Words matter when talking about addiction. People suffering from mental health issues and substance use disorders face a stigma that does not plague other chronic illnesses, such as diabetes and hypertension. Many of the terms we use to discuss addiction in our society, including words widely-used in the field of addiction treatment, are implicitly pejorative, subtly signaling the reader or listener that a drug or alcohol problem is a moral failing, or an act deserving of punishment.
Words from the White House
In January of 2017, the White House Office of National Drug Control Policy issued a document addressing the role that stigma plays in health care and treatment outcomes, and detailing the need to use language that aligns with the latest edition of The Diagnostic and Statistical Manual of Mental Disorders when talking about substance use disorders. The document identifies research findings in scientific and medical literature which show how the language used to discuss addiction can alter people’s perception of the disease, not only discouraging individuals with substance use disorders from seeking treatment, but also negatively impacting the quality of care provided by medical professionals.
Why Language Matters in Addiction Support
Addiction is a disease. Endless research has shown how repeated substance use changes brain chemistry and structure in ways that damage the individual’s motivation, ability to make decisions, and capacity to feel pleasure. Over time, persons with addiction drink or use drugs, not to “get high,” but to merely function normally in everyday tasks. There is no moral failing or weakness involved in a substance use disorder. It is a medical issue that requires quality, professional treatment, and yet many of the commonly used addiction-related terms reinforce a punitive approach, rather than a medical one.
A 2010 Harvard study found that when doctoral-level addiction and mental health clinicians were reading case vignettes, they were more likely to reject treatment in favor of a jail sentence when the character was described as “substance abuser,” than when reading identical vignettes describing the character as having a “substance use disorder.” The same effect occurred among mental health practitioners at professional conferences. When a person is described with the word “abuser,” the reader or listener, no matter their professional training and experience, will automatically lean towards seeing them as deserving of punishment.
Using inappropriate terminology can also be misleading, perpetuating myths about addiction. For example, the term, “getting high.” As discussed above, continued substance misuse diminishes a person’s ability to feel pleasure. Therefore, the substance that initially made them feel euphoria, is soon needed to merely relieve withdrawal symptoms and allow for normal functioning.
How Stigma Impacts Addiction Support and Recovery
Changing people’s habitual language use is difficult, but essential. Sarah Wakeman, the medical director of the Substance Use Disorders Initiative and the Addiction Consult Team at Massachusetts General Hospital wrote in an article for the American Society of Addiction Medicine, that the terms abuse and abuser “imply a willful misconduct and have been shown to increase stigma and reduce the quality of care.”
When it comes to addiction terminology, word choice is about more than kindness. Yes, rejecting the word “addict” in favor of “person with a substance abuse disorder” is more sensitive, but more importantly, it avoids the cognitive bias that words like “addict” and “abuse” have been proven to create. To solve the problem of addiction, Wakeman explains, “you want to remove any barriers and obstacles,” and the fact that healthcare professionals can be influenced to recommend punishment over treatment due to the language used is a major barrier to substance use recovery.
If substance use and mental health professionals have a negative view of their clients, they will be unable to provide those clients with the high-quality care needed for positive treatment outcomes. If the general public views addiction as something shameful, then individuals with substance use disorders will be deterred from seeking treatment. Those who do seek help will be more likely to rely solely on 12-step groups like AA and NA, attempting to overcome the disease of addiction with a non-medical, abstinence-only approach that has been shown to lead 90% of individuals in recovery to resume drug or alcohol use within months.
How to Talk about Addiction
Scientific journals and professional associations already consider “person-first language” to be the appropriate way to discuss disabilities and other health conditions. To say that a person with a disability is “crippled” today would be regarded as offensive, antiquated, and unprofessional. This change in terminology began many years ago in the medical profession, and then gradually spread to the public vernacular. We need this same progression to occur when it comes to substance use disorders.
Using people-first or person-first language prevents addiction from becoming the individual’s whole identity. Rather than labeling someone as an alcoholic, a term with negative connotations, you acknowledge them as a person with a medical condition—alcohol use disorder. Calling someone an addict imposes the burden of judgement, and even dehumanizes them. If we instead call someone a person with an addiction, we distinguish the individual from their diagnosis, acknowledging their personhood.
Think about the terms “dirty” and “clean.” When treating someone with kidney disease, a medical professional would never dream of saying a patient’s lab work came back “dirty,” if test results showed the need for dialysis. Patients undergoing addiction treatment deserve the same level of respect. Instead of saying a person’s blood or urine tested “clean,” we should say they tested “negative,” or were shown to be “not currently using substances.”
