Words Matter - Terms to Use and Avoid When Talking About Addiction

Image
Media Name: wordsmatter.jpg

This page offers background information and tips for providers to keep in mind while using person-first language, as well as terms to avoid to reduce stigma and negative bias when discussing addiction. Although some language that may be considered stigmatizing is commonly used within social communities of people who struggle with substance use disorder (SUD), clinicians can show leadership in how language can destigmatize the disease of addiction.

Stigma and Addiction

Image
Words Matter Cover
Download the PDF

What is stigma?

Stigma is a discrimination against an identifiable group of people, a place, or a nation. Stigma about people with SUD might include inaccurate or unfounded thoughts like they are dangerous, incapable of managing treatment, or at fault for their condition.

Where does stigma come from?

For people with an SUD, stigma may stem from antiquated and inaccurate beliefs that addiction is a moral failing, instead of what we know it to be—a chronic, treatable disease from which patients can recover and continue to lead healthy lives.

How does stigma affect people with SUD?

  • Feeling stigmatized can reduce the willingness of individuals with SUD to seek treatment.1,2
  • Stigmatizing views of people with SUD are common; this stereotyping can lead others to feel pity, fear, anger, and a desire for social distance from people with an SUD.2
  • Stigmatizing language can negatively influence health care provider perceptions of people with SUD, which can impact the care they provide.3

How can we change stigmatizing behavior?

  • When talking to people with SUD, their loved ones, and your colleagues, use non-stigmatizing language that reflects an accurate, science-based understanding of SUD and is consistent with your professional role.
  • Because clinicians are typically the first points of contact for a person with an SUD, health professionals should “take all steps necessary to reduce the potential for stigma and negative bias.”3 Take the first step by learning the terms to avoid and use.
  • Use person-first language and let individuals choose how they are described.4 Person-first language maintains the integrity of individuals as whole human beings—by removing language that equates people to their condition or has negative connotations.5 For example, “person with a substance use disorder” has a neutral tone and distinguishes the person from his or her diagnosis.6

What else should I keep in mind?

It is recommended that “substance use” be used to describe all substances, including alcohol and other drugs, and that clinicians refer to severity specifiers (e.g., mild, moderate, severe) to indicate the severity of the SUD. This language also supports documentation of accurate clinical assessment and development of effective treatment plans.7 When talking about treatment plans with people with SUD and their loved ones, be sure to use evidence-based language instead of referring to treatment as an intervention. 


Terms to avoid, terms to use, and why

Consider using these recommended terms to reduce stigma and negative bias when talking about addiction.

Instead of… Use... Because...
  • Addict
  • User
  • Substance or drug abuser
  • Junkie




     
  • Alcoholic
  • Drunk


     
  • Former addict
  • Reformed addict
  • Person with substance use disorder8
  • Person with opioid use disorder (OUD) or person with opioid addiction [when substance in use is opioids]
  • Patient

     
  • Person with alcohol use disorder
  • Person who misuses alcohol/engages in unhealthy/hazardous alcohol use
     
  • Person in recovery or long-term recovery
  • Person who previously used drugs
  • Person-first language.
  • The change shows that a person “has” a problem, rather than “is” the problem.7
  • The terms avoid elicit negative associations, punitive attitudes, and individual blame.7
  • Habit
  • Substance use disorder
  • Drug addiction
  • Inaccurately implies that a person is choosing to use substances or can choose to stop.6
  • “Habit” may undermine the seriousness of the disease.
  • Abuse
For illicit drugs:
  • Use
For prescription medications:
  • Misuse
  • Used other than prescribed
  • The term “abuse” was found to have a high association with negative judgments and punishment.9
  • Legitimate use of prescription medications is limited to their use as prescribed by the person to whom they are prescribed.  Consumption outside these parameters is misuse. 
  • Opioid substitution replacement therapy
  • Opioid agonist therapy
  • Medication treatment for OUD
  • Pharmacotherapy
  • It is a misconception that medications merely “substitute” one drug or “one addiction” for another. 6
  • Clean
For toxicology screen results:
  • Testing negative
For non-toxicology purposes:
  • Being in remission or recovery
  • Abstinent from drugs
  • Not drinking or taking drugs
  • Not currently or actively using drugs
  • Use clinically accurate, non-stigmatizing terminology the same way it would be used for other medical conditions.10
  • Set an example with your own language when treating patients who might use stigmatizing slang.
  • Use of such terms may evoke negative and punitive implicit cognitions.7
  • Dirty
For toxicology screen results:
  • Testing positive
For non-toxicology purposes:
  • Person who uses drugs
  • Use clinically accurate, non-stigmatizing terminology the same way it would be used for other medical conditions.9
  • May decrease patients’ sense of hope and self-efficacy for change.7
  • Addicted baby
  • Baby born to mother who used drugs while pregnant
  • Baby with signs of withdrawal from prenatal drug exposure
  • Baby with neonatal opioid withdrawal/neonatal abstinence syndrome
  • Newborn exposed to substances
  • Babies cannot be born with addiction because addiction is a behavioral disorder—they are simply born manifesting a withdrawal syndrome.
  • Use clinically accurate, non-stigmatizing terminology the same way it would be used for other medical conditions.10
  • Using person-first language can reduce stigma.

References

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937046
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5854406
  3. https://www.tandfonline.com/doi/abs/10.1080/10826084.2019.1581221?journalCode=isum20
  4. https://www.ncbi.nlm.nih.gov/pubmed/31140667
  5. https://apastyle.apa.org/6th-edition-resources/nonhandicapping-language
  6. https://obamawhitehouse.archives.gov/sites/whitehouse.gov/fles/images/Memo%20-%20Changing%20Federal%20Terminology%20Regrading%20 Substance%20Use%20and%20Substance%20Use%20Disorders.pdf
  7. https://www.thenationalcouncil.org/wp-content/uploads/2016/10/Substance-Use-Teminology.pdf
  8. https://psycnet.apa.org/record/2018-44736-001
  9. https://www.sciencedirect.com/science/article/abs/pii/S0955395909001546?via%3Dihub
  10. https://jamanetwork.com/journals/jama/article-abstract/1838170