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Talking about Addiction: Language Matters

     

An estimated 20 million people in the United States have alcohol or other substance use disorder, yet only about one in 10 receives needed treatment. The stigma around addiction can be a major barrier to people seeking treatment.

Research has found that people with substance use disorders are viewed more negatively than people with other mental illness or physical illness. The language we use about addiction can contribute to the stigma. (1, 2)

Writing in JAMA Viewpoint last October, former head of the White House Office of the National Drug Control Policy (ONDCP) Michael Botticelli and former Assistant Secretary for Health Howard Koh, M.D., M.P.H., argued many commonly used addiction-related terms, such as “junkies” or “crackheads,” imply personal failings or fault for their disease.(3)

Addiction expert John F. Kelly, Ph.D., with Harvard Medical School summarizes(4):

  • Addiction and substance-related conditions are highly stigmatized.
  • Stigma and discrimination are barriers to acknowledging problem, accessing help and staying in recovery.
  • Language/terminology of addiction influence perceptions and may affect policy and clinical care.

Stigma about people with substance use disorders exists even among clinicians. One study found that even mental health professionals judged an individual identified as a “substance abuser” more harshly than an individual identified as having a “substance use disorder.” (5) The language used about addiction reflects, and can perpetuate, negative perceptions about people with substance use disorders.

The ONDCP has developed, in collaboration with other federal agencies and with public input, a guidance document to address the language of addiction. The guidance statement notes that words used in discussions of substance use can suggest that substance use disorders are the result of “personal failing, that people choose the disorder, or they lack the willpower or character to control their substance use.” The guidance goes on to say “the evidence is clear that this is not the correct: instead, research has shown that substance use disorders are neurobiological disorders.”

Suggestions from ONDCP guidance, Changing the Language of Addiction, include:

  • Use person-first language, such as been widely adopted for use with other conditions and disabilities, for example ‘person with substance use disorder’ (or replace with specific substance) rather than ‘substance abuser’ or ‘addict’ or ‘alcoholic.’
  • Use ‘substance use disorder’ or ‘misuse’ rather than ‘substance abuse’ or ‘drug habit,’ which implies it is a choice.
  • Instead of using the terms ‘clean’ or ‘dirty’ to refer to a toxicology screen, use ‘person who is [or is not] currently using substances.’
  • Use ‘in recovery’ rather than being ‘clean.’

Changing our language is one of the keys to addressing stigma, concludes Kelly, along with education, personal witness (putting a face and voice on recovery) and communicating that addiction is a treatable psychiatric disorder from which most people recover.

Resources

  1. Barry CL, McGinty EE, Pescosolido BA, Goldman HH. Stigma, discrimination, treatment effectiveness, and policy: public views about drug addiction and Mental Illness. Psychiatr Serv. 2014 Oct;65(10):1269-72.
  2. Kelly JF1, Westerhoff CM. Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms. Int J Drug Policy. 2010 May;21(3):202-7
  3. Botticelli, M.P. and Koh, HK. Changing the Language of Addiction. JAMA, 2016 October;316(13);1361-62
  4. Kelly, JF. Addiction, Stigma, and Discrimination: Implications for Treatment and Recovery. American Psychiatric Association Webinar Series, Sept. 8, 2015.
  5. van Boekel LC1, Brouwers EP, van Weeghel J, Garretsen HF. Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. Drug Alcohol Depend. 2013 Jul 1;131(1-2):23-35.

     

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