Overview #
This case study explores using Stages of Change to tackle problem drinking through a 988 helpline campaign in Central Maryland, USA. The programme used harm-reduction messaging to reach people who use drugs and alcohol, to encourage earlier help-seeking for problem drinking.
Abstract #
The team found that messages combining mental health and substance use often fell flat, since audiences saw them as separate and combined messaging felt too generic. Their research showed that a crisis helpline could help during two Stages of Change in the Transtheoretical Model: contemplation and preparation. People in these stages are considering or preparing to seek help but aren’t ready for treatment.
In summer 2024, the team ran two phases of research. Phase one involved 60-minute in-depth interviews (n=27) via Zoom with people in active recovery across four Central Maryland counties. They included young adults, White men, older Black men and LGBTQ+ participants. Phase two involved 15- to 20-minute intercept interviews (n=22) at Charm City Care Connection, exploring reactions to messaging concepts among people at different stages of use.
The research found that people committed to recovery preferred abstinence-focused messages. Those earlier in their journey responded better to non-judgemental, harm-reduction messaging. As one participant in long-term recovery put it, “everyone has to start by trying to cut back.” People already in recovery reported less need for the helpline, since they had access to other community resources.
A winter campaign encouraged residents to find alternatives to alcohol and assess their drinking. It generated 5,340,419 impressions, reached over 314,000 people on YouTube and nearly 209,000 on TikTok, and drove 12,000 visits to a landing page with tips on cutting back. Young adults aged 18–24 and men aged 25–44 engaged equally with video content, suggesting both groups are actively seeking support.
The research shows that harm reduction approaches can be critical to engaging people who use drugs and alcohol during the earlier stages of their journey. Applying the Transtheoretical Model can help social marketers build trust and support people to take the first steps past denial.
Access #
Sara Isaac (sara.isaac@forchange.agency), Marketing for Change
Case study and materials: https://marketingforchange.com/the-work/bhsb-988/
Location #
Central Maryland, USA (Baltimore City, Baltimore County, Carroll County and Howard County)
Key words #
Substance use, problem drinking, harm reduction, Stages of Change, Transtheoretical Theory, WSMC conference 2025
