Perceived alcohol stigma and treatment for alcohol use disorders

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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.