In both 2015 and 2016, over 50 000 Americans died as a result of a drug overdose; making dying of an overdose the leading cause of accidental death in the United States. Studies are finding that stigmatizing language that refers either to the person or their substance use may be creating barriers that prevent them from seeking treatment for their condition. Finding ways to address this is vital as America finds itself in the midst of a national crisis due to overdose deaths and a growing opioid epidemic. The shift in language becomes even more important with the realization that specific terms used within the field of addiction treatment are undermining clinical and public health efforts to address the crisis.
The need to focus on word choice and terminology is a result of current outdated terminology that implies that suffering from a substance-related condition is the result of a character flaw o r moral failure. Shifting the language to focus on the condition is an attempt to replace outdated, stigmatizing terminology with words that are evidence-based, medically accurate and reflect the biological, psychological, and social attributes of the condition.
Five leading medical addiction treatment organizations recently released a joint statement in the British Medical Journal highlighting the detrimental effects of the most commonly used addiction-related terms.1 It explained that the stigmatizing nature of currently accepted addiction terminology that undermines the impact of substance use disorders.
Language that is non-specific or ambiguous (as well as slang) works to undermine clinical and public health as they attempt to address addiction. Vague terms such as drugs (which could mean either prescribed or non-prescribed substances) should be avoided and replaced with terms such as “medications” or “non-medically used psychoactive substances” instead. Other language that detracts from the seriousness of an event and its medical implications such as “lapse” or “slip” should be replaced by “reoccurrence”.
To fundamentally change the way that the general public perceives and interacts with addiction, there needs to be a move away from individual blame and stigmatization, and towards care and collective engagement. If this is to happen, the way that words are used needs to change to evoke compassion rather than contempt. In a statement released by the Office of National Drug Control Policy in 2016, guidelines for non-stigmatizing language for addiction were shared including using “person first” language (e.g., not an addict, but rather a person with a substance use disorder).
The terms that have the strongest negative biases are addiction-related, according to a new study by the University of Pennsylvania, and include “addict,” “alcoholic,” and “substance abuser.”2
The reason for the negative bias is that they attach a label to the person rather than the disease affecting the person, invoking negative attitudes towards the person, not the disease. The study looked at both explicit, views that participants were able to verbalize, as well as implicit, or subconscious, responses. Explicit responses to questions about participants’ willingness to associate with fictional characters that were labeled with the negative terms were recorded. Participants were then set a word-association task to test for implicit bias.
Changing the words used to describe addiction and addicts can be modified to move the negative bias from the person to the disease. Some examples include changing “substance abuser” to “person who uses substances”, using “reoccurrence of use” rather than “relapse”, and “pharmacotherapy” in place of “medication-assisted treatment”. Other helpful terminology substitutions include “accidental drug poisoning” for “overdose”, and “person with a substance use disorder” for stigmatized terms such as “addict”, “alcoholic” and “opioid addict”.
The negative language of addicts, alcoholics and alcohol addiction may still be appropriate in therapy sessions and mutual aid meetings. However, the terminology of addiction needs to change in public settings, healthcare environments, when advocating for people who have a substance abuse disorder and in journalism to help change negative biases towards people who use substances.
Many newspapers and leading publications are heeding the call to make the needed changes. Recently the Associated Press recommended that news publishers use person-first language (separating the disease from the person), as well as avoiding terms such as “addict”. Philadelphia Inquirer and Daily News have also adopted a similar policy on the basis of these recommendations.
There are also a growing number of scholars and organizations that are speaking out against the use of stigmatizing language as well as offering insights into specific word choice. They are emphasizing the use of terminology that treats substance use disorders as one would any other medical condition and are advocating changing word choices that may imply a double standard.3 This includes the re-evaluation of terms such as “medical assisted treatment” as medications that are used to treat other health conditions (such as diabetes) are not referred to in this way. As such, medications that are used to treat addiction cravings and symptoms (such as buprenorphine and methadone) should be labelled as other medications normally would be with the word “assisted” removed. Words such as “medications for addiction treatment” could be used instead as research has proven that these medications are effective, and in many cases life-saving, regardless of whether they are offered in conjunction with psychological support or not.
Other medical partners that have added their voice include peer-reviewed academic journals in the addiction field including the “Addiction-ary,” which is a glossary of over 200 terms creating a golden standard in addiction terminology and word choice.
There are encouraging signs that the archaic language of addiction is slowly being transformed with people from a wide range of disciplines including many from the medical field and journalism heeding the call. But change takes time. The International Society of Addiction Journal Editors (ISAJE) released a statement in 2015 against the use of stigmatizing language in addiction science journals, but academic journals and medical communities have yet to adopt policies that more stringently guard against the use of stigmatizing language. On a government level, very little progress has been made, with agency names, such the National Institute on Drug Abuse (NIDA) and Substance Abuse Mental Health Administration (SAMHSA), still communicating outdated thinking. There is a lot of work to be done, and it needs to be done quickly to address the crisis that is claiming over 50 000 American lives annually.
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