Title: Barriers and facilitators to drug use behavior change in diverse community health center patients in Los Angeles Authors: Stephanie Sumstine, MPH, Michael Park, BA, Whitney Akabike, MSPH, Dallas Swendeman, PhD, MPH, Lillian Gelberg, MD, MSPH Background: Self-monitoring and feedback are core elements for supporting behavior change over time. Feedback provided by a therapist or counselor has limited scalability beyond session-limited interventions. There is evidence that automated text-messaging may be efficacious for reducing substance use, however, several studies have not observed drug use reductions when feedback messages were completely automated, not personalized, and did not involve any human contact. Automated feedback messages that are tailored to individuals’ barriers and facilitators to drug use reduction may be a scalable, yet personalized, strategy to enhance counselor delivered interventions and sustain patient engagement in drug use reduction goals after counseling sessions cease. Objectives: This analysis aimed to identify barriers and facilitators to drug use reduction to guide tailoring of personalized feedback text-messages in response to weekly self-monitoring by patients with moderate risk drug use in the new NIDA-funded QUIT-Mobile study. Methods: Analysis included thematic content analysis of QUIT-Binational study health educator coaching log data. Two research assistants closely examined the data to identify common themes through iterative rounds of coding and discussion with the study team. Results: The most common barriers to drug use reduction cited by QUIT-Binational participants were: 1) peers/social environment, 2) relaxation and being able to “mellow out”, 3) pain relief, and 4) perceived to work better than prescribed medication. The most common facilitators that helped participants stay focused on their drug use reduction goals were: 1) exercise, 2) family and peer support, 3) motivation in spending less money, 4) alternative pain relief (i.e. stretching), and 5) relaxation techniques (i.e. meditation, journaling). Conclusion: Findings suggest there are unique barriers and facilitators to drug use reduction in diverse low-income primary care patients. Feedback messages should be tailored to individuals’ noted barriers and facilitators to enhance motivation and reinforce alternatives to drug use. Future studies should comprehensively examine how cultural, social, and environmental aspects influence drug use to develop specialized feedback that appeals to diverse patients to a greater degree than standard feedback.