Alcohol use disorder has more stigma surrounding it than do other mental health conditions

Stigmatization surrounding alcohol use disorder is high compared with most other mental health conditions, according to results of a systematic review published in Alcoholism: Clinical & Experimental Research.

“Understanding the public stigmatization of people with mental disorders or substance use disorder is essential to reduce or eliminate negative consequences for those affected and warrants particular attention in research,” Carolin Kilian, a research assistant and doctoral candidate at the Institute of Clinical Psychology and Psychotherapy at the Dresden University of Technology in Germany, and colleagues wrote. “Yet, most research on the public's mental health stigma has employed descriptive rather than systematic approaches or conceptual models which are needed for an in-depth understanding. In this systematic review, we summarize population-based research on the public stigmatization of people with [alcohol use disorder] compared to the stigma of other conditions (ie, mental disorders and other [substance use disorders]).”

The current study updated findings of a prior systematic review conducted in 2011 that evaluated attitudes toward individuals with alcohol use disorder. Kilian and colleagues searched five databases for population-based studies on public stigma toward alcohol use disorder and at least one other mental health condition, published between Oct. 1, 2010, and Dec. 20, 2020. This allowed them to include all studies published since the prior systematic review in this research area. They included 24 records with results from 16 unique studies conducted in nine different countries.

Results showed individuals with alcohol use disorder were generally less likely to be perceived as having a mental condition compared with individuals with mental disorders unrelated to substances. Moreover, they were seen as being more dangerous and responsible for their condition. Certain studies showed a stronger preference for social distance from individuals with alcohol use disorder compared with individuals with depression or tobacco addiction, with people less likely to want individuals with alcohol use disorder to marry into the family or take care of children.

Kilian and colleagues observed no consistent differences in the public stigma toward individuals with alcohol use disorder compared with those with other substance use disorders.

“The findings suggest that the development of stigma toward people with [alcohol use disorder] is complex,” the researchers wrote. “For example, labeling [alcohol use disorder] as mental illness was associated with a lower likelihood of expressing anger, but with an increased likelihood of expressing fear toward those with an [alcohol use disorder]. This could indicate that [two] contrasting conceptualizations shape our responses to [alcohol use disorder]: If regarded as a stable and trait-like condition, related to assumptions on ‘bad character,’ blame and feelings of anger might be less pronounced but fear and social exclusion nevertheless high.

“Conversely, if regarded as a ‘bad behavior’ — that is, a state that needs to be overcome — moral judgments and blame of people with [alcohol use disorder] could be harsher, possibly leading to more discrimination and social exclusion,” they added.