Softly Spoken Advocacy

Be mindful of the words you choose when speaking of addiction, people with substance use disorder, and their treatment and recovery. Here are some practical examples of compassionate language.

By Ed Baker

One of the many things I have learned practicing over the past 30 years is that words matter. They have power.

I am a licensed alcohol and drug counselor and licensed independent clinical social worker who has spent an entire career practicing psychotherapy with individuals and substance use disorder.

Words can dismiss, demean and discourage: “You are a drug abuser. You’ve chosen this life, and you choose not to stop abusing drugs. You’ve made your bed, and now you get to sleep in it.”

Or words can affirm, 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 Centers for Disease Control and Prevention data over the past six years regarding drug overdose fatalities, my heart 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 or fear 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 Murthy 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 percent received treatment. As a result, more than 63,600 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, like we have 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.

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. Here are some practical examples of compassionate language.


Words such as “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.


Terms such as “substance abuser” and “drug abuse” are best avoided. These terms characterize the person with elicit judgment and punitive attitudes. Person-first language is most appropriate here.

When referring to substance use testing results, terms such as “dirty” or “clean” should be avoided. These terms 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. Try this instead: “The patient’s substance use test results were negative for …” or “positive for …”


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.

Medication-assisted treatment (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.


Terms such as “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; therefore, it 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. The surgeon general’s report of 1989 sparked the equally remarkable response to the AIDS crisis.

The following quote is from 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 on this subject, simply by mindfully choosing the language we use.

Words matter.

Ed Baker is a licensed independent clinical social worker and licensed alcohol and drug counselor. He has practiced psychotherapy with individuals with substance use disorder for over 30 years in several clinical settings.

He is focused on researching and developing educational programs in the areas of brain addiction, psychoactive drug use and use trends, substance use treatment, recovery, positive messaging to dispel the stigma associated with addiction, and current developments related to emerging novel psychoactive substances and synthetic fentanyl. Baker hosts and produces the Addiction Recovery Channel on CCTV Channel 17 in Burlington, Vermont. He is in recovery from addiction for 34 years.

Additional Reading

Facing Addiction in America Surgeon General Vivek Murthy’s Report addiction.surgeongeneral.gov/sites/default/files/surgeon-generals-report.pdf

“Stop Talking ‘Dirty”

American Journal of Medicine



Recovery Research Institute recoveryanswers.org/addiction-ary/

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