Alcoholism is increasingly seen as medical illness; U.S. survey also finds heightened stigma.

WASHINGTON -- The public became more likely to regard alcohol dependence as a medical illness over a 10-year period, but stigmatization of alcoholism increased over that period as well, the latest results of a biannual survey addressing public attitudes toward the disorder show.

Most of the respondents who answered questions relating to alcoholism on the 2006 General Social Survey approved of treatment from a medical doctor (89%) or psychiatrist (81%), Marilyn Sinkewicz, Ph.D., reported at a joint meeting sponsored by the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. However, only about half (54%) endorsed prescription medication for treatment.

In comparison, on the 1996 survey, 76% endorsed treatment from a medical doctor, 67% endorsed treatment from a psychiatrist, and 41% endorsed the use of prescription medications. These differences were statistically significant.

The General Social Survey is administered biannually to a nationally representative sample of noninstitutionalized adults in the United States. In 1996 and 2006, the General Social Survey incorporated a set of vignettes describing individuals who meet the criteria for DSM-IV alcohol dependence and other mental illnesses.

Questions probed the participants' conceptions of alcohol dependence, stigmatization of alcohol dependence, and beliefs about treatment for alcohol dependence. The sex, ethnicity, and education level of the individual described in the vignettes were randomly varied.

For the 2006 survey, demographic data were available for 377 participants. Roughly half were female (55%), and most were white (71%). Most had at least a high school education (83%). Almost all (98%) identified the subject of the vignette as being alcohol dependent. In 1996, 48% identified the subject as being alcohol dependent. In contrast, only half (52%) identified the subject as having a mental illness. A comparable percentage (51%) identified the subject as having a nervous breakdown or (52%) a physical illness.

In general, respondents thought that alcohol dependence was a serious problem. However, researchers found a statistically significant difference based on ethnicity: Eighty-three percent of white respondents considered alcohol dependence a very serious problem, compared with 90% of nonwhite respondents.

The researchers also asked about perceived causes of alcohol dependence. Respondents were allowed to select more than one from a list of possible causes. "The vast majority of respondents believe that alcohol dependence is stress," said Dr. Sinkewicz, a postdoctoral research fellow in epidemiology at Columbia University, New York. Stress was the most commonly cited cause (92%), followed by genetics (71%), chemical imbalance (70%), upbringing (70%), and a bad character (67%).

These perceptions of cause have changed over time. In 1996, 65% of respondents indicated that chemical imbalances cause alcohol dependence, 62% cited genetic factors, 68% cited upbringing, and 52% cited a person's bad character. Interestingly, while the percentage of respondents who named these as possible causes increased for all four, the only statistically significant difference was for bad character. "The most disparate--15 percentage points--and only statistically significant change was in the public's view that the cause of alcohol dependence is the afflicted person's own bad character."

The researchers also looked at social distance--the willingness of respondents to interact with a person with alcohol dependence. They found that 63% were willing to befriend someone with alcohol dependence. In addition, 61% were willing to live near someone dependent on alcohol, 46% were willing to be social, 25% were willing to work closely, and 20% were willing to have an alcohol dependent person marry into their family.

"I think the take-away message here really is that more interaction was endorsed when it involved looser social bonds but less interaction was endorsed when it involved closer social bonds," she said.

They also looked at the extent to which the public is willing to endorse negative stereotypes of alcohol-dependent people. About half believed that alcohol-dependent individuals are competent to make decisions about treatment (55%) or money (44%). The public was much more likely to believe that people who are dependent on alcohol are violent to others (69%) or to themselves (83%).

In term of treatment, only 13% believed that an alcohol-dependent person can recover on their own, while almost all (98%) believed that recovery was possible with therapy. In terms of coercive treatment, 38% endorsed mandatory medical treatment of alcohol-dependent individuals. Almost all (90%) thought that forced hospitalization was appropriate if the individual was perceived as dangerous.

In 2006, 79% believed that the government should be responsible for providing care for alcohol-dependent individuals. In addition, 51% believed that government insurance should be primarily responsible for this care. Less than half (42%) thought the government should spend more on this care. In 1996, 79% believed that the government should be responsible for the provision of care for alcohol-dependent individuals. In addition, 40% believed that government insurance should be primarily responsible for this care. About half (51%) thought that the government should spend more on such care.

BY KERRI WACHTER

Senior Writer