Sharon C. Wilsnack, Ph.D.,
& Margaret M. Murray, M.S.W.
Negative social attitudes toward excessive drinking and alcohol use disorders are widely documented in surveys in North America, the U.K, and other European countries, including Russia. These attitudes interact with negative labeling of other stigmatizing conditions (e.g., poverty, ethnic minority status, alternative sexual orientation) to produce particularly punitive social responses to persons with combinations of stigmatizing conditions, e.g., poor, ethnic minority, HIV-positive, pregnant substance abusers.
The stigma surrounding
alcohol abuse is similar to that surrounding other marginalized statuses in
several respects: it discourages the affected individual from seeking help;
prevents significant others from acknowledging the problem and supporting the
stigmatized individual; and has negative effects on the stigmatized
individual’s sense of self-worth, leading to further destructive behavior.
Alcohol abuse also differs
from other stigmatizing conditions in some important ways. Alcohol and drug abuse are more likely to be
viewed as self-inflicted than are other mental disorders, and are seen as
creating greater social disruption than disabilities such as blindness and
paraplegia. These more negative
attitudes toward alcohol and substance abuse may in turn be associated with
less optimistic views regarding treatment and recovery, and less public support
for and professional interest in research on addictive behavior and addictive
disorders.
Effective interventions to
reduce alcohol abuse and related problems may require simultaneously addressing
the two faces of stigma: (1) strengthening and channeling naturally occurring
negative responses toward the destructive behavior of the alcohol
abuser, while at the same time (2) trying to reduce negative attitudes
toward the affected individual as a person who deserves compassion and
respect and who can recover from his or her alcohol problems with appropriate
intervention. The general strategy of
strengthening social norms against undesirable behavior has proven effective in
relation to tobacco use and drinking-driving behavior, although these
efforts have not always succeeded in reducing stigmatizing attitudes toward the
persons who engage in the undesirable behaviors.
One factor contributing to
the stigmatization of alcohol abuse is the pervasive lack of public knowledge
about the effectiveness of treatment, in particular treatment that addresses
both biological and psychosocial aspects of alcohol use disorders. The lack of knowledge about the nature and
effectiveness of alcohol abuse treatment not only reinforces the stigma
surrounding alcohol abuse but also allows unqualified practitioners of untested
and potentially harmful “treatments” to exploit persons and families desperate
to recover from the devastating effects of alcohol use disorders.
Prevention programs designed
to reduce the stigma of HIV/AIDS have been implemented in many countries, and
several major campaigns have been conducted to increase public understanding of
mental health disorders. Similar public
education campaigns are needed for alcohol and substance use disorders. These campaigns should be implemented and
evaluated in a variety of cultural settings, using culturally sensitive methods
and messages, and should include a major emphasis on the nature and
effectiveness of treatment for alcohol use disorders.
Future research on alcohol
abuse and stigma should include (1) better documentation of the extent, nature,
and effects of stigmatization of alcohol abuse, particularly in countries
outside North America and Europe; (2) comparative analyses of the extent,
nature, and effects of stigmatization of alcohol abuse (a) in different
countries and cultures, and (b) across subgroups (e.g., based on gender,
race/ethnicity, age, socioeconomic status, and sexual orientation) within
countries or cultures; (3) comparisons of the extent, nature, and effects of
stigmatization of various combinations of physical and mental disorders (e.g.,
alcohol abuse and HIV/AIDS; alcohol abuse and epilepsy; alcohol abuse and
developmental disorders); and (4) development and evaluation of interventions
to reduce stigmatization of alcohol abuse, including (a) public education
campaigns to increase knowledge about and support for alcohol abuse treatment,
and (b) programs designed to simultaneously strengthen negative social
responses to undesirable alcohol-related behavior while also weakening negative
social responses to the alcohol abuser as a person.