The doctor fighting to save lives by removing the stigma of 'alcoholism'

by Christine Humphreys

Published: March 11, 2024

Prejudice against alcoholics - those with ‘self-inflicted’ health problems ‘undeserving’ of sympathy and placing an ‘unnecessary burden’ on public finances - isn’t new.

Blame and shame goes hand in hand with alcoholism and the stereotypical image of the urine-soaked drunk sprawled on the park bench or ranting at disgusted passers-by.

Now, however, this prejudice is being recognised as a major obstacle to those with alcohol use disorder seeking help. This means more lives lost and more treatment costs as patients present with advanced disease.

Tackling the stigma associated with alcohol dependency is being put under the spotlight as an area of research to improve treatment and break down the barriers to recovery.

The impact of stereotypes and stigma on seeking help

Dr Ashwin Dhanda, a consultant in liver disease, believes too many problem drinkers are doomed to die due to this stigma.

Negative attitudes prevail, he says, in several forms that stand in the way of addicts seeking support.

These include personal shame, societal prejudice and bias in service structures and policy - such as where clinics are located or denying mental health therapies to active drinkers.

Nowhere is that stigma more keenly felt than within the healthcare settings patients need to trust; GP surgeries, A&E services and hospital wards.

Dr Dhanda manages patients with acute and chronic liver disease at the South West Liver Unit at Derriford Hospital in Plymouth, England.

While the unit in Plymouth is a beacon of quality care and compassion, Dr Dhanda frequently hears of the humiliation and condemnation that has deterred patients from seeking help sooner.

“Most patients I see already have significant damage with cirrhosis and fluid build-up due to liver failure,” said Dr Dhanda.

“Often, I hear they’ve faced stigma throughout their treatment experience from the reception desk in primary care to the specialist hospital unit.

“I’ve had patients talk of paramedics who will say, ‘Oh, it’s you again.’ and, although I don’t see this in my own unit, I’m told of nurses in specialist units who treat people with alcohol-related liver disease differently, as though they’re not worth it.

“The way to break down this stigma is through education but it’s not about people like me and other professionals talking to colleagues; it needs to come from strong advocates from within the community sharing their own lived experience.

Personal testimonies and the fight against stigma

Dr Dhanda says it is his patients’ stories that have led him to champion research on the impact of stigma and encouraging people to seek treatment sooner.

He is making it his mission to change the way patients are perceived in the field of alcohol addiction and liver disease treatment.

His research is being funded by the National Institute of Health and Social Care to investigate methods to eradicate this stigma.

He believes that only by removing the shame associated with alcohol-related health issues will people feel confident enough to seek help before it’s too late.

He said: “People with alcohol use disorder will hide their drinking from family and friends and they’re less likely to seek professional help until the health impact is severe.

“They may present with some symptoms but won’t be truthful about their intake and this delays them being directed to the appropriate services. They may feel they will be judged and that they’re unworthy.

“If we can overcome this stigma and remove judgement, we can encourage people to come forward and get help.”

Innovative approaches to encourage early treatment

He commended the introduction of mobile outreach clinics offering walk-in liver scans across the UK including his own region. In its first year, the initiative found one in 10 suffering from hepatic disease that can lead to cancer.

“The mobile outreach scanning programme gives access to early diagnosis that targets the most vulnerable communities; areas where there are significant health inequalities.

“It’s another way to remove a barrier and, with the right approach in the right target group, to remove the stigma and get people treated before the disease is well advanced.

“Alcohol use disorder doesn’t just cause liver disease. Alcohol is associated with a wide range of health issues including cancer, diabetes, and heart disease.

“If we remove the stigma that prevents people seeking early treatment and recovery, we can avoid these associated health problems and avoid the additional costs to the NHS. In the long term, this is a saving.”

Success stories from mental health awareness campaigns

Dr Dhanda pointed to successes in the mental health arena where campaigns have raised awareness with celebrity and even royal support to bring the topic into the open.

“It’s not only alcohol use disorder that’s stigmatised in the health service. Other areas of healthcare like obesity and mental health have similar problems to overcome but the bias in alcohol services is disproportionate,” he said.

“There has been a lot of success in campaigns to change attitudes towards mental health issues. We can learn a lot from these types of campaigns.”

But he admits he doesn’t expect a rapid improvement.

He said: “It’s a long-term strategy. We’re not going to see change quickly. We’re looking at a decade.”

About The Author

Christine Humphreys

Chris Humphreys is the co-founder of The Alcohol-Free Shop and AlcoholFree.com. She was a journalist for more years than she cares to remember. Ex-wife of an alcoholic, enthusiastic amateur musician and a passionate dog lover.