Stigma Around Alcohol-Related Liver Disease Poses Major Barrier to Care

New research is shedding light on the heightened stigma experienced by patients with alcohol-associated liver disease (ALD) compared to those with non-alcohol-related liver disease, highlighting a critical barrier to care and a frequent delay in diagnosis among these patients.1

Study findings were presented at the American Association for the Study of Liver Diseases (AASLD) The Liver Meeting 2025 by Wei Zhang, MD, a transplant hepatologist and assistant professor of medicine at Massachusetts General Hospital and Harvard Medical School, and pose important implications for the implementation of stigma-reducing interventions to improve clinical outcomes for patients diagnosed with ALD.1

“ALD carries added layers of moral judgment and blame, often rooted in perceptions of personal responsibility for illness,” wrote Zhang and colleagues. “While prior studies have described stigma in patients with ALD, few have quantitatively assessed stigma severity across liver disease etiologies using a validated, liver-specific instrument. Understanding how stigma differs by etiology is essential to developing equitable, stigma-informed care.”1

Over the past 20 years, the risk of ALD has increased >50% and represents a main cause of liver-related death. By 2030, the prevalence of cirrhosis is projected to rise by >50% as well, with greater complications reported among men compared to women. Despite its growing impact, the increased stigma associated with ALD patients carries significant implications for treatment at all stages, including barriers surrounding prevention, diagnosis, transplant allocation, and overall increased negative health outcomes.2,3

Previous studies have found stigma related to public, structural, and the self, specifically related to patients with ALD. Blame is widely seen as a central aspect of stigma in ALD and leads to non-disclosure in individualized and healthcare settings. At each level, public, structural, and self-stigma can heighten illness burden, create delays and obstacles to accessing healthcare, and impact treatment adherence.4

In the research presented at The Liver Meeting, Zhang and colleagues quantified stigma using the Liver Disease Stigma Scale (LDSS), an innovative 28-item instrument aimed to measure internalized, anticipated, and experienced stigma. The scale further assessed stigma as related to familial relations, healthcare experience, and the self. Additionally, investigators evaluated specific attitudes toward LD treatment and LD itself. LDSS subscale scores were compared between groups using t-tests. Using theory-informed, pilot-tested measures to assess negative treatment beliefs and perceived undeservingness, investigators examined attitudes toward liver disease and its treatment.

The study included 221 adults with liver disease, including 133 with ALD and 88 with non-ALD etiologies. Patients with ALD were more likely to be male and to have lower educational attainment (P<.01).

Across all LDSS subscales, investigators discovered a significantly greater stigma in ALD, including experienced stigma (mean standard deviation [SD]: 1.75 [0.90] vs 1.23 [0.46]; P <.001), anticipated stigma (SD, 1.57 [0.77] vs 1.24 [0.50]; P <.001), and internalized stigma (SD, 2.34 [1.12] vs 1.54 [0.84]; P <.001).

Between domains, differences were also observed in both family and healthcare settings. Family-related experienced stigma was higher in patients with ALD (1.79 [1.07]) compared with those with non-ALD (1.19 [0.37]), as was healthcare-related experienced stigma (1.71 [0.93] vs 1.27 [0.62]). ALD patients also endorsed more negative attitudes toward liver disease (SD, 2.11 [0.87] vs 1.44 [0.59]; P <.001) and liver disease treatment (SD, 1.38 [0.54] vs 1.21 [90.39]; P = .008).

“Patients with alcohol-associated liver disease experience significantly greater liver disease–related stigma than those with non–alcohol-related liver disease,” concluded investigators. “These findings highlight the role of stigma as a modifiable barrier to equitable care in ALD and emphasize the need for etiology-sensitive, stigma-reducing interventions within hepatology.”

References

1. Wei Zhang. Greater Liver Disease-Related Stigma Among Patients with Alcohol-Associated Liver Disease Compared to Non-Alcohol-Related Liver. Presented at: American Association for the Study of Liver Diseases The Liver Meeting 2025, 2025, Washington, DC.

2. Keck. Alcohol-related liver disease has more than doubled in the last 20 years. Alcohol-related liver disease has more than doubled in the last 20 years . Published July 23, 2025. Accessed November 7, 2025. https://news.keckmedicine.org/alcohol-related-liver-disease-has-more-than-doubled-in-the-last-20-years/

3. Shi Y, Zhang X, Wong T, et al. Sex Differences in Risk of Adverse Liver Events in Patients With Cirrhosis. JAMA Network Open. 2025;8(7):e2523674-e2523674. doi:https://doi.org/10.1001/jamanetworkopen.2025.23674

4. Schomerus G, Leonhard A, Manthey J, et al. The stigma of alcohol-related liver disease and its impact on healthcare. Journal of Hepatology. 2022;77(2). doi:https://doi.org/10.1016/j.jhep.2022.04.026