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Have you ever called someone a drunk? An alcoholic? A drug user? A druggie? An addict or a junkie? Almost all of us either have or heard others use these or similar terms. However, research shows that labels like these can perpetuate the stigma associated with disorders of addiction.
Social reproach, fear of rejection and punishment, and personal feelings of guilt and shame are major barriers for patients who struggle with symptoms related to disorders of illicit drug and alcohol use to ask for help. This is even more compelling when we look at those who refrain from seeking professional treatment. According to the 2018 National Survey on Drug Use and Health, 89 percent of people in need of treatment for disorders of addiction do not receive any type of professional help.
Historically, drug and alcohol problems have been viewed in society—including in the medical profession—as a problem of personal responsibility and/or of moral failing. In opposition to the abundance of medical research, these lingering judgments and misconceptions affect how we view our options for treatment. Even terms within treatment circles, such as “clean and sober,” “clean time,” “dirty urine,” and “chronic relapser” reinforce stigma both in society at large, as well as within professional, medical, and recovery communities.
What if word choice was the most cost-effective and clinically useful strategy to reduce the incidence, increase access to services, and prevent deaths associated with disorders of addiction? This concept has been promoted and discussed for several years. Studies demonstrate that language has a direct impact on implicit and explicit bias, and that talking about disorders of addiction and their related behaviors differently can help remove what many people find to be an insurmountable barrier to seek treatment known to be as effective as for other medical diseases and disorders. Just a shift in our own language and word choice can open the doors and encourage those whose lives lay in the balance to safely ask for help.
For professionals, families, friends, and anyone interested in shifting our thoughts, reducing social stigma, and increasing access to life-saving treatment for those suffering from disorders of addiction, we suggest these recommendations:
Don’t use the term “substance abuse.”
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has abandoned the use of the term “abuse” in its medical terminology. The professional communities involved in the treatment of disorders of addiction found that the terms “substance abuse,” “drug abuse,” and “alcohol abuse” were problematic. The term “abuse” is typically reserved for behaviors that involve maltreatment of others (e.g., child abuse and physical abuse). When used in reference to known medical disorders, “abuse” implies that an individual is to blame for their “problems” or disorder. A study comparing the public perceptions on terms “substance abuser” and “substance use disorder” found that participants were substantially more likely to view the individual with a “substance use disorder” as in need of treatment versus believing the “substance abuser” was in need of punishment.
Do use individual or patient-first language.
The use of “person-first” language promotes respect for the worth and dignity of all persons. It avoids the negative assumption that all “addicts” are the same, or that recovery is impossible because “once an addict always an addict.” Using terms such as “patients suffering from disorders of addiction” or a “person with a substance use disorder” instead of “an addict” or “a substance abuser” shifts the focus to the medical needs of an individual as opposed to slapping on a pejorative label. When we use person-first language, our family members, loved ones, neighbors, and patients feel supported, not judged. They are hopeful, not ashamed.
Do focus on the medical nature of disorders of addiction.
The American Society of Addiction Medicine (ASAM) recommends that professionals avoid terms that stigmatize addiction such as “user,” “abuser,” “relapse,” “addict,” “drunk,” or “junkie.” Professionals should use non-judgmental language that is clinical and focuses on the medical nature of addiction as a chronic brain disease. Though some people in the recovery community may self-identify as an “addict” and “alcoholic,” this is an individual decision as used within their supportive communal groups—not for the legal and medical community or family members and loved ones to decide.
Do focus on the recovery process.
Instead of using language that focuses on the “problem,” use language that focuses on treatment, remission, and recovery from a chronic disease. Persons who identify with behaviors or have been diagnosed with disorders of addiction prefer that professionals and loved ones use terms that focus on their paths to recovery, not on “problems” associated with stigma. In one research study, individuals in recovery experienced outmoded terminology as pejorative. Instead, they preferred recovery-focused labels such as “recurrence of use,” “person with a substance use disorder,” “recovering person,” and “person in long-term recovery.”
Now we can see that it is time to replace stigmatizing terms with person-first and recovery-oriented language to reduce the feelings of guilt, shame, and embarrassment that prevent persons in need of services for disorders of addiction from getting life-saving treatment they deserve.
Resources available for professionals and individuals interested in helping to reduce the stigma associated with language
- The Recovery Research Institute has created an Addiction-ary to help identify and clarify terms related to treatment and recovery.
- The Office of National Drug Control Policy’s Changing the Language of Addiction outlines recommendations for terminology related to substance use disorders and addiction.
- SAMHSA’s resource guide on stigma and language: The Power of Perception and Understanding: Changing How We Deliver Treatment and Recovery Services
Authors
E. Vaughan Gilmore, LCSW, LCDC, is the Director of Addictions Services at Menninger, where she leads a team of approximately 15 licensed chemical dependency counselors.
Frank P. James, MD, JD, is board-certified in General, Child & Adolescent, and Forensic Psychiatry, and Addiction Medicine and a Distinguished Fellow of the American Society of Addiction Medicine.
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