Abstract
Background:
Despite available and effective prevention and treatment strategies for substance use disorders (SUD), drug overdose deaths in the US remain high. Further, limited public knowledge of SUD pharmacotherapies may contribute to increased stigmatization towards SUD medications and a lack of willingness to help people with SUD.
Objectives:
This study evaluated knowledge and attitudes about SUD pharmacotherapies and willingness to help people with SUD among a sample of U.S. adults.
Method:
Participants recruited through Amazon's Mechanical Turk (N=314; 62.1% male) completed online surveys evaluating knowledge, attitudes, and willingness to help by various demographic factors, history of substance use, and experience with someone with SUD.
Results:
Results revealed a significant difference in attitudes by race/ethnicity (F(1,307)=11.85, p<.001). Participants with a personal history of substance use exhibited greater knowledge (F(1,312)=31.94, p<.001) and willingness to help someone with a SUD (F(1,312)=7.84, p=.005). Participants with experience with someone with a SUD also exhibited greater knowledge (F(1,311)=19.42, p<.001) and willingness to help (F(1,311)=13.63, p<.001).
Conclusion:
Results emphasize the importance of targeted education to bridge gaps in knowledge, enhance public attitudes, and promote willingness to help individuals with SUD. Utilizing public health strategies that promote empathy, willingness to help, and increase accessibility and acceptance of SUD treatment options, could be potential avenues that ultimately improve outcomes for individuals with SUD.
Introduction
Despite the existence of effective prevention and treatment strategies for substance use disorders (SUD), drug overdose deaths continue to be a leading cause of death in the U.S.(1). Further, while safe and effective “gold standard” pharmacotherapies for SUD such as methadone, buprenorphine, and naltrexone are widely available in primary care, community settings, and self-help organizations, they remain largely unknown and underutilized(2).
Prior research examining knowledge and understanding of SUD pharmacotherapy has demonstrated relative underutilization of these medications(3), which may be partly attributable to providers’ under-prescribing due to a lack of knowledge/understanding and negative attitudes towards SUD medications (4,5). Moreover, the general populations’ knowledge and perception have substantial impact on public health and insurance policy, financial allocation, and quality of SUD care (6-8). Therefore, the current study sought to survey a sample of adults living in the US to assess knowledge of SUD pharmacotherapies, attitudes towards people with SUD and pharmacotherapies, and willingness to help people with SUD, as well as how this may differ by various demographic characteristics, personal substance use history, and experience with someone with a SUD.
Previous studies, mostly conducted outside of the US (9,10) have found public knowledge of SUD pharmacotherapies to be low (11) and attitudes towards SUD medications and people with a SUD to skew neutral to negative (9). Willingness to help someone with SUD among general populations remains relatively unexplored. There is some evidence suggesting differences in knowledge, attitudes, or willingness to help by demographic characteristics such as income, education level, gender, and race (9,10,12). For example, in studies conducted mostly among participants who report a history of illicit substance use and/or are SUD treatment-seeking, research has suggested women, people who are unemployed, people of lower income, and highly educated individuals hold more favorable attitudes toward people with SUD (9,12). However, other work has found no differences in attitudes towards SUD by demographic characteristic (9,13,14).
Similarly, public surveys have in some cases found that participants’ own history of substance use is associated with lower levels of stigmatization and more favorable attitudes toward people with SUD, (9,15) which may be attributed to more familiarity and understanding of the complexities of substance use. However, other work has linked participants’ personal history of substance use with more stigmatizing attitudes and reluctance to offer help to others with SUD (10) , possibly due to self-biases in substance use attributions, which suggest people who have used substances minimize personal responsibility for their own behavior but view others as having “lost control” and seek to distance themselves from other individuals who use substances (10). However, these studies included small samples of people who have a history of substance use (N<100), which may not be suitable for drawing generalizable conclusions. Furthermore, though previous work has suggested the public’s overall knowledge of SUD pharmacotherapies is low, there is little known about how knowledge of these medications differs by substance use history, despite evidence showing that those who are more knowledgeable about SUD medications tend to view them and people with SUD in a more favorable light (9). Therefore, this study sought to explore differences in knowledge/attitudes toward SUD pharmacotherapies and people with SUD and willingness to help people with SUD by various demographic factors and participants’ substance use history.
