In addiction, self-stigma is defined as your own internalized negative beliefs about the condition and such beliefs may influence the timing and chances of recovery. Identifying who may be prone to self-stigma could inform strategies to address it and prevent relapses. This study analyzed data from adults enrolled in telehealth alcohol use disorder treatment to determine characteristics of those with high self-stigma.
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Self-stigma is the process through which people may come to believe negative stereotypes about groups to which they belong. For example, a person with an alcohol use disorder may come to believe that their alcohol use issues are due to self-indulgence at the expense of other people, or other type of a character flaw and not a medical condition. Evidence suggests that heightened self-stigma is associated with alcohol craving and compulsive alcohol use, and lowered belief in being able to refuse an alcoholic drink when offered.
Self-stigma can also negatively impact the recovery process. Evidence shows that self-stigma can reduce an individual’s willingness to seek alcohol use treatment and make it challenging for those receiving care to continue treatment. The mechanisms through which self-stigma may impact treatment outcomes vary and include negative emotions and reduced self-esteem which can lead to a “why try” effect: an individual’s self-worth is lowered so much that they no longer pursue personal goals (e.g., career milestones) and/or abandon self-care practices (e.g., pursuing medical treatment). These processes may help explain why shame about alcohol use issues is associated with relapse.
Despite self-stigma being common among individuals with alcohol use disorders, limited research has investigated characteristics associated with it. For instance, one study found that higher self-stigma was associated with alcohol use disorder severity, but more research is needed to confirm such findings. Those with a family history of problematic alcohol use may be more prone to self-stigmatization because they witnessed their loved ones experiencing discrimination, but to date no work has examined this potential association.
Furthermore, it is unclear if such characteristics may differentially predict self-stigma across genders. One study suggests that women may experience more substance use-related self-stigma than men, but other research has not. There is a need to explore what factors are predictive of self-stigma among those with alcohol use disorders and how these associations vary across genders. To this end, this study assessed which demographic (e.g., family history of alcohol use disorder) and clinical (e.g., alcohol use disorder severity) factors were associated with self-stigma and how these associations varied between women and men among treatment-seeking adults enrolled in telehealth treatment for alcohol use disorder.
This study utilized data from an online survey of patients enrolled in the Ria Health program. Ria Health is a private company which offers telehealth services for alcohol use disorder in the United States. Through Ria health, patients work with a team of healthcare providers to create an individualized treatment plan which includes medication-assisted treatments to reduce alcohol cravings and reduce withdrawal symptoms (e.g., naltrexone) and may include individual counseling sessions with recovery coaches. All patients in the Ria Health program are provided with a Bluetooth breathalyzer which they are encouraged to use daily to track their alcohol use and treatment goal progress.
To assess predictors of self-stigma, the authors measured patient characteristics across multiple domains. The first domain was patient demographics, including gender, age, race, and ethnicity. This domain also included family history of alcohol use disorder, which was assessed via the number of biologically related family members who had a significant drinking problem. The second domain was clinical profiles of alcohol use disorder, which included participants’ drinking goal. This was assessed via a single item measuring if participants intended to continue using alcohol (e.g., “occasionally”), to abstain from alcohol (e.g., permanently), or if they had no specific alcohol related goal. Goals were dichotomized as either “controlled drinking” or abstinence. This domain also included alcohol use disorder severity. This was measured via the Alcohol Symptom Checklist which asks participants to self-report if they experienced any of 11 alcohol use disorder symptoms (e.g., withdrawal) within the past year. This scale yields a total score of alcohol use disorder severity level (none: 0-1; mild: 2–3; moderate: 4–5; severe: 6–11).
The main outcome of this study was self-stigma related to alcohol use, which was assessed via the Modified Substance Abuse Self-Stigma Scale. This scale includes 3 single items representing subscales measuring constructs which comprise self-stigma: self-devaluation (internalized negative attitudes towards those who use substances), fear of enacted stigma (worry about being the target of discrimination due to substance use), and stigma avoidance (hiding one’s history of alcohol use). See graphic below for specific item content.
