National Alcohol Awareness Month: When it Comes to Alcohol Use Disorder, Stigma Hinders Treatment

Peer recovery specialists are one of the evidence-based treatments available

Alcohol is the most widely used substance in the U.S., and excessive alcohol use is the leading cause of preventable death. Here, Allison Smith, M.D., defines alcohol use disorder and discusses the disorder’s stigma, the road to recovery and how MUSC Health can help.

What is excessive alcohol use?

A standard drink is defined as:

• 5 oz. of wine
• 12 oz. of beer
• 1.5 oz. of spirits

Health guidelines recommend that women should not have more than seven standard drinks per week. Men should not have more than 14 drinks per week. Alcohol use disorder (AUD) is diagnosed when alcohol impairs a person’s health and functioning.

“If you’re drinking more than the guidelines advise, you could be putting yourself at risk,” says Dr. Allison Smith, an addiction psychiatrist in MUSC Health’s Institute of Psychiatry and medical director of the Division of Bio-behavioral Medicine. 

The Barrier to Treatment: Stigma

Despite the prevalence of alcohol use disorder, few people receive treatment, says Dr. Smith. A national survey on drug use and health showed that 81 percent of people who met the criteria for alcohol use disorder had received medical care in the last year. Of those 81 percent, only 12 percent received a brief intervention and less than six percent received treatment. 

The stigma associated with substance use disorder is one reason it goes untreated, says Dr. Smith. “We have evidence-based medicines and behavioral treatments for this disorder, but they are not sought out or used enough. Addiction is a complex brain disorder and not a sign of weakness or flaw in character, but it’s still often viewed that way.” 

Removing that stigma is key, she says. “It’s not a moral failing, it’s not a choice. It’s important we understand and recognize it as a chronic medical illness. Alcohol use disorder and addiction are multifactorial and related to environmental, social and psychological factors much like diabetes and high blood pressure. Yet people with addiction are often judged and discriminated against, causing shame and guilt. 

“Alcohol use disorder is a relapsing, remitting disease just like other chronic diseases,” she adds. 

Tragically, the stigma prevents people from reaching out for help. “I tell patients, if you were diagnosed with Type 1 diabetes, you would be prescribed insulin and advised to adjust your lifestyle choices to improve your health,” says Dr. Smith. “The same applies to addiction disorders: we have medicines and treatments available.” 

• There are three FDA-approved medicines available for people with alcohol use disorder.
• In addition, therapy treatments including cognitive behavioral therapy, and individual and group therapies are proven effective.

Newer treatments include programs with peer recovery specialists or people living in recovery who help others with that journey.

Shared Experience to Empower Recovery

Peer recovery and support specialists are health care workers who have been personally successful in the recovery process and help others by sharing their own lived experiences. By sharing, they’re able to engage individuals in the recovery process and help link them to treatment. The use of peer support specialists in recovery has fast gained momentum in the past few years.

“The peer support role helps advocate for people in recovery by decreasing stigma, sharing resources, serving as a mentor, navigating barriers to care and helping patients set goals,” says Dr. Smith.

It can be a powerful experience for patients to meet with someone who truly understands their alcohol use because they’ve also walked that path, says Dr. Smith. “It’s motivating and I think it instills hope in patients.” 

One study showed that linking patients to peer recovery coaching increased their engagement in treatment. Six months after leaving the hospital, 80 percent of patients who had engaged with a peer support specialist were still engaged in recovery support services. 

MUSC Health has peer support programs in the emergency department in Charleston and nine other satellite locations, as well as partnership programs across the state. These programs have been successful in identifying substance use disorders and fast-tracking patients to treatment. 

Peer recovery specialists also play an important role in removing the stigma, says Dr. Smith. “People start to view addiction differently when they see somebody who’s in recovery, who’s doing well and is professional and helpful. It empowers health care workers, in general, to have peer specialists as a resource. 

“Most importantly, peer specialists meet patients where they are,” she says. 

Getting Help

If you or someone you love is struggling with alcohol or another substance, Dr. Smith wants you to know there are many treatment options available including medicines, peer support, 12-step programs and more. Programs are available around the state for patients with and without insurance. To learn more, contact MUSC Health’s Institute of Psychiatry or call 843-792-9162.