How Does Stigma Manifest in Clinical Settings?

“I was seen by the head of [the general hospital department (not drug and alcohol service)] and he just berated the crap out of me for drinking and you know, not particularly helpful. That’s not really going to make someone who’s not feeling very good about themselves and their drinking habits stop drinking, just because someone slaps you around your head a little bit.” 

Research has found that stigma is common across healthcare settings for people experiencing problems with alcohol. It is a significant barrier to accessing health and other services with examples of practitioners denying treatment or appropriate care to patients experiencing alcohol dependency, including practitioners not wanting to ‘take on’ patients with known substance use problems for fear of ‘attracting more’ to their practice.  

Patients have reported receiving sub-par treatment such as: being offered advice based on clinicians own opinions rather than evidence; being told to simply cease alcohol use (i.e. pursue abstinence without support), being talked down to and scolded or blamed for the problems they are experiencing with alcohol. These experiences and fear of stigma deters help-seeking and can readily become internalised, resulting in lower self-efficacy, self-esteem and internalised blame. This in turn impacts on treatment outcomes, decreasing the likelihood of treatment completion and increasing depression and substance use.