Approximately half of all people with high alcohol consumption in Sweden fulfill criteria for either harmful consumption or dependence. Among the alcohol-dependent, the majority have dependence with low severity. They are also reluctant to seek treatment. This qualitative study, with data from seven focus group discussions and 14 individual interviews, aims to describe and explain how representations of alcohol consumption, dependence, and treatment create barriers to treatment. Thirty-two adults from the general population fulfilling DSM-IV criteria for alcohol dependence participated. Most of the participants agreed that they were heavy drinkers but did not perceive themselves as alcohol dependent. Having alcohol problems, as well as realizing the need for and entering treatment, was associated with shame and stigma, producing a strong barrier to treatment. The participants’ knowledge about treatment was limited and somewhat faulty, as they thought that treatment mainly involves medication with disulfiram, lifelong abstinence, and inpatient care at rehabilitation clinics. As these treatments are socially restrictive and stigmatizing, this understanding created a barrier to treatment. While treatment for alcohol problems in primary care was seen as less stigmatizing, the expertise among general practitioners in this field was questioned. Results indicate that, to lower the threshold for treatment seeking, treatment services need to better match the needs and wishes of the potential service users as well as take stigmatization into account. Primary care practices and general practitioners need to market their ability to treat people with drinking problems. The clinical understanding of alcohol dependence needs to be expanded to include mild to moderate dependence, conditions which can be managed in primary care.

What’s interesting in the above excerpt is that those with an alcohol problem who were questioned about addiction treatment centers thought that treatment is primarily about lifelong abstinence. I’m not sure what was meant by this — I don’t know if the researchers doing this study think that abstinence is not a goal in addiction treatment centers or whether they’re suggesting something more nuanced, but I’ll make the more nuanced point. I would never lead an alcoholic to believe they can drink successfully, because the evidence suggests otherwise. Some people who abuse alcohol temporarily because of a divorce, a death in the family, a job loss, or some other life event that was stressful will likely be able to drink socially once they’ve dealt with the stress and learned better ways to cope with stress, but anyone who shows definite signs and symptoms of alcohol addiction should make abstinence a goal, although lifelong abstinence is not a realistic approach. No one can choose to change forever by simply choosing a long term goal, only one day at a time through a plan of recovery management. Excuse my cliché of one day at a time, but it’s a cliché phrase because it’s true.

A recovering alcoholic remains abstinent one day at a time, and then after a while he/she realizes that their life has changed for the better, so they choose sobriety as a way of life. At first a person getting help for an alcohol problem might use their energy to stay away from the first drink, but after being in recovery for a while and going through positive mental/emotional/physical/spiritual change the person loses the mental obsession to drink and is pulled toward more positive change — sobriety becomes something the recovering person embraces and seeks out.

Yes, there’s much bad information about alcohol and other drug problems, and there’s much misunderstanding about substance abuse and addiction treatment, but hopefully we can all change these perceptions and remove the stigma surrounding substance abuse and addiction through education.