Alcohol Use Disorder is More Stigmatized than Other Substance-Unrelated Mental Health Conditions

Newswise — Alcohol use disorder (AUD) is among the most stigmatized mental health conditions, and people with AUD are seen as more dangerous and more responsible for their disorder compared to people with other substance-unrelated mental health diagnoses, according to a review of studies in nine countries. The review found that people with AUD are targets of pervasive stigmatizing beliefs and behaviors. Socially distancing from people with AUD and discriminating against them is considered more acceptable than similar treatment of people whose mental health conditions are not related to substance use, says the article in Alcoholism: Clinical & Experimental Research. Stigmatization of AUD has serious implications for treatment and research, and contributes to health care inequality, though receives minimal attention.

Researchers reviewed 24 articles based on 16 separate studies published between 2010 and 2020 that compared public attitudes toward people with AUD and people with other mental health conditions. The studies were conducted in Europe (seven) and the US (four); others were from Australia (two), Brazil, Singapore, and South Korea. Stigma around AUD was most commonly compared with stigma aspects related to depression, schizophrenia, or other substance or behavioral addictions. Three studies considered other mental health conditions. The researchers summarized and compared findings on mental health labeling, stereotypes and prejudices, and forms of discrimination such as social distancing or approval for discrimination by public services and administration. They also explored how aspects of stigma around AUD are related and looked for changes since a systematic review in 2011.

People with AUD experienced a high level of stigmatization. The studies explored different aspects of AUD stigma and the results were variable. Overall, however, they suggested that people with AUD were perceived as more dangerous to others than were those whose mental health conditions did not relate to substances. They were also seen as more responsible for their condition, with AUD often considered to be caused by a “bad character” or the persons’ “personality”. Some studies showed a stronger preference for social distance from people with AUD compared to depression or tobacco addiction, such as not wanting people with AUD to marry into the family or take care of children. Stigma appeared similar toward people with AUD and other substance use disorders (SUDs), reflecting a moral judgment related to addiction. In the USA and Germany, stigma toward AUD did not appear to have changed since 1990.

The thoughts and beliefs underlying discriminatory behaviour of AUD appear different from those of depression and schizophrenia, the researchers conclude. However, they emphasize that among all the articles reviewed, only three carried out this kind of in-depth analysis. The review supported cultural differences affecting stigma. The researchers recommend standardized study methods and improved exploration of the beliefs underlying AUD stigma.

Stigmatisation of people with alcohol use disorders: An updated systematic review of population studies. C. Kilian, J. Manthey, S. Carr, F. Hanschmidt, J. Rehm, S. Speerforck, G. Schomerus. (p xxx)

ACER-21-4754.R1