Samberg Diana, Spinella Sara, Rothenberger Scott, Tetrault Jeanette M, Childers Julie
Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Department of Medicine, University of Pittsburgh School of Medicine and VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
Subst Use Addctn J. 2025 Apr;46(2):313-319. doi: 10.1177/29767342241298057. Epub 2024 Dec 17.
Addiction is a chronic, treatable disorder, yet it carries considerable stigma. Stigmatizing language biases how clinicians view patients with substance use disorders (SUDs) and negatively affects patient care. While national medical organizations have recommended educational initiatives to reduce the stigma associated with SUDs, studies of initiatives are lacking. We aimed to improve documentation of SUDs and reduce measured stigma by teaching standardized, non-stigmatizing language.
We created an online, 25-minute interactive curriculum about vocabulary for addiction and why language matters. Before and 8 weeks after completing the curriculum, internal medicine residents viewed a video encounter between a physician and a "challenging" simulated patient with opioid use disorder, then completed a case write-up and a SUD stigma survey. We analyzed the frequency of usage of stigmatizing terms and quantified participants' stigma levels.
During the fall of 2020, UPMC Internal Medicine residents completed the curriculum. In all, 98 participants (out of ~150) completed the pre-curriculum assessment, and 39 completed the entire course. In pre-curriculum write-ups, stigmatizing terminology was used 4 times more often than clinical terminology (30 terms per 100 write-ups versus 7.6, = .032). Clinical terminology was used 134% more often post-curriculum than pre-curriculum (24 terms per 100 write-ups vs 7.6), but this result was not significant. There was no difference between measured stigma levels pre- and post-curriculum. In total, 34/45 (75.6%) participants who completed the post-curriculum survey said that they learned new information, and 32/45 (71.1%) would recommend it to others.
There were trends toward improvement in language, including decreased use of stigmatizing terminology and increased usage of clinical terminology, though not statistically significant. The curriculum was well-received, but the study was limited in participation by the COVID-19 pandemic. However, the simple design of the curriculum-a short, web-based module-allows for easy delivery to workers across the healthcare sector.
成瘾是一种慢性、可治疗的疾病，但它带有相当大的污名。污名化语言会影响临床医生对物质使用障碍（SUDs）患者的看法，并对患者护理产生负面影响。虽然国家医学组织已建议开展教育活动以减少与SUDs相关的污名，但缺乏对这些活动的研究。我们旨在通过教授标准化、无污名化的语言来改善SUDs的记录并减少可测量的污名。
我们创建了一个25分钟的在线互动课程，内容涉及成瘾词汇以及语言为何重要。在内科住院医师完成课程之前和之后8周，他们观看了一段医生与一名患有阿片类药物使用障碍的“具有挑战性”模拟患者之间的视频会诊，然后完成一份病例报告和一项SUD污名调查。我们分析了污名化术语的使用频率，并对参与者的污名水平进行量化。
在2020年秋季，匹兹堡大学医学中心（UPMC）的内科住院医师完成了该课程。总共98名参与者（约150名中的）完成了课程前评估，39名完成了整个课程。在课程前的报告中，污名化术语的使用频率比临床术语高4倍（每100份报告中30个术语对7.6个，P = 0.032）。课程后临床术语的使用频率比课程前高134%（每100份报告中24个术语对7.6个），但这一结果不显著。课程前后测量的污名水平没有差异。总共，完成课程后调查的45名参与者中有34名（75.6%）表示他们学到了新信息，45名中有32名（71.1%）会向其他人推荐该课程。
语言使用有改善的趋势，包括污名化术语使用减少和临床术语使用增加，尽管在统计学上不显著。该课程受到好评，但该研究因新冠疫情在参与度方面受到限制。然而，该课程的简单设计——一个简短的基于网络的模块——便于向医疗保健部门的工作人员提供。
