Chapter 18 Before “rock bottom”? Problem framing effects on stigma and change amongst harmful drinkers
Under the disease model of alcoholism, “rock bottom” represents the point at which problem drinkers hit a low, after which denial is overcome and recovery begins. More specifically, the brain disease model of alcoholism implies those with the disease have a distinct pathology. However, a far broader population of drinkers experience harm without conforming to alcoholism stereotypes, reflecting a broader continuum of alcohol harms.
The false binary created by an alcoholism/brain disease model allows harmful drinkers to distinguish their own ‘responsible’ use from the stereotyped/pathologized alcoholic other. This drives stigma via processes of separation and difference, raising the threshold for problem recognition.
Whilst attributing problem drinking to a disease may reduce blame toward the individual, evidence shows that blame is an insufficient measure of stigma and may come at the cost of increased discrimination. In contrast, continuum framings appear to offer benefits for increased problem recognition, likely via reduced stigma through reducing a perceived fundamental difference between problem and non-problem drinkers.
Evidence-led approaches to addiction stigma reduction should include the use of person-first language, humanizing narratives, and alternatives to disease models of alcohol problems to broaden understanding of the continuum of alcohol use, harms and recovery.
James Morris - ORCiD: https://orcid.org/0000-0002-7048-8844
Evaluating the Brain Disease Model of Addiction is available from: