Before ‘Rock Bottom’? Problem framing effects on stigma and change among harmful drinkers

Under the disease model of alcoholism, ‘rock bottom’ represents the point at which problem drinkers hit a low, after which denial is overcome and recovery begins. More specifically, the brain disease model of alcoholism implies those with the disease have a distinct pathology. However, a far broader population of drinkers experience harm without conforming to alcoholism stereotypes, reflecting a broader continuum of alcohol harms. The false binary created by an alcoholism/brain disease model allows harmful drinkers to distinguish their own ‘responsible’ use from the stereotyped/pathologized alcoholic other. This drives stigma via processes of separation and difference, raising the threshold for problem recognition. While attributing problem drinking to a disease may reduce blame toward the individual, evidence shows that blame is an insufficient measure of stigma and may come at the cost of increase