Why Shame Keeps Patients from Alcohol Use Disorder Treatment (Blog)
By Rene Wisely
February 12, 2019
Fear of public embarrassment and career repercussions prevent many from seeking help, a new study finds. Experts discuss how to break the cycle.
Patients diagnosed with an alcohol-related liver disease such as hepatitisor cirrhosis may feel an unexpected complication: shame.
That’s because friends, family members and even medical providers might make assumptions about a patient’s lifestyle habits.
“Because liver disease is so linked to alcohol use in the public consciousness, it quickly becomes stigmatized,” says Jessica Mellinger, M.D., a specialist in transplant hepatology, gastroenterology and internal medicine at Michigan Medicine.
“Then a blame game emerges,” she adds. “Onlookers point to the patient. They believe that person engaged in repeated excessive drinking — a risky behavior — bringing the illness upon themselves.”
The stigma is one of the reasons some patients avoid seeking help to curb or quit drinking, according to a study by Mellinger and colleague G. Scott Winder, M.D., an assistant professor of psychiatry with the Transplant Center at the University of Michigan.
Why some people don’t quit drinking
Researchers examined the treatment preferences and misconceptions of alcoholic liver disease patients — and the barriers to getting help to stop drinking.
Often, patients try to abstain from drinking on their own without the aid of effective therapeutic tools such as 12-step support groups, one-on-one counseling, inpatient rehab, cognitive behavioral therapy and medications for withdrawal or cravings.
The study also found patients from small towns want treatment anonymity but worry that word about their drinking may spread, making them less willing to participate.
Likewise, some patients avoid using their insurance benefits to get help.
And because alcohol use disorder treatment is documented by their health insurance, study subjects reported concern about financial and career repercussions.
Separating struggle and self-identity
Society often judges people with drinking problems.
Notes one study participant: “No matter how much people say, ‘No, we don’t judge you,’ you know what, there’s always somebody.”
That’s human nature, Winder says.
“There is something fundamentally different when a medical or psychological problem involves our brain and humanity,” he says. “Once a problem goes from something a person has to something that somebody is — alcoholic, schizophrenic, epileptic, demented — something happens in our brain as we consider and interact with these people in society.
“We just don’t look at these problems the same way. We infuse them with unique essence and consequence because they directly involve our personhood and autonomy.”
Treatment requires care, courtesy
Language can play a role in changing the conversation.
Instead of saying “alcoholism,” health care workers and a patient’s loved ones can use the medical diagnosis: alcohol use disorder, or AUD. And “alcoholic” can be replaced by “a person with AUD.”
“Terminology is really important when discussing sensitive matters like drinking — just like dexterity and sterility are important to an operating surgeon,” Winder says.
Doctors must also be nonjudgmental when helping patients explore treatment options and making a plan to move forward, Mellinger says.
It’s why both providers recently founded a clinic, the Michigan Alcohol Improvement Network, or MAIN.
Established as a stigma-free zone for patients with alcohol-related liver disease, the practice combines liver care, addiction treatment and psychiatric care in the same appointment.
“The heart of it is the people that work there,” Winder says, “and the culture of the clinic is one of compassion, and hopefully our patients will feel the difference.”