kentuckians. Annals of Medicine, 56(1), Article 2322051. https://doi.org/10.1080/07853890.2024.2322051

44.

Woo

Bhalerao

Bawor

Bhatt

Dennis

Mouravska

Zielinski

Samaan

(2017). “Don’t judge a book by its cover”: A qualitative study of methadone patients’ experiences of stigma. Substance Abuse: Research and Treatment, 11, 1–12. https://doi.org/10.1177/117822181668508

45.

World Health Organization . (2007). Guide to starting and managing needle and syringe programmes. https://www.who.int/publications/i/item/guide-to-starting-and-managing-needle-and-syringe-programmes