Author's School

Brown School of Social Work

Author's Department/Program

Social Work


English (en)

Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)

Chair and Committee

Enola K Proctor


Despite the availability of effective treatments, the overwhelming majority: 85%) of individuals suffering from alcohol use disorders: AUDs) never receive help for their problems. AUDs include the disorders of alcohol abuse and alcohol dependence. An objective of Healthy People 2020 is to increase the number of individuals diagnosed with AUDs who receive alcohol treatment. The extent to which one believes that stigmatizing attitudes towards those with AUDs exist is defined as "perceived alcohol stigma": PAS). Although it is known that persons with AUDs who have higher levels of PAS are at an even greater risk of not receiving treatment, the specific mechanisms by which PAS affects treatment utilization remain unknown. Additionally, while the comorbidity of AUDs and other psychiatric disorders is highly prevalent, scant research has explored the relationship between PAS and comorbidity. The aims of this study were:: 1) to examine how PAS may influence the receipt of alcohol treatment for those who have met criteria for AUDs in their lifetime, and: 2) to examine PAS in persons with AUDs alone as compared to those with co-occurring AUDs and other psychiatric disorders.

This study used data from the National Epidemiologic Survey on Alcohol and Related Conditions: NESARC), which is a population-representative survey of United States adults living in noninstitutionalized settings. Respondents were included in the analyses if they completed both Wave 1: collected during 2001-2002) and Wave 2: collected during 2004-2005) survey interviews, and met criteria for DSM-IV AUD. Based on these criteria, data from 11,303 out of 43,093 respondents were analyzed. The primary analytic strategy was structural equation modeling.

While prior work identified an inverse relationship between PAS and alcohol treatment utilization among persons with lifetime AUDs, this study revealed that the relationship between PAS and perceived need for treatment and actual treatment utilization is complex. In each of the two aims of this study, one of three hypotheses was directly supported. Important considerations for design, measurement, and theory development were derived. However, longitudinal research and an improvement in the assessments of alcohol stigma, problem recognition, and perceived need for alcohol treatment must be accomplished in order to better quantify and describe any potential effect of PAS on treatment utilization.


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