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What’s In A Name? Changing the Conversation 

June 05, 2015  |  Falmouth Enterprise

Dr. Michael Bihari

It is a scientifically proven fact that addiction is a disease of the brain. The National Institute on Drug Abuse defines addiction as a “chronic, relapsing brain disease” that changes the structure and function of the brain. 

If addiction is a chronic brain disease, why do so many of us think of it as a moral failing? Why do so many of us continue to refer to people who have a substance use disorder as freaks, alcoholics, junkies, crackheads and garden-variety addicts?

The idea that people with a substance use disorder are weak, deserving of their fate and less worthy of care is so ingrained in our culture that it’s often impossible to separate addiction from shame and guilt. When the subject comes up it’s not uncommon to hear things like “his son’s a junkie, he must be a bad father” or “another junkie dead. So what?”

The labels that we use for an individual with a substance use disorder can have a serious negative impact; we need to start changing the language for people struggling with this disease. In an interview with the Huffington Post, Michael Botticelli, the newly appointed Director of National Drug Control Policy (a.k.a the U.S. Drug Czar) said, "Research shows that the language we use to describe this disease can either perpetuate or overcome the stereotypes, prejudice and lack of empathy that keep people from getting treatment they need. Scientific evidence demonstrates that this disease is caused by a variety of genetic and environmental factors, not moral weakness on the part of the individual. Our language should reflect that."

Consequences of Stigma in Drug Addiction

The dictionary defines stigma as “a mark of disgrace associated with a particular circumstance, quality, or person.” In regards to substance abuse disorders, stigma is a negative attitude imposed by many of us on people who we judge as not ‘normal’. It is a reaction of fear,  prejudice, and especially ignorance.

The stigma of having a substance use disorder can have significant negative consequences for an individual in need of treatment.  According to the National Institute on Drug Abuse, nearly 24 million Americans age 12 or older had used an illicit drug or abused a medication in the previous month. Some 23 million needed help with a drug or alcohol problem, yet only about 2.5 million (about 10 percent) "received treatment at a specialty facility.” Compare this to the more than 70 percent of people with diabetes who receive treatment for their disease.

And, even when people get treatment, stigmatization can continue and contribute to poor treatment outcomes. It is critical that we do not send messages to patients in recovery that are blaming (for relapse) and shaming (for being weak). Unfortunately, many people in recovery are always under suspicion and always presumed to be on the verge of relapse—once an addict, always an addict.

A New Glossary

To lower the barriers to seeking and getting help, Dr. John F. Kelly, associate professor of psychiatry at Harvard Medical School and other researchers are working with the Director of National Drug Control Policy calling for “more medically appropriate language that conveys the same dignity and respect offered to other kinds of patients.”

The White House Office of National Drug Control Policy has drafted a preliminary glossary of suggested language. These are some of the recommendations: 

  • instead of “addict”, try “person with a substance use disorder”
  • instead of “addicted to heroin”, try “has a heroin use disorder” or “has a substance use disorder involving heroin”
  • instead of “addiction”, try “substance use disorder”
  • instead of “clean”, try “abstinent”
  • instead of “clean screen”, try “substance free” or “testing negative for substance use”
  • instead of “dirty”, try “actively using” or “positive for substance use”
  • instead of “drug habit”, try “substance use disorder”
  • instead of “former addict”, try “person in recovery”

According to Dr. Kelly, ”This change goes beyond mere political correctness. Whether we are consciously aware of it or not, the language we use actually makes a profound difference in our attitudes and, thus, how we may approach our nation's number one public health problem. Use of terms more in keeping with this medical malfunction, such as describing an affected person as an individual with, or suffering from, a 'substance use disorder' -- as opposed to a 'substance abuser' -- may decrease stigma and increase perceptions of a need for treatment.”

In a research study, Dr. Kelly found that the way a person is described causes significant differences in how that person is judged. As part of this study he asked people to read two randomly assigned paragraphs identifying the same individual as either a "substance abuser" or "having a substance use disorder." Participants in the study who read the "substance abuser" language, even those who were mental health or addiction specialists, tended to see that individual as engaging in "willful misconduct" and constituting a greater social threat. 

On a personal note, I have type 2 diabetes, a chronic incurable disease, which can be modified by lifestyle choices. Even though I have diabetes, I have never been defined as a diabetic and I have never been subject to: discrimination; shame or embarrassment, causing me to try to hide my diabetes; social isolation or exclusion; a reluctance to seek professional help; loss of a job, or my home or family; a medical insurance company refusing payment for any of my care; or, my family being stigmatized or blamed for my diabetes. Hopefully our cultural norms will change so that all people with a substance use disorder can say the same.

After his unanimous approval by Congress to become the nations Drug Czar, Michael Botticelli posted the following on the Office of National Drug Control Policy's blog: “I am open about my recovery not to be self-congratulatory, I am open about my recovery to change public policy. I hope that many more of the millions of Americans in recovery like me will also choose to ‘come out’ and to fight to be treated like anyone else with a chronic disease. By putting faces and voices to the disease of addiction and the promise of recovery, we can lift the curtain of conventional wisdom that continues to keep too many of us hidden and without access to lifesaving treatment. It is time to make a simple, yet courageous decision to be counted, to be seen and to be heard.” 


John F. Kelly: Stop Talking ‘Dirty’: Clinicians, Language, and Quality of Care for the Leading Cause of Preventable Death in the United States 

Office of National Drug Control Policy 

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