Short, animated storytelling social contact videos reduce addiction stigma in the UK, USA, and South Africa: a randomised controlled trial of 13,397 participants

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Background Societal stigma towards people with addiction fuels exclusion, undermines social support, and inhibits help-seeking. We evaluated a wordless, short animated storytelling (SAS) social contact video in three countries. Methods We conducted a three-arm, online randomised controlled trial in the UK, USA, and South Africa. Adults aged 18–49 years were recruited via Prolific Academic between July 10th and July 24th, 2025, and randomly assigned (1:1:1) to a 2 min 40 s SAS video with soundtrack, the same video without soundtrack, or an informational control delivered within the online survey platform. The primary outcome was stigma towards people with addiction, measured using the 18-item Attribution Questionnaire (AQ-18) immediately post-exposure (T1) and two weeks later (T2). Secondary outcomes were optimism (Brief García Interactive Optimism Scale), hopefulness and attitudes of warmth towards people with addiction. Analyses included all participants who completed the relevant assessment and met attention-check criteria. Effects were estimated as ratios of means with robust standard errors and country fixed effects. The trial was registered with ClinicalTrials.gov (NCT06705205; Nov 22, 2024). Findings Between July 10th and July 24th, 2025, 13,500 participants were recruited; 13,397 (99%) completed T1 and 92% completed T2. Compared with control, mean stigma scores were 9% lower at T1 in the soundtrack group (ratio of means 0·91; 95% CI 0·90–0·93) and 6% lower in the no-soundtrack group (0·94; 0·93–0·95). At T2, stigma remained 4% lower with soundtrack (0·96; 0·95–0·97) and 2% lower without soundtrack (0·98; 0·97–0·99). Secondary outcomes improved at T1 in both intervention groups; at T2, warmth remained higher with attenuation. Interpretation Single exposure to a wordless SAS social contact intervention reduced addiction stigma across three countries, with greater and more durable effects when accompanied by soundtrack. Our findings support integrating SAS social contact interventions into population-level addiction stigma reduction campaigns. Funding Heidelberg Institute for Global Health, Heidelberg University Hospital, Germany. No specific grant number was assigned.

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