Previous experience with someone with a SUD, rather than one’s personal substance use history has been mostly explored in the context of its influence on attitudes towards SUD medications or people with a SUD and have yielded mixed findings (16,17). Among healthcare professionals, patients with SUD tend to be perceived less favorably compared to patients with other mental health disorders (18), though those with more hands-on experience with SUD patients tend to hold more favorable attitudes towards SUD patients (19). This pattern has also been seen among more generalized samples, in which some studies have found people with experience with someone with SUD report more favorable attitudes towards people with SUD compared to participants with no such experience (16). However, other work has found people with personal experience with SUD (i.e., if they or a close friend/family member had experienced a SUD) endorse more stigmatizing attitudes towards people with SUD (17), which may be a consequence of strained relationships attributable to a person’s substance use (17). Notably, however, most of the US population does not have experience with someone with an SUD (20), and public opinion, which includes those with no such experience, is influential in informing substance use-related policy decision-making (21). Therefore, this study sought to further explore the relationship between knowing someone with a SUD and attitudes towards people with SUD and SUD medications. This study also sought to investigate the relationship between knowing someone with SUD and knowledge of SUD medications and willingness to help someone with SUD.
Given previous mixed findings and gaps in the available literature, the current study sought to survey adults in the US to explore differences in public knowledge of SUD pharmacotherapies, attitudes towards SUD pharmacotherapies and people with SUD, and willingness to help people with SUD by participant demographic characteristics, substance use history, and experience with someone with a SUD.
Method
Participants and Procedures
All procedures were approved by the university’s Institutional Review Board. The current study is a secondary data analysis; the parent study examined US adult familiarity with topics related to substance use disorders. In November 2019, participants were recruited directly from Amazon’s Mechanical Turk (MTurk) participant pool. MTurk made the online study available to participants in the US who were 18 years of age or older and spoke English. Interested participants were asked to electronically consent then complete an online survey. Participants took an average of 8.45 minutes to complete the survey and were awarded monetary compensation for their participation. To maximize data quality, a minimum number of approved HITs (Human Intelligence Tasks) was set to above 10,000 and a HIT approval rate was set at 98%. Participants who did not meet these requirements (n=37) were removed from the dataset. Participants who did not complete the online survey were also removed prior to analyses (n=15). To further ensure data quality, data from participants who failed to correctly answer at least 2 out of 3 attention checks were also removed (n=71). Final data analyses were conducted with n=314 participants.
Measures
Demographic Information
Participants were asked to report on their age, gender, race/ethnicity, sexual orientation, level of education completed, and approximate household income.
Substance Use History
Substance use history was assessed with two questions: “Have you used illicit substances other than those required for medical reasons?” and “Have you used medical prescriptions for recreational or non-medical purposes (i.e., the resulting euphoria?)”. Responses were coded dichotomously as yes/no. Responses were then combined into a single substance use variable, where all participants who endorsed either a history of illicit substance use or nonmedical use of prescription drugs were coded as endorsing a history of substance use.
Experience with someone with a substance use disorder (SUD)
Experience/knowledge of someone with a SUD was assessed with a single question “Do you currently know or have experience with a friend or family member with a substance use disorder?” Responses were dichotomously coded as yes/no.
Knowledge of Pharmacotherapies
Knowledge of pharmacotherapies was assessed by asking participants to identify medications they recognized from a list of commonly used SUD pharmacotherapies. Respondents were presented with a list of medication names (Suboxone, Subutex, Vivitrol, Revia, Narcan, Methadone, Buprenorphine, Naltrexone, and Naloxone) and asked to select the names they recognize or select “none of the above.” Total knowledge scores were calculated by adding the number of names participants recognized. This list contained most (although not all) of the most frequently prescribed medications for opioid and alcohol use disorders.
Attitudes Towards Pharmacotherapies and People with SUDs
Attitudes towards people with SUDs and pharmacotherapies were assessed using adapted questions from the Acceptance and Action Questionnaire (22,23) (current study α=0.90). Our study adapted the question to evaluate participants’ attitudes towards people with SUD. Participants were asked to rate how strongly they agreed with 18 statements such as “Individuals undergoing pharmacotherapy are capable of working towards success” and “Pharmacotherapy is simply replacing one drug for another” on a Likert scale from 1 (strong agreement) to 7 (strong disagreement). Several items were reversed coded, and an average score was calculated, where higher scores indicated more favorable attitudes.
