Alcohol stigma and persistence of alcohol and other psychiatric disorders: a modified labeling theory approach.
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.
School of Social Work, University of Wisconsin-Madison, 1350 University Avenue, Madison, WI 53706, United States. Electronic address: jglass2@wisc.edu.
Joseph E
JE
Glass
Orion P
OP
Mowbray
Bruce G
BG
Link
Sean D
SD
Kristjansson
Kathleen K
KK
Bucholz
D000328:Adult; D019973:Alcohol-Related Disorders / Q000523:psychology; D000437:Alcoholism / Q000150:complications / Q000453:epidemiology / Q000523:psychology*; D003430:Cross-Sectional Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004522:Educational Status; D005006:Ethnicity; D005190:Family; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000523:psychology*; D008875:Middle Aged; D009010:Monte Carlo Method; D012044:Regression Analysis; D015203:Reproducibility of Results; D012931:Social Environment; D057545:Social Stigma; D012944:Social Support; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
Alcohol; Alcoholism stigma; Modified labeling theory; Psychiatric disorders; Social network; Social support