Several theoretical frameworks have conceptualized stigma as a predictor of psychiatric disorders (Link et al. 1989; Meyer 1995; Hatzenbuehler 2009) as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM). Common psychiatric disorders have been broadly described as “internalizing” (e.g. mood and anxiety) and “externalizing” (e.g. addictive disorders, antisocial personality) disorders based on their “inward” and “outward” expressions, respectively (Krueger 1999). Both internalizing and externalizing psychiatric disorders are common among people with past-year AUD (range 12–19%). (Grant et al. 2004a; Grant et al. 2004b; Stinson et al. 2005). A positive association between addiction stigma and internalizing symptoms (e.g., depression severity) has been consistently found in several cross-sectional studies (Ahern et al. 2007; Luoma et al. 2007; Schomerus et al. 2011; Glass et al. 2013b). However, the relationship between addiction stigma and externalizing symptoms has been less consistent. Most existing studies have found no association between addiction stigma and addiction symptoms (Ahern et al. 2007; Luoma et al. 2007; Schomerus et al. 2011), but one study found that perceived alcohol stigma was associated with an increased risk of AUD