Willingness to Help those with SUDs
Participants were presented with a list of six potential ways they could help someone with an SUD (e.g., making regular visits, attending therapy sessions with someone, or providing financial support) and asked, “In what ways would you be willing to assist these individuals?”. These items were adapted for the purpose of this study from a similar measure based on the Bogardus Social Distance Scale (BSDS) (24,25), which was originally used to assess individuals’ comfort levels with someone of a different racial/ethnic identity but has more recently been adapted and used to assess comfort between other groups, including people with a SUD (26,27). A total score of the number of ways respondents were willing to help was calculated to assess participants’ willingness to help someone with an SUD.
Analysis Plan
Data analyses were conducted using SPSS version 28. Descriptive characteristics are presented to summarize sample characteristics. Analyses of variance (ANOVA) were conducted to compare average knowledge of pharmacotherapies, attitudes towards pharmacotherapies and people with SUDs, and willingness to help someone with a SUD by participant demographic variables including gender, race/ethnicity, sexual orientation, education level achieved, and approximate household income. For these ANOVAs, demographic cells with fewer than 10 participants were combined for analysis (i.e., participants identifying as Native Hawaiian/Pacific Islander and Asian American were combined to form a single Asian American and Native Hawaiian/Pacific Islander group; participants who identified as transgender and non-binary were combined into one category). ANOVAs were also conducted to compare participants’ knowledge of pharmacotherapies, attitudes towards pharmacotherapies and people with SUDs, and willingness to help someone with a SUD by one’s personal substance use history, and experience with someone with a SUD. Tukey’s Honest Significant Difference (HSD) tests were utilized for post hoc analysis of differences among group means. Chi-square analyses were conducted to compare participants’ knowledge of SUD medications based on substance use history. To mitigate the chance of Type I error, this study utilized a significance level of p<.01 rather than the conventional p<.05.
Results
Participants included in analyses (N=314) were predominantly White (n=222, 70.7%), male (n=195, 62.1%), heterosexual (n=238, 75.8%), and on average were 38.2(SD=9.63) years of age (range 23-71). Approximately 49.7% (n=156) of participants reported lifetime illicit substance use and 65.0% (n=204) participants reported having experience with someone with a SUD. Additional descriptive information is presented in Table 1.
Table 1.
Participant Characteristics
| Participant Characteristic | n (%) |
|---|---|
| Gender | |
| Male | 195 (62.1) |
| Female | 112 (35.7) |
| Transgender/Non-Binary | 3 (1.0) |
| Prefer not to say | 4 (1.36) |
| Race/Ethnicity | |
| White | 222 (70.7) |
| Black/African American | 48 (15.3) |
| American Indian/Alaska Native | 9 (2.9) |
| Asian | 15 (4.8) |
| Native Hawaiian/Pacific Islander | 2 (0.6) |
| Hispanic/Latinx | 17 (5.4) |
| Other | 1 (0.3) |
| Sexual Orientation | |
| Heterosexual (Straight) | 238 (75.8) |
| Homosexual (Gay) | 20 (6.4) |
| Bisexual | 46 (14.6) |
| Other | 2 (0.6) |
| Prefer not to say | 8 (2.5) |
| Education | |
| High School Graduate/GED | 258 (82.2) |
| Some College, No Degree | 40 (12.7) |
| Completed College (at least an associate degree) | 16 (5.1) |
| Income | |
| <$10,000 | 12 (3.8) |
| $10,000-$50,000 | 133 (42.4) |
| $50,000-$100,000 | 137 (43.6) |
| $100,000-$150,000 or more | 32 (10.2) |
| Know/Have Experience with someone with a SUD | |
| Yes | 204 (65.0) |
| No | 109 (34.7) |
| Prefer not to say | 1 (0.3) |
| History of Illicit Substance Use | |
| Yes | 156 (49.7) |
| No | 158 (50.3) |
On average, participants recognized 3.01 (SD=1.91) SUD medication names out of the list of nine, and 12.5% (n=41) of participants reported being unfamiliar with all of the listed medications. Attitudes towards pharmacotherapies and people with a SUD were generally neutral (M=3.80; SD=1.05), and participants reported being willing to help someone with a SUD in an average of 2.01 (SD=1.51) ways (out of 6 non-mutually exclusive options). Approximately 11.5% (n=36) of participants indicated that they would not be willing to help someone with an SUD in any of the listed ways.
Methadone was the most widely known medication among the full sample and among those with and without a history of substance use, and Revia was the least widely recognized. Participants’ knowledge of pharmacotherapies is presented in Table 2.
