Perceived alcohol stigma and treatment for alcohol use disorders

尽管有有效的治疗方法，但绝大多数（85%）患有酒精使用障碍（AUDs）的人从未得到过针对其问题的帮助。AUDs包括酒精滥用和酒精依赖。《健康人2020》的一个目标是增加被诊断患有aud的人接受酒精治疗的人数耻辱被认为是接受服务的最大障碍，因此必须克服人们认为存在对aud患者的污名化态度的程度被定义为感知酒精污名（PAS）。虽然已知PAS水平较高的aud患者不接受治疗的风险更大，但PAS影响寻求治疗的具体机制仍不清楚。为了克服耻辱感作为接受酒精治疗服务的障碍，我们必须首先建立一个知识库，以便更好地具体了解酒精耻辱感如何影响寻求治疗。本研究的总体目标是确定PAS如何影响酒精治疗的接受。假设PAS与治疗需求的感知减少有关。在那些认为需要治疗的人中，假设PAS与寻求帮助的减少有关。护理的内部/心理障碍的经历预计将调解PAS和接受酒精治疗之间的关系。研究伴有AUDs和精神障碍的患者的PAS经验也很有意义。同时伴有疾病的患者PAS水平较高。虽然那些同时出现疾病的人通常表现出更高的求助率，但假设PAS会缓和/减弱同时出现疾病和接受酒精治疗之间的关系。为了验证这些假设，奖学金申请人将对国家酒精及相关疾病流行病学调查（NESARC）进行二次分析NESARC是一项针对生活在非机构环境中的美国成年人的人口代表性调查。NESARC是同类调查中唯一包含有效PAS测量的调查。在拟议的研究和培训计划中，奖学金申请人将接受以下方面的培训：1)高级统计方法；2)酒精流行病学、疾病分类学和合并症；3)卫生服务研究；4)病耻感；5)学术写作和研究传播。这一培训将为申请人的独立研究生涯做好准备，这将涉及努力大大提高对接受酒精治疗的个人和组织障碍的理解。在完成拟议的研究后，申请人将寻求培训，以制定干预措施，以增加接受治疗的aud患者人数。所提议的研究和职业规划符合PA-10-100所讨论的研究所的目标。

Despite the availability of effective treatments, the overwhelming majority (85%) of individuals suffering from alcohol use disorders (AUDs) never receive help for their problems. AUDs include the disorders of alcohol abuse and alcohol dependence. An objective of Healthy People 2020 is to increase the number of individuals diagnosed with AUDs who receive alcohol treatment.1 Stigma is thought to be the most formidable obstacle to receiving services, and thus, must be overcome.2 The extent to which one believes that stigmatizing attitudes towards those with AUDs exist is defined as perceived alcohol stigma (PAS). Although it is known that persons with AUDs who have higher levels of PAS are at an even greater risk of not receiving treatment,3 the specific mechanisms by which PAS affects treatment seeking remain unknown. To overcome stigma as a barrier to receiving alcohol treatment services, we must first develop a knowledge base to better understand specifically how alcohol stigma affects treatment seeking. The overall objective of this study is t identify how PAS may influence the receipt of alcohol treatment. It is hypothesized that PAS is associated with decreased perceptions of treatment need. Among those who perceive a need for treatment, it is hypothesized that PAS is associated with reductions in help seeking. The experience of internal/psychological barriers to care is expected to mediate the relationship between PAS and the receipt of alcohol treatment. It is also of interest to examine the experience of PAS among those with co-occurring AUDs and psychiatric disorders. Those with co-occurring disorders are expected to have higher levels of PAS. Although those with co- occurring disorders typically exhibit higher rates of help seeking, it is hypothesized that PAS wil moderate/attenuate the relationship between the presence of co-occurring disorders and the receipt of alcohol treatment. To test these hypotheses, the fellowship applicant will perform secondary analyses of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).4 NESARC is a population- representative survey of United States adults living in noninstitutionalized settings. NESARC is the only survey of its kind which contains a validated measure of PAS. In the proposed research and training plan, the fellowship applicant will receive training in 1) advanced statistical methods, 2) alcohol epidemiology, nosology, and comorbidity, 3) health services research, 4) stigma, and 5) scholarly writing and research dissemination. This training will prepare the applicant for an independent research career which will involve efforts to significantly advance the understanding of the personal and organizational barriers to receiving alcohol treatment. After the completion of the proposed research, the applicant will seek training to develop interventions to increase the number of individuals with AUDs who are treated. The proposed research and career plans are consistent with goals of the NIAAA as discussed in PA-10-100.