Understanding the Association between Alcohol Stigma and Alcohol Consumption within Europe: A Cross-Sectional Exploratory Study

Abstract

<b><i>Introduction:</i></b> Stigma towards alcohol-related conditions is more pronounced than stigma against any other mental illness and has remained high throughout past decades. Although alcohol consumption is a known and persistent contributor to the burden of disease and interpersonal threat and may thus shape public attitudes towards consumption, no study to date has provided an overview of the prevalence of alcohol stigma and its association with (a) alcohol consumption and (b) harm attributable to alcohol across Europe. As a social reaction to thresholds of accepted use of alcohol, stigma could impact consumption, resulting in a reduced quantity or at least less harmful drinking patterns. This contribution provides an initial overview by addressing the following research questions. (i) What are the country-level prevalence rates of alcohol stigma compared across European countries? (ii) Is alcohol stigma associated with (a) alcohol consumption and (b) alcohol-attributable harm? (iii) Is there an association between alcohol stigma and alcohol consumption by type of beverage? <b><i>Methods:</i></b> We combined data on country-level desire for social distance towards “heavy drinkers” (European Values Survey, operationalization of “alcohol stigma”) with indicators of alcohol consumption, including adult per capita consumption (APC), heavy episodic drinking, consumption by type of beverage (wine, beer, spirits), and harm attributable to alcohol, namely age-standardized disability-adjusted life years lost to alcohol consumption (AADALYs) for 28 countries. Linear regression models were applied<i>.</i> <b><i>Results:</i></b> (i) Social distance varied noticeably across countries (M = 62.9%, SD = 16.3%) in a range of 28.3% and 87.3%. (ii) APC was significantly positive related to social distance (β = 0.55, <i>p</i> = 0.004). (iii) Wine consumption was significantly negative related to social distance; the opposite was true for spirits consumption. No association was found for beer consumption<i>.</i> The best model fit was achieved with APC (β = 0.48, <i>p</i> = 0.002) and wine per capita consumption (β = −0.55, <i>p</i> < 0.001) explaining 57.0% (adjusted <i>R</i><sup>2</sup>) of the variance in social distance. <b><i>Conclusion:</i></b> Our study shows a strong relationship between country-level alcohol stigma and alcohol consumption. If stigma was to deter people from harmful alcohol consumption, it would be expected that higher levels of alcohol stigma are associated with lower levels of overall alcohol consumption or consumption of spirits in particular. Instead, stigma seems to be a reaction to harmful drinking patterns without changing these patterns for the better.

Relationship between self-stigma about alcohol dependence and severity of alcohol drinking and craving

“…Our study contributes to the growing body of literature pointing to potential associations between self-stigma and alcohol-related outcomes 13. This observed association between higher self-stigma and poorer alcohol-related outcomes can be explained by several mechanisms.…”

Problematic alcohol use: A relational illness

“…Moreover, while drinking norms along with PAU stigma differ between countries (Kummetat et al., 2022; Nordlund & Østhus, 2013), population studies consistently show perceptions of blame towards those with PAU for their condition compared with other illnesses (Schomerus et al., 2006). Individuals are widely seen as responsible for developing PAU and for not recovering (Kilian et al., 2021).…”

Why stigma matters in addressing alcohol harm

“…The stigma of alcohol problems remains persistently highmore so than many other medical, substance or mental health problems-and is pervasive in its prevalence and harmful consequences [13,14]. Alcohol stigma is well established as a major barrier to help-seeking and treatment engagement [15][16][17] and multiple forms of overt or subtle discrimination against people with alcohol use disorder (AUD), including by healthcare practitioners [13,18,19].…”

“…But this ethically flawed argument (i.e., accepting discrimination against those with more severe AUD to deter others) does not seem to reflect the reality of alcohol stigma. The limited available empirical evidence in fact suggests alcohol stigma is embedded within heavy drinking cultures, rather than serving as a positive force [14].…”