Table 2.
Knowledge of Pharmacotherapies by Substance Use History
| Full Sample | History of Illicit Substance Use |
No History of Illicit Substance Use |
χ2 (p=) | |
|---|---|---|---|---|
| Medication Name | n (%) | |||
| Brand Name | ||||
| Suboxone | 123 (39.2) | 80 (51.3) | 43 (27.2) | 19.08 (p<0.001) |
| Subutex | 71 (22.6) | 51 (32.7) | 20 (12.7) | 18.01 (p<0.001) |
| Vivitrol | 74 (23.6) | 45 (28.8) | 29 (18.4) | 4.78 (p=0.03) |
| Revia | 41 (13.1) | 27 (17.3) | 14 (8.9) | 4.93 (p=0.03) |
| Narcan | 156 (49.7) | 86 (55.1) | 70 (44.3) | 3.68 (p=0.06) |
| Methadone | 204 (65.0) | 106 (68.4) | 98 (62.0) | 1.40 (p=0.24) |
| Buprenorphine | 82 (21.7) | 61 (39.1) | 21 (13.3) | 27.10 (p<0.001) |
| Naltrexone | 68 (21.7) | 46 (29.5) | 22 (13.9) | 11.21 (p<0.001) |
| Naloxone | 84 (26.8) | 56 (35.9) | 28 (17.7) | 13.23 (p<0.001) |
Note. Chi-Square analyses were conducted to assess differences in knowledge of specific pharmacotherapies based on substance use history. Bolded text indicates significant difference between groups (those with a history of substance and those with no such history), p<0.05. Individuals with a history of substance use were more knowledgeable of all individual medications than those without a history of substance use, except for Narcan and Methadone, for which there were no group differences.
Differences by Demographic Variables
Knowledge.
ANOVAs indicated no significant differences in pharmacotherapy knowledge by any reported demographic characteristic. Descriptive information for knowledge across demographic groups is provided in Table 3.
Table 3.
Average Knowledge, Attitudes, and Willingness to Help Scores by Participant Characteristic (N=314)
| Knowledge of Pharmacotherapies | Attitudes | Willingness to Help | ||||
|---|---|---|---|---|---|---|
| n | M (SD) | n | M (SD) | n | M (SD) | |
| Gender | ||||||
| Male | 195 | 2.98 (1.89) | 193 | 3.92 (1.05) a | 195 | 1.95 (1.05) |
| Female | 112 | 3.16 (1.87) | 112 | 3.63 (1.01) | 112 | 2.06 (1.01) |
| Transgender/Non-Binary | 3 | 5.00 (2.65) | 3 | 2.50 (0.43) | 3 | 4.00 (0.43) |
| Race | ||||||
| White | 221 | 2.99 (1.86) | 222 | 3.64 (0.98) | 222 | 2.07 (1.51) |
| Black/African American | 48 | 3.17 (1.95) | 48 | 4.70 (0.84) b | 48 | 1.77 (1.43) |
| AANHOPI | 17 | 2.94 (2.28) | 17 | 3.75 (0.93) | 17 | 1.94 (1.71) |
| Hispanic/Latinx | 16 | 3.35 (1.84) | 17 | 3.67 (1.38) | 17 | 1.71 (1.36) |
| Other | 10 | 3.80 (1.99) | 10 | 3.31 (0.73) | 10 | 2.30 (1.77) |
| Sexual Orientation | ||||||
| Heterosexual (Straight) | 238 | 2.96 (1.92) | 236 | 3.76 (0.93) | 238 | 2.00 (1.54) |
| Homosexual (Gay) | 20 | 2.60 (1.14) | 20 | 3.50 (1.42) | 20 | 2.00 (1.49) |
| Bisexual | 46 | 3.59 (1.98) | 46 | 4.15 (1.31) | 46 | 1.98 (1.47) |
| Other | 2 | 4.00 (2.83) | 2 | 2.64 (0.51) | 2 | 3.50 (0.71) |
| Education | ||||||
| High School Graduate/GED | 258 | 3.07 (1.87) | 256 | 3.79 (1.04) | 258 | 1.98 (1.48) |
| Some College, No Degree | 40 | 3.10 (2.19) | 40 | 3.93 (1.17) | 40 | 2.00 (1.57) |
| Completed College (at least an associate degree) | 16 | 2.50 (1.55) | 16 | 3.57 (0.70) | 16 | 2.44 (1.86) |
| Income | ||||||
| <$10,000 | 12 | 2.58 (1.83) | 12 | 3.38 (1.00) | 12 | 1.83 (1.56) |
| $10,000-$50,000 | 133 | 3.22 (2.07) | 132 | 3.71 (1.05) | 133 | 2.05 (1.59) |
| $50,000-$100,000 | 137 | 2.93 (1.74) | 136 | 3.92 (0.88) | 137 | 2.01 (1.45) |
| $100,000-$150,000 or more | 32 | 2.97 (1.77) | 32 | 3.84 (1.05) | 32 | 1.91 (1.42) |
| Know/Have Experience with someone with a SUD | ||||||
| Yes | 204 | 3.38 (1.90) | 203 | 3.91 (1.04) | 204 | 2.23 (1.50) |
| No | 109 | 2.41 (1.73) | 109 | 3.60 (1.03) | 109 | 1.56 (1.45) |
| History of Illicit Substance Use | ||||||
| Yes | 156 | 3.02 (1.91) | 156 | 3.90 (1.11) | 156 | 2.24 (1.47) |
| No | 158 | 2.47 (1.71) | 156 | 3.70 (0.97) | 158 | 1.77 (1.51) |
