‘This could be my last chance’: Therapeutic optimism in a randomised controlled trial for substance use disorders

Kaitlyn Jaffe, Todd Korthuis, Lindsey Richardson

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


In randomised controlled trials (RCTs), ‘therapeutic optimism’ describes a participant's belief they will benefit from the study treatment, despite the express goal of RCTs to test unknown aspects of interventions. Harbouring such expectations may interfere with RCT participation experiences, particularly among marginalised populations, such as people with substance use disorders (PSUD) who may experience social and structural barriers to participation that also increase their vulnerability to therapeutic optimism. However, little research explores therapeutic optimism within substance use trials. Thus, we conducted a nested qualitative study within an RCT testing a treatment for alcohol and opioid use disorders in HIV clinics. Using interviews with 22 participants in Vancouver, Canada, analysis revealed themes relevant to therapeutic optimism, that were specifically linked to intrinsic (e.g. health-related) or extrinsic motivations (e.g. stipend). First, compared to extrinsically motivated participants, intrinsically motivated participants held high expectations for the trial and attributed greater agency to the study medication. Second, intrinsically motivated participants expressing therapeutic optimism anticipated marked changes in their lives from the study/medication. Finally, some participants predicted the treatment would solve substance-related issues in their communities. These findings highlight the interplay between therapeutic optimism and complex interpretations of RCT objectives among PSUD.

Original languageEnglish (US)
Pages (from-to)1286-1300
Number of pages15
JournalSociology of Health and Illness
Issue number5
StatePublished - Jun 2021


  • Canada
  • Vancouver
  • medical research participation
  • qualitative
  • randomised controlled trials
  • substance use disorders
  • therapeutic optimism

ASJC Scopus subject areas

  • Health(social science)
  • Health Policy
  • Public Health, Environmental and Occupational Health


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