Old habits die hard: How low self-esteem and over-thinking impact your ability to stay sober

Australian drinking culture is socially driven. Having a beer with mates at the weekend, with colleagues after work, or at home during a family barbecue, is a significant part of our lives. However, many Australians cannot control the amount of alcohol they consume. This can lead to serious health ramifications such as cirrhosis of the liver, socio-economic consequences such as the loss of a job, and personal costs such as loss of relationships. All these losses can lead to various mental health problems such as depression or anxiety.

According to the statistics from World Health Organisation (WHO), over 3 million people across the globe die annually due to harmful use of alcohol. In Australia, 3.9% of the population suffers from an alcohol related disorder, and 1.5% of the population is diagnosed with an alcohol dependency. These figures suggest that Australia’s drinking culture is not just a happy, prosocial story, but that it also creates serious health complications.

Most people are accepting of others’ choice to consume alcohol occasionally. However, they are not as accepting of those who are dependent on alcohol. Common issues that the public associates with alcohol dependency are lack of employment, health problems, and a sense of incompetency and selfishness. However, what they may not be aware of is that most individuals who cannot control their alcohol consumption are usually suffering from a secondary mental health issue such as depression or generalised anxiety.

Stigma

Alcohol dependent individuals are frequently subject to stigma, which causes  substantial distress and thus affects their mental well-being. Stigma is defined as a public mark of shame placed on people with physical or behavioural characteristics perceived as negative by society at large – e.g. leprosy (physical) or criminality (behavioural). Stigma negatively influences public opinion, and typically creates negative behaviour towards marginalised groups.

Alcoholics are one such marginalised group. Public stigma towards alcoholism contributes to alcohol dependent individuals feeling worthless, leading to the development of self-stigmatisation. Self-stigmatisation is defined as the internalisation of negative social beliefs and attitudes regarding the circumstances of addiction. This is one of the major contributors to depression among this population.

Self-stigmatisation is detrimental to individuals dependent on a substance, and is particularly harmful when the substance concerned is legal and deeply embedded in cultural and social norms. The way self-stigma develops is in a series of steps. It starts with the awareness of public stigma, followed by agreeing with this stigma, then applying those negative beliefs to oneself, finally resulting in lowered self-esteem.  

Self-stigma can affect alcohol dependent individuals adversely by lowering their ability to stop themselves from consuming alcohol, which is known as drinking-refusal self-efficacy. This increases the chance of alcohol use and relapse.

Many alcohol dependent persons have reported feelings of worthlessness, causing them to not pursue personal goals or seek treatment. This leads to what has been dubbed the ‘why try’ phenomenon, which is defined as the lowering of a person’s self-respect and self-esteem to the point that they don’t seek treatment, which normally prolongs their addiction.

Depression and rumination

Self-stigma leads to further complications in the lives of individuals addicted to alcohol – most commonly an additional diagnosis of depression or anxiety. Dual diagnoses are not uncommon when it comes to addiction, not unlike other diagnoses of lifelong illnesses.

Depression in alcoholism often causes lapses and relapses, and the problem is also fuelled by the language used around addiction. For example, if a substance dependent individual consumes that substance once following a period of abstinence and does not continue to consume the substance, that is termed a lapse. However, if they continue using a substance, that is termed relapse. Unfortunately, many rehabilitation centres and mental health facilities may not be conscious of this distinction, and often use the term ‘relapse’ when referring to individuals having one drink following a sober period. This creates a greater sense of failure, which can lead to higher levels of self-stigmatisation, thus increasing the chance of further alcohol use and relapse.

Most alcohol dependent individuals who suffer from self-stigmatisation also display symptoms associated with depression such as mood swings, guilt and rumination. According to previous research, rumination is a strategy or a repetitive thinking method used to cope with a negative or depressive mood by focusing attention on oneself. In other words, rumination is a form of self-directed brooding.

Research has shown that rumination has two possible outcomes for alcohol dependent individuals. They will experience cravings as a result of rumination, causing them to drink; or they will consume alcohol in order to stop the rumination process from occurring. As such, rumination has negative effects on individuals who are trying to abstain from alcohol consumption.

Future directions

Current research is exploring the relationship between rumination, self-stigmatisation and depression among individuals dependent on alcohol. As previous research has found that rumination has adverse effects on drinking-refusal self-efficacy, current research is attempting to examine what other effects rumination has on self-stigmatisation experienced by alcohol dependent individuals.

Given the nature of Australian drinking culture, it appears that alcoholism is not going anywhere. Therefore, it is up to us to assist anyone dealing with addiction by trying to minimise the projection of stigma or shame on people who struggle with substance abuse. We need to understand that the language we use is important, and we need to understand that addiction is often coupled with depression or anxiety.

So next time you are dealing with someone who is living with such an addiction, be it a co-worker, friend or family member, remember to treat them with understanding rather than judgement. Without that, they may not be able to help themselves.

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