Social stigma – judgment from employers, neighbors, clinicians and family – is one of the main reasons why only one in 10 of the roughly 400 million people worldwide with alcohol or drug use disorders receive adequate care, according to recent WHO statistics.

A growing body of research suggests that social contact, the experience of encountering someone else’s lived reality, is one of the most effective ways to reduce that stigma, said Maya Adam, MD, PhD, Director of Health Media Innovation at Stanford Medicine. But in-person contact doesn’t scale easily, and public health interventions that use this approach are often limited by language and cultural barriers.

To address this challenge, Adam’s Health Media Innovation Lab worked with the Stanford Medicine Office of Communications to develop a short, animated video with no dialogue and test whether it could reduce stigma toward people with drug and alcohol use disorders.

The 2-minute, 40-second video features a young fish, a strange blobby substance (that an older fish warns him to leave alone), and his slow unraveling as he gradually gets hooked. Toward the end of the story, the older fish reveals his own history of addiction and recovery.

Matt Torode / Stanford Medicine

In a randomized controlled trial published in eClinicalMedicine this month, Adam and an international team of researchers assigned participants in the United Kingdom, the United States, and South Africa to watch the animation, with or without its soundtrack,  or to read an informational text about substance use disorders.

Nearly all 13,397 participants completed the first round of questions, and 92% came back two weeks later.

The video had a modest but measurable effect: Across countries, those who watched the animation with its soundtrack scored 9% lower on a validated measure of addiction stigma than the group who read the informational text. Two weeks later, that group still scored 4% lower.

The silent version also worked, but less effectively: viewers scored 6% lower on stigma immediately after exposure, and 2% lower at follow-up. Participants who watched either version also reported warmer feelings toward people with addiction and more optimism, with those feelings still elevated two weeks later.

While a single short video can’t overhaul someone’s worldview, we’re excited by the potential for these interventions to be delivered repeatedly, at scale, and meet people where they regularly consume short-form content,” said Adam, who is the study’s lead author. We asked her to discuss the video’s evolution and the philosophy behind this approach.

Maya Adam | Timothy Archibald

What made you think of using a fish as the protagonist?

This video was part of a mental health series that we hoped would cross language and literacy barriers. But I worried about translating a message about addiction across cultures into an animated film that wouldn’t look comical. I started exploring idioms.

Phrases like “drinks like a fish” or “being hooked” fit well with an underwater world. The fish became a symbol. He doesn’t belong to any specific country or culture. That anonymity allows him to be universally relatable.

In what settings can a video like this be effective?

We call these “micro-interventions” because they are short, two-minute, wordless messages designed for dissemination on social media or via other digital pathways. Unlike a weeklong course or a clinical intervention, these videos are built to shift attitudes in the short term – just motivating people to begin questioning their attitudes. We try to make them engaging, so that people share them with their online communities.

The goal is to spread scientific knowledge and public health messages to people who aren’t actively looking for them, and who might otherwise never encounter them. The video has already been released on the Stanford Medicine YouTube channel. Our content is available for reposting, and several community partners amplify it. There’s an organization based in San Francisco, for example, that plays our videos in clinic waiting rooms all over the city.

Why did the video have more impact with music?

We think that music does something narration can’t. It guides you on how to feel about what you’re watching without telling you what to think; it provides an emotional roadmap. This finding also highlights the capacity for human beings to be moved by storytelling and art – things we don’t often associate with traditional health messaging.

What is next for this method of health communication?

We are continuing to use this approach to target stigma toward people with mental health problems. We are also about to launch a trial to promote colorectal cancer screening, featuring a polyp as the main character. Additionally, we are studying whether human-created art and music elicit different psychological outcomes than AI-generated content.

Have you seen any real-world impact beyond the data?

One participant wrote to say that she lost a neighbor in her apartment building to a drug-related death while she was participating in the trial. She admitted that she had kept her distance from him because of his addiction. After reflecting on the study and the video, she told us that she would make a conscious decision to react differently in the future and to reach out if she found herself in a similar situation again.