Psychologists and mental health experts use the term stigma to identify the seriously negative associations and judgments that can build up toward individuals or groups on the basis of their appearance, behaviors or other personal or group characteristics. People affected by alcohol abuse or alcoholism often experience such stigma either before or after they begin seeking treatment. In a study published in May 2014 in the journal Alcoholism: Clinical & Experimental Research, researchers from four U.S. institutions examined the potential role of stigma in the well-established connection between serious alcohol problems and the presence of other prominent mental health conditions.
Alcohol and Mental Illness
People with serious alcohol-related issues and/or other substance issues make up a disproportionate percentage of Americans affected by severe forms of mental illness such as depressive disorders and bipolar disorders (known together as mood disorders), certain anxiety disorders and schizophrenia and schizophrenia-related conditions. Current thinking links three potentially overlapping factors to the connection between alcohol or drug use and mental health issues. These factors are the desire to use alcohol or drugs to ease the effects of an existing mental illness, the potential ability of alcohol or drug use to trigger new symptoms of mental illness in some individuals and the potential for alcohol/drug use or alcohol/drug withdrawal to worsen latent or relatively minor mental health issues. Mental health and addiction experts use the term dual diagnosis to describe the simultaneous presence of diagnosable alcohol or drug problems and other diagnosable mental health concerns. As a rule, such a diagnosis typically predicts worse outcomes for both substance treatment and mental illness treatment.
Stigma can occur when individuals or groups of people start attributing negative characteristics or attributes to other specific individuals or groups. It can also occur when a given person starts to define himself or herself according to the same sorts of negative assessments. A number of damaging outcomes are associated with stigmatization of the self or others, including acts of discrimination in the workplace, acts of discrimination in other social environments, bullying and other violent or harassing behaviors, loss of the empathetic bonds that help stabilize society and human relationships, and development of feelings of inferiority that significantly limit a person’s self-perceived options or life choices. In the U.S. and other countries, stigma often builds up around people with serious substance issues, as well as around people affected by mental illness.
Influence on People With Alcohol Use Disorder
Alcohol use disorder is a diagnosis established in May 2013 to acknowledge the overlapping effects of alcohol abuse and alcoholism; people who receive this diagnosis may have combined symptoms of these two problems, symptoms only related to alcohol abuse or symptoms only related to alcoholism. In the study published in Alcoholism: Clinical & Experimental Research, researchers from the University of Wisconsin-Madison, University of Washington School of Public Health and two other U.S. institutions used information from a nationwide project conducted in the early 2000s, called the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), to explore the connection between the stigma associated with alcohol abuse/alcoholism and the presence of a dual diagnosis for mental illness.
After analyzing the NESARC data, the researchers concluded that, in terms of additional mental illness, people with alcohol use disorder fall into four separate groups. These groups are individuals not affected by a coexisting mental illness, individuals simultaneously affected by an “internalized” mental illness such as an anxiety disorder or a mood disorder, individuals simultaneously affected by an “externalized” mental illness such as another substance use disorder or antisocial personality disorder, and people simultaneously affected by both an internalized and an externalized mental illness. The researchers found that the self-reported levels of alcohol use disorder-related stigma are substantially higher in people who have the symptoms of an internalized mental illness. However, they also found that the self-reported levels of stigma are not elevated in people with combined cases of internalized and externalized mental illness, or in people only affected by externalized mental illness.
The study’s authors note that there are two potential relationships between an increased sense of stigma related to alcohol use disorder and the presence of mood disorders, anxiety disorders or other internalized mental illnesses. In some cases, the emotional/psychological stress of stigma may make the appearance of such illnesses more likely. On the other hand, people already affected by an internalized mental illness may be unusually susceptible to a self-perceived sense of stigma regarding their alcohol use.