Academics describe stigma as a "master status". By that they mean, it eclipses all other aspects of stigmatized persons, their talents and abilities. In other words, you always see the stigma first and foremost (a mental or physical disability, the drug addiction, the "problem", such as HIV positive or AIDS, being poor, being on welfare), and not the person.

Seniors, Alcohol, and Stigma

In the focus groups we held, seniors were very clear that stigmatization of older people who have alcohol problems commonly occurs. Seniors dealing with an alcohol problem had been shunned in many different ways. Those who do not have a problem with alcohol reported seeing it happen to people they know, and in some cases having done it themselves.

Stigmatization is closely connected to people's perceptions about how a particular problem or condition develops, and who is responsible for the results. (See Weiner, Judgments of Responsibility)  Seniors discussed the shame and stigmatization of having an alcohol problem:

When we asked, "And what would happen if you let someone know you have (or had) an alcohol problem?", their responses were:

Because of the stigmatization of alcohol problems in Canada, for a senior acknowledging the problem (to oneself or to others) is a risky business:

Negative stereotypes are very common when a person is stigmatized. 

There are many inaccuracies about alcohol problems in both popular media and professional education. Common stereotypes in this area include that the person is weak, lazy (lacks "willpower"), unproductive, dirty, immoral, and/or violent. 

As one senior in one focus group noted:

Seniors who are experiencing alcohol problems explained that they can face two types of stigmas:

a)   the stigma of having an alcohol problem and

b)   the stigma of now being a non- drinker ("recovering alcoholic").

Their comments illustrated, time and again, just how isolating and stigmatizing their situation can be. A one woman noted

a. Dealing with alcohol dependence:

Another woman noted that her grown children were proud of her accomplishments (e.g. 3 years of sobriety). However, when they mentioned to their friends "Ma is a recovering alcoholic", the friends tended to hang around very briefly. [In stigmatization theory, this is referred to as 'fear of contagion' or 'fear of contamination'].

b. The stigma of now being a non-drinker.

In Canadian society, consuming alcohol is the norm among adults, generally. It has increasingly become the norm among older adults. According to the 1998-9 Statistics Canada figures, 62% of women and 72% of men aged 65 to 74 are current drinkers, as are 61% of men and 45% of women aged 75 and over.

Seniors noted that part of stigmatization may come from other people's insecurities.

Social Expectations about Being a Non Drinker

What Reinforces the Stigma

Seniors' observations suggested that some of the stigmatization may reflect stereotypes and common messages the public hears espoused (such as in A.A. approaches). As one senior noted:

Stigmatization can often reflect lack of knowledge misconceptions, or simplistic generalizations.

People are often unaware of the range of diversity of alcohol problems among seniors, how alcohol problems develop, and what causes/ does not cause relapse. In one illustration given, one senior explains that her family were worried about what would happen  that if they consumed any alcohol at all around her. They believed that would start her drinking again. 

People who drink may also feel uncomfortable being around a senior who has decided not to drink. As one woman notes, she had to let her family know "Go ahead and drink, it doesn't bother me."

Seniors found that the stigmatization of people with alcohol problem can also be reinforced by former drinkers:

In other instances, family will monitor a senior's drinking, expecting failure. Another senior gave the example of her sister (who she describes as a "controlled alcoholic" consuming a bottle a day,) who actively criticizes her drinking:

Seniors also find that the popular terminology being used is also stigmatizing - "Oh you know, like, 'on the wagon' "; or "clean and sober". (They ask "Does that mean you are "dirty" if you drink, or if you are not sober?")

Stigmatization and Gender

Older women noted they felt stigmatized more than men.

Effects of Stigmatization

The stigmatization makes it feel unsafe for the senior to alcohol concerns, or to accurately report how much she or he is drinking. The person is fearful of being judged. Stigma affects people's willingness to disclose.

Seniors also expressed surprise (and dismay) at the fact their doctors often did not ask about them about whether they drank and how much, even in light of other evidence that alcohol was becoming a problem in their lives. We have seen a similar type of stigmatized response to homosexuality in the American Armed Forces ("Don't ask, don't tell.") Stigma affects people's willingness to ask.

