Determining the Feasibility and Acceptability of a Novel Stigma Resistance Text Message Intervention for People who Use Drugs

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Project Summary Nearly 850,000 Americans have died from overdose in the past two decades. Stigma remains an under- addressed central barrier to ending the drug epidemic. Substance use stigma reduces treatment and harm reduction utilization among people who use drugs (PWUD) and is associated with increased drug use, depression, social isolation, and numerous other psychosocial indicators of healthy functioning. Though interventions focused on education and social contact have proven successful in reducing stigmatizing attitudes in the public, much less is known about how to intervene on self-stigma, the negative feelings PWUD have about their drug use. Developing strategies for PWUD to cope with and resist stigma may promote quality of life and reduce overdose in this population. Stigma resistance is a promising approach that promotes resilience through self-empowerment and positive identity formation. In line with NIDA’s priorities of reducing stigma and developing recovery support strategies, the goal of this application is to develop and evaluate a stigma resistance text message intervention for PWUD. Nested within the NIDA-funded Ohio Opioid Project (UG3/UH3DA044822), the specific aims of the proposal are to: 1) Identify PWUD self-stigma subgroups and describe associated demographic, health, and drug use risk factors among rural PWUD in an eight-state multi- site cohort using latent class analysis; 2) identify stigma-related attitudes and beliefs and text message content and delivery preferences through iterative elicitation interviews with 20 rural Ohio PWUD; 3) develop a four- week automated daily text message stigma resistance intervention; and 4) evaluate the feasibility, acceptability, and preliminary effectiveness of the intervention in a sample of 30 rural Ohio PWUD in active use. An iterative convergent mixed-methods design informed by health communication and behavioral health theories will guide the development of interactive messages that are hypothesized to increase stigma resistance and reduce self-stigma. This proposal will lay the groundwork for a self-stigma intervention and provide further evidence for text messaging as a cost-effective, impactful modality for engaging this hard-to- reach population. Alongside the planned research, the applicant proposes training that will enhance his theoretical understanding of stigma, advance his quantitative analysis skills, strengthen his competence in health communication strategies, and build his communication record through scholarly presentations and publications. Under the expert mentorship of co-sponsor Drs. Vivian Go and William Miller and other collaborators, this research and training plan will contribute to the applicant’s career trajectory as an independent mixed-methods substance use and stigma researcher.