Note. Average knowledge of pharmacotherapies, attitudes towards pharmacotherapies and people with SUDs, and willingness to help someone with a SUD are presented with results of ANOVA analyses that were conducted to compare average knowledge of pharmacotherapies, attitudes towards pharmacotherapies and people with SUDs, and willingness to help someone with a SUD based on various participant demographic variables. Demographic cells with <10 participants were combined for analysis. ANOVAs were also conducted to compare participants’ knowledge of pharmacotherapies, attitudes towards pharmacotherapies and people with SUDs, and willingness to help someone with a SUD based on one’s personal substance use history, and experience with someone with a SUD. Bolded text indicates a significant difference based on ANOVA analyses, p<0.01.
Attitudes by gender differed significantly at p=0.007, but no significant differences at p<.01 were found by post hoc Tukey.
African Americans significantly differed at p<.001 and compared to AAPI and Hispanic/Latinx groups post hoc Tukey test. African Americans significantly differed at p<.001 compared to White, Other racial groups.
Attitudes.
ANOVAs indicated significant differences in attitudes towards pharmacotherapies and people with SUDs by demographic group (see Table 3). A significant difference in attitudes towards people with SUD by gender (F(2,305)=5.11, p=.007) was found. However, Tukey HSD tests yielded non-significant results. There were also significant differences in attitudes by racial/ethnic group, (F(4,307)=11.85, p<.001) such that participants identifying as Black/African American reported the most favorable attitudes compared to all other groups. Attitudes toward people with SUD by sexual orientation, although trending, did not meet our current criteria for statistical significance (F(3,300)=3.50, p=.021). Descriptive information for attitudes across demographic groups is provided in Table 3.
Willingness to Help.
ANOVA analyses indicated no significant differences in willingness to help someone with an SUD by any reported demographic characteristic (Table 3).
Differences by One’s Own Substance Use History
Knowledge.
Descriptive information for knowledge by history of substance use is provided in Table 2. Knowledge of pharmacotherapies for SUD differed significantly by history of illicit substance use (F(1,312)=31.94, p<.001), where on average, participants with a history of illicit substance use report being familiar with more medications than participants with no history of illicit substance use. Table 2 shows differences in knowledge of specific pharmacotherapies by substance use history. Individuals with a history of substance use were more knowledgeable of all individual medications than those without a history of illicit substance use, except for Methadone and Narcan, for which there were no group differences.
Attitudes.
Attitudes towards pharmacotherapies and people with SUDs did not differ significantly by individuals’ history of illicit substance use (Table 3).
Willingness to Help.
Willingness to help someone with SUD was trending significance by participants’ substance use history (F(1,312)=7.84, p=.005). On average, respondents with a substance use history reported more ways in which they would be willing to help someone with SUD compared to those with no such history (Table 3).
Differences by Experience with Someone with a SUD
Knowledge.
ANOVAs indicated knowledge of medications for SUD also differed significantly by prior experience with someone with a SUD (F(1,311)=19.42, p<.001), where participants who reported having prior experience with someone with a SUD were significantly more familiar with pharmacotherapy names compared to participants with no such prior experience (Table 3).
Attitudes.
