Rethinking How We Talk About Addiction

People with substance use disorders and other mental health issues face greater stigma than those with other illnesses. As the head of the White House Office of the National Drug Control Policy (ONDCP), Michael Botticelli, and former Assistant Secretary for Health, Howard Koh, argued in JAMA Viewpoint last month, many of the addiction-related terms widely used in our society—even in the addiction field—retain an implicit moral judgment and subtly frame drug problems as transgressions worthy of punishment. Thus, reexamining how we talk about substance use disorders and those who suffer from them is an important step in overcoming the misconceptions and moralizing that have hindered access to treatment and compassionate recovery supports in our society.

The word addiction in bold on a printed dictionary page

Repeated substance use changes key brain circuits in fundamental ways, and people who become addicted often lose their motivation and ability to derive pleasure from natural rewards. They experience distress when not using and diminished ability to resist the drug-seeking urge or follow through with decisions to quit. Thus, addiction is not a weakness of willpower or a moral failing—it is a medical issue. But studies show that subtle differences in how people describe those with addictions can reinforce a punitive rather than medical approach.

In a 2010 study conducted by Harvard addiction psychiatrist John F. Kelly and colleagues, doctoral-level mental health and addiction clinicians were more likely to favor a jail sentence over treatment when a character in a case vignette was described as a "substance abuser" than when that character was described as having a "substance use disorder." (All other words of the two descriptions were the same.) In another study, they found that mental health practitioners at professional conferences were likewise more likely to consider the subject of a case vignette worthy of punishment (instead of treatment) if he was described as a "substance abuser" (again, versus having a "substance use disorder").

Other terms can sometimes carry misleading assumptions, even when they are not stigmatizing. The term getting high is an example: Even though initial drug use or infrequent use produces euphoria, people with addiction have a diminished ability to feel pleasure from drugs; their primary motivation is not to feel euphoric but to temporarily escape the extreme lows caused by withdrawal. Much of the moralizing and judgment directed at people with addictions arises from a false belief that they have willfully abandoned their responsibilities in favor of a search for pleasure, a belief reinforced when we characterize disordered substance use as simply pursuing drug highs.

This month, after working with the NIDA, the National Institute on Alcohol Abuse and Alcoholism, and other federal partners such as the Substance Abuse and Mental Health Services Administration, ONDCP released a draft set of guidelines, Changing the Language of Addiction, to set new language standards around addiction for the federal government and its stakeholders. The new ONDCP recommendations include avoiding the terms addict and abuser and consistently adopting terms consistent with current diagnostic terminology—i.e., person with a substance use disorder. They also include replacing abuse with less pejorative terms such misuse or unhealthy/harmful use. The ONDCP also recommends avoiding the terms clean (for a negative drug test) or getting clean (for achieving abstinence from drugs or alcohol) in favor of less stigmatizing terminology. The guidelines instead recommend that people describe those who have achieved long-term abstinence as being in recovery, for instance.

The ONDCP draft language guidelines are open for public comment until November 3, 2016.

Dr. Nora Volkow, Director

Here I highlight important work being done at NIDA and other news related to the science of drug use and addiction.

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 Addiction Surviviors

I am a current student at Utah Valley University, I am doing a cited paper on this topic. I was wondering if there is any more information that may help with this topic? This is a topic that is close to my heart and something that I have plenty of street experience in. ( not me personally, but my family and friends have suffered) since the age of 6yrs old I have seen various types of substance abuse. In which only a few I love and that are dear to me have recovered from.
This topic, has become more now of a passion and a motivator for me to work on. I plan to work as an advocate, to help those in my community overcome addiction and clear their names. I would like to create the best paper possible for my ENGH class and also have it be apart of my educational focus, for the next 3.5 years. Is there any information that may help me in my studies and to get this paper as proper as possible?
Thank you sincerely,
Amber W Has faith

 Applaud efforts/Treatment/Training needs to be re-visited

I applaud these efforts to use less stigmatizing terminology in describing the disease of addiction as it almost always views those afflicted as having a choice, and applaud efforts to re-educate the medical community as a whole with the science behind addiction, as I have found psychiatrists themselves, appear to favor behavioral treatment and 12-step approaches as opposed to those backed by science. Perhaps how addiction is taught in medical school should be re-visited almost immediately. In addition, current treatment options are deplorable, and suggest the afflicted person is able to make treatment decisions on their own. In fact, even for those insured, attempting to find medical treatment options is a tangled, complicated journey no afflicted person can maneuver without help. For example, a call to the insurer includes often being provided a list of centers covered, which then require follow-up phone calls to those centers, many which don't provide in-patient options. Hours upon hours of research that that would frustrate a non-afflicted person. Most Insurers and hospitals for that matter have departments such as 'behavioral health', suggesting that addiction is a behavioral issue, not a medical one. Furthermore, Insurance companies do not pay for anything close to a three month period of treatment recommended, and cite 'doctors on staff' making decisions on the length of stay often less than 3 weeks with no explanation how that is derived. I cannot even imagine what treatment might be available for one who is uninsured. Thank you in advance for your consideration.

 Addiction, Recovery & MAT

I appreciate this article, for one of many reasons: it is affirmation of the discourse many of us experience. These findings exemplify the difficulty in translating research to clinical practice *and* to create a societal understanding for opioid treatment as well. Clients in opioid treatment venues are stigmatized and shamed to simply admit they are in treatment- as though opioid treatment that is supported with medicine is "bad" . Even among addictions specialists, choosing to utilize Medication Assisted Treatment is not "treatment" and certainly isn't considered "recovery. " As with the many other stigmas relation to addiction disorders, those related to opioid abuse and recovery seem to be particularly hard hit by society and various treatment stigmatization. It is as though we want people to be "recovered" but we don't want to know how they "got there". Similarly, OTP centers are expected to actively engage in community building outside their own doors, however we discourage them to have a sign indicating "There is a treatment program here. It also makes those challenged with opioid addiction disorders to not easily find the treatment of their choice. Thank you for the article, information, affirmation and continued support. In times such as these we need all the support we can give to each other.


If you worried about helping opioid addicted Americans quit their addictions by making BUPRENORPHINE available to the masses, which it ISN'T, as much as you worried about "stigma's" (which is a wonderful cause, that should be prioritized somewhere BELOW death) you could truly help this nation!

 Shame, fear of asking for help due to the Stigma leads to.....

A lack of education in the medical field.
Every ER needs to improvise and implement a standardized procedure. This could start with a small consultation room somewhere in or near the ER.Their needs to be a staff member (trained in addiction/recovery) on call at ALL times. This could be a LPN, RN, PA, or even a Nurse practitioner. Someone to start the intake process. Also having recovering addict on call?
Yet, our goal here is to get these people help. Make them feel human. Show true compassion for their illness. If they're already sick, from withdrawal? And then to be shunned, belittled, or turned away. We have done them a disservice! If they come for help. Once in and stabilized. The assessment process can start Then the detox. Sorting of other health issues can be addressed. Education, and vocation can follow. WE HAVE to implement more intake centers. To start the process."Have you ever heard the phrase?"
"You can lead a horse to water, you can't make it drink, Keep it there long enough, it'll get thirsty!"
I am one of these people. I have struggled for years on and off. With chronic pain, kidney stones, multiple surgeries, Myalgia, etc. Each time, I'm at the point to stop the pain meds. (Having had to give monthly UA's)
I then experience withdrawal. I prefer to taper. Over being looked down on. And to not substitute with methadone, Suboxone, etc.
I hope to help our young. From experience.