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Background: Stigma toward people with substance use disorders (SUD) remains a major barrier to care. There have been multiple calls to action to address SUD stigma in healthcare settings and other reviews have clarified the need for more rigorous effectiveness research. In addition to attention to effectiveness research, there is a need to attend to the implementation strategies used to deliver SUD stigma reduction interventions. Delineating discrete implementation strategies that have been used to address stigma will support future research efforts to arrive at the most optimal interventions to address SUD stigma.
Methods: We searched three databases and extracted data to identify interventions tested to reduce SUD stigma. We used the adapted Expert Recommendations for Implementing Change (ERIC) taxonomy to characterize the discrete implementation strategies used to support the adoption, implementation, sustainment, and scale-up (or spread) of each intervention.
Results: This scoping review synthesized 108 peer-reviewed studies reporting on interventions which to address SUD stigma among healthcare professionals. Most interventions were implemented in training environments, including higher education and continuing education settings, and focused on providing basic education on SUD broadly or opioid use disorder. Within interventions, educational and training implementation strategies were most prominent with 74% of studies using educational meetings and 39% distributing training materials. Far fewer studies used implementation strategies that used experiential approaches such interactive assistance, simulation, case-based learning, or contact with people with lived experience. Most studies (73%) reported reductions in stigmatizing attitudes, most often immediately post-intervention, though the need for higher study quality was notable.
Conclusions: Existing stigma-reduction interventions are overwhelmingly education-focused and primarily implemented in academic settings, with limited use of strategies that promote reflective learning, contact-based engagement, or organizational change. Future work should employ more rigorous designs that systematically test implementation strategies to create packaged SUD stigma reduction interventions optimized for effectiveness and implementation.
Stigma toward people with substance use disorders (SUD) remains a major barrier to care. This presentation described the methods, results, and implications of a scoping review completed by the CTN T&I SIG’s Implementation Strategies Workgroup to identify and describe implementation strategies used to reduce stigmatizing attitudes toward people with SUD in healthcare settings.
This presentation featured the work of CTN-0095: Clinic-Randomized Trial of Clinical Decision Support for Opioid Use Disorders in Medical Settings. Drs. Rebecca Rossom, Stephanie Hooker, and Gavin Bart shared their study approach, key findings, and lessons learned from implementing this pragmatic trial.
In this webinar for the CTN Translation & Implementation SIG, Gail D’Onofrio, MD, MS, and David A. Fiellin, MD, shared their study approach and results for CTN-0069: Opioid Use Disorder in the ED (Project ED Health), as well as considerations for integrating implementation outcome evaluations in efficacy/effectiveness protocols.
In this session at the 2025 Quarterly CTN Steering Committee Meeting on March 11, 2025, presenters Mark McGovern, Joe Glass, and Sophia Gonzalez provided updates from the CTN T&I SIG, including:
- An overview of the history and purpose of the SIG
- Some background on the purpose of implementation science
- A description of the two T&I SIG workgroups: Implementation Strategies and Implementation Outcomes
- A detailed presentation on the results of a systematic review by the Implementations Outcomes workgroup on implementation outcomes included in NIDA CTN studies over 20 years of research.
In this webinar for the CTN Translation & Implementation SIG Speaker Series, Dr. Kelly Aschbrenner presented case examples from an implementation science network integrating a focus on health equity.
Dr. Aschbrenner referenced several resources during her presentation, including:
In this webinar for the CTN Translation & Implementation SIG, Dr. Arthur Robin Williams, Assistant Professor of Psychiatry at Columbia University, presented about the OUD Cascade of Care, a public health framework for monitoring population-level outcomes with an emphasis on MOUD initiation and retention. Buprenorphine treatment can be tailored under the Cascade framework based on patient risk level. For instance, patients with active fentanyl use who are naïve to buprenorphine often need more intensive services early in treatment compared to patients entering care already on buprenorphine, whether prescribed or otherwise.
In this webinar for the CTN Translation & Implementation SIG, Danny Almirall, a statistician and effectiveness implementation intervention scientist, discussed the need for multilevel, multicomponent implementation strategies from the perspective of implementation support professionals; and multilevel adaptive implementation strategies (MAISYs) as a potential solution. He also described 14 different types of scientific questions that an Optimization Implementation Scientist might ask about MAISYs, as well as how best to match these optimization scientific questions with the appropriate randomized trial design.
This presentation reviews the role of Community-Based Participatory Research (CBPR) principles and practices in the implementation of evidence-based and/or community-informed practices. It will include illustrations from current and recent studies of community engagement in identification of barriers and facilitators, co-design of implementation strategies, and conduct of formative evaluations of implementation process and outcomes using the RAPICE (Rapid Assessment Procedures-Informed Community Ethnography) methodology.
This presentation focuses on barriers faced by youth involved in the legal system to access treatment, ongoing efforts going across Indiana to improve training in evidence-based treatment, as well as implementation strategies to improve treatment.
This presentation discusses the field of human-centered design (HCD), its alignment with implementation science, and ways that HCD can be leveraged to advance the goals of contemporary implementation science, especially surrounding the strategic adaptation of complex psychosocial interventions and implementation strategies.
In this presentation, Dr. Curran discusses ways to integrate implementation-focused research concepts and questions into clinical trials. He will cover concepts and approaches such as “design for dissemination/implementation,” “implementability,” and effectiveness-implementation hybrid designs. He will share examples from his own work and from others who combine their efficacy/effectiveness and implementation research.
This presentation from Leopoldo J. Cabassa, PhD, MSW (Center for Mental Health Services Research, Brown School of Social work, Washington University) presents strategies and ways to infuse equity approaches into implementation science studies to proactively address healthcare inequities in historically marginalized populations.
In this webinar for the CTN Translation & Implementation SIG, Andrew Quanbeck, PhD (University of Wisconsin-Madison) described his research into a strategy to improve patient safety by instituting a set of universal precautions for opioid prescribing in primary care based on leading clinical guidelines.
In this webinar for the CTN Translation & Implementation SIG, Lori Ducharme, PhD, of the NIH Division of Epidemiology, Services and Prevention Research, reviewed priority areas for implementation science at NIDA, D&I research funding opportunities, how to build a D&I grant application, and general grantsmanship pointers.