Participants for the current study were recruited from Ria Health between July 2023 and March 2024. Eligible participants 1) lived in the United States, 2) were 18 years or older, 3) had access to technology that would allow telehealth treatment (e.g., a smartphone), 4) reported a desire to reduce/abstain from drinking, 5) had an American Society of Addiction Medicine criteria score of 1.0–3.1 (indicating need for outpatient or managed low-intensity residential alcohol use disorder treatment), 6) had completed the intake process for Ria Health with a medical provider, 7) had submitted at least 1 breathalyzer reading, and 8) were prescribed at least 1 medication for alcohol use disorder. All patients who met inclusion criteria were invited to provide informed consent and complete an online survey. Participants were compensated $20 via electronic gift cards upon survey completion.
Analyses first examined whether women and men were different on the self-stigma items. Then analyses examined in simple correlations whether alcohol use disorder severity (measured by number of DSM-5 alcohol use disorder criteria met), family history of alcohol use disorder, and age were correlated with the three self-stigma items. Finally, analyses examined simultaneously unique predictors of each self-stigma item, with possible predictors including gender, age, drinking goal, family history of a drinking problem, and number of DSM-5 alcohol use disorder criteria. They also examined, for any significant predictors, whether this effect was conditional on participant gender.
This study consisted of 121 people. Most participants were non-Hispanic (81%) White (84.3%). The sample was almost evenly split between men (46.3%) and women (52.9%). The average participant alcohol use disorder score was 8.9 and the variability around this estimate was relatively narrow (1.8), indicating many in the sample had severe alcohol use disorder symptomatology. About half (50.4%) of participants reported that their treatment goal was to be abstinent from alcohol, whereas the remainder indicated they would prefer to control (e.g., limit but not abstain from) alcohol use (47.1%) or had no set recovery goal (2.5%).
Women reported higher self-stigma than men
Women reported significantly higher self-devaluation and stigma avoidance than men. However, women and men were similar on fear of enacted stigma.
Higher alcohol use disorder severity was associated with greater self-stigma
Results showed that higher alcohol use disorder severity was associated with greater endorsement of stigma avoidance, a moderate correlation, as well as self-devaluation, a moderate correlation. No other characteristics were correlated with the self-stigma items, however. In models with all variables, the only unique predictor for any self-stigma item was greater alcohol use disorder severity for stigma avoidance. For every additional alcohol use disorder symptom, the odds were 1.8 times greater of being in the next highest stigma avoidance response (e.g., from 3 to 4 or 4 to 5, etc.).
There was no evidence that the association between alcohol use disorder severity and stigma avoidance differed by gender
Analyses tested whether gender changed the association between alcohol use disorder severity and self-stigma and found no evidence of a difference. This indicates that despite women reporting more self-stigma than men, the association between alcohol use disorder severity and self-stigma did not vary across genders.
This study found that women reported higher levels of self-stigma (including stigma avoidance and self-devaluation) than men, and that greater alcohol use disorder severity was associated with higher stigma avoidance. When the authors tested whether gender influenced the association between alcohol use disorder severity and self-stigma, they found no evidence of differences. This suggests that although levels of self-stigma may differ between women and men, alcohol use disorder severity may be a more robust correlate of self-stigma than gender. This association may have a simple explanation – the more severe someone’s alcohol use disorder, the greater the consequences, and remorse and shame they feel. Therefore, the more they have to hide.
That said, given these findings, it may be useful for treatment programs to screen individuals seeking care for alcohol use disorder for self-stigma, particularly stigma avoidance. Because higher levels of alcohol use disorder severity were associated with greater efforts to hide one’s alcohol use history, individuals with more severe alcohol use disorder may be less likely to disclose their drinking or treatment history in clinical or screening settings and are also more likely to drop out of treatment sooner. Incorporating measures of stigma avoidance into intake or assessment processes may help identify individuals at higher risk for severe alcohol use disorder who might otherwise underreport their drinking. This may be especially important for women, as women in this study reported higher levels of self-stigma, including stigma avoidance, than men. Other studies have found that when comparing women to men, the general public tends to view women as more to blame for causing their substance use problems and such stigma may be internalized more by women than men.
