The Power of Language: Ending Stigma in Substance Use Disorders

Psycho, lunatic, cripple: all words that now have a demeaning connotation.  If someone had a medical condition and got labeled with these words, they were not being complimented. These words, and others even worse, created a stigma that resulted in a person having problems getting proper help, or even participating in society. This article is a discussion on ending stigma in substance use disorders by changing the language.

A common theme with those terms and others is the recognition that these words are no longer appropriate, especially when discussing a person who is suffering from a mental or physical condition.  Using these words in essence was saying, that person over there is bad, evil, possessed; ultimately, that person over there is not “me.”  It is always easier to dehumanize “the other.”  It demonstrated an “us versus them” attitude and implied that the person using those words thought he or she was better than the person with the disease.  Fortunately, those terms are no longer used in the medical and mental health fields and it is becoming recognized that they are also inappropriate in general society as well.

Language and Substance Use Disorders-Ending Stigma

But sadly we still have a long way to go when using phrases  that discuss diseases, especially when the disease involves a substance use disorder. In today’s society, people who are “addicted” to a substance may be called a junky, crack head, drug fiend, doper, alkie, souse, wino and many other possible terms.  Again, none of them are compliments.  But what is forgotten, or by some not even know, is that those individuals are suffering a treatable disease[1] of the brain, a disease that can touch any person, in any community, in any country.

Did you know that almost one in nine Americans are “addicted” to alcohol and other drugs?   In 2015, it is estimated that 20.8 million Americans aged 12 or older had alcohol or other drug use disorders. Because of drug use more people die from overdoses than die from motor vehicle crashes.  Yet, with such a significant number of “addicted” individuals, only 11% may seek help for their “addiction.”  As noted by the Surgeon General in 2016:

“Most Americans know someone with a substance use disorder, and many know someone who has lost or nearly lost a family member as a consequence of substance misuse. Yet, at the same time, few other medical conditions are surrounded by as much shame and misunderstanding as substance use disorders. Historically, our society has treated addiction and misuse of alcohol and drugs as symptoms of moral weakness or as a willful rejection of societal norms, and these problems have been addressed primarily through the criminal justice system.” It is time for an effort for ending stigma. [2]

Putting aside demeaning people in the first place, we now know, because of scientific advances, that “addiction” has nothing to do with moral weakness.  It is a treatable disease that has significantly altered the brain.

With such a widespread epidemic happening nationwide impacting millions of people, it is time that we change not only the discussion but also the words used to describe it.  The World Health Organization (WHO) did a study that found that drug “addiction” is the most stigmatized social problem in the world.  We need to recognize that someone who is being put down, stigmatized, and demeaned is not going to consider getting help from anyone. They are told through our language that they are a failure and not worth our support or help, and not only are those individuals who are suffering feeling that despair, the language used impacts the people who are supposed to be providing support and assistance.

Language Impacts Everyone

A study published in the International Journal of Drug Policy found that even doctors are influenced by derogatory language when discussing people who are “addicted” to a substance.  In that study, clinicians were given two identical situations with only two phrases used differently to describe the individuals.  In one scenario, the phrase “substance abuser” was used to describe the  patient and in the other situation, the phrase used was “having a substance use disorder.” What was the result?  Doctors found that someone who was a “substance abuser” was deserving of blame and punishment unlike the person who had a substance use disorder.  What is more is astonishing is the finding that while there was no difference in the belief that either individual was more or less a social threat,  yet the “substance abuser” was more culpable and deserved more punishment than the “person with the substance use disorder.”[3]

Showing Respect and Understanding

Did you know that April is Alcohol Awareness Month?  Or that May is National Drug Treatment Court Month or September is National Alcohol and Drug Addiction Recovery Month? Essentially all of these activities, and more, are designed to raise the bar and increase the discussion on “addiction;” to let people know that this brain disease is treatable and impacts everyone.  They are trying to change the perception of “addiction” and ending stigma when someone suffers from this disease.

Earlier this year the Office of National Drug Control Policy distributed a memorandum on “Changing the Language of Addiction.” The focus of the memorandum is to recognize that with so few people receiving treatment, part of the challenge is changing the words used to those that are   non-stigmatizing for substance use. That memorandum was directed to federal agencies, but it is important for that change to happen everywhere, including with you and with me.  Below is a table with a number of changes that each of us can make in our own language.

Ending Stigma-Change Begins With Each of Us

You may have noticed that I used the word “addiction” or “addicted” a number of times in this article but always with quotations marks.  It is a term that most people are familiar with, which is why I purposefully used it in this article; but it is time to change that recognition for all of us from “addiction” to “substance use disorder,” from “addict” to a “person with a substance use disorder.” Will it be easy?  No, change is hard for everyone.  I have no doubt that I will make mistakes, but it is important to start that change and work to improve my words and my actions—lives depend on it. It is a start to ending stigma.

As an attorney, I recognize the importance of words.  The words I use in a courtroom can impact a jury or a judge and have repercussions for many years.  That is no less true when discussing substance use disorders.   A person with a substance use disorder in not morally corrupt or a bad person; he or she is a person with a disease  who needs help and support.  With that support she or he can be a person in recovery and live a full and happy life.  Once we all understand that truth, real change can start and the millions of people who need treatment can receive the assistance they so desperately need.

Footnotes:

[1] Some people think it is wrong to call a substance use disorder a “disease” because they can’t catch it like a common cold.  However, they forget that they can’t ‘catch’ diabetes or heart disease or cancer and they most likely have no issue saying those medical conditions are diseases.   A disease is defined by the Oxford Dictionary as: “A disorder of structure or function in a human, animal, or plant, especially one that produces specific signs or symptoms or that affects a specific location and is not simply a direct result of physical injury.” With the significant changes in the brain that occur because of the substance, the brain clearly has a ‘disorder of structure.’  And like so many other diseases, treatment can make a difference.

[2] Facing Addiction in American: The Surgeon General’s Report on Alcohol, Drugs, and Health, U.S. Department of Health & Human Services, 2016.

[3] 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. doi: 10.1016/j.drugpo.2009.10.010. Epub 2009 Dec 14.