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Stigma about addiction, which is fed and reinforced by public perceptions, still remains the biggest barrier to Substance Use Disorder (SUDs) treatment, despite the efforts taken to educate the public about the disease.

We, as treatment professionals responsible for helping individuals overcome addiction, make a conscious effort to correct stereotypes and misconceptions however we can. One way is by choosing the language that is not stigmatizing when talking about addiction and drug use.

Destigmatizing the language associated with SUDs will allow individuals who need help to regain their self-esteem, allow lawmakers to appropriate funding, allow doctors to treat without the disapproval of their peers, allow insurers to cover treatment, and help the public understand that this is a medical condition, and it is as real as any other disease. Below is a list of stigmatizing words and phrases which could be replaced with the suggested "preferred terminology", as a start to better communication with others about addiction. Choosing the words we use more carefully is one way we can all make a difference and help decrease the stigma associated with this national problem.

Addict, Abuser, Junkie

Problem with the terms: These terms are demeaning because they label a person by his/her illness. By making no distinction between the person and the disease, they deny the dignity and humanity of the individual. In addition, these labels imply permanency to the condition, leaving no room for a change in status.

Preferred terminology:
Person in active addiction, person with a substance misuse disorder, person experiencing an alcohol/drug problem, patient (if referring to an individual receiving treatment services).

Abuse

Problem with the term: Although "abuse" is a clinical diagnosis in the DSMIV and ICD10, it is stigmatizing because: (1) it negates the fact that addictive disorders are a medical condition; (2) it blames the illness solely on the individual with the illness, ignoring environmental and genetic factors, as well as the ability of substances to alter brain chemistry; (3) it absolves those selling and promoting addictive substances of any wrongdoing; and (4) it feeds into the stigma experienced not only by individuals with addictive disorders but also family members and the addiction treatment field.

Preferred terminology:
Misuse, harmful use, inappropriate use, hazardous use, problem use, risky use.

Clean, Dirty (when referring to drug test results)

Problem with the terms: Commonly used to describe drug test results, these terms are stigmatizing because they associate illness symptoms (i.e. positive drug tests) with filth.

Preferred terminology:
Negative, positive, substance-free.

Habit or Drug Habit

Problem with the terms: Calling addictive disorders a habit denies the medical nature of the condition and implies that resolution of the problem is simply a matter of willpower in being able to stop the habitual behavior.

Preferred terminology:
Substance misuse disorder, alcohol and drug disorder, alcohol and drug disease, active addiction.

Replacement or Substitution Therapy

Problem with the terms: This implies that treatment medications such as buprenorphine are equal to street drugs like heroin. The term suggests a lateral move from illegal addiction to legal addiction, and this does not accurately characterize the true nature of the treatment. The essence of addiction is uncontrollable compulsive behavior. The first goal of addiction treatment is to stop this dangerous addictive behavior. With successful buprenorphine therapy, as part of a comprehensive treatment plan, the dangerous addictive behavior is stopped not replaced

Preferred terminology:
Treatment, medication-assisted treatment, medication.

User

Problem with the term: The term is stigmatizing because it labels a person by his/her behavior. It is also misleading because the term user has come to refer to one who is engaged in risky misuse of substances, but ‘use’ alone is not necessarily problematic.

Preferred terminology:
Referring to use: person who misuses alcohol/drugs.

Referring to misuse: person engaged in risky use of substances.

Category: For Friends and Family on 16 June 2020

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