Words have power. Their meaning shapes our perceptions of reality, drives our behaviors, and defines our beliefs. Language derives its power from the emotional response it elicits. In day to day life, we may rarely consider the hidden power of our words, but there is a reason why clinicians choose their words carefully when discussing substance use disorders (SUD).
The medical community recognizes addiction, or a severe substance use disorder, as a chronic illness from which people can and do recover. However, the language historically used to discuss problematic substance use often implies a personal, moral failing – suggesting that the individual with a substance use disorder chose the illness and they lack the willpower to control their use. Use of stigmatizing language can keep individuals from seeking life-saving treatment, shape social and cultural views on SUD, and inform public health policy. The language we use when discussing substance use disorders has the power to reduce stigma and aid in addressing one of the United States largest public health crises1.
Stigma and Language
Stigma can be defined as a characteristic, behavior, or circumstance that is socially discrediting1. Substance use disorders remain one of the most highly stigmatized conditions throughout the world. The stigma surrounding SUD is heavily influenced by the beliefs that addiction is caused by the individual and that the individual should be able to control it1. These beliefs result in the use of language that describes a person with a substance use disorder as a problem, rather than as having a problem1,2
Use of stigmatizing language has been shown to result in:
- Reluctance to seek treatment for those dealing with a substance use disorder3,4
- Reinforced stereotypes of individuals with SUD leading to societal labeling and discriminatory behavior4,5
- Negatively impacted care for SUD due to provider bias2
Some examples of stigmatizing language are6,7:
Reducing Stigma through Language
The language used to discuss substance use disorders, and those diagnosed with them, should be person-centered and used consistently5. Utilizing person-first language works to distinguish the individual from the diagnosis and carries neutral connotations rather than negative labels7.
The list below outlines some de-stigmatizing terminology regarding SUD6,7:
- Person with a substance use disorder
- Person in active use
- Person in Recovery
- Tested positive (on a drug test)/Tested negative (on a drug test)
- Abstinent from drugs and/or alcohol
- Substance use disorder
When we focus on using person-first language when discussing substance use disorders, we also influence others and challenge the stigmas still surrounding all forms of SUD. Changing the language we use to discuss SUD takes a small amount of effort, but has a huge impact.
- Kelly, J.F., Saitz, R., Wakeman, S. (2016). Language, substance use disorders, and policy: the need to reach consensus on an “addiction-ary”. Alcoholism treatment quarterly, 34(1), 116-123. DOI:10.1080/07347324.2016.1113103
- Robert D. Ashford, Austin M. Brown, Jessica McDaniel & Brenda Curtis (2019) Biased labels: An experimental study of language and stigma among individuals in recovery and health professionals, Substance Use & Misuse, 54:8, 1376-1384, DOI: 10.1080/10826084.2019.1581221
- Hadland, S. E., Park, T. W., & Bagley, S. M. (2018). Stigma associated with medication treatment for young adults with opioid use disorder: a case series. Addiction science & clinical practice, 13(1), 15. https://doi.org/10.1186/s13722-018-0116-2
- Yang, L. H., Wong, L. Y., Grivel, M. M., & Hasin, D. S. (2017). Stigma and substance use disorders: an international phenomenon. Current opinion in psychiatry, 30(5), 378–388. https://doi.org/10.1097/YCO.0000000000000351