Better Word Choices Can Make the Difference between Life and Death
As stated earlier, knowing how to talk about addiction can improve accuracy and prevent the spread of misinformation. For example, saying that someone has a “drug habit” implies that there is willpower and choice involved. “Substance use disorder” is more accurate, because it reflects the range of physical and mental impairments that are inevitably caused by repeated substance misuse. Misinformation can lead people to make risky health choices.
The Associated Press Stylebook, which journalists turn to for advice on the most accurate and appropriate terminology to use in reporting, recently made changes that specify “dependence” should never be used as a synonym for “addiction.” The reason why is simple—the two just aren’t the same. Dependence essentially means relying on a medication to be able to function normally. People using insulin for diabetes, SSRIs for depression, or blood pressure medications for hypertension, are dependent, and will suffer intense withdrawal symptoms if they suddenly stop using those substances. This in no way means that they are addicted.
Addiction is a disease characterized by compulsive drug-seeking behavior that persists despite negative consequences. In other words, addiction is always a medical problem in need of a solution, while dependence may be part of the solution to a medical problem. Patients with chronic pain may be physically dependent upon opioids to function, but unless they use compulsively and suffer negative consequences, they are not addicted.
When left untreated, chronic pain can cause stress-related health complications, debilitating depression and anxiety, as well as suicidal thoughts and intent. Individuals who stop necessary pain treatment because they mistake their dependence for addiction may face fatal consequences. Using the right word in the right context is crucial.
How to Talk About Addiction with a Loved One
1. Mentally prepare.
Talking with a loved one about their substance use disorder is going to be emotionally charged, no matter what, so it is important for you to prepare yourself for the discussion in advance. Think about your loved one’s personality and what approach they might respond to best. Consider what sort of reactions they may have and the things they might say, and practice what you might say to them in response. You may even want to write things down and practice what you want to say, just as you would before making a speech. Remember to use person-first language.
2. Choose your moment.
A serious discussion about the need for addiction treatment can’t take place in the middle of the grocery store, or in the ten minutes before you have to leave for an appointment. You have to choose the right time and place for everyone involved. The right moment should also be one where no one is under the influences of substances, if possible.
3. Ground the discussion in the relationship.
Your loved one will be more receptive to your feedback if you first tell them how much you care about them and how important they are to you. Remind them of memories you share, especially memories before your loved one developed a substance use disorder. This can help them remember how good it felt to be sober.
4. Base everything around a core message.
The core message of any substance use discussion is usually, “I love you and I want you to get help.” Help your loved one understand that you’re having this talk with them because you’re worried. This will help keep them from assuming that you’re judging them as being somehow “bad” or “wrong.”
5. Remind yourself that addiction is a disease.
It isn’t enough to speak as if you aren’t judging your loved one, you must do your best to believe it yourself. Remember that no matter how many “bad” things your loved one may have done in the service of their substance use disorder, they, themselves, are not “bad.” Their brain has been physically altered in a way that changes their behavior, thought processes, judgement, and motivation. Such profound changes cannot heal without professional treatment.
6. Be specific.
Speaking in general terms will only encourage denial in a person with a substance use disorder. Bring up specific incidents where substance misuse had a negative impact on the lives of your loved one and those around them. Specificity will also help you avoid blame, because instead of telling your loved one that they “never follow through,” you will be reminding them of a specific time when substance misuse caused them to break a promise, or miss out on a valuable opportunity.
7. Use “I” phrases.
If you communicate with phrases like “I’m worried,” or “I feel,” you make it difficult for your loved one to deny or argue.
8. Keep the discussion two-ways.
Even though you may have prepared pages of words you want to say, don’t try to deliver those words all at once, like a speech. Make sure the discussion is a two-way street. Really listen to what your loved one has to say so they don’t feel attacked, or like you are making assumptions about their motives or behavior.
9. Don’t expect that a single talk will change everything.
There is a slim chance you might convince your loved one to check into rehab the first time you discuss it, but most likely you’ll have to bring the topic up more than once. If the denial seems too firmly intrenched, or the emotions involved too volatile, you may want to stage a formal intervention, possibly with help from a professional.
10. Have a plan of action for treatment.
Even if you succeed in convincing your loved one they need treatment, they may be too overwhelmed or intimidated to seek it out. Make this step simple by researching treatment programs in advance. Find out about cost and insurance coverage and eligibility, and perhaps even set up an intake appointment for them. At the very least, make up a list of options to discuss with your loved one.
The Power of Language
Language has the power to change how people think and feel, especially when it is repeated over and over on TV, on the internet, in the media, and in daily conversation. No one, not even medical professionals, are immune to this phenomenon. Quality treatment and long-lasting recovery requires compassion, and that compassion must be reflected in our word choices, no matter the situation.
Words are powerful, and we should use that power to help one another.