Participants with experience with someone with an SUD reported more favorable attitudes towards pharmacotherapies and people with an SUD compared to respondents who did not report any such experience. However, this difference, although trending, did not meet our current criteria for statistical significance (F(1,310)=6.27, p=.013; Table 3).
Willingness to Help.
Participants who reported experience with someone with a SUD reported being willing to help someone with a SUD in significantly more ways than compared to participants who did not report any such experience (F(1,311)=13.63, p<.001) (Table 3).
Discussion
The purpose of this study was to explore differences in knowledge of SUD pharmacotherapies, attitudes towards these medications and people with SUD, and willingness to help people with SUD by various demographic factors, participants’ substance use history, and experience with someone with a SUD among an adult population in the US. Our findings expand upon extant literature to help explicate and delineate public knowledge, attitudes, and willingness to help those with SUD as it could have implications for public health and implementation of SUD treatment-related policies.
Consistent with prior literature, findings suggest those with a substance use history or have experience with someone with SUD reported significantly more knowledge of SUD medications (28). However, among these groups, overall knowledge of SUD medications remained low. This is consistent with previous findings indicating a general lack of public knowledge of SUD medications (9). Of note, data collection (November 2019) took place during a period in which increased attention was paid to the public health concerns of opioid-related overdoses (29). Potentially, topics of substance use disorders and overdoses may have been issues discussed as major news networks were frequently reporting this news. Further, our analyses revealed no significant variations in pharmacological knowledge by demographic groups, highlighting a need for broader educational initiatives aimed at improving public understanding of SUD medications.
Lack of public knowledge about SUD pharmacotherapies may be particularly relevant when examined in the context of substance use-related attitudes and willingness to help. Prior literature suggests a link between increased knowledge about SUD medications and more favorable attitudes and willingness to help, particularly among medical professionals (30,31). Among the study population, the current study found several important differences in attitudes across sociodemographic groups. Notably, current findings were consistent with previous work suggesting Black/African American individuals may endorse less stigmatizing attitudes towards people who use substances. This finding adds nuance to the existing literature on racial/ethnic differences in SUD-related attitudes and may reflect varying cultural perspectives on substance use and treatment that also influence willingness to help someone with SUD, particularly because analyses yielded no significant differences in willingness to help someone with an SUD by any demographic variable. Contextually, results may be consistent with discrepancies previously found between African Americans’ attitudes and beliefs toward SUD treatment and treatment utilization (32). Previous work has suggested African Americans hold beliefs that mental health problems will dissipate on their own, regardless of beliefs about the effectiveness of mental health treatment (32). These findings illustrate a gap between favorable attitudes towards people with SUD/SUD medications, willingness to help people with SUD, and highlight a need for further investigation into contributors to individuals’ willingness to help people with SUD through culturally sensitive approaches in SUD education and treatment programs.
Contrary to previous findings, men in the present study indicated the most favorable substance use-related attitudes, whereas prior literature has typically found women to hold more favorable substance use-related attitudes (33-35). Though unexpected, these findings do further support postulations that gender does play a role in attitudes towards SUD (34). Therefore, further investigation into the nuances of the specific role of gender in substance use-related attitudes is warranted. Results also support a need for tailored, gender-specific education and prevention approaches. Importantly, despite significant differences found in substance use-related attitudes by gender, there were no significant differences in willingness to help by gender (36). Instrumental (helping with treatment/care by attending therapy sessions or participating in outpatient therapy) and financial means of support were assessed in this study, while more emotional ways of helping someone with a SUD were not assessed. Women have been historically shown to provide more emotional forms of support, (i.e., social support) (37), while men are traditionally socialized to provide more structural support (i.e., practical assistance, financial aid) (38). This may explain the discrepancy in our findings and prior literature, but it also serves to highlight a need for further investigation aimed at parsing out specific demographic differences in willingness to help someone with an SUD.
(34)Analyses indicated that participants with a history of substance use (vs. no history of substance use) and those who had experience with someone with a SUD (vs. no experience with someone with a SUD) were more knowledgeable about SUD pharmacotherapies and more willing to help someone with SUD. However, significant differences in substance-use related attitudes by participants’ history of substance use or experience with someone with a SUD were not found. Findings related to increased knowledge of SUD medications by personal history of substance use and knowledge of someone with SUD are consistent with previous research suggesting greater familiarity with SUD is associated with more knowledge and favorable attitudes (9,15), potentially due to the highly regulated nature of SUD medications. Many SUD medications require specialized training and/or federal authorization to prescribe/administer (39), and participants who have personal or second-hand experience with SUD are more likely to have come across providers who can provide this information. In fact, only 10% of adults who need specialized substance use treatment receive these services (40), suggesting many of those in need of psychoeducation on SUD pharmacotherapies do not receive this information, and those who have no personal need to be referred to specialty substance use treatment have even fewer opportunities to receive information regarding SUD pharmacotherapies.
