Alcohol stigma and persistence of alcohol and other psychiatric disorders: a modified labeling theory approach.
- Authors
- Glass, Joseph E; Mowbray, Orion P; Link, Bruce G; Kristjansson, Sean D; Bucholz, Kathleen K
- Year
- 2013
- Journal
- Drug and alcohol dependence
- PMID
- 24071569
- DOI
- 10.1016/j.drugalcdep.2013.08.016
- PMCID
- PMC3980578
BACKGROUND: We sought to apply modified labeling theory in a cross-sectional study of alcohol use disorder (AUD) to investigate the mechanisms through which perceived alcohol stigma (PAS) may lead to the persistence of AUD and risk of psychiatric disorder. METHODS: We conducted structural equation modeling (SEM) including moderated mediation analyses of two waves (W1 and W2) of data from the National Epidemiologic Survey on Alcohol and Related Conditions. We analyzed validated measures of PAS, perceived social support, social network involvement, and psychiatric disorders among (n=3608) adults with two or more DSM-5 AUD symptoms in the first two of the three years between the W1 and W2 survey. Cross-sectional analyses were conducted owing to the assessment of PAS only at W2. RESULTS: Per mediation analyses, lower levels of perceived social support explained the association of PAS with past-year AUD and past-year internalizing psychiatric disorder at W2. The size of the mediated relationship was significantly larger for those classified as labeled (i.e., alcoholic) per their prior alcohol treatment or perceived need (n=938) as compared to unlabeled (n=2634), confirming a hypothesis of moderated mediation. Unexpectedly, mediation was also present for unlabeled individuals. CONCLUSIONS: Lower levels of social support may be an important intermediate outcome of alcohol stigma. Longitudinal data are needed to establish the temporal precedence of PAS and its hypothesized intermediate and distal outcomes. Research is needed to evaluate direct measures of labeling that could replace proxy measures (e.g., prior treatment status) commonly employed in studies of the stigma of psychiatric disorders.
Path diagram displaying coefficients used to calculate the total indirect effects. Mediator-specific indirect effects are calculated by taking the product of the regression coefficients that represent the paths directed to and from the mediators. The total indirect effect is calculated by summing the mediator-specific indirect effects for each group. The paths involving the outcome variables (cβ, b1 and b2) were computed separately for each outcome (e.g., b1 ALCOHOL USE DISORDER, b1 INTERNALIZING DISORDER) and for each group. The paths a1, a2, and a3 do not involve the outcome variables, thus required a single calculation for each group. PAS = perceived alcohol stigma, SNI = social network involvement, ISS = perceived interpersonal social support.
| # | Section | Preview |
|---|---|---|
| 40 | 4. Discussion β 4.2. Conclusions | This cross-sectional study provided support for the relevance of two major propositions of MLT toβ¦ |
| 41 | Fig. 1 | A conceptual model of alcohol use disorder stigma based on modified labeling theory. |
| 42 | Fig. 2 | Path diagram displaying coefficients used to calculate the total indirect effects. Mediator-specific⦠|
| Name | Type |
|---|---|
| Active heavy drinkers local | phenotype |
| addiction | phenotype |
| Addictions treatment sample local | cohort |
| alcohol | phenotype |
| Alcohol dependence recovery local | phenotype |
| Alcohol detoxification sample local | cohort |
| Alcoholics Anonymous | drug |
| alcoholism | phenotype |
| Alcohol Problems | phenotype |
| Alcohol problem severity measure local | phenotype |
| Alcohol Stigma local | phenotype |
| Alcohol treatment services local | phenotype |
| Alcohol Use Disorder | phenotype |
| amphetamine | drug |
| anxiety | phenotype |
| AUD | phenotype |
| AUD persistence local | phenotype |
| AUD remittance local | phenotype |
| bipolar I disorder | phenotype |
| bipolar II disorder | phenotype |
| cannabis use | phenotype |
| cocaine | phenotype |
| denial | phenotype |
| depression | phenotype |
