(Mis)understanding alcohol use disorder: Making the case for a public health first approach

Morris, James; Boness, Cassandra L.; Burton, Robyn

doi:10.1016/j.drugalcdep.2023.111019

Cited by 9 publications

(5 citation statements)

References 107 publications

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“…For example, it has been argued that in many societies, most practices of harmful alcohol use are exempted from 'disapproval' through normative representations of 'who' problem drinkers are (J. Morris, Boness, & Burton, 2023). Despite the widespread use of alcohol and cultural acceptability of many forms of heavy drinking, only those with the most severe AUD are labelled as problem drinkers (e.g., as 'alcoholics') and in turn, heavily stigmatized (Kilian et al, 2021;J.…”

Section: The Role Of 'Disapproval' Within Contemporary Stigma Theorymentioning

confidence: 99%

Can ‘justified disapproval’ be separated from addiction stigma? An empirical focus is required.

Morris,

Kummetat,

Schomerus

2024

Preprint

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Stigma is largely recognized as a harmful practice of social devaluation and discrimination, yet some scholars still advance arguments that stigma also serves an important disincentivizing force towards addictive behaviours. Whilst others counter that stigma is fundamentally harmful process, a more nuanced call has been made for “justified disapproval” as a beneficial normative force to be separated from addiction stigma. The legitimacy of such a claim requires empirical support which has been lacking thus far. We review evidence in the domains of social norms, stigma, addiction and behavioural sciences as a starting point for an empirically focused evaluation of the possibility of “justified disapproval” as a legitimate positive force. We note that whilst normative influences, emotions and addiction-relevant appraisals affect such behaviours under certain conditions, there are important questions regarding whether these can be harnessed without invoking the known and pervasive effects of stigma. Rather, we propose that efforts to curb addiction-related behaviours via normative influences are likely to fail or backfire. In the absence of empirical evidence to support the use of normative ‘disapproval’ strategies, alternative approaches should be pursued, particularly those which address the broader socio-cultural and structural drivers of addiction problems.

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Section: The Role Of 'Disapproval' Within Contemporary Stigma Theorymentioning

confidence: 99%

Can ‘justified disapproval’ be separated from addiction stigma? An empirical focus is required.

Morris,

Kummetat,

Schomerus

2024

Preprint

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“…We welcome the UK Government's Office for Health Improvement and Disparities' consultation on forthcoming clinical guidelines for harmful drinking and dependence [1]. We wish to highlight the importance of recognizing the broader determinants of health and opportunities to address alcohol harms upstream, particularly via prevention-focused policy levers [2,3] and an improved understanding of alcohol problems among the public [4].…”

mentioning

confidence: 99%

“…Crucially, increasing treatment capacity and effectiveness does not address the multiple broader causes of alcohol problems for which many upstream opportunities remain under-utilized [2,3]. This reflects a well-documented lack of political will to effectively tackle the social determinants, which clearly drive unequal levels of poor health [8,9].…”

mentioning

confidence: 99%

“…We urge stakeholders to proactively support a public health first approach to alcohol problems [3]. This means not only endorsing crucial treatment agendas, but also actively highlighting the existence of a continuum of alcohol use and harms across the population and avoiding dichotomous 'alcoholism' narratives [17].…”

mentioning

confidence: 99%

“…This means not only endorsing crucial treatment agendas, but also actively highlighting the existence of a continuum of alcohol use and harms across the population and avoiding dichotomous 'alcoholism' narratives [17]. Despite a comprehensive evaluation of Scotland's minimum unit pricing policy providing yet more evidence of the potential for public health initiatives [18,19], there remains a strong resistance to viewing alcohol problems through a public health lens [3]. While supporting vital treatment agendas, we call for a fundamental shift in how alcohol problems are framed.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Clinical alcohol guidelines are welcome—but upstream action is paramount

Morris,

Rose,

Cox

et al. 2023

Addiction

Self Cite

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Falling, slipping, and stumbling backwards

Jackson

2024

MSW

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This paper identifies how experiences of alcohol use disorder (AUD) are metaphorically framed in online alcohol support materials, using a dataset curated to isolate the language individuals seeking support may encounter. Individuals affected by AUD face barriers including self-stigma, shame, and a perceived lack of agency, which have been shown to inhibit help-seeking behaviours. Framings of alcohol use may challenge or reinforce stigmatising perceptions, in ways which may empower or disempower those affected. There has been little research examining how metaphor is used to communicate perceptions surrounding AUD, particularly at crucial access points such as the language of support materials. This paper applies the Metaphor Identification Procedure (Pragglejaz Group, 2007) to identify how metaphor use frames four key aspects of AUD: lived experience; coping strategies; the disorder; treatment options. The findings show that Journey framings dominate in this context, highlighting both the long-term nature and potential impermanence of recovery. Individuals are represented with varying degrees of agency at different stages of dependence, and framings acknowledging mitigated agency tend to anthropomorphise AUD itself in violent and highly agentive terms. The discussion examines the implications of the identified framings for support-seeking individuals, highlighting the need for further research exploring how those individuals may respond to and evaluate these framings.

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(Mis)understanding alcohol use disorder: Making the case for a public health first approach

Cited by 9 publications

References 107 publications

Can ‘justified disapproval’ be separated from addiction stigma? An empirical focus is required.

Can ‘justified disapproval’ be separated from addiction stigma? An empirical focus is required.

Clinical alcohol guidelines are welcome—but upstream action is paramount

Falling, slipping, and stumbling backwards

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