Notably, no significant differences in substance use-related attitudes by participants’ history of substance use or experience with someone with a SUD were found. This is contrary to findings that participants who indicate a history of substance use may foster greater empathy and understanding of the complexity of SUDs and SUD recovery (41), but supports other work that has found those with a history of substance use to hold more stigmatizing views of others with SUD, potentially due to biases in substance use attributions (10). These findings raise important questions around the complexities of substance use experiences and suggest that while personal substance use experiences may enhance knowledge of SUD medications and willingness to help, this experience may not influence attitudes in the same way. This supports a need for targeted educational interventions that do not only provide information about SUD and pharmacotherapy, but also address underlying stigma and misconceptions about these topics. By fostering greater empathy and understanding, such initiatives may play a crucial role in enhancing support for individuals with SUD and improving access to necessary treatment options.
Limitations
The current study is not without limitations. Primarily, while this study examined one’s substance use history as a factor for examining knowledge, attitude, and willingness to help, additional information on the severity of the history (i.e. frequency of use, SUD diagnosis…etc.) may provide more nuanced examination of one’s history on the outcome variables. Similarly, more detailed information (i.e., participants’ relationship with the person with SUD, level of involvement with that person’s substance use, etc.) could help to further investigate these associations. Additionally, this study includes measures (i.e., attitudes, willingness to help measures) that have not been validated for use in this sample. Further expansion on assessments administered, such as items exploring participants’ direct and indirect experiences with substance use and ways in which they are willing to help someone with an SUD may help expand understanding of how interaction with someone with an SUD influences knowledge and attitudes. Finally, the cross-sectional nature of data collection does not allow for the determination of change in the association between variables across time.
Implications and Future Directions
The results of this study have implications across multiple domains. For instance, significant differences and attitudes towards SUD medications and people with SUD were found by gender and race. Given established inverse relationships between stigmatization and prosocial behavior (42), results suggest interventions can be aimed at groups with more favorable attitudes towards SUD to capitalize on these favorable attitudes and increase willingness to help people with SUD. Similarly, stigma reduction focused psychoeducational programming among groups with more negative perceptions of SUD medications and people with SUD may be effective in decreasing stigma.
Furthermore, public opinion often strongly influences policy (43), suggesting unfavorable attitudes towards medications for SUD and people with SUD may dispel policymakers from prioritizing this as a public health issue. The misconceptions and stigma surrounding medications for SUD negatively affect help-seeking and treatment retention (44). Favorable attitudes and more willingness to help people with SUD among specific demographic groups, as well as within groups with more knowledge of SUD pharmacotherapies, suggest a potential utility of psychoeducation programs that disseminate accurate information about people with SUD and SUD medications. These interventions may then foster a culture less stigmatizing of people with SUD and SUD, which may have waterfall effects for medication uptake, policy enactment, and increased efforts toward harm-reduction approaches to addressing substance use.
Conclusions
This study expands upon extant literature to provide further insight into the knowledge, attitudes and willingness to help regarding SUD and their medications among US adults. By highlighting differences in these areas among a US population, our findings contribute to a more nuanced understanding of how targeted public health initiatives may be designed to increase knowledge, reduce stigma, and promote support for individuals with SUD. For instance, these findings suggest a potential for leveraging personal experiences through peer support and education programs that may be utilized to harness the knowledge and empathy of individuals with experience with SUD though targeted psychoeducational and stigma-reduction programming. Further, culturally informed initiatives that consider cultural contexts surrounding SUD and SUD recovery may also be implemented through public health messaging to help foster a less stigmatizing culture surrounding substance use and increase willingness to help someone with a SUD. These changes may then in turn encourage SUD treatment-seeking populations to engage with and maintain adherence to medication-based SUD therapies.
Disclosures/Funding:
Lidia Z Meshesha was supported by the National Institute on Alcohol Abuse and Alcoholism grant, K23 AA028269. The authors report no relevant disclosures.
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