These findings also suggest that integrating stigma-reduction strategies into alcohol use disorder treatment, particularly for individuals with more severe symptoms, may be important. Psychoeducational emphasis on the biogenetic and neurobiological aspects of substance use disorder may help in this regard. Individuals with more severe alcohol use disorder may be less likely to fully engage in treatment due to fear of being stigmatized and/or negative self-evaluation related to their alcohol use. This may contribute to disengagement from treatment and potentially increase relapse risk. Addressing self-stigma early in treatment could potentially improve retention and treatment outcomes. This is speculative as the current data came from individuals enrolled in alcohol use disorder treatment. It is possible that participants with higher levels of self-stigma later dropped out of the Ria Health program, or perhaps the online nature of the treatment can help address this greater stigma avoidance. It is also possible that individuals with more stigma avoidance are less likely to seek treatment, acting as a counterweight to the increased treatment readiness that usually comes along with higher severity alcohol and/or other drug use disorders. While interesting questions, they are beyond the scope of these data and may be fruitful questions for future research. Indeed, further research is needed to assess how addressing self-stigma early in treatment or addressing self-stigma from a public health perspective may improve treatment engagement, retention, and outcomes.
This study found that, among a sample of alcohol use disorder treatment seeking adults, more severe alcohol use disorder was associated with greater self-stigma. This could indicate that screening for self-stigma (particularly stigma avoidance) in treatment settings would be helpful in identifying patients potentially at risk of discontinuing treatment. Given the study design features outlined above (e.g., cross-sectional data with a relatively small sample size), further research is needed to understand the role of self-stigma on substance use disorder treatment utility and health outcomes for diverse populations.
Tuchman, F. R., Montgomery, L., Hallgren, K. A., Hoskisson, C., Linde, P., Mulholland, P., Peters, A., Hamilton, D. A., Mendelson, J., & Witkiewitz, K. (2025). Preliminary predictors of self‐stigma among individuals in a telehealth‐based treatment program for alcohol use disorder. Alcohol: Clinical and Experimental Research, 49(12). doi: 10.1111/acer.70197.
l
Self-stigma is the process through which people may come to believe negative stereotypes about groups to which they belong. For example, a person with an alcohol use disorder may come to believe that their alcohol use issues are due to self-indulgence at the expense of other people, or other type of a character flaw and not a medical condition. Evidence suggests that heightened self-stigma is associated with alcohol craving and compulsive alcohol use, and lowered belief in being able to refuse an alcoholic drink when offered.
Self-stigma can also negatively impact the recovery process. Evidence shows that self-stigma can reduce an individual’s willingness to seek alcohol use treatment and make it challenging for those receiving care to continue treatment. The mechanisms through which self-stigma may impact treatment outcomes vary and include negative emotions and reduced self-esteem which can lead to a “why try” effect: an individual’s self-worth is lowered so much that they no longer pursue personal goals (e.g., career milestones) and/or abandon self-care practices (e.g., pursuing medical treatment). These processes may help explain why shame about alcohol use issues is associated with relapse.
Despite self-stigma being common among individuals with alcohol use disorders, limited research has investigated characteristics associated with it. For instance, one study found that higher self-stigma was associated with alcohol use disorder severity, but more research is needed to confirm such findings. Those with a family history of problematic alcohol use may be more prone to self-stigmatization because they witnessed their loved ones experiencing discrimination, but to date no work has examined this potential association.
Furthermore, it is unclear if such characteristics may differentially predict self-stigma across genders. One study suggests that women may experience more substance use-related self-stigma than men, but other research has not. There is a need to explore what factors are predictive of self-stigma among those with alcohol use disorders and how these associations vary across genders. To this end, this study assessed which demographic (e.g., family history of alcohol use disorder) and clinical (e.g., alcohol use disorder severity) factors were associated with self-stigma and how these associations varied between women and men among treatment-seeking adults enrolled in telehealth treatment for alcohol use disorder.
This study utilized data from an online survey of patients enrolled in the Ria Health program. Ria Health is a private company which offers telehealth services for alcohol use disorder in the United States. Through Ria health, patients work with a team of healthcare providers to create an individualized treatment plan which includes medication-assisted treatments to reduce alcohol cravings and reduce withdrawal symptoms (e.g., naltrexone) and may include individual counseling sessions with recovery coaches. All patients in the Ria Health program are provided with a Bluetooth breathalyzer which they are encouraged to use daily to track their alcohol use and treatment goal progress.
