Kummetat Johanna Leona, Leonhard Anya, Manthey Jakob, Speerforck Sven, Schomerus Georg
Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany.
Institute of Clinical Psychology and Psychotherapy, Technical University, Dresden, Germany.
Eur Addict Res. 2022;28(6):446-454. doi: 10.1159/000526200. Epub 2022 Sep 9.
Stigma towards alcohol-related conditions is more pronounced than stigma against any other mental illness and has remained high throughout past decades. Although alcohol consumption is a known and persistent contributor to the burden of disease and interpersonal threat and may thus shape public attitudes towards consumption, no study to date has provided an overview of the prevalence of alcohol stigma and its association with (a) alcohol consumption and (b) harm attributable to alcohol across Europe. As a social reaction to thresholds of accepted use of alcohol, stigma could impact consumption, resulting in a reduced quantity or at least less harmful drinking patterns. This contribution provides an initial overview by addressing the following research questions. (i) What are the country-level prevalence rates of alcohol stigma compared across European countries? (ii) Is alcohol stigma associated with (a) alcohol consumption and (b) alcohol-attributable harm? (iii) Is there an association between alcohol stigma and alcohol consumption by type of beverage?
We combined data on country-level desire for social distance towards "heavy drinkers" (European Values Survey, operationalization of "alcohol stigma") with indicators of alcohol consumption, including adult per capita consumption (APC), heavy episodic drinking, consumption by type of beverage (wine, beer, spirits), and harm attributable to alcohol, namely age-standardized disability-adjusted life years lost to alcohol consumption (AADALYs) for 28 countries. Linear regression models were applied.
(i) Social distance varied noticeably across countries (M = 62.9%, SD = 16.3%) in a range of 28.3% and 87.3%. (ii) APC was significantly positive related to social distance (β = 0.55, p = 0.004). (iii) Wine consumption was significantly negative related to social distance; the opposite was true for spirits consumption. No association was found for beer consumption. The best model fit was achieved with APC (β = 0.48, p = 0.002) and wine per capita consumption (β = -0.55, p < 0.001) explaining 57.0% (adjusted R2) of the variance in social distance.
Our study shows a strong relationship between country-level alcohol stigma and alcohol consumption. If stigma was to deter people from harmful alcohol consumption, it would be expected that higher levels of alcohol stigma are associated with lower levels of overall alcohol consumption or consumption of spirits in particular. Instead, stigma seems to be a reaction to harmful drinking patterns without changing these patterns for the better.
对酒精相关疾病的污名化比针对任何其他精神疾病的污名化更为明显，并且在过去几十年中一直居高不下。尽管饮酒是疾病负担和人际威胁的一个已知且持续存在的因素，可能因此塑造公众对饮酒的态度，但迄今为止，尚无研究概述欧洲范围内酒精污名化的流行情况及其与（a）酒精消费和（b）酒精所致危害之间的关联。作为对酒精可接受使用阈值的一种社会反应，污名化可能会影响消费，从而导致饮酒量减少或至少形成危害较小的饮酒模式。本论文通过解决以下研究问题提供了初步概述。（i）欧洲各国之间酒精污名化在国家层面的流行率如何比较？（ii）酒精污名化是否与（a）酒精消费和（b）酒精所致危害相关？（iii）酒精污名化与不同类型饮料的酒精消费之间是否存在关联？
我们将关于国家层面与“酗酒者”保持社交距离的意愿数据（欧洲价值观调查，“酒精污名化”的操作化）与酒精消费指标相结合，包括成人人均消费量（APC）、大量饮酒、不同类型饮料（葡萄酒、啤酒、烈酒）的消费量以及酒精所致危害，即28个国家因饮酒导致的年龄标准化残疾调整生命年损失（AADALYs）。应用线性回归模型。
（i）在28个国家中，社交距离差异显著（M = 62.9%，SD = 16.3%），范围在28.3%至87.3%之间。（ii）APC与社交距离呈显著正相关（β = 0.55，p = 0.004）。（iii）葡萄酒消费与社交距离呈显著负相关；烈酒消费则相反。未发现啤酒消费与社交距离存在关联。APC（β = 0.48，p = 0.002）和人均葡萄酒消费量（β = -0.55，p < 0.001）对社交距离方差的解释率达到57.0%（调整R²）时，模型拟合效果最佳。
我们的研究表明，国家层面的酒精污名化与酒精消费之间存在密切关系。如果污名化能阻止人们进行有害的酒精消费，那么预计较高水平的酒精污名化会与较低水平的总体酒精消费，特别是烈酒消费相关联。然而，污名化似乎是对有害饮酒模式的一种反应，却并未使这些模式得到改善。
