Health professional stigma as a barrier to contingency management implementation in opioid treatment programs.

Abstract

Contingency management (CM) has robust evidence of effectiveness as an adjunct to medication for opioid use disorders. However, CM implementation in opioid treatment programs has been limited by a myriad of well-documented barriers. One relatively unexplored barrier that may hinder CM implementation is health professional stigma toward patients with opioid use disorders. Qualitative interviews were conducted with 43 health professionals (21 leaders, 22 front-line counselors) from 11 different opioid treatment programs across Rhode Island to explore their familiarity with CM and to elucidate barriers and facilitators to CM implementation. Interviews were transcribed and coded by 3 independent raters using a reflexive team approach. Transcripts were analyzed for both a priori and emergent themes. Health professional stigma was identified as an emergent major theme with 4 distinct subthemes: (a) distrust of patients (44%, N = 19); (b) infantilizing views about patients (19%, N = 8); (c) belief that patients do not deserve prizes (19%, N = 8); and (d) recognition of patient self-stigma and community-based stigma (23%, N = 10). In addition, we identified multiple instances of health professional use of potentially stigmatizing language toward patients with opioid use disorders via terms such as drug abuser, addict, and clean or dirty urine screens (70%, N = 30). Stigma themes were identified in 86% of the transcripts, highlighting potential targets for multilevel implementation strategies. Findings of this study suggest that multiple types of health professional stigma should be considered and proactively addressed in efforts by psychologists to implement CM and other evidence-based interventions in opioid treatment programs.

Cross-Training Needs Among Community-Based Clinicians in HIV and Substance Use

“…In regards to areas of speci c training need, both HIV and substance use clinicians discussed a need for sensitivity or anti-stigma training, as well as training in the latest medications and referral resources. In line with previous studies, some clinicians expressed that stigmatized behavior towards PLWH and people who use drugs could serve as a barrier to treatment retention [22][23][24]. Medications to treat opioid use disorder and medications to prevent/treat HIV were also cited as areas in need of further training.…”

Cross-training needs among community-based clinicians in HIV and substance use

“…In regards to areas of specific training need, both HIV and substance use clinicians discussed a need for sensitivity or anti-stigma training, as well as training in the latest medications and referral resources. In line with previous studies, some clinicians expressed that stigmatized behavior towards PLWH and people who use drugs could serve as a barrier to treatment retention [13,[28][29][30]. Medications to treat opioid use disorder and medications to prevent/treat HIV were also cited as areas in need of further training.…”

Digital Contingency Management in the Treatment of Substance Use Disorders

“…Some objections to CM are based on principle. Such barriers can be mitigated through education (Bride et al, 2010; Scott et al, 2021) and exposure to CM (Kellogg et al, 2005; Kirby et al, 2012). Indeed, evidence now refutes concerns such as incentives “crowding out” intrinsic motivation (Ledgerwood & Petry, 2006; Promberger & Marteau, 2013) or that incentives will be used for harmful purposes (Vandrey et al, 2007).…”