To assess predictors of self-stigma, the authors measured patient characteristics across multiple domains. The first domain was patient demographics, including gender, age, race, and ethnicity. This domain also included family history of alcohol use disorder, which was assessed via the number of biologically related family members who had a significant drinking problem. The second domain was clinical profiles of alcohol use disorder, which included participants’ drinking goal. This was assessed via a single item measuring if participants intended to continue using alcohol (e.g., “occasionally”), to abstain from alcohol (e.g., permanently), or if they had no specific alcohol related goal. Goals were dichotomized as either “controlled drinking” or abstinence. This domain also included alcohol use disorder severity. This was measured via the Alcohol Symptom Checklist which asks participants to self-report if they experienced any of 11 alcohol use disorder symptoms (e.g., withdrawal) within the past year. This scale yields a total score of alcohol use disorder severity level (none: 0-1; mild: 2–3; moderate: 4–5; severe: 6–11).
The main outcome of this study was self-stigma related to alcohol use, which was assessed via the Modified Substance Abuse Self-Stigma Scale. This scale includes 3 single items representing subscales measuring constructs which comprise self-stigma: self-devaluation (internalized negative attitudes towards those who use substances), fear of enacted stigma (worry about being the target of discrimination due to substance use), and stigma avoidance (hiding one’s history of alcohol use). See graphic below for specific item content.
Participants for the current study were recruited from Ria Health between July 2023 and March 2024. Eligible participants 1) lived in the United States, 2) were 18 years or older, 3) had access to technology that would allow telehealth treatment (e.g., a smartphone), 4) reported a desire to reduce/abstain from drinking, 5) had an American Society of Addiction Medicine criteria score of 1.0–3.1 (indicating need for outpatient or managed low-intensity residential alcohol use disorder treatment), 6) had completed the intake process for Ria Health with a medical provider, 7) had submitted at least 1 breathalyzer reading, and 8) were prescribed at least 1 medication for alcohol use disorder. All patients who met inclusion criteria were invited to provide informed consent and complete an online survey. Participants were compensated $20 via electronic gift cards upon survey completion.
Analyses first examined whether women and men were different on the self-stigma items. Then analyses examined in simple correlations whether alcohol use disorder severity (measured by number of DSM-5 alcohol use disorder criteria met), family history of alcohol use disorder, and age were correlated with the three self-stigma items. Finally, analyses examined simultaneously unique predictors of each self-stigma item, with possible predictors including gender, age, drinking goal, family history of a drinking problem, and number of DSM-5 alcohol use disorder criteria. They also examined, for any significant predictors, whether this effect was conditional on participant gender.
This study consisted of 121 people. Most participants were non-Hispanic (81%) White (84.3%). The sample was almost evenly split between men (46.3%) and women (52.9%). The average participant alcohol use disorder score was 8.9 and the variability around this estimate was relatively narrow (1.8), indicating many in the sample had severe alcohol use disorder symptomatology. About half (50.4%) of participants reported that their treatment goal was to be abstinent from alcohol, whereas the remainder indicated they would prefer to control (e.g., limit but not abstain from) alcohol use (47.1%) or had no set recovery goal (2.5%).
Women reported higher self-stigma than men
Women reported significantly higher self-devaluation and stigma avoidance than men. However, women and men were similar on fear of enacted stigma.
Higher alcohol use disorder severity was associated with greater self-stigma
Results showed that higher alcohol use disorder severity was associated with greater endorsement of stigma avoidance, a moderate correlation, as well as self-devaluation, a moderate correlation. No other characteristics were correlated with the self-stigma items, however. In models with all variables, the only unique predictor for any self-stigma item was greater alcohol use disorder severity for stigma avoidance. For every additional alcohol use disorder symptom, the odds were 1.8 times greater of being in the next highest stigma avoidance response (e.g., from 3 to 4 or 4 to 5, etc.).
There was no evidence that the association between alcohol use disorder severity and stigma avoidance differed by gender
Analyses tested whether gender changed the association between alcohol use disorder severity and self-stigma and found no evidence of a difference. This indicates that despite women reporting more self-stigma than men, the association between alcohol use disorder severity and self-stigma did not vary across genders.
This study found that women reported higher levels of self-stigma (including stigma avoidance and self-devaluation) than men, and that greater alcohol use disorder severity was associated with higher stigma avoidance. When the authors tested whether gender influenced the association between alcohol use disorder severity and self-stigma, they found no evidence of differences. This suggests that although levels of self-stigma may differ between women and men, alcohol use disorder severity may be a more robust correlate of self-stigma than gender. This association may have a simple explanation – the more severe someone’s alcohol use disorder, the greater the consequences, and remorse and shame they feel. Therefore, the more they have to hide.
