Barriers for treatment in alcohol use disorders (AUD) – the role of stigmatization: A consumer’s perspective

Background

Individuals with Alcohol Use Disorders (AUD) are less likely to seek formal help than individuals with other mental health disorders, although treatment system is well established and effective. Studies using standardized questionnaires are often not able to fully capture underlying causes for the rejection of formal help. Qualitative studies on barriers for treatment, on the other hand, are rare.

Methods

The project „Alcohol-related treatment – a consumer’s perspective“ (ART-COPE) was based on semi-structured narrative interviews that assessed barriers to treatment in a biographical context. In total, 27 predominantly untreated individuals with moderate to severe AUD (AUDIT >/= 20) were recruited in general health practices and other health settings. Interviews were transcribed verbatim and coded with MAXQDA and analyzed using qualitative content analysis. In addition, the project included a standardized questionnaire on barriers to treatment used in population-based surveys.

Results

In the interviews, shame, fear of stigmatization, milieu-related factors, inadequate availability of treatment, negative experiences of others within treatment, institutional and personal conditions, a lack of drive and self-abandonment were identified as barriers to treatment. Half of the participants reported fear of stigmatization as a barrier to treatment or experiences of being stigmatized or being treated without respect by health providers. Especially in the group of untreated participants, societal and structural stigmatization of AUD played a significant role and led to increased shame and a self-perception as a weak, worthless person. Additionally, fear of stigmatization led to a general mistrust of others and health institutions. Participants with a strong problem recognition and fear of stigmatization as main barrier for treatment utilization were all female. On the other side, the standardized questionnaire could only insufficiently cover the individually significant barriers to treatment.

Conclusions

The results indicate that a significant factor for not seeking help for AUDs is the fear of stigmatization and – resulting – shame and a decreased self-efficacy. The representation of this fear especially in females may be based on societal and internalized gender role expectancies. A careful contextualization of alcohol-related problems in various health care settings and gender-sensitive treatment approaches appear to be necessary.