The Power of Words: Changing the Language of Addiction

Submission Date: February 1, 2018
Attributing Author: Sam Snodgrass, PhD

Words matter. They determine how we understand and perceive our world. They carry power, for good and for ill. Stigma is driven by the pejorative words, the labels, that are used to describe us. This is not a matter of political correctness. Until we are seen as people, until we are provided the same respect and dignity as everyone else, we will continue to die. We have to change the cultural perception of those with an opioid disorder. To do that we have to first change the language of opioid addiction:

“The words “addict” and “clean” do not reduce stigma, they drive it. I am not an “addict.” I am a person. An addict is a thing. Yes, I live with an addiction, but that addiction does not define me. And I am not in “recovery.” My addiction is in remission. And as with any other chronic disease that is in remission, it can come back. And I am not “clean” when I haven’t used and I’m not “dirty” when I have.

Stigma is driven by the words we use. To decrease stigma, if that’s the goal, we should start with our words. Person first language. A person with an alcohol disorder; a person with an opioid disorder, a person with a substance disorder. These words take the blame off of the person and put it where it should be; on the medical disorder:

“People-first language literally puts the words referring to the individual before words describing his/her behaviors or conditions. This practice helps highlight the fact that an individual’s condition, illness, or behavior is “only one aspect of who the person is, not the defining characteristic.” 12 In the realm of addiction, terms such as “alcoholics,” “addicts,” and even the more generic “users” are terms that group, characterize, and label people by their illness, and in so doing, linguistically erase individual differences in experience. To a large extent, these terms also presume a homogeneity in experience, character, and motivation that depersonalizes the people to whom the terms are applied. 13 Instead, referring to the person first, e.g., “person with a cocaine use disorder,” “adolescent with an addiction,” or “individuals engaged in risky use of substances,” reinforces the affected individual’s identity as a person first and foremost.”…/262940305_Confronting_Inadve

“Use of “abuse” and “abuser” terminology may evoke implicit punitive biases compromising the quality of medical care and also may create unintended barriers to honest self-disclosure and treatment engagement for those suffering from alcohol or drug use conditions. For individuals receiving treatment for addiction, describing urine toxicology screen results as “dirty” or “clean” instead of “positive” or “negative,” in a similar way may evoke more negative and punitive implicit cognitions (Kelly et al., 2015). Such language is inconsistent with other medical language and standards. People themselves, also, can be described as being “clean” or “dirty.” Use of such terms may also decrease patients’ own sense of hope and self-efficacy for change diminishing the effectiveness of treatment.”

“In the evolution of languages, there is a tacit goal toward enhanced utility and ever greater efficiency. Consequently, there is a definite tension between being clear and unambiguous and communicating in shorthand with more speed and efficiency. It does take longer to describe someone as “a person with, or suffering from, a substance use disorder” than describing that same person as “a substance abuser” or “addict.” However, modifying language has been important in the recognition of equity and the resolution of prior stigmatization. In this case, where the lives of a historically marginalized population are at stake, there is a need to sacrifice efficiency in favor of accuracy and the potential of minimizing the chances for further stigma and negative bias.”…/Substance-Use-Teminolo…

“Every day in our work, we see and hear individuals described as “alcohol/substance abusers” and urine toxicology screens coming back “dirty” with drugs. Clinicians may even praise a patient for staying “clean” instead of for having “a negative test result.” We argue such language is neither professional nor culturally competent and serves only to perpetuate stigma. Use of such terms may evoke implicit punitive biases and decrease patients’ own sense of hope and self-efficacy for change.”

“Growing up, we all heard and sometimes voiced the childish refrain, “Sticks and stones may break my bones, but words will never hurt me.” But words can and do hurt, and in ways that we are not aware and cannot always anticipate. Because substance-related conditions are the number one public health concern in the United States and stigma is a major barrier to accessing treatment,1 reducing stigma is vital for enhancing public health. One inexpensive way we could begin to do this would be to remove the terms “abuse” and “abuser,” “dirty” and “clean” from our vocabulary and commit to a medically appropriate lexicon that conveys the same dignity and respect we offer to other patients.”

“The language we use related to addiction treatment also impacts stigma. Methadone and buprenorphine are lifesaving, effective medications for opioid use disorder. Their use reduces relapse and death far more than any other available treatment. And yet they are frequently referred to as “replacements,” worsening the mistaken notion that these medications are simply a way to substitute a legal opioid for an illicit opioid. They are not. Addiction is a behavioral syndrome characterized by compulsive drug use despite negative consequences. Patients successfully treated with methadone no longer meet the criteria for active opioid use disorder. Taking a medication to manage an illness is the hallmark of chronic disease treatment. Individuals taking medication to successfully treat addiction are physically dependent, just as someone taking insulin for diabetes requires a daily shot to be able to function normally. Both will get sick if they stop their medication. But someone on methadone is no more “addicted” than any person who relies on a daily prescription to keep a chronic disease under good control.”…/words-matter-language-addi…

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