That said, given these findings, it may be useful for treatment programs to screen individuals seeking care for alcohol use disorder for self-stigma, particularly stigma avoidance. Because higher levels of alcohol use disorder severity were associated with greater efforts to hide one’s alcohol use history, individuals with more severe alcohol use disorder may be less likely to disclose their drinking or treatment history in clinical or screening settings and are also more likely to drop out of treatment sooner. Incorporating measures of stigma avoidance into intake or assessment processes may help identify individuals at higher risk for severe alcohol use disorder who might otherwise underreport their drinking. This may be especially important for women, as women in this study reported higher levels of self-stigma, including stigma avoidance, than men. Other studies have found that when comparing women to men, the general public tends to view women as more to blame for causing their substance use problems and such stigma may be internalized more by women than men.
These findings also suggest that integrating stigma-reduction strategies into alcohol use disorder treatment, particularly for individuals with more severe symptoms, may be important. Psychoeducational emphasis on the biogenetic and neurobiological aspects of substance use disorder may help in this regard. Individuals with more severe alcohol use disorder may be less likely to fully engage in treatment due to fear of being stigmatized and/or negative self-evaluation related to their alcohol use. This may contribute to disengagement from treatment and potentially increase relapse risk. Addressing self-stigma early in treatment could potentially improve retention and treatment outcomes. This is speculative as the current data came from individuals enrolled in alcohol use disorder treatment. It is possible that participants with higher levels of self-stigma later dropped out of the Ria Health program, or perhaps the online nature of the treatment can help address this greater stigma avoidance. It is also possible that individuals with more stigma avoidance are less likely to seek treatment, acting as a counterweight to the increased treatment readiness that usually comes along with higher severity alcohol and/or other drug use disorders. While interesting questions, they are beyond the scope of these data and may be fruitful questions for future research. Indeed, further research is needed to assess how addressing self-stigma early in treatment or addressing self-stigma from a public health perspective may improve treatment engagement, retention, and outcomes.
This study found that, among a sample of alcohol use disorder treatment seeking adults, more severe alcohol use disorder was associated with greater self-stigma. This could indicate that screening for self-stigma (particularly stigma avoidance) in treatment settings would be helpful in identifying patients potentially at risk of discontinuing treatment. Given the study design features outlined above (e.g., cross-sectional data with a relatively small sample size), further research is needed to understand the role of self-stigma on substance use disorder treatment utility and health outcomes for diverse populations.
Tuchman, F. R., Montgomery, L., Hallgren, K. A., Hoskisson, C., Linde, P., Mulholland, P., Peters, A., Hamilton, D. A., Mendelson, J., & Witkiewitz, K. (2025). Preliminary predictors of self‐stigma among individuals in a telehealth‐based treatment program for alcohol use disorder. Alcohol: Clinical and Experimental Research, 49(12). doi: 10.1111/acer.70197.
l
Self-stigma is the process through which people may come to believe negative stereotypes about groups to which they belong. For example, a person with an alcohol use disorder may come to believe that their alcohol use issues are due to self-indulgence at the expense of other people, or other type of a character flaw and not a medical condition. Evidence suggests that heightened self-stigma is associated with alcohol craving and compulsive alcohol use, and lowered belief in being able to refuse an alcoholic drink when offered.
Self-stigma can also negatively impact the recovery process. Evidence shows that self-stigma can reduce an individual’s willingness to seek alcohol use treatment and make it challenging for those receiving care to continue treatment. The mechanisms through which self-stigma may impact treatment outcomes vary and include negative emotions and reduced self-esteem which can lead to a “why try” effect: an individual’s self-worth is lowered so much that they no longer pursue personal goals (e.g., career milestones) and/or abandon self-care practices (e.g., pursuing medical treatment). These processes may help explain why shame about alcohol use issues is associated with relapse.
Despite self-stigma being common among individuals with alcohol use disorders, limited research has investigated characteristics associated with it. For instance, one study found that higher self-stigma was associated with alcohol use disorder severity, but more research is needed to confirm such findings. Those with a family history of problematic alcohol use may be more prone to self-stigmatization because they witnessed their loved ones experiencing discrimination, but to date no work has examined this potential association.
