By Laura Williamson
Early in 2011 the National Institute for Health and Clinical Excellence (NICE) published guidance intended to improve treatment for alcohol dependence and harmful use in England, Wales, and Northern Ireland. The guideline focuses on identifying the clinical interventions best suited to supporting recovery. However, given the influence social factors have on drinking behaviours, NICE also emphasises the need to cultivate environments and attitudes which help to ensure those with alcohol problems feel no “apprehension” about seeking treatment and discussing their alcohol misuse. It does this by identifying principles that should form the basis of treatment: a trusting, respectful relationship between healthcare providers and patients, which acknowledges and seeks to overcome “stigma and discrimination” is crucial, as is the need to support families and carers.
It is vital that individuals can expect to be treated with respect when seeking treatment because only around 5.6% of people in England and 8.2% of people in Scotland who need specialist treatment for dependence actually receive it. Part of the reason for this is that stigma acts as an obstacle for individuals in admitting their alcohol problem and opting to receive therapy. As Schomerus and colleagues stated in their systematic review of stigma and dependence published in the March-April (2011) edition of Alcohol and Alcoholism:
“People suffering from alcohol dependence (and from other addictions) are particularly severely stigmatized. They are less frequently regarded as mentally ill, they are held much more responsible for their condition, they provoke more social rejection and more negative emotions and they are at a particular risk of being structurally discriminated against.”
In the United Kingdom, and internationally, public policy on alcohol has done little to improve attitudes towards dependence. In England, for example, alcohol policy under the New Labour government prioritised the need to persuade people to drink ‘sensibly’. A key aim of the 2004 Alcohol Harm Reduction Strategy for England was to secure “long term change in attitudes to irresponsible drinking”. In his ‘Foreword to the Strategy’, then Prime Minister Tony Blair stated that individuals are expected to make “informed and responsible decisions about their own levels of alcohol consumption.” This focus on “sensible” drinking makes no allowance for the “difficulties in controlling substance-taking” or the “strong desire or sense of compulsion” that are used to diagnose dependence. As a result, it risks implicitly stigmatising the dependent by promoting in the public consciousness the notion that all heavy drinkers, even the alcohol-dependent, are simply “irresponsible.”
Under the coalition government, the stigmatisation of alcohol dependence has worsened and become increasingly explicit in England. In 2010 the government published its new Drug Strategy. The strategy enforces “sanctions” on benefit claimants who are dependent on alcohol (and drugs) if they do not engage with treatment services. This policy sits uncomfortably with the emphasis of the NICE Guidance on the importance of “supportive, empathic