Updated: Nov 30
Alcohol use disorder (AUD) is increasing in America and is a growing concern as the country's demand for alcohol continues to escalate (NIH, 2022). 85% of individuals eighteen and older report consuming alcohol at some point during their lifetime (NIH, 2022). In fact, as of 2019, binge drinking within the past thirty days was reported among 25.8% of American adults (NIH, 2022).
AUD is considered a chronic mental illness that causes failed self-controlling behaviors around alcohol imbibement and is characterized by uncontrollable desires to consume alcohol (NIH, 2022) (Won, 2018).
Outcomes related to AUD affect the individual’s mental health, physical health, relationships, and ability to function in society (NIH, 2022).
The health behavior of daily and excessive amounts of alcohol consumption can increase an individual’s chances of developing Alcohol Use Disorder, leading to various complications, including health and social consequences.
AUD has been used as a form of self-treatment for decades and has been considered a brain disease (NIH, 2022). The effects of alcohol can act as a social lubricant and stress reliever to mitigate physical and emotional pain (Anton, 2010).
Behavior theories such as the Theory of Planned Behavior, Self Efficacy Model, and the Social Ecological Model help explain alcoholism among adults. With the constructs they contain, a theoretical framework can be implemented (Hayden, 2023).
The Theory of Planned Behavior comprises the following constructs: attitudes, subjective norms, perceived behavior control, and volitional control (Hayden, 2023). Applying the Theory of Planned Behavior helps gauge volitional control among adult alcoholics (Cooke et al., 2016). Attitudes lead to beliefs about self-regulatory behaviors, and these attitudes and beliefs appear to trump self-efficacy (Cooke, 2016). With low self-efficacy, there is also low perceived behavioral control over self-regulatory actions, and this perception seems to result in a cyclic pattern of perpetual alcohol use (Cooke et al., 2016). Interestingly, perceived behavior control is directly linked to AUD outcomes.
The Social Ecological Model comprises the following perspectives or viewpoints since this model is not based on constructs (Hayden, 2023). The constructs include intrapersonal, interpersonal, institutional, community, and societal level influences (Hayden, 2023).
Considering the Social Ecological Model, alcohol consumption is increased by community demand and availability, which explains why attitudes are ineffective in promoting self-regulatory behaviors (Gruenewald, 2013).
The self-efficacy model comprises four factors: mastery experience, vicarious experience, verbal persuasion, and physiological and emotional states (Hayden, 2023). Associations between attitudes and self-efficacy influence alcohol abuse and indicate that a person’s attitudes regarding binge drinking will lead to beliefs about self-regulatory behaviors (DiBello, 2019).
Based on data analysis, attitudes and perceived behavior control appear to be the most significant influences in determining intention about alcohol recovery or hindrances to recovery (Haydon, 2018). Attitudes influence intention, and self-efficacy is the strongest predictor of intention (Cooke, 2016).
Multiculturalism and Social Determinants of Health
The social determinants of health and multiculturalism are essential in the theoretical framework, as these factors significantly influence the determinants and risks that lead to AUD.
The theoretical framework consists of emotional state, self-efficacy, attitudes, subjective norms, and volition as impacting perceived behavior control which drives intention and ultimately leads to alcohol consumption.
The odds of developing AUD increase within communities where there is a higher demand for alcohol. Additionally, the social demand for alcohol influences behaviors around the occurrence, quantity, and duration of a person’s alcohol consumption within their natural environment (Motschman, 2022), (Mosel, 2022).
Cultural influences can negate positive outcomes if the culture has a high demand for drinking, as this is the first influencing factor in determining consistent drinking within communities (Yakovlev, 2020). Additionally, alcohol use is a learned behavior influenced by social norms such as peer pressure, environmental influences in advertisements promoting alcohol, and poor emotional regulation, such as needing to escape complicated feelings or situations through alcohol use (Haydon, 2018).
Factors that make up culture include but are not limited to education, gender, age, socio-economic status, beliefs, religion, ethnicity, language, location, sexual orientation, and upbringing (Lyles, 2017). Other factors that increase the risk of developing AUD include trauma, family abuse, peers, mental health status, work, and income (Jacobsen, 2022). This is undoubtedly challenging when considering treatment options, as alcoholism is multidimensional and based on socio-ecological and genetic factors unique to each individual.
Alcohol use is influenced by socio-ecological factors and not just biology (Jacobsen, 2022). Other health determinants influencing AUD risk are genetics, income, physical environment, social network support, culture, gender, health services, policies, and education (WHO, 2017).
Incorporating diverse cultural influences into the theoretical framework means altering the framework based on the determinants of health model (WHO, 2017). This model factors the individual’s ethnicity, gender, level of social support, genetic factors, education level, income, religion, beliefs, upbringing, and possible superstitions or cultural rituals (WHO, 2017), (Lyles, 2017).
A recommendation for effective ways of incorporating multicultural influences would be to utilize screening tools to understand what the individual is most influenced by, personally, culturally, and socially.
Educating health professionals on the importance of diversity and culture in its application to behavior theory can be increased by applying the theoretical framework.
The framework will not be practical if the theories applied are not accurately utilized based on cultural, social, and subjective norms. Therefore, it is crucial to factor health determinants and multiculturalism into the model.
A potential benefit to the framework is an increase in screening high-risk individuals who may be genetically predisposed to addictions. Another benefit is increasing a person’s awareness of the seriousness and consequences of the behavior and helping the individual understand that their lack of perceived behavior control leads to the intention to drink.
Culture undoubtedly influences healthcare approaches, and by considering diversity within culture and society, approaches to understanding AUD more thoroughly can be applied for effective outcomes.
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