Seniors also offered examples of where they were trying to let their physician know they were worried about alcohol becoming a problem, and the physician was not listening to what he or she was trying to say.

Most felt this reluctance of physicians to ask and talk about alcohol reinforced the stigma, because it conveyed that it was socially wrong. It ignored the effects that the alcohol was having on the senior's health and treated an alcohol as moral problem.

Late recognition of the problem is often the result of this stigmatization. that, in turn, often means a damaged social life or career, a broken family, increased risk of poor health, and diminished independence or an early death (Simerson et al., 1983)

We have found that stigmatization also leads to older adults being denied fundamental services in emergency wards, hospitals, and even being denied admission to long term care facilities when their health needs are clearly evident. Stigmatization leads to overt discrimination.

Stigmatization, the stereotypes associated with alcohol or medication use problems, as well as the lack of understanding about the nature of substance dependence can create almost inhumane and professionally indefensible responses at times. Consider for example, the real life situation of an older woman who did not have an anaesthetic during her dental and her stomach surgeries because a nurse told her if she did, she would become addicted to the drugs.

Supports Groups and Stigmatization

Peer support groups can be very helpful for many seniors in dealing with stigma. 

Directly and indirectly, support groups carry out the important functions of providing members with information that can help seniors cope with stigma and its effects. Researchers on stigma find the salience of the stigma itself is greatly reduced in some kinds of support groups. Psychologists and others social scientists researching stigma explain that the support group is a good place to share the stress of being stigmatized. In the group, the person also sees evidence of effective coping strategies and people coping successfully.

At the same time, it is important to understand the feelings of the older person who does not want to join a support group --it can put the label and stigma of alcohol problems right in his or her face.

"A Rose by Any Other Name"

According seniors, the name of a program or support groups is very important in normalizing and destigmatizing their situation. Programs specifically designed for seniors experiencing alcohol  problems typically use acronyms or non-stgmatizing names, such as COPA, LESA, Age -Wise, VISTA, SWAP, OPUS-55 or SAILL.

As one senior noted:

Combating Stigmas
 

Other issues have been heavily stigmatized in the past. For example, divorce, disabled children, diseases such as cancer, and living common law or having children without marrying seems much less stigmatized now than 40 or 50 years ago. For example, in previous generations, people whispered in shame about cancer in the family and referred to it as the "C" word. No one talked about breast cancer.

The seniors' group was asked "How did these changes in attitudes happen? How did these other issues become less stigmatized?" Here are some the elements the seniors noted:

-      Frequency of the matter: "Divorce is very common now- that makes it less unusual."

-      "Lessened effect of the church- casting fear on their parishioners."

-       Availability of resources: "There are more resources around to help handicapped people now."

-      Social Change: "Women's liberation, it was another big social change."

-    Changes in social structure, as shown in popular music and its effect on people's thinking. "The caste system lost its effect-- 60s and 70s as the hippie generations-'"let it all hang out'- a lot of things became less secret, secretive."

-       Visibility: Having high profile examples of other people dealing with the issue (e.g. "the Kennedy's with their retarded child").

-      Education: "People are better educated now. They have a better understanding of why certain things (like cancer) happen."

The seniors' observations closely parallel what the researchers have found. Destigmatization in some areas has resulted from better information, positive role models, changing norms and values, and people actively addressing the stigmas.

References and Readings

Stigmas have primarily been researched during the 1980s.

(1986) The Dilemma of Difference: a multidisciplinary view of stigma S. C. Ainlay, B G. Becker, & L.M. Coleman eds. Plenum Press New York.

(1984) Social Stigma: The psychology of marked relationships. W.H. Freeman & Co. New York

(1995) Weiner, B. Judgments of Responsibility. Guilford Press, New York.

Simerson, G.R., Brannas, V.A., Pizzuti, A., & Inskeep, R. (1983) Project ears: ALMACA listens to salaried alcoholics. EAP Digest, 3(6):14-23.

Statistics Canada: http://www.statcan.ca/english/Pgdb/People/Health/health05b.htm.