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.
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.
It might be added, as well, that the very idea of a stigma-free social environment for active alcoholism -- if that were Mann's utopian vision for a post-disease concept society -- has never been one I could quite get my brain fully around. What would such a world look like? I think, for example, of the delicate situation of a daughter bringing home her fiancé to meet her parents for the first time. What if he's an alcoholic? How would the introduction go with respect to that aspect of his identity in an alcoholism-has-no-stigma world?
Daughter (after introducing Charlie and his various good qualities to her parents): "Oh, and I almost forgot, Charlie's an alcoholic too."
Father: "Well, that's fine, Charlie. It's very nice to meet you. I think we have a pretty good stock of refreshments in the house. Would you like a drink? Or are you, as they say, 'on the wagon' currently?"
Mother looks on with small but satisfied smile.
One thing this imagined scene illustrates, I think, is that the subject of stigma is riven with nuances and complexities. Even suggesting the notion of a zero-stigma social environment may involve the need for numerous meaning specifications along those nuance dimensions. Moreover, the different kinds of stigma on, say, cancer, divorce, HIV, drug addiction, and alcoholism may also vary significantly along those meaning dimensions. All of which provides excellent fodder for further thinking and investigation.