| depressive symptoms | phenotype |
| Diagnostic labels local | phenotype |
| drug | drug |
| drug dependence | phenotype |
| DSM-IV | phenotype |
| DSM-IV psychiatric disorders | phenotype |
| dysthymia | phenotype |
| earnings | phenotype |
| education | phenotype |
| Exacerbation of psychiatric conditions local | phenotype |
| First-degree relative with alcohol problems local | phenotype |
| full sample | cohort |
| generalized anxiety disorder | phenotype |
| general population | cohort |
| General well being local | phenotype |
| hallucinogens | drug |
| heavy drinking | phenotype |
| income | phenotype |
| Ineffective coping orientations local | phenotype |
| Inhalant local | drug |
| Institutional discrimination | phenotype |
| INTERNALIZING_DISORDER local | phenotype |
| internalizing disorders | phenotype |
| Internalizing Psychiatric Disorder local | phenotype |
| Internalizing psychiatric disorders local | phenotype |
| Interpersonal Support Evaluation List local | phenotype |
| Interpersonal Support Scale local | phenotype |
| ISS local | phenotype |
| Job market participation local | phenotype |
| Labeled group local | cohort |
| labeled individuals local | cohort |
| Labeled status local | phenotype |
| labeling local | phenotype |
| Labeling local | phenotype |
| Labeling status local | phenotype |
| Live-in partner with alcohol problems local | phenotype |
| major depressive disorder | phenotype |
| Mental Health Functioning local | phenotype |
| Mental health patients local | cohort |
| mood disorders | phenotype |
| National Epidemiologic Survey on Alcohol and Related Conditions | cohort |
| negative outcomes | phenotype |
| NESARC | cohort |
| Non-analytic sample local | cohort |
| Non-substance-related psychiatric disorders local | phenotype |
| Non-substance-related psychiatric illness local | phenotype |
| Non-substance-related Psychiatric Stigma local | phenotype |
| opioid | drug |
| PAS local | phenotype |
| past-year AUD | phenotype |
| Past-year psychiatric disorder local | phenotype |
| Perceived Alcohol Stigma local | phenotype |
| PERCEIVED_ALCOHOL_STIGMA local | phenotype |
| Perceived alcohol stigma (PAS) local | phenotype |
| Perceived Devaluation-Discrimination scale local | phenotype |
| PERCEIVED_INTERPERSONAL_SOCIAL_SUPPORT local | phenotype |
| Perceived social support local | phenotype |
| Perceived Social Support local | phenotype |
| Perceived substance use stigma local | phenotype |
| physical health | phenotype |
| Post-Traumatic Stress Disorder | phenotype |
| Prior psychiatric disorder local | phenotype |
| Prior treatment status local | phenotype |
| psychiatric disorders | phenotype |
| psychiatric outcomes | phenotype |
| quality of life | phenotype |
| relapse | phenotype |
| sedatives | drug |
| Self-concealment local | phenotype |
| Self-efficacy | phenotype |
| self-esteem | phenotype |
| Self-esteem decrement local | phenotype |
| Self-labeling local | phenotype |
| Self-stereotyping | phenotype |
| serious mental illness | phenotype |
| SNI local | phenotype |
| Social involvement local | phenotype |
| Social labeling local | phenotype |
| Social network local | phenotype |
| Social Network Index local | phenotype |
| Social network involvement local | phenotype |
| Social Network Involvement local | phenotype |
| SOCIAL_NETWORK_INVOLVEMENT local | phenotype |
| social phobia | phenotype |
| social support | phenotype |
| specific phobia | phenotype |
| stigma | phenotype |
| substance use | phenotype |
| Substance use stigma local | phenotype |
| Tranquilizer local | drug |
| treatment | phenotype |
| Treatment providers local | cohort |
| treatment utilization | phenotype |
| United States | cohort |
| United States general population local | cohort |
| Unlabeled group local | cohort |
| unlabeled individuals local | cohort |
| Unlabeled individuals local | cohort |
| Unmet need for treatment | phenotype |
| W2 AUD local | phenotype |
| W2 data local | cohort |
| W2 internalizing disorder local | phenotype |
| wave 2 | cohort |
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