Promoting substance use stigma resistance through an automated text message intervention (project RESTART): Outcomes...

Stigma in people who use drugs predicts treatment engagement, psychosocial health, and overdose, yet there are few evidence-based interventions to support people who use drugs in managing and coping with substance-related stigma and even fewer for people in active use. mHealth is one option to engage this hard-to-reach population.

Premised on the theory of stigma resistance, this mixed-methods study explored the feasibility, acceptability, and preliminary effectiveness of Project RESTART, a four-week, automated text message intervention for rural-dwelling people who use drugs (n = 30) using a one-group pre-post design. The study recruited participants from syringe service programs and by word-of-mouth.

Key outcomes included high retention (90 %), message engagement (median responses: 4, interquartile range: 1-17), acceptability (mean item score: 3.55, standard deviation: 0.34, range: 1-4), and preliminary effectiveness in the main outcomes (Cohen's d: stigma resistance (0.56), self-stigma (0.50)). Results were corroborated in sub-sample follow-up interviews (n = 13).

These promising findings suggest text messaging is a feasible and acceptable modality for delivering stigma education and coping resources. Effectiveness should be established in a full-scale randomized controlled trial. This trial was registered at ClinicalTrials.gov on February 20, 2024 (NCT06281548).