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Article Title: Ending Stigma… What We Say Matters

Article Content

Two years ago I was assigned to a subcommittee tasked with raising awareness of stigma around substance use disorder in our community. I was nervous because it was outside of my field. I have a background in marketing and public relations, not in substance use. I was at the table with people who were primarily from the medical field or treatment and recovery. I didn’t feel comfortable contributing to the conversation for fear I would unintentionally  say something wrong. I knew things had progressed with the science of addiction medicine, as had the terms, but I didn’t know exactly what was correct or incorrect.

Before these meetings I hadn’t taken the opportunity to examine certain language or statements, for example, “babies born addicted.” I had never really questioned

this phrase before, but given the opportunity to evaluate its meaning, I realized how inaccurate it was. Of course babies aren’t born addicted, and such terms create stigma. Babies can’t develop addiction. Addiction is a disorder characterized by pathologically pursuing reward or relief through the use of substances. The American Society of Addiction Medicine describes it as “inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response.” None of these things are possible in a baby. When people talk about babies who are “born addicted” they are actually referring to neonatal abstinence syndrome (NAS), or the symptoms presented by infants who were exposed to drugs in the womb.

The lessons became more personal. I had received the disappointing news that a good friend of mine, who had abstained from drug and alcohol use for over 11 years, was actively using again. I came home discouraged and said to my sister, “I don’t understand, he had been ‘clean’ for 11 years.” My sister, who works in public health and has experience with substance use prevention programs, in her kind and nonjudgmental way, said, “so, he’s DIRTY now?” Well, when she put it that way, I understood what a terrible term that was and how it was loaded with stigma. The language we use really does matter.

For many of us outside the medical field or treatment and recovery world, we may not have had the opportunity to pause from our busy lives to learn destigmatizing words and phrases. We may want to join the conversation because we have loved ones, friends and neighbors we care about battling substance use disorder. We might want to be a part of the solution, but are unsure of the correct terms; even in the treatment and recovery world there are differences of opinions over the language to use.

It can be intimidating to join the conversation, but it is important that we do, and that people help us learn along the way, because stigma erodes confidence that substance abuse disorder is a valid and treatable health condition. It can lead people to avoid socializing, employing, or working with persons who have substance-related problems or histories. It can make us accept certain types of addiction more than others. It can even lead us to believe a person is sometimes beyond help. We can consciously and even subconsciously have assumptions that those struggling with substance use disorders are immoral, weak or even sinful. This is what stigma looks and sounds like.

Together, we can reduce stigma by using language that more accurately describes the chronic brain disease of addiction. Let’s stop stigma against those who are impacted by this complex condition, a brain disease, substance use disorder! To end stigma for any subject, it helps to be kind to one another, assume right intentions, and gently educate people along the way if other so know the correct language.

Here is a chart of “preferred terminology” in reducing the stigma associated with addiction that I found helpful.

Words to avoid                                                             Words to use

Addict                                                                          Person with substance use disorder

Alcoholic                                                                     Person with alcohol use disorder

Drug problem, drug habit                                       Substance use disorder

Drug abuse                                                                 Drug misuse, harmful use

Drug abuser                                                               Person with substance use disorder

Clean                                                                           Abstinent, not actively using

Dirty                                                                            Actively using

A clean drug screen                                                   Negative for substance use

A dirty drug screen                                                     Testing positive for substance use

Former/reformed addict/alcoholic                            Person in recovery, person in long-term recovery

Opioid replacement, methadone maintenance         Medication assisted treatment

Drug-addicted babies                                                 Infants with neonatal abstinence syndrome