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The Stigma of Alcoholism

“What are you, like…an alcoholic or something?”

Here’s a scenario to consider: A girl walks into a bar with friends and orders a soda in the midst of flowing IPAs and lagers. Not much is made of it – other than a possible sneer by the bartender – but that could simply be her imagination.

When it comes time for the next round, however, the girl orders water – spiked with three lemons. That move prompts the question, “What are you, like an alcoholic or something?” The girl’s friend quickly interjects, “No, she’s not an alcoholic, she just gave up alcohol for Lent!”

This is my story and brief stint into sobriety. I noticed over the past forty days, that not only had I made a choice to give up alcohol, but I had also unwittingly gone under cover. These past days have given me an insider’s glimpse into what it means to be sober, social and stigmatized. For people who do struggle with alcohol abuse and are making strides in sobriety, they encounter ridicule and judgment on a daily basis.

How About a Little Tact?

In the scene illustrated above, not only did the bartender’s question come off as insulting and condescending…what if I happened to be an alcoholic after all? But what surprised me even more was my friend’s almost knee-jerk response in justifying my choice of abstinence.

Alcoholics are equated in social contexts to people who are unlovable, unemployed and criminals. In short, addictions are treated like moral and criminal issues.-Helen FarrellIn my private psychiatry practice, I treat a lot of binge drinkers and alcoholics. I listen empathically as they tell me how it’s a daily struggle. And I’ve now come to recognize that, not only is the choice to live a sober life a struggle, but, moreover, it’s dealing with the societal demand to explain one’s decision.

Stigma is a socio-cultural process in which alcoholics are traditionally devalued, rejected and excluded. It’s a form of health-related stigma, as it’s predicated on the basis of a socially discredited health condition.

Substance use behaviors are linked symbolically to a range of other stigmatized health conditions. These range from HIV/AIDS to hepatitis to depression and schizophrenia. Alcoholics are equated in social contexts to people who are unlovable, unemployed and criminals. In short, addictions are treated like moral and criminal issues. They are not acknowledged for the health concern that they impose.

But new research suggests that addictions like alcoholism are rampant and escalating in the middle- and upper-class. The gender gap is closing too, as Ann Dowsett-Johnston highlights in her book Drink and her 2014 TEDx Talk, Drinking and How it Changed My Life.

It’s Much More Than an Illness

Alcohol use disorder is a well-defined mental illness, not to mention a public health crisis. But it is treated vastly differently from other deadly illnesses, such as cancer. Rather than running in celebrated annual races or participating in fund raisers, alcohol’s victims are hiding in shame. There is a chasm between our understanding of mental illness and our acceptance of it.

The truth about addiction is that it is a brain disease. The American Society of Addiction Medicine and the National Institute on Drug Abuse agree. Addiction is a chronic condition involving brain disease that results in relapses.

On a microscopic scale, here’s what happens to the addicted brain:

With every drink of alcohol, the frontal lobe of the brain – the part that helps us prioritize, strategize, and filter information – takes a hit. Repeated use disrupts the development and neural circuitry of this key organ. When the frontal lobe is damaged, so is our ability to inhibit impulsivity and delay gratification. Addiction also affects neurotransmission and interactions between cortical and hippocampal circuits and brain reward structures.

The DSM-V (Diagnostics and Statistics Manual) – the psychiatrist’s Bible, defines alcohol use disorder as having the following symptoms:

  • Recurrent drinking resulting in failure to fulfill role obligations
  • Recurrent drinking in hazardous situations
  • Continued drinking despite alcohol-related social or interpersonal problems
  • Evidence of tolerance
  • Evidence of alcohol withdrawal or use of alcohol for relief or avoidance of withdrawal
  • Drinking in larger amounts or over longer periods than intended
  • Persistent desire or unsuccessful attempts to stop or reduce drinking
  • Great deal of time spent obtaining, using, or recovering from alcohol
  • Important activities given up or reduced because of drinking
  • Continued drinking despite knowledge of physical or psychological problems caused by alcohol
  • Alcohol craving

The severity of alcohol use disorder at the time of diagnosis can be specified as a subtype based on the number of symptoms present:

  • Mild: Two to three symptoms
  • Moderate: Four to five symptoms
  • Severe: Six or more symptoms

Getting Rid of the Stigma

Reducing stigma starts with caring communities. We are our greatest allies and sources of strength. SAMHSA’s (Substance Abuse and Mental Health Services Administration) Recovery Community Services Program (RCSP) advances recovery by providing peer recovery support services across the nation.

Reducing stigma starts with caring communities. We are our greatest allies and sources of strength.-Helen FarrellTalking openly about alcoholism can also help people to feel less alone and part of a community. Studies show that a range of interventions demonstrate promise for achieving meaningful improvements in stigma related to substance use disorders. Self-stigma, for example, can be reduced through therapeutic interventions such as group-based acceptance and commitment therapy. Effective strategies for addressing social stigma include motivational interviewing and communicating positive stories of people with substance use disorders.

No; I’m not an alcoholic. But thanks to an unaware bartender and a close friend, I now have some first-hand insight into the everyday stigma facing those who do struggle with alcoholism. And I have the power to do something about it.

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