Ethical Imperatives to Overcome Stigma Against People With Substance Use Disorders

Adams, Jerome; Volkow, Nora D.

doi:10.1001/amajethics.2020.702

Cited by 46 publications

(22 citation statements)

References 15 publications

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“…Our findings support studies showing that more effort is needed to reduce real and perceived stigmatization of pregnant women and mothers who use opioids ( Nichols et al, 2021 ). Empathy, compassion, respect, and support provide greater treatment-seeking motivation among opioid-dependent women with children than the current focus on supervision and surveillance ( Howard, 2015 ; Stone, 2015 ; Adams and Volkow, 2020 ). We enhance the findings of these studies with evidence provided by our life course examination of the women’s experiences over time.…”

Section: Discussionmentioning

confidence: 99%

“…The barriers caused by the stigma of MAT, including attitudes from service professional staff and community, were reinforced by perceptions the women had about MAT from their own experiences or experiences they heard from others. While the social stigma associated with MAT is changing as public education on the success of MAT to combat rising overdose death rates increases ( Heavey et al, 2018 ; Irvine et al, 2018 ; Silverstein et al, 2019 ; Adams and Volkow, 2020 ), institutionalized and public stigma of mothers or pregnant women who use opioids is still prevalent ( Stone, 2015 ; Nichols et al, 2021 ). Being seen entering a MAT clinic increases the chances that such women will be discredited by the community ( Goffman, 1959 ; Chaudoir et al, 2013 ), and disapproving attitudes of some providers toward pregnant women who use opioids remain.…”

Section: Discussionmentioning

confidence: 99%

“…We add to the literature not only by providing insights on suburban women who use opioids, but also by disentangling barriers that can be addressed structurally from those that are entwined as potential barriers and/or motivators, specifically relational factors impacting treatment-seeking behavior. We know stigma related to MAT and perspectives of MAT are changing in the public view due to the opioid crisis ( Adams and Volkow, 2020 ). Moreover, the structural barriers we identified regarding facilities can be addressed through policy change, such as increased funding for residential treatment exclusive to the needs of pregnant women and mothers, and consideration of location and operating hours of treatment facilities.…”

Section: Discussionmentioning

confidence: 99%

“…Women of childbearing age who misuse opioids are a particularly vulnerable population as they juggle their own substance dependence, pregnancy, and motherhood. To address the rising rates of overdose morbidity and mortality, there has been a shift toward medication-assisted treatment (MAT) for opioid dependence ( Scholl et al, 2019 ; Abraham et al, 2020 ; Adams and Volkow, 2020 ). MAT has become the gold standard for opioid dependence in pregnant women ( Timmermans and Berg, 2010 ; Klaman et al, 2017 ; Reddy et al, 2017 ; Verduin, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

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Barriers and Motivators to Opioid Treatment Among Suburban Women Who Are Pregnant and Mothers in Caregiver Roles

et al. 2021

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Women of childbearing age who misuse opioids are a particularly vulnerable population, and their barriers to treatment are unique because of their caregiver roles. Research on treatment for opioid use generally draws from urban and rural areas. This study fills a gap in research that focuses on barriers and motivators to opioid treatment in suburban areas. The aim of this study was to give voice to suburban pregnant women and mothers caring for children while using opioids. Ethnographic methods were used for recruitment, and 58 in-depth interviews were analyzed using a modified grounded theory approach. Barriers to medication-assisted treatment (MAT) included stigma, staff attitudes, and perceptions the women had about MAT treatment. Barriers associated with all types of treatment included structural factors and access difficulties. Relationships with partners, friends, family, and providers could be barriers as well as motivators, depending on the social context of the women’s situation. Our findings suggest increasing treatment-seeking motivators for mothers and pregnant women by identifying lack of resources, more empathetic consideration of social environments, and implementing structural changes to overcome barriers. Findings provide a contemporary understanding of how suburban landscapes affect mothers’ treatment-seeking for opioid dependence and suggest the need for more focus on emotional and structural resources rather than strict surveillance of women with opioid dependence who are pregnant or caring for children.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Barriers and Motivators to Opioid Treatment Among Suburban Women Who Are Pregnant and Mothers in Caregiver Roles

et al. 2021

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“…In addition to the limited availability of effective counseling services, attitudinal barriers such as stigma can also prevent individuals from seeking or receiving counseling or psychotherapy [ 33 - 35 ]. Patients often worry about how their doctor will react to a disclosure of substance use and potential consequences of having this information in their medical records [ 34 ].…”

Section: Introductionmentioning

confidence: 99%

A Personalized, Interactive, Cognitive Behavioral Therapy–Based Digital Therapeutic (MODIA) for Adjunctive Treatment of Opioid Use Disorder: Development Study

Meyer¹,

Utter²,

Hillman³

2021

JMIR Ment Health

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Background Opioid use disorder (OUD) is characterized by the inability to control opioid use despite attempts to stop use and negative consequences to oneself and others. The burden of opioid misuse and OUD is a national crisis in the United States with substantial public health, social, and economic implications. Although medication-assisted treatment (MAT) has demonstrated efficacy in the management of OUD, access to effective counseling and psychosocial support is a limiting factor and a significant problem for many patients and physicians. Digital therapeutics are an innovative class of interventions that help prevent, manage, or treat diseases by delivering therapy using software programs. These applications can circumvent barriers to uptake, improve treatment adherence, and enable broad delivery of evidence-based management strategies to meet service gaps. However, few digital therapeutics specifically targeting OUD are available, and additional options are needed. Objective To this end, we describe the development of the novel digital therapeutic MODIA. Methods MODIA was developed by an international, multidisciplinary team that aims to provide effective, accessible, and sustainable management for patients with OUD. Although MODIA is aligned with principles of cognitive behavioral therapy, it was not designed to present any 1 specific treatment and uses a broad range of evidence-based behavior change techniques drawn from cognitive behavioral therapy, mindfulness, acceptance and commitment therapy, and motivational interviewing. Results MODIA uses proprietary software that dynamically tailors content to the users’ responses. The MODIA program comprises 24 modules or “chats” that patients are instructed to work through independently. Patient responses dictate subsequent content, creating a “simulated dialogue” experience between the patient and program. MODIA also includes brief motivational text messages that are sent regularly to prompt patients to use the program and help them transfer therapeutic techniques into their daily routines. Thus, MODIA offers individuals with OUD a custom-tailored, interactive digital psychotherapy intervention that maximizes the personal relevance and emotional impact of the interaction. Conclusions As part of a clinician-supervised MAT program, MODIA will allow more patients to begin psychotherapy concurrently with opioid maintenance treatment. We expect access to MODIA will improve the OUD management experience and provide sustainable positive outcomes for patients.

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How Does One Approach the Patient With an Opioid Use Disorder?

Ho,

Jones,

Merlin

et al. 2023

Evidence-Based Practice of Palliative Medicine

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Ethical Imperatives to Overcome Stigma Against People With Substance Use Disorders

Cited by 46 publications

References 15 publications

Barriers and Motivators to Opioid Treatment Among Suburban Women Who Are Pregnant and Mothers in Caregiver Roles

Barriers and Motivators to Opioid Treatment Among Suburban Women Who Are Pregnant and Mothers in Caregiver Roles

A Personalized, Interactive, Cognitive Behavioral Therapy–Based Digital Therapeutic (MODIA) for Adjunctive Treatment of Opioid Use Disorder: Development Study

How Does One Approach the Patient With an Opioid Use Disorder?

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