Alcohol is dangerous. So is ‘alcoholic.’ — Harvard Gazette
Alcohol is dangerous. So is 'alcoholic.' — Harvard Gazette Harvard Gazette
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When Mass General transplant hepatologist Wei Zhang says he wants his colleagues to think before they speak, he has the tragedy of a recent patient in mind.
Admitted to intensive care for advanced alcohol-associated liver disease, the 36-year-old woman hid the truth when asked about her drinking. “She was like, ‘No, I quit over a year ago, I didn’t drink at all,’” said Zhang, also director of the hospital’s Alcohol-Associated Liver Disease Clinic. “But we have tools that can detect the use of alcohol in the past three, four weeks.”
The patient, who had been traumatized by years of physical abuse, was denied a liver transplant, in part because she withheld information about her alcohol use. Her death days later was “a consequence of stigma,” Zhang said. Patients too often “feel they’re being judged and may fear that their condition is seen as a result of personal failing rather than a medical issue that needs treatment.”
Amid increases in high-risk drinking and alcohol-associated liver disease across the country, he hopes that new research can help complete the years-long work of erasing that stigma, saving lives in the process.
For decades, medical terminology has labeled liver disease and other alcohol-related conditions as “alcoholic”: alcoholic liver disease, alcoholic hepatitis, alcoholic cirrhosis, alcoholic pancreatitis. Meanwhile, clinicians and administrators have described patients as addicts and alcoholics.
More recently, specialists and advocates have sought with some success to revise how we talk about substance use and those struggling to overcome it, not just to reduce stigma but also to combat bias among medical professionals. According to the National Institute on Alcohol Abuse and Alcoholism, the term “alcohol use disorder” is now preferable to “alcohol abuse,” “alcohol dependence,” and “alcoholism.”
“Emphasizing non-stigmatizing language is crucial not only for fostering honesty but also for supporting the overall treatment process and patient outcomes,” Zhang said.
The new study is a step toward that goal.
Inspired by his patients, Zhang set out to observe whether the terminology used by institutions that treat alcohol-associated liver disease reflects or rejects stigma. He and his team reviewed messages on more than 100 accredited liver transplant center websites, along with language used by addiction psychiatry sites. They found that almost nine of 10 transplant center websites use stigmatizing language such as “alcoholic.” Less than half of addiction psychiatry websites do the same.
“The gap between professional society recommendations and actual practice is concerning, since patients frequently use these online resources for information which can significantly influence their behavior and perceptions about alcohol-associated liver disease,” Zhang said.
Research backs him up, according to Harvard Medical School psychiatrist John F. Kelly, who published “Does It Matter How We Refer to Individuals with Substance-Related Conditions?” in 2009.
“Emphasizing non-stigmatizing language is crucial not only for fostering honesty but also for supporting the overall treatment process and patient outcomes.”
“Drug use disorder and alcohol use disorder are among the most stigmatized conditions universally across different societies because people feel that it’s self-induced — that people are to blame because they put it in their body,” said Kelly, also the founder of Mass General’s Recovery Research Institute. “Just because they made that decision initially, doesn’t mean they plan on becoming addicted.”
In the 2009 study, Kelly and his colleagues described patients to more than 600 clinicians, alternating between “substance abuser” and “having a substance use disorder.” Those in the latter category were viewed more sympathetically and as more worthy of treatment.
“I was quite surprised just how susceptible they were,” Kelly said. “These were passionate, dedicated clinicians. They were still susceptible to the negative punitive bias.”
They still are today, Zhang’s findings suggest.
“We are very good at seeing patients with liver disease but if we add this behavioral mental disorder, it is somewhat out of our scope,” he said. “I think education could at least have them be more familiar with this topic and be willing to at least listen to the adoption and use of non-stigmatizing language.”
“I think education could at least have them be more familiar with this topic and be willing to at least listen to the adoption and use of non-stigmatizing language.”
Building on the new study, Zhang has recommended to healthcare institutions and professional societies that they implement website feedback mechanisms and carry out regular content audits to guard against potentially harmful language.
“The steps we are recommending should not only help to align clinical practice with sound language guidelines, but also foster a more empathetic and supportive healthcare environment for patients,” he said.
Zhang also said healthcare institutions should look to leverage technology to support adoption of appropriate standards.
His team is collaborating with Mass General’s Research Patient Data Registry to obtain de-identified patient records, which they plan to review for instances of stigmatizing language. He hopes the process will help researchers quantify the prevalence of such language in clinical notes and identify patterns that can inform interventions. The team will also analyze the association of stigmatizing language with patient outcomes.
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SDGs, Targets, and Indicators in the Article
1. Which SDGs are addressed or connected to the issues highlighted in the article?
- SDG 3: Good Health and Well-being
- SDG 10: Reduced Inequalities
The article discusses the stigma associated with alcohol-related liver disease and the need to use non-stigmatizing language when referring to individuals with substance-related conditions. This connects to SDG 3, which aims to ensure healthy lives and promote well-being for all at all ages. It also relates to SDG 10, which focuses on reducing inequalities within and among countries.
2. What specific targets under those SDGs can be identified based on the article’s content?
- SDG 3.5: Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol
- SDG 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies, and practices
The article highlights the importance of using non-stigmatizing language to support the overall treatment process and patient outcomes. This aligns with the target of strengthening the prevention and treatment of substance abuse (SDG 3.5). Additionally, addressing the stigma associated with alcohol-related conditions contributes to reducing inequalities of outcome (SDG 10.3).
3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?
Yes, there are indicators mentioned in the article that can be used to measure progress towards the identified targets. These include:
- Language used by institutions that treat alcohol-associated liver disease: The study reviewed messages on more than 100 accredited liver transplant center websites and found that almost nine out of ten use stigmatizing language such as “alcoholic.” This indicator reflects the need to improve language practices in healthcare institutions.
- Language used by addiction psychiatry sites: Less than half of addiction psychiatry websites use stigmatizing language. This indicator suggests that some sites have already adopted non-stigmatizing language and can serve as examples for others.
- Prevalence of stigmatizing language in clinical notes: The team plans to review de-identified patient records to quantify the prevalence of stigmatizing language in clinical notes. This indicator will help assess the extent of the problem and track progress over time.
- Association of stigmatizing language with patient outcomes: The team will analyze the association between stigmatizing language and patient outcomes. This indicator will provide insights into the impact of language on treatment effectiveness and patient well-being.
These indicators can be used to measure progress towards using non-stigmatizing language and reducing inequalities in healthcare.
Table: SDGs, Targets, and Indicators
| SDGs | Targets | Indicators |
|---|---|---|
| SDG 3: Good Health and Well-being | 3.5: Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol | – Language used by institutions that treat alcohol-associated liver disease – Language used by addiction psychiatry sites – Prevalence of stigmatizing language in clinical notes – Association of stigmatizing language with patient outcomes |
| SDG 10: Reduced Inequalities | 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies, and practices | – Language used by institutions that treat alcohol-associated liver disease – Language used by addiction psychiatry sites – Prevalence of stigmatizing language in clinical notes – Association of stigmatizing language with patient outcomes |
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Fuente: news.harvard.edu
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