Promoting problem recognition amongst harmful drinkers: a conceptual model for problem framing factors
Harmful drinkers are characterised by low problem recognition in that they typically see themselves as ‘non-problem’ drinkers, i.e., they describe themselves as exempt from alcohol-related harms and distinct from the ‘alcoholic other’. Harmful drinkers are currently underserved by interventions, including those promoting self-change, and represent an important opportunity in public health terms. Opportunities to enhance problem recognition amongst this group may include promoting continuum or other beliefs/attitudes that avoid threats such as stigma, threats to the self-concept or expectations such as lifelong abstinence. A conceptual model for problem recognition factors amongst harmful drinkers is presented as summarised. Firstly, the model assumes problem recognition as an important first step in behaviour change amongst harmful drinkers, whether leading to self-help or help-seeking. The model proposes that to facilitate problem recognition, threat control responses must be mitigated. Threat control responses reflect a number of processes identified amongst harmful drinkers and other stigmatised groups whereby an identity threat is minimised or deflected to protect the self-concept. Threat control responses as a barrier to problem recognition may include more implicit responses such as defensive processing or avoidance of relevant information. More explicit threat control processes may include the othering of ‘alcoholics’ as ‘true’ problem drinkers, thus excusing harmful drinkers from problem drinking status. The model presents a number of framing factors (e.g., alcohol problem/addiction beliefs, stigma) with evidence of relevant effects in experimental studies, and important outcome-relevant moderators such as self-efficacy.