Words Matter: Starting Conversations Without Stigma

How would you react if one of your coworkers told you that they had a problem with alcohol? What if your neighbor confided they were addicted to a prescription opioid? Would you be angry or ashamed if your spouse revealed they’d become addicted to Xanax? You probably hope you’d react to this kind of news with compassion and support, but when confronted with it, you might be surprised to find the stigma of addiction affects you more than you realize.

Shatterproof founder and CEO Gary Mendell’s personal story is a prime example. At the same time as his son, Brian, started dealing with a substance use disorder, another high school classmate was diagnosed with cancer. For the student with cancer, the community rallied in support, but Gary’s family didn’t experience the same outpouring. Instead, he’s admitted feeling embarrassed to even tell others about Brian’s disease, saying “Frankly, I felt like I was a failure as a father and I didn’t deserve any help.”

Gary’s story is very sad and all too common. Science has proven that addiction is a disease , but society is still catching up to that reality, and the stigma of addiction is pervasive. Some people continue to think drug or alcohol use disorders are a result of a lack of will power or a moral shortcoming, and even those who know better don’t always offer the same kind of support, encouragement, and understanding given to those with other chronic medical conditions. With these attitudes so prevalent it’s not surprising that less than 12% of people who need treatment for substance use disorders seek help .

Dr. Andrew Szeto, the Director of Mental Health Strategy at the University of Calgary and an expert in the field of stigma and mental health, has conducted extensive research on the stigma associated with mental health issues. Based on his own findings and research by others like Pat Corrigan , having conversations about mental health disorders such as addiction is one of the most important things we can do to reduce stigmatization. “The most effective way is through contact. Where people talk about their own experience – but the focus needs to be about help seeking, recovery, treatment, [and] those who help them…and less about the actual illness or stigma aspects.”

Knowing exactly what – and what not – to say can be difficult, but Szeto suggests sharing facts about mental health issues to break the ice. “Prevalence of mental illnesses are often eye opening. [There’s] about 45% lifetime prevalence, meaning nearly one in two people will experience some kind of mental illness.” Over 20 million Americans have substance use disorders – and 78 people die each day from opioid overdose alone.

Of course, the language we use is as important as what we’re saying. Words like “addict,” “dirty,” and “habit” all work to reinforce the negative ideas associated with substance use disorder. To successfully end stigma, we need to change our vocabulary.

Establishing that common set of language is one of the goals of the Office of National Drug Control Policy. In “Changing the Language of Addiction,” a memo released in 2017, Director Michael P. Botticelli created a set of guidelines for federal departments and agencies regarding terminology related to substance use. These guidelines include:

  • Using the term “substance use disorder” in place of terms like abuse or dependence
  • Using first person language like “person with a substance use disorder” instead of “addict” or “abuser,” or “person in recovery” instead of “clean”
  • Referring to any medication approved to treat substance use disorder as “medication assisted treatment” instead of “substitute” or “replacement” drugs
  • Find a chart of more words to avoid, and words to use instead, here

SAMHSA’s Center for Substance Abuse Treatment (CSAT) has also created a language guide with stigma-reducing suggestions, such as:

  • “patient” to reinforce that substance use disorder is a disease
  • “partial recovery” or “recovery process” to acknowledge that recovery happens in increments and over time
  • “chemical dependency” to emphasize that drug and alcohol disease creates changes in brain chemistry
  • “recovery support groups” to underscore the ways in which group members help one another, not just themselves
  • “remission” to show understanding that substance use disorder is like many diseases in which signs and symptoms may disappear and then reappear at a later time

Research has shown the words we use influence our own perceptions. Even medical professionals who know that substance use disorder is a disease were more likely to blame a person with substance use disorder or support punishment instead of treatment when that person was called an “abuser.” These negative attitudes can not only result in a poorer quality of care , but blaming and shaming can also deter those who need help from seeking it.

Neither SAMSHA’s guide nor the “Changing the Language of Addiction” guide are meant to be comprehensive glossaries, but both provide useful suggestions for how to choose words that will reduce the negativity, judgment, and blame that’s often associated with substance use disorder. This use of clinical language is supported by agencies like the American Medical Association, the American Society of Addiction Medicine, and the International Society of Addiction Journal Editors to help reduce the stigma of substance use disorders.

Former US Surgeon General Vivek Murthy said that to end the stigma of addiction, “We have to stop seeing addiction as a moral failing and see it for what it really is, which is a chronic illness we must treat with compassion and urgency.” Changing attitudes will take time, but we can change our vocabulary today. Through awareness, education, and conversation, we can bring addiction into the light and break the stigma once and for all.

Fixing the broken treatment system starts now

Fixing the broken treatment system starts now

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