SOFTLY SPOKEN ADVOCACY
By Ed Baker ACSW, LICSW, LADC
I am a Licensed Alcohol/Drug Counselor and Licensed Independent Clinical Social Worker who has spent an entire career practicing psychotherapy with individuals with Substance Use Disorder.
This has been my life’s work. I have listened for over 30 years.
One of the many things I have learned is that words matter. They have power.
Words can dismiss, demean and discourage: “You are a drug abuser. You’ve chosen this life and you choose to not stop abusing drugs. You’ve made your bed now sleep in it.”
Or words can affirm, they can empower and motivate: “You have a Substance Use Disorder. This is a medical condition that is very likely to respond to treatment that is available to you. This will require cooperation and effort on your part.”
As I review the Centers for Disease Control’s data over the past six years regarding drug overdose fatalities, my heart literally breaks at the sheer magnitude of our current public health emergency. The number of deaths associated with drug overdose has increased steadily, reaching 70,237 in 2017.
How many of these individuals were reluctant to seek life-saving treatment because of shame, because of stigma?
All too often, the words we have grown accustomed to using when referring to brain addiction and people with substance use disorder have been influenced by a partial or inaccurate understanding of science, or, worse, stigma.
As Vivek H. Murthy, M.D. noted in his Surgeon General’s Report of 2016, “stigma has created an added burden of shame that has made people with substance use disorders less likely to come forward and seek help.”
When it comes to addiction, hesitation to seek help costs lives.
Of the estimated 21 million people with substance use disorder in our country in 2016, a mere 10% received treatment. As a result, more than 63,600 people died of drug overdoses that year. How many of these people would still be here today, had they been in treatment?
In 2013, the National Drug Policy Reform Summit introduced a new focus on addiction as a brain disease that profoundly affects public health. Rather than the previous “War on Drugs,” which encouraged punitive measures and stigma around drug use, the new approach focused on a science-based understanding of the causality and controllability of addiction.
If public perception mistakenly attributes causality and controllability to individual choice, the response is likely to be blame and punishment. If public perception is instead informed by science and research, and correctly attributes causality and controllability to genetic predisposition, adverse environmental impact, and brain function impairment, the public’s response is more likely to be compassionate and inclusive, as it rightly is for other diseases. As a result, more people with substance use disorder will likely seek and receive medical and psychotherapeutic treatment, followed by recovery support services. Lives will be saved.
In order to raise public consciousness and dispel the stigma associated with substance use disorder, we, as concerned and informed partners, can contribute to a compassionate approach to addiction and recovery in very impactful ways by being mindful of the words we choose when speaking of addiction, people with substance use disorder, their treatment and recovery.
Here are some practical examples of compassionate language:
Words like “addict” and “alcoholic,” while seeming benign and without malintent, tend to nonetheless limit the definition of the entire person to their disease. Person-first language, such as “person-with-an-opioid-use-disorder,” or “person-with-a-substance-use-disorder,” serves to more accurately affirm the entire person, with the medical disorder being a part of the person’s experience. Including the medical term “disorder” tends to raise public consciousness by emphasizing the medical nature of addiction.
Avoiding Judgmental Terms
Terms like “substance abuser” and “drug abuse” are best avoided. These terms characterize the person with a substance use disorder as abusive, and elicit judgment and punitive attitudes. Person-first language is most appropriate here, as are terms like “substance use” or “drug use.”
When referring to Substance Use Testing Results, terms like “dirty” or “clean” should be avoided. These terms elicit judgment and unintentionally invite a punitive response. Medical terms are more accurate, and tend to encourage a respectful and compassionate response, as does terminology for other medical tests. “The patient’s substance use test results were negative for …”, or “positive for …”
Accurate Portrayal of Medication for Addiction Treatment (MAT)
When it comes to terms used to describe Methadone or Buprenorphine for the treatment of Opioid Use Disorder, it is best to avoid terms such as “replacement,” or “substitution” therapy. These terms imply a lateral move from illicit addiction to legal addiction, a mere replacement of one drug for another. MAT is medical treatment, designed to assist patients in avoiding opioid withdrawal and opioid intoxication, while achieving medical stability, and the capacity to engage in other needed therapies and support services, if indicated.
Avoiding Misleading Terminology
Terms like “recreational use,” or “casual use” can be misleading and add an inaccurate shade of safety, or fun, to drug use. This is especially dangerous considering adolescents’ heightened tendency to use a drug if their perceived risk of harm is low. The term “use,” without “recreational” or “casual” as a descriptor, is neutral, and therefore does not imply safety or fun.
Our country and our citizens are facing an unprecedented public health emergency today. Our history clearly attests to our ability to respond to similar emergent situations successfully, when we become motivated and organized. The Surgeon General’s Report of 1964 sparked the initiative that has led to remarkable progress regarding tobacco use and health. And the Surgeon General’s Report of 1989 sparked the equally remarkable response to the AIDS crisis.
The following quote is from Surgeon General Vivek Murthy’s 2016 Report, “Facing Addiction in America”:
“We must help everyone see that addiction is not a character flaw – it is a chronic illness that we must approach with the same skill and compassion with which we approach heart disease, diabetes, and cancer.”
We can contribute to this effort in important ways every day, within every conversation we have with people on this subject, simply by mindfully choosing the language we use.
For more information: Ed Baker firstname.lastname@example.org
Surgeon General Vivek Murthy’s Report, “Facing Addiction in America”:
“Stop Talking Dirty”, American Journal of Medicine Article:
Addictionary, Recovery Research Institute: