Einstellung der Bevölkerung zu Alkoholkranken

 

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Zusammenfassung

Anliegen Was weiß man über die Haltung der Bevölkerung zu Alkoholkranken? Methode Übersicht über alle zwischen 1948 und 2008 publizierten repräsentativen Bevölkerungserhebungen zu diesem Thema. Ergebnisse Alkoholkranke werden meist selbst für ihre Erkrankung verantwortlich gemacht. Sie werden stärker als z. B. Patienten mit Schizophrenie oder Depression abgelehnt. Schlussfolgerungen Bisher fehlen Untersuchungen, die Zusammenhänge zwischen bestimmten Vorstellungen über Alkoholkranke und deren Diskriminierung aufzeigen.

Abstract

Objective Although among the most prevalent psychiatric conditions, alcoholism seems to be neglected within the current debate on mental illness stigma. We establish the state of current research on public attitudes towards alcohol dependent people. Methods In an extensive search of the literature, we identified 49 population studies on this topic between 1948 and 2008. 27 studies contained relevant information from Western countries and were included in this review. Results Although most people regard alcoholism as an illness, there is a strong tendency to blame those affected for their condition. Psycho-social causal attributions prevail over biologic explanations. Most people regard alcohol dependent persons as unpredictable and dangerous. The desire for social distance is stronger towards alcohol dependent persons than towards those with other psychiatric diagnoses such as depression or schizophrenia; only those addicted to illegal drugs suffer stronger rejection. Preferences of the public for resource allocation within the health care system put alcohol dependent patients at a potential disadvantage. Conclusions Alcoholism is a severely stigmatized condition. In order to change the stigma of alcoholism, studies exploring theoretical models and mechanisms of stigmatization seem necessary.

Literatur

• 1 Jacobi F, Wittchen H U, Hilting C. et al . Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS).  Psychol Med. 2004;  34 597-611
  Google Scholar
• 2 Weithmann G, Hoffmann M. Häufigkeit und Kosten zusätzlicher stationärer Behandlungen im Jahr nach tagesklinischer oder vollstationärer Alkoholentzugsbehandlung.  Psychiat Prax. 2007;  34 15-19
  Article in Thieme ConnectPubMedGoogle Scholar
• 3 Rehm J, Mathers C, Popova S. et al . Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders.  Lancet. 2009;  373 2223-2233
  CrossrefPubMedGoogle Scholar
• 4 Schomerus G. Steine auf dem Weg – Stigma und Hilfesuchverhalten.  Psychiat Prax. 2009;  36 53-54
  Article in Thieme ConnectPubMedGoogle Scholar
• 5 Lindenmeyer J. Alkoholabhängigkeit. 2 ed. Göttingen; Hogrefe 2005
  PubMedGoogle Scholar
• 6 Alber K, Kliemt H, Nagel E. Priorisierung: Selbstverantwortung als Kriterium kaum operationalisierbar.  Deutsches Ärzteblatt. 2009;  106 A 1361-1363
  PubMedGoogle Scholar
• 7 Konferenzband „Stigma and Discrimination: Evidence for Action”. London, UK; Institute of Psychiatry, University of London and World Psychiatric Association 2009
  Google Scholar
• 8 Stein O. Trinkgewohnheiten: Eine empirische Untersuchung über Trinkverhalten und Alkoholismus in Saarbrücken. Stuttgart; F. Enke 1985
  PubMedGoogle Scholar
• 9 Angermeyer M C, Matschinger H, Siara C E. Wissensbestände, Überzeugungssysteme und Einstellungsmuster der Bevölkerung der Bundesrepublik Deutschland bezüglich psychischer Erkrankungen. Abschlussbericht. Mannheim; Zentralinstitut für Seelische Gesundheit 1992
  PubMedGoogle Scholar
• 10 Schomerus G, Matschinger H, Angermeyer M C. Alcoholism: Illness beliefs and resource allocation preferences of the public.  Drug Alcohol Depend. 2006;  82 204-210
  Google Scholar
• 11 Mulford H A, Miller D E. Public definitions of the alcoholic.  Q J Stud Alcohol. 1961;  22 312-320
  PubMedGoogle Scholar
• 12 Mulford H A, Miller D E. Measuring public acceptance of the alcoholic as a sick person.  Q J Stud Alcohol. 1964;  25 314-323
  PubMedGoogle Scholar
• 13 Haberman P W, Sheinberg J. Public attitudes toward alcoholism as an illness.  Am J Public Health Nations Health. 1969;  59 1209-1216
  PubMedGoogle Scholar
• 14 Beigel A, McCabe T R, Tamerin J S. et al . Planning for the development of comprehensive community alcoholism services: II. Assessing community awareness and attitudes.  Am J Psychiatry. 1974;  131 1116-1121
  PubMedGoogle Scholar
• 15 Dean J C, Poremba G A. The alcoholic stigma and the disease concept.  Int J Addict. 1983;  18 739-751
  PubMedGoogle Scholar
• 16 Caetano R. Public opinions about alcoholism and its treatment.  J Stud Alcohol. 1987;  48 153-160
  PubMedGoogle Scholar
• 17 Rodin M B. Alcoholism as a folk disease. The paradox of beliefs and choice of therapy in an urban American community.  J Stud Alcohol. 1981;  42 822-835
  PubMedGoogle Scholar
• 18 Ries J K. Public acceptance of the disease concept of alcoholism.  J Health Soc Behav. 1977;  18 338-344
  CrossrefPubMedGoogle Scholar
• 19 Orcutt J D, Cairl R E, Miller E T. Professional and public conceptions of alcoholism.  J Stud Alcohol. 1980;  41 652-661
  PubMedGoogle Scholar
• 20 Caetano R. Concepts of alcoholism among whites, blacks and Hispanics in the United States.  J Stud Alcohol. 1989;  50 580-582
  PubMedGoogle Scholar
• 21 Hingson R, Mangione T, Meyers A. et al . Seeking help for drinking problems; a study in the Boston Metropolitan Area.  J Stud Alcohol. 1982;  43 273-288
  PubMedGoogle Scholar
• 22 Link B G, Phelan J C, Bresnahan M. et al . Public conceptions of mental illness: Labels, causes, dangerousness, and social distance.  Am J Public Health. 1999;  89 1328-1333
  CrossrefPubMedGoogle Scholar
• 23 Pescosolido B A, Martin J K, Link B G. et al .American's views of mental health and illness at century's end: Continuity and change. In: Indiana Consortium for Mental Health Service Research, Bloomingdale, and Joseph P. Columbia University; Mailman School of Public Health 2000
  PubMedGoogle Scholar
• 24 Kuppin S, Carpiano R M. Public conceptions of serious mental illness and substance abuse, their causes and treatments: Findings from the 1996 General Social Survey.  Am J Public Health. 2006;  96 1766-1771
  CrossrefPubMedGoogle Scholar
• 25 Martin J K, Pescosolido B A, Tuch S A. Of fear and loathing: The role of „disturbing behavior”, labels, and causal attributions in shaping public attitudes toward people with mental illness.  J Health Soc Behav. 2000;  41 208-223
  CrossrefPubMedGoogle Scholar
• 26 Schnittker J. An uncertain revolution: Why the rise of a genetic model of mental illness has not increased tolerance.  Soc Sci Med. 2008;  67 1370-1381
  Google Scholar
• 27 Crawford J R, Thomson N A, Gullion F E. et al . Does endorsement of the disease concept of alcoholism predict humanitarian attitudes to alcoholics?.  Int J Addict. 1989;  24 71-77
  PubMedGoogle Scholar
• 28 Crawford J, Heather N. Public attitudes to the disease concept of alcoholism.  Int J Addict. 1987;  22 1129-1138
  PubMedGoogle Scholar
• 29 Crisp A H, Gelder M G, Rix S. et al . Stigmatisation of people with mental illnesses.  Br J Psychiatry. 2000;  177 4-7
  CrossrefPubMedGoogle Scholar
• 30 Crisp A H, Gelder M G, Goddard E. et al . Stigmatization of people with mental illnesses: a follow-up study within the Changing Minds campaign of the Royal College of Psychiatrists.  World Psychiatry. 2005;  4 106-113
  Google Scholar
• 31 Bromley C, Ormston R. Part of the Scottish way of life? Attitudes towards drinking and smoking in Scotland – Findings from the 2004 Scottish Social Attitudes Survey. Edinburgh; Scottish Executive Social Research 2005
  PubMedGoogle Scholar
• 32 Maxwell M A. Drinking behavior in the State of Washington.  Q J Stud Alcohol. 1952;  13 219-239
  PubMedGoogle Scholar
• 33 Linsky A S. Theories of Behavior and Social Control of Alcoholism.  Soc Psychiatry. 1972;  7 47-52
  CrossrefPubMedGoogle Scholar
• 34 Angermeyer M C, Matschinger H, Grobel S. Einstellung der Bevölkerung zu Alkoholkranken Teil 2: Stereotype und Stigma.  Sucht. 1995;  41 237-244
  PubMedGoogle Scholar
• 35 Wieser S. Das Trinkverhalten der Deutschen. Eine medizin-soziologische Untersuchung. Herford i. W.; Nicolai 1973
  PubMedGoogle Scholar
• 36 Angermeyer M C, Matschinger H, Grobel S. Einstellung der Bevölkerung zu Alkoholkranken, Teil 1: Soziale Distanz [Attitude of the public towards alcoholics, part 1: Social distance].  Sucht. 1995;  41 232-237
  PubMedGoogle Scholar
• 37 Angermeyer M C, Matschinger H, Holzinger A. Gender and attitudes towards people with schizophrenia. Results of a representative survey in the Federal Republic of Germany.  Int J Soc Psychiatry. 1998;  44 107-116
  CrossrefPubMedGoogle Scholar
• 38 Angermeyer M C, Matschinger H. Soziale Distanz der Allgemeinbevölkerung gegenüber psychisch Kranken.  Gesundheitswesen. 1996;  58 18-24
  PubMedGoogle Scholar
• 39 Angermeyer M C, Matschinger H. Social distance towards the mentally ill: results of representative surveys in the Federal Republic of Germany.  Psychol Med. 1997;  27 131-141
  CrossrefPubMedGoogle Scholar
• 40 Beck M, Angermeyer M C, Brähler E. Gibt es einen Zusammenhang zwischen Rechtsextremismus und sozialer Distanz gegenüber psychisch Kranken? Ergebnisse einer Repräsentativerhebung bei der deutschen Allgemeinbevölkerung.  Psychiat Prax. 2005;  32 68-72
  Article in Thieme ConnectPubMedGoogle Scholar
• 41 Link B G, Struening E L, Neese-Todd S. et al . The consequences of stigma for the self-esteem of people with mental illnesses.  Psychiatr Serv. 2001;  52 1621-1626
  CrossrefPubMedGoogle Scholar
• 42 Blizard P J. The social rejection of the alcoholic and the mentally ill in New Zealand.  Soc Sci Med. 1970;  4 513-526
  PubMedGoogle Scholar
• 43 Beck M, Dietrich S, Matschinger H. et al . Alcoholism: Low standing with the public? Attitudes towards spending financial resources on medical care and research on alcoholism.  Alcohol Alcohol. 2003;  38 602-605
  PubMedGoogle Scholar
• 44 Matschinger H, Angermeyer M C. The public's preferences concerning the allocation of financial resources to health care: results from a representative population survey in Germany.  EurPsychiatry. 2004;  19 478-482
  CrossrefPubMedGoogle Scholar
• 45 Schomerus G, Matschinger H, Angermeyer M C. Preferences of the public regarding cutbacks in expenditure for patient care: Are there indications of discrimination against those with mental disorders?.  Soc Psychiatry Psychiatr Epidemiol. 2006;  41 369-377
  Google Scholar
• 46 Pescosolido B A, Monahan J, Link B G. et al . The public's view of the competence, dangerousness, and need for legal coercion of persons with mental health problems.  Am J Public Health. 1999;  89 1339-1345
  CrossrefPubMedGoogle Scholar
• 47 Lucht M J, Kuehn K U, Schroeder W. et al . Influence of the dopamine D2 receptor (DRD2) exon 8 genotype on efficacy of tiapride and clinical outcome of alcohol withdrawal.  Pharmacogenetics. 2001;  11 647-653
  CrossrefPubMedGoogle Scholar
• 48 Link B G, Phelan J C. Conceptualizing stigma.  Annual Review of Sociology. 2001;  27 363-385
  CrossrefPubMedGoogle Scholar
• 49 Jorm A F, Oh E. Desire for social distance from people with mental disorders.  Aust N Z J Psychiatry. 2009;  43 183-200
  CrossrefPubMedGoogle Scholar
• 50 Phelan J C, Link B G, Dovidio J F. Stigma and prejudice: one animal or two?.  Soc Sci Med. 2008;  67 358-367
  Google Scholar

1 Behinderungsbereinigte Lebensjahre: Durch früheren Tod verlorene und mit Behinderung gelebte Lebensjahre werden zu einer globalen Maßzahl addiert, die einen Vergleich der Krankheitslast zwischen verschiedenen Krankheiten und verschiedenen Populationen erlaubt.

Dr. med. Georg Schomerus

Klinik für Psychiatrie und Psychotherapie der Ernst-Moritz-Arndt-Universität Greifswald im Hanse-Klinikum Stralsund

Rostocker Chaussee 70

18437 Stralsund

Email: georg.schomerus@uni-greifswald.de