Why Shame Keeps Patients from Alcohol Use Disorder Treatment

Fear of public embarrassment and career repercussions prevent many from seeking help, a new study finds. Experts discuss how to break the cycle.

7:00 AM

Author | Rene Wisely

https://healthblog.uofmhealth.org/digestive-health/new-clinic-promotes-shared-care-to-treat-alcohol-related-liver-diseasePatients diagnosed with an alcohol-related liver disease such as hepatitis or cirrhosis may feel an unexpected complication: shame.

That's because friends, family members and even medical providers might make assumptions about a patient's lifestyle habits.

LISTEN UP: Add the new Michigan Medicine News Break to your Alexa-enabled device, or subscribe to our daily audio updates on iTunes, Google Play and Stitcher.

"Because liver disease is so linked to alcohol use in the public consciousness, it quickly becomes stigmatized," says Jessica Mellinger, M.D., a specialist in transplant hepatology, gastroenterology and internal medicine at Michigan Medicine.

"Then a blame game emerges," she adds. "Onlookers point to the patient. They believe that person engaged in repeated excessive drinking a risky behavior bringing the illness upon themselves."

The stigma is one of the reasons some patients avoid seeking help to curb or quit drinking, according to a study by Mellinger and colleague G. Scott Winder, M.D., an assistant professor of psychiatry with the Transplant Center at the University of Michigan.

Why some people don't quit drinking

Researchers examined the treatment preferences and misconceptions of alcoholic liver disease patients and the barriers to getting help to stop drinking.

MORE FROM MICHIGAN: Sign up for our weekly newsletter

Often, patients try to abstain from drinking on their own without the aid of effective therapeutic tools such as 12-step support groups, one-on-one counseling, inpatient rehab, cognitive behavioral therapy and medications for withdrawal or cravings.

The study also found patients from small towns want treatment anonymity but worry that word about their drinking may spread, making them less willing to participate.

Likewise, some patients avoid using their insurance benefits to get help.

And because alcohol use disorder treatment is documented by their health insurance, study subjects reported concern about financial and career repercussions.

Because liver disease is so linked to alcohol use in the public consciousness, it quickly becomes stigmatized.
Jessica Mellinger, M.D.

Separating struggle and self-identity

Society often judges people with drinking problems.

Notes one study participant: "No matter how much people say, 'No, we don't judge you,' you know what, there's always somebody."

SEE ALSO: Do You Have a Drinking Problem? 11 Warning Signs to Know

That's human nature, Winder says.

"There is something fundamentally different when a medical or psychological problem involves our brain and humanity," he says. "Once a problem goes from something a person has to something that somebody is alcoholic, schizophrenic, epileptic, demented something happens in our brain as we consider and interact with these people in society.

"We just don't look at these problems the same way. We infuse them with unique essence and consequence because they directly involve our personhood and autonomy."

Treatment requires care, courtesy

Language can play a role in changing the conversation.

Instead of saying "alcoholism," health care workers and a patient's loved ones can use the medical diagnosis: alcohol use disorder, or AUD. And "alcoholic" can be replaced by "a person with AUD."

"Terminology is really important when discussing sensitive matters like drinking — just like dexterity and sterility are important to an operating surgeon," Winder says.

SEE ALSO: Doctors Are Seeing More Alcoholic Liver Disease in Young Adults

Doctors must also be nonjudgmental when helping patients explore treatment options and making a plan to move forward, Mellinger says.

It's why both providers recently founded a clinic, the Michigan Alcohol Improvement Network, or MAIN.

Established as a stigma-free zone for patients with alcohol-related liver disease, the practice combines liver care, addiction treatment and psychiatric care in the same appointment.

"The heart of it is the people that work there," Winder says, "and the culture of the clinic is one of compassion, and hopefully our patients will feel the difference."

To meet with a Michigan Medicine hepatologist to get a referral to the MAIN clinic, call 844-233-0433.


More Articles About: Digestive Health Addiction and Mental Illness Nonalcoholic fatty liver disease (NAFLD) Cirrhosis of the Liver Mental Health Assessment Addiction and Substance Abuse
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of health care news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]

734-764-2220

Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Subscribe
Featured News & Stories
Health Lab
New Clinic Promotes Shared Care to Treat Alcohol-Related Liver Disease
The facility offers multiple types of medical care, all under one roof — and during the same appointment. Learn more about the unique treatment model.
dad and daughter in hospital room in hospital beds and on right father and daughter standing together outside with blue michigan donor shits on
Health Lab
A daughter’s lifesaving gift to her father
The human liver can regenerate, making living donor liver transplants possible. Michigan Medicine’s Transplant Center is one of only a few in the country offering this option.
girl hugging teddy bear with alcohol bottles on ground
Health Lab
1 in 4 kids live with parents who have alcohol or other drug problems
Children living with parents who have addiction issues, also called substance used disorder, have higher risks later in life. A new study shows 1 in 4 currently live in such households.
Health Lab
8 facts to know about childhood suicide
With suicidal thoughts and behaviors on the rise among kids, experts provide suicide prevention tips for families experiencing a mental health crisis. 
red cells stacked ontop of darker red background
Health Lab
Medicaid unwinding linked to opioid addiction treatment disruptions
Buprenorphine prescription interruptions were most common in states that had the biggest coverage drops during Medicaid unwinding; study has importance for future Medicaid policy.
blood vessel up close with red cells and yellow inside
Health Lab
Drug candidate successfully treats atherosclerosis, fatty liver disease in large mammals 
A compound that was previously found to treat severe fatty liver disease also reduces atherosclerosis, a primary driver of cardiovascular death, in non-human primates. The drug candidate was developed at the University of Michigan.