Language and concepts in alcohol use disorder: how framing affects stigma and recovery

Harmful drinkers are an important but under-recognised Alcohol Use Disorder (AUD) group characterised by low problem recognition and low treatment engagement. This has been attributed to binary conceptualisations in which only the ‘alcoholic other’ as seen as ‘problem drinkers’. In contrast, continuum models of alcohol use and harms may be beneficial to problem recognition and help-seeking. Three experimental studies were undertaken to test the effects of continuum vs binary models of AUD on problem recognition, stigma and help-seeking amongst harmful drinkers. Convenience samples of predominantly UK harmful drinkers were recruited via social media and Prolific in 3 studies testing related framing effects on problem recognition and behaviours, including the role of stigma (study 2) and self-efficacy (study 3). Hypotheses were tested via a series of ANCOVA and regression models. In study 1, continuum beliefs were associated with higher problem recognition versus binary beliefs (p < 0.001) and control (p = 0.007). There was no significant difference between binary beliefs and control (p = 0.350). In study 2, binary beliefs and stigmatizing terminology (stigma) was significantly associated with lower problem recognition versus control stigma (p = .017) and continuum stigma (p = .002). In study 3, continuum beliefs or self-efficacy were not significantly different from control or other conditions. However, at 6 month follow up, continuum beliefs were associated with a significantly higher odds ratio of help-seeking behaviours (OR=2.98, p = .007). These results demonstrate alcohol problem framing and related language can have important implications for problem recognition and behaviour change amongst harmful drinkers. In particular, stigmatising labels such as ‘alcoholic’ should be avoided (unless self-labelling). However, promoting a continuum model of alcohol use and harms may be beneficial for problem recognition and help-seeking, potentially by reducing the threat and implications posed by binary stigmatising labels.