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What We Talk About When We Talk About Substance Use Disorders

Language matters. Language is how we filter in the world around us. Language is how we articulate our experiences and emotions to ourselves and to others. And it is through language that we come to define who it is we think we are—who it is we think you think we are. This is especially true with regards to medical conditions, which can be unjustly characterized through public description and discourse as good conditions or bad conditions. For example, the rhetoric used when discussing cancer has grown increasingly martial in ways intended to empower those who are sick. Today, we are less inclined to describe chemotherapy as simply going through treatment. Instead, we are likely to say that they are battling cancer or that they’re fighting back against the disease. Should someone’s cancer go into remission, we bestow upon them the epithet of survivor. Should they die as a result of their illness, we will say they lost their battle with cancer.

The language we use for people who use drugs and those who have been diagnosed with disorders that fall underneath the umbrella of addiction are far less kind. even the most well-meaning people use terms that can still be stigmatizing to describe people use drugs. It doesn’t matter if you’re a primary care doctor, an addictions counselor, a spouse, or a dear friend—there is no amount of professional experience or unconditional love that can inoculate you from adversely affecting someone who actively uses drugs if the language you use is stigmatizing.

Take the term substance abuse. Odds are, if you’ve attended an inpatient or outpatient drug treatment facility, sat through a D.A.R.E. presentation, or read anything in the Addiction & Recovery or Self-Help & Relationships section of a bookstore you heard the term substance abuse used as the clinical label for people who had unhealthy relationships with drugs and alcohol. This is because, beginning in 1980 with the publication of the third iteration of the Diagnostic and Statistical Manual of Mental Disorders, adopted substance abuse and substance dependence as the official clinical terms for all manner of substance use and misuse. 

On the surface, substance abuse might seem to be a relatively stigma-free diagnosis, especially when compared with the professional use of terms like addict. However, the word abuse is one that comes loaded with judgement that is often acutely felt by the individual drug user. Think of the other instances in which we, as a society, refer to people as abusers. We speak of spousal abusers and sex abusers and child abusers—all of whom are seen by society as dangerous and disturbed. This has the effect of not just diminishing self-esteem and self-perception of people who use drugs, but also of cultivating bias and negative perceptions among those charged with treating that person and among their loved ones.

 A study examining the impact of stigmatizing language on perceptions of drug users showed that mental health professionals who were randomly assigned one of two case studies that were identical except in that one described the individual in question as “a substance abuser” and the other referred to the individual as “having a substance use disorder.” The study demonstrated that participants who read the substance abuser case studies were more likely to believe the individual featured was personally responsible for their actions and deserving of punishment. 

It is for this reason that the White House Office of National Drug Control Policy (ONDCP) recently released a draft document that outlined a number of changes the agency will make to reform the terminology it uses to be more inclusive and evidence-based when framing their work. In the document, ONDCP highlighted the necessity of adopting standards and practices that promote “person-first language” that reduces negative labeling and works to humanize people diagnosed with a substance use disorder—a term that is now utilized in the DSM-V. 

In addition to that major change, ONDCP plans to remove antiquated language surrounding drug testing—replacing the terms “clean” and “dirty” with negative and positive when discussing toxicology screenings—and recommends not using words like alcoholic or addict in a professional setting. These changes may not seem major—and, in certain respects they aren’t—but they represent a slow, steady progression from a law enforcement-focused paradigm popularized in the 1990s to an organization that advocates for people living with substance use disorders and their families. Hopefully, the release of these proposed language changes are a sign of things to come from ONDCP under the administration of the country’s next president.

Posted By: AIDS United, Policy Department - Friday, November 04, 2016

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