Stigmatism among physicians and nurses towards patients with alcohol use disorder: a systematic review

Alcohol use disorder (AUD) is a common and debilitating condition in Western countries. AUD is often stigmatized, which can worsen the condition and be a barrier for treatment seeking. This is a systematic review that aimed to identify and analyze stigmatizing attitudes and behaviors of physicians and nurses towards patients with AUD in Western hospital and primary care settings, 2014-2024. The study also examines potential differences between physicians and nurses, settings, and changes over time.

A systematic review was conducted in accordance with the PRISMA reporting guideline. Pubmed, PsycINFO and Embase were searched using MeSH terms and free-text keywords covering alcohol use disorders, healthcare professionals and stigma-related concepts (e.g. "Stereotyping," "Attitude," "Prejudice"). Two reviewers independently completed the full screening of articles, data extraction, and quality assessment. The included studies were assessed for quality using the Critical Appraisal Skills Programme (CASP).

Of the 2835 articles screened, 11 studies were included. Stigmatizing behaviors and attitudes towards patients with AUD were common and often characterized by stereotyping, prejudice, and negative feelings. Recurring themes and patterns included avoidance of patients, moral judgment, and perceptions of patients as resistant to treatment, all contributing to the perception that treatment is futile. No differences were observed between physicians and nurses, across healthcare settings, or over time. The qualitative studies were generally of higher quality, while the quantitative studies showed methodological weaknesses.

Stigmatizing attitudes and behaviors towards patients with AUD persist among physicians and nurses, hindering effective care. Further research, including patient perspectives and ethnographic approaches, is needed to understand these behaviors and their impact on patient care and treatment-seeking. Addressing stigma is crucial for improving care outcomes.