Why the words we choose matter

by Sarah S. Dermody, PhD @SarahSDermody

“Addict” or “junkie” are some of the words that are used to refer to people who have difficulties with their substance use. These are words used by people in the media (just one for example) and in our communities, and perhaps you have even used them as well. These words should be avoided, and here are some of the important reasons why.

An important place to start is to understand stigma.

Close your eyes and take a moment to imagine a recent media story or film that spoke about or portrayed someone who uses substances heavily. Perhaps they shared some negative beliefs and attitudes (or stereotypes) about how this person would behave, what they look and sound like, and what it would be like to spend time with them. The negative beliefs and attitudes towards people with addiction is called stigma.

Stigma is a problem with many health conditions, and we continue to see it with addiction. Stigma can truly hurt people coping with substance use related difficulties in many ways. Research has shown that fear of stigma is one of the top reasons that people choose not to get treatment for their substance use (Table 7.67B).¹ When someone gets treatment, stigma can also get in the way of their successful treatment and recovery.² Unfortunately, we also see that stigma can be an issue for treatment providers who are not properly trained to work with people who use substances.³

A timely example of this is with the COVID-19 pandemic. Dr. Nora Volkow, the director of NIDA, recently wrote about this issue in her blog.

“the legitimate fear around contagion may mean that bystanders or even first responders will be reluctant to administer naloxone to people who have overdosed. And there is a danger that overtaxed hospitals will preferentially pