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Key points
- Stigmatizing words like "addict," "abuser," and "alcoholic" lump together incredibly diverse groups as if they were all the same.
- Research shows that helping professionals are at risk of having their work affected by stigmatizing language and its negative connotations.
- Self-identifying as an addict or alcoholic for community reasons is very different than being labeled by someone else.
Words matter. Our society’s beliefs about substance use and compulsive behavior problems—and the potential for change—are built into the words we use to speak about these issues.
Why does our word choice matter when talking about substance use problems? Because when we use words like "addict," "abuser," and "alcoholic," we lump together an incredibly diverse group as if they were all the same. You also don’t have to dig very deep to hear the negative connotations of these words in many people’s minds (e.g., lazy, weak-willed, failing moral compass, diseased). The easiest way to confirm this for yourself is to listen to the tone of voice most people use when they refer to someone as an addict. More often than not, there is a tone freighted with denigration or suspicion.
Language choice is related to increased stigmatization
Studies have found that helping professionals are at risk of having the negative connotations associated with these words creep into their work. Dr. John Kelly, at Massachusetts General Hospital and a leader in the substance use treatment field, surveyed health professionals who were asked to answer questions about a hypothetical patient described as either a “substance abuser” or “having a substance use disorder.” They found that referring to patients as a “substance abuser” resulted in negative attitudes and assumptions about the patient, including that they should be punished for not following a treatment plan and that their “character” was culpable.
Dr. Terri Moyers, a leader in motivational treatment approaches, conducted research with substance use counselors and found that when counselors attached the label “alcoholic” to their clients, those counselors held beliefs such as “alcoholics are liars,” “cannot make good decisions for themselves,” “have personality deficits that predate drinking,” have “spiritual deficits,” and “need strong confrontation.”
These studies concluded that the choice of language was related to increased stigmatization of clients with substance use disorders. Thankfully, these lines of evidence have promoted leading research institutes to advocate changes in the language we use.
Labels blur reality
Another problem with using these labels is that they blur the reality that people struggling with substance use problems have dramatically different levels of a problem, have the problem for different reasons, have different prognoses, and will take a variety of paths with their relationship to substances moving forward. People who use substances are more diverse than they are similar. When you refer to someone struggling with a substance use disorder simply as an addict or alcoholic, you lose sight of all the distinctions and variations that matter tremendously.
How often have you heard people say, “Well, he’s an addict. What did you expect?" In our work, we often hear clients say, “I’m an addict. That’s what we addicts do,” or “Yeah, over the holidays, I started to withdraw more, but that’s me being an alcoholic.” Referring to someone else or oneself as an addict seemingly explains a lot of behaviors neatly and under one heading without addressing the real answers. For example, “I’m an addict” does not explain why I lie a lot. Instead, I may have gotten into the habit of lying because I am ashamed or embarrassed about my behavior, or I got hit as a kid when I expressed myself. These are real reasons the lying habit forms, not a reflection of an innate addict character trait.
Additionally, the behaviors people with substance use issues sometimes struggle with are behaviors that the rest of the non-substance-abusing world often share, like lying to avoid conflict or hiding out when overwhelmed. The difference is that non-substance users don’t explain their behavior by saying, “I’m an addict.”
When our clients use these words to identify themselves or their behaviors, we typically pause the conversation to explore what they mean because there is nothing to be learned from us accepting the label. We do this knowing that many people find connection when self-identifying as an addict/alcoholic and find immense comfort in being part of a community that relates to these words. In the context of the 12-step community, identifying as an addict or alcoholic can be a powerful act. However, it is always worth examining what the word means to our clients and their families, as self-identifying for community reasons is very different than being labeled by someone else. Our language matters, and the language of the person we are trying to help matters.
Stigmatizing language pushes people away from change
From the perspective of cultural ease, we understand the pull to find one-word explanations, especially in our current world of soundbites. But the reality is that labeling anyone with a substance problem as an “addict,” “alcoholic,” or even “substance abuser” does stigmatize them in the real world, pushes too many people away from the help they need and want, and makes simplistic a profoundly complex problem. We cannot escape the reality that stigma is conveyed by word choice: Once spoken, the genie cannot return to the bottle.
And while you may not feel anything negative about these words and may relate to them deeply, it is important not to minimize the stigma they may carry for the person you are talking with. For example, many a well-intentioned therapist may say something like, “I’m glad you’re here Sarah, and that you’ve recognized, you are an alcoholic.” The potential internal dialogue of someone who just got this message? “No, I’m not, I just thought I was drinking too much in the evening.”
While the alternatives are awkward and far from a soundbite, phrases such as “person struggling with substance use” or “person with substance use disorder” are more accurate and less at risk of pushing a person away from change. The scientific evidence is clear that our words matter. They can open doors to change and expand our perspectives or set up barriers and roadblocks to understanding. I, for one, would like to keep the doors open to change.
