A short, animated storytelling video to reduce addiction stigma: A pilot randomized controlled trial

Public stigma towards people with addiction negatively impacts help-seeking, treatment and recovery. This pilot study tested the feasibility of conducting a large-scale, online trial to measure the effect of a short, animated storytelling (SAS) stigma reduction video, with and without soundtrack, on addiction stigma, optimism, warmth towards people with addiction, and hopefulness at two timepoints (immediately post-exposure and 14 days later).

We used a parallel group, three-arm randomized controlled trial (RCT).

We conducted this fully online study on the Prolific Academic research platform (participant recruitment) and the Qualtrics survey platform (data collection).

We recruited 631 English-speaking adult participants, aged 18-49, residing in the United States.

Intervention group A received the SAS video intervention. Intervention group B group received the SAS video intervention without sound. The control group received written information about global addiction prevalence, estimated to be time-equivalent with the video interventions.

We measured participant retention rate at the two-week follow-up to determine the feasibility of conducting the definitive trial. Our co-primary outcomes were addiction stigma, optimism, warmth towards people with addiction and hopefulness, measured using an abbreviated 18-item version of the Attribution Questionnaire (AQ-18), the Brief García's Interactive Optimism Scale (BIOS-G), a stigma thermometer and a visual analogue scale (VAS). We used repeated-measures ANOVA to assess group-by-time interactions and compared changes from baseline to post-intervention. Participants completed follow-up surveys 14 days post-intervention.

The retention rate from baseline to follow-up was 88.0 %. Exposure to both the video with sound and without sound resulted in significant positive changes compared to the control group, for pity [F (4,1046) = 3.26, η² = 0.012, p = 0.011], willingness to help [F (4,1046) = 8.48, η² = 0.031, p < 0.001], dangerousness [F (4,1046) = 2.95, η² = 0.011, p = 0.019], avoidance [F (4,1046) = 4.25, η² = 0.016, p = 0.002], as well as optimism [F (2,595) = 7.7, η² = 0.014, p < 0.001], warmth toward people with addiction [F (2,594) = 6.5, η² = 0.014, p = 0.002], and hopefulness [F (2,594) = 5.4, η² = 0.013, p = 0.005]. No effects were observed for fear or blame stigma sub-scales. These effects were no longer visible at follow-up in this pilot sample. No significant differences were observed between the video with sound and the video without sound.

This pilot study demonstrates the feasibility of proceeding with our registered, largescale, multi-country, online RCT. The significant effect observed in a relatively small pilot population, after a single exposure to this 2.5 min SAS intervention aimed at reducing addiction stigma, was unanticipated and is worthy of highlighting. A larger sample size will adequately power the full trial to detect both immediate effects and their potential durability over time, in various global settings.