Can Stigma on Active Alcoholics Help to Push Them to Treatment?

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Not all alcoholics respond to stigma in the same way, but it stands to reason that drinkers would embrace the benefits of "in recovery" status.

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It seems to me -- and, incidentally, it has seemed to me for a long time -- that a key shortcoming in much of the prevailing research and thought surrounding the subject of the stigma on alcoholism stems from a failure to distinguish clearly between the moral and social definition placed upon, on the one hand, the "active alcoholic" and, on the other, that placed upon the successfully abstaining or "recovering alcoholic."

What I have to offer about this shortcoming and its implications will, I'm sure, strike more than a few readers as restating the obvious. Yet, and surprisingly, sometimes even obvious-seeming propositions, when some of their implications are extracted, can generate new conclusions and a counterintuitive perspective on an old topic.

Active alcoholism is certainly subject to social stigma; the drinking alcoholic, in sociologist Erving Goffman's evocative words, occasions a "spoiled identity." On the other hand, the alcoholic in recovery may be said to gain a modicum of social credit or approbation. Hence, the stigma situations of the active and the recovering alcoholic are sharply different. Indeed, when viewed through the lens of stigma, the individual alcoholic's transition from active alcoholism to recovery -- whether through the medium of treatment, "spontaneous remission," Alcoholics Anonymous membership, or by any other means -- amounts to a stigma exchange, leaving behind the opprobrium attached to active alcoholism and exchanging it for the new social credit attached to recovery.

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It follows that the stigma on active alcoholism -- contrary to the prevailing view -- may actually help push the active alcoholic toward treatment or recovery, both in order to rid himself of active alcoholism's stigma and to embrace the benefits of a new "in recovery" status. Not all active alcoholics respond to stigma in the same way of course; nor might any given alcoholic respond to stigma the same way in different life situations or at different times. Yet, from the vantage point I'm suggesting, stigma may play a positive role in recovery. In this sense, then, stigma may impell active alcoholics toward treatment or recovery as much or even more than it putatively thwarts or poses a barrier to treatment or recovery.

Mrs. Marty Mann held that the disease conception of alcoholism provided a great social change instrument by which alcoholism's stigma could be reduced or eliminated. Yet, clearly differentiating the stigma situations of the active and recovering alcoholic has implications for Mann's great thesis too. To the extent that the disease concept supplied a quasi-medical explanation for alcoholism it also harbored some of the implications of Talcott Parsons' famous "sick role" for the alcoholic. The doctor-patient relationship, as Parsons memorably pointed out, held role obligations for the patient as well as for the doctor. For example, the patient must want to get well and must follow doctor's orders in furthering a recovery. This aspect of the sick role, I suggest, can relatively heighten, rather than relatively reduce, stigma. With the emergence and widespread social acceptance of the alcoholism-as-disease idea, the alcoholic acquired in effect a Parsonsian positive duty to recover. The active alcoholic who resists or rejects that duty, in turn, acquired the added opprobrium attaching to that resistance. The concept of denial and the added negatives it brings to the resistant alcoholic's identity gained gravity in a world where the disease concept had become widely accepted.

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It bears noting, in passing, that the conceptual content of AA's allergy-like formulation of the disease concept of alcoholism also harbored stigma-enhancing potentials. In AA's and Dr. Silkworth's allergy model of alcoholism, it will be recalled, the alcoholic retained moral control over choosing to drink the first drink but lost control with subsequent drinks. This is a conceptual framework with obvious moral implications. Taken at face value, the alcoholic's choice to drink the first drink, hence, became invested with heightened moral meaning. The alcoholic who chose to take that first drink in effect turned his back on both the paradigm that offered a path to recovery and the good people who offered this prospect.

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Ron Roizen is an independent scholar and author of some of the earliest interdisciplinary studies of the alcoholism industry. He works in Kaye Fillmore’s research group at the Scientific Analysis Corporation in San Francisco and Alameda, California.

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