Stigmatizing Terminology for Outcomes and Processes (STOP) in Alcohol Research: A Meta-epidemiologic Assessment of Language Used in Clinical Trial Publications

Abstract

Introduction: Stigmatizing language used to describe patients and medical conditions is associated with poorer health outcomes. A recent investigation showed that approximately 80% of medical literature focused on alcohol use disorder (AUD) contained stigmatizing terms related to individuals; however, the quantification of stigmatizing terminology for outcomes and processes (STOP) among AUD research is unknown. Thus, our primary objective was to evaluate publications of clinical trials for their inclusion of STOP. Methods: We performed a systematic search of PubMed for AUD clinical trials between January 1, 2017 and June 30, 2021. Article screening and data extraction were performed in a masked, duplicate manner by 2 investigators. We searched the full text of included manuscripts for STOP. We reported the frequency and percentage of manuscripts with STOP and individual terms. We evaluated associations between STOP usage and several clinical trial characteristics via logistic regression.Results: Our search returned 1552 articles, which were then randomized and the first 500 were screened for inclusion. Of 147 included articles, 115 (78.2%) included STOP. The most common STOP were "drop out" (38.78%; 57/147), "relapse" (36.05%; 53/ 147), and "adherent, nonadherence" (35.37%; 52/147). No significant associations were found between STOP usage and trial characteristics. Discussion: STOP was found in a majority of AUD clinical trial publications. As AUD is highly stigmatized, steps should be taken to eliminate usage of STOP in literature pertaining to AUD treatments. Many stigmatizing terms can be replaced by person-centered, more clinically accurate terms to further combat AUD stigma.

Why stigma matters in addressing alcohol harm

“…Nonetheless, dissipating the still dominant narrative of alcoholism and its associated stereotypes in all contexts outside of self-labelling (i.e., within Alcoholics Anonymous) is an essential first-line strategy. This includes within alcohol research and practice where stigmatising terminology still persists in journal names, manuscripts [73] and clinical settings [18,19]. Doing so will help shift the public towards a non-stigmatising master narrative within which efforts to address the structural and other aspects of alcohol stigma can be advanced.…”