Furthermore, it is unclear if such characteristics may differentially predict self-stigma across genders. One study suggests that women may experience more substance use-related self-stigma than men, but other research has not. There is a need to explore what factors are predictive of self-stigma among those with alcohol use disorders and how these associations vary across genders. To this end, this study assessed which demographic (e.g., family history of alcohol use disorder) and clinical (e.g., alcohol use disorder severity) factors were associated with self-stigma and how these associations varied between women and men among treatment-seeking adults enrolled in telehealth treatment for alcohol use disorder.
This study utilized data from an online survey of patients enrolled in the Ria Health program. Ria Health is a private company which offers telehealth services for alcohol use disorder in the United States. Through Ria health, patients work with a team of healthcare providers to create an individualized treatment plan which includes medication-assisted treatments to reduce alcohol cravings and reduce withdrawal symptoms (e.g., naltrexone) and may include individual counseling sessions with recovery coaches. All patients in the Ria Health program are provided with a Bluetooth breathalyzer which they are encouraged to use daily to track their alcohol use and treatment goal progress.
To assess predictors of self-stigma, the authors measured patient characteristics across multiple domains. The first domain was patient demographics, including gender, age, race, and ethnicity. This domain also included family history of alcohol use disorder, which was assessed via the number of biologically related family members who had a significant drinking problem. The second domain was clinical profiles of alcohol use disorder, which included participants’ drinking goal. This was assessed via a single item measuring if participants intended to continue using alcohol (e.g., “occasionally”), to abstain from alcohol (e.g., permanently), or if they had no specific alcohol related goal. Goals were dichotomized as either “controlled drinking” or abstinence. This domain also included alcohol use disorder severity. This was measured via the Alcohol Symptom Checklist which asks participants to self-report if they experienced any of 11 alcohol use disorder symptoms (e.g., withdrawal) within the past year. This scale yields a total score of alcohol use disorder severity level (none: 0-1; mild: 2–3; moderate: 4–5; severe: 6–11).
The main outcome of this study was self-stigma related to alcohol use, which was assessed via the Modified Substance Abuse Self-Stigma Scale. This scale includes 3 single items representing subscales measuring constructs which comprise self-stigma: self-devaluation (internalized negative attitudes towards those who use substances), fear of enacted stigma (worry about being the target of discrimination due to substance use), and stigma avoidance (hiding one’s history of alcohol use). See graphic below for specific item content.
Participants for the current study were recruited from Ria Health between July 2023 and March 2024. Eligible participants 1) lived in the United States, 2) were 18 years or older, 3) had access to technology that would allow telehealth treatment (e.g., a smartphone), 4) reported a desire to reduce/abstain from drinking, 5) had an American Society of Addiction Medicine criteria score of 1.0–3.1 (indicating need for outpatient or managed low-intensity residential alcohol use disorder treatment), 6) had completed the intake process for Ria Health with a medical provider, 7) had submitted at least 1 breathalyzer reading, and 8) were prescribed at least 1 medication for alcohol use disorder. All patients who met inclusion criteria were invited to provide informed consent and complete an online survey. Participants were compensated $20 via electronic gift cards upon survey completion.
Analyses first examined whether women and men were different on the self-stigma items. Then analyses examined in simple correlations whether alcohol use disorder severity (measured by number of DSM-5 alcohol use disorder criteria met), family history of alcohol use disorder, and age were correlated with the three self-stigma items. Finally, analyses examined simultaneously unique predictors of each self-stigma item, with possible predictors including gender, age, drinking goal, family history of a drinking problem, and number of DSM-5 alcohol use disorder criteria. They also examined, for any significant predictors, whether this effect was conditional on participant gender.
This study consisted of 121 people. Most participants were non-Hispanic (81%) White (84.3%). The sample was almost evenly split between men (46.3%) and women (52.9%). The average participant alcohol use disorder score was 8.9 and the variability around this estimate was relatively narrow (1.8), indicating many in the sample had severe alcohol use disorder symptomatology. About half (50.4%) of participants reported that their treatment goal was to be abstinent from alcohol, whereas the remainder indicated they would prefer to control (e.g., limit but not abstain from) alcohol use (47.1%) or had no set recovery goal (2.5%).
Women reported higher self-stigma than men
Women reported significantly higher self-devaluation and stigma avoidance than men. However, women and men were similar on fear of enacted stigma.
Higher alcohol use disorder severity was associated with greater self-stigma
Results showed that higher alcohol use disorder severity was associated with greater endorsement of stigma avoidance, a moderate correlation, as well as self-devaluation, a moderate correlation. No other characteristics were correlated with the self-stigma items, however. In models with all variables, the only unique predictor for any self-stigma item was greater alcohol use disorder severity for stigma avoidance. For every additional alcohol use disorder symptom, the odds were 1.8 times greater of being in the next highest stigma avoidance response (e.g., from 3 to 4 or 4 to 5, etc.).
There was no evidence that the association between alcohol use disorder severity and stigma avoidance differed by gender
Analyses tested whether gender changed the association between alcohol use disorder severity and self-stigma and found no evidence of a difference. This indicates that despite women reporting more self-stigma than men, the association between alcohol use disorder severity and self-stigma did not vary across genders.
This study found that women reported higher levels of self-stigma (including stigma avoidance and self-devaluation) than men, and that greater alcohol use disorder severity was associated with higher stigma avoidance. When the authors tested whether gender influenced the association between alcohol use disorder severity and self-stigma, they found no evidence of differences. This suggests that although levels of self-stigma may differ between women and men, alcohol use disorder severity may be a more robust correlate of self-stigma than gender. This association may have a simple explanation – the more severe someone’s alcohol use disorder, the greater the consequences, and remorse and shame they feel. Therefore, the more they have to hide.
That said, given these findings, it may be useful for treatment programs to screen individuals seeking care for alcohol use disorder for self-stigma, particularly stigma avoidance. Because higher levels of alcohol use disorder severity were associated with greater efforts to hide one’s alcohol use history, individuals with more severe alcohol use disorder may be less likely to disclose their drinking or treatment history in clinical or screening settings and are also more likely to drop out of treatment sooner. Incorporating measures of stigma avoidance into intake or assessment processes may help identify individuals at higher risk for severe alcohol use disorder who might otherwise underreport their drinking. This may be especially important for women, as women in this study reported higher levels of self-stigma, including stigma avoidance, than men. Other studies have found that when comparing women to men, the general public tends to view women as more to blame for causing their substance use problems and such stigma may be internalized more by women than men.
These findings also suggest that integrating stigma-reduction strategies into alcohol use disorder treatment, particularly for individuals with more severe symptoms, may be important. Psychoeducational emphasis on the biogenetic and neurobiological aspects of substance use disorder may help in this regard. Individuals with more severe alcohol use disorder may be less likely to fully engage in treatment due to fear of being stigmatized and/or negative self-evaluation related to their alcohol use. This may contribute to disengagement from treatment and potentially increase relapse risk. Addressing self-stigma early in treatment could potentially improve retention and treatment outcomes. This is speculative as the current data came from individuals enrolled in alcohol use disorder treatment. It is possible that participants with higher levels of self-stigma later dropped out of the Ria Health program, or perhaps the online nature of the treatment can help address this greater stigma avoidance. It is also possible that individuals with more stigma avoidance are less likely to seek treatment, acting as a counterweight to the increased treatment readiness that usually comes along with higher severity alcohol and/or other drug use disorders. While interesting questions, they are beyond the scope of these data and may be fruitful questions for future research. Indeed, further research is needed to assess how addressing self-stigma early in treatment or addressing self-stigma from a public health perspective may improve treatment engagement, retention, and outcomes.
This study found that, among a sample of alcohol use disorder treatment seeking adults, more severe alcohol use disorder was associated with greater self-stigma. This could indicate that screening for self-stigma (particularly stigma avoidance) in treatment settings would be helpful in identifying patients potentially at risk of discontinuing treatment. Given the study design features outlined above (e.g., cross-sectional data with a relatively small sample size), further research is needed to understand the role of self-stigma on substance use disorder treatment utility and health outcomes for diverse populations.
Tuchman, F. R., Montgomery, L., Hallgren, K. A., Hoskisson, C., Linde, P., Mulholland, P., Peters, A., Hamilton, D. A., Mendelson, J., & Witkiewitz, K. (2025). Preliminary predictors of self‐stigma among individuals in a telehealth‐based treatment program for alcohol use disorder. Alcohol: Clinical and Experimental Research, 49(12). doi: 10.1111/acer.70197.
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