Discrimination and social identity processes predict impairment and dysfunction among heavy drinkers

• Published in: Social science & medicine (1982) Vol. 343; p. 116549
• Main Authors: Cruwys, Tegan, Selwyn, Joseph, Rathbone, Joanne A., Frings, Daniel
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.02.2024
• Subjects: Health risk behaviour; Mental health; Social cure; Social identification; Stigma; Substance use; Substance use; Social cure; Health risk behaviour; Stigma; Mental health; Social identification
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2023.116549

Previous research has linked discrimination to poorer health. Yet health risk behaviours such as heavy alcohol consumption are often targeted with stigmatising public health campaigns. The current study sought to establish the link between experiencing discrimination and health outcomes among heavy drinkers, with a focus on exploring the multiple social identity processes that might underpin this relationship. A survey was conducted with 282 people who self-reported consuming alcohol above recommended guidelines. We measured discrimination experienced as a drinker, components of social identification as a drinker (centrality, satisfaction, solidarity, homogeneity, and self-stereotyping), and two health outcomes: psychological distress and severity of alcohol use disorder symptomatology. Discrimination was a moderate-large predictor of psychological distress and alcohol use disorder symptoms. Three social identity constructs were implicated in the link between discrimination and ill-health: identity centrality and homogeneity positively mediated this relationship while identity satisfaction was a negative mediator. The model explained a large proportion of the variance (39–47%) in health outcomes. Results are interpreted with an emphasis on the need to avoid stigmatising messaging and to prioritise social identity processes to prevent and treat substance use disorders. We further highlight the need for social identity researchers to consider the multidimensional nature of social identities, especially in the context of stigmatised groups. •Discrimination may affect mental health and health risk behaviour differently.•Social identity is not unidimensional in stigmatised groups.•In 282 heavy drinkers, discrimination predicted more alcohol impairment and distress.•Identity centrality and homogeneity diverged from identity satisfaction.•Findings support the central role of identity in substance use and recovery.