Substance use disorders affect nearly 45 million Americans age 12 and older; 25.7 million people have an alcohol use disorder, 26 million have a substance use disorder, and 7.1 million people have both. Accessing care remains a significant challenge, with an estimated 16% of individuals who needed treatment in 2025 receiving care. While many barriers to seeking treatment exist—including people’s belief that they should be able to quit on their own, feeling unready to seek treatment, and simply not having the time—stigma remains a persistent challenge, with 41% of people reporting concern about what others would think if they sought care, according to recent Substance Abuse and Mental Health Services Administration dataopens in new window.
Research suggests that an effective way to address that stigma is through “social contact,” or exposure to the lived reality of another person. Researchers at Stanford University have been exploring how digital media can be used as a scalable interventionopens in new window to potentially reduce stigma. They developed a brief animated videoopens in new window titled “Breaking Free,” of a young fish who becomes dependent on an unidentified substance.
The video is structured in three acts: the young fish is warned to avoid the substance by an older fish; the young fish tries the substance, becomes dependent, and experiences physical and psychosocial consequences; and the older fish provides support and reveals his own experience of substance dependence. The wordless video aims to humanize lived experience, encourage help seeking, and demonstrate the possibility of recovery. The imagery of a fish was chosen as a symbol that could potentially cross language and literacy barriers, making it broadly relatable.
The video was evaluated in a recent randomized controlled trialopens in new window in the United Kingdom, United States, and South Africa. Over 13,000 participants, ages 18–49, were randomly assigned to either view the animated video with or without a soundtrack or to the control group who viewed a static information sheet with facts and statistics about substance use disorders.
Participants completed measures about stigma prior to beginning the study, immediately following the intervention, and two weeks later. Results revealed that both versions of the video significantly reduced stigma immediately after viewing and two weeks later; however, those who viewed the video with the soundtrack had greater reductions in stigma compared with those who saw the silent version. Additionally, those who viewed the video reported more warmth toward individuals with substance use disorder, as well as increased hopefulness and optimism compared with those in the control group.
This research suggests that short videos can reduce stigma and could be a simple, low-cost tool to include in population-level public health campaigns. The researchers are using this same approach to address stigma toward people with mental health conditions and plan to launch a trial aimed at promoting colorectal screening.
Learn more about the work of the Stanford Medicine Health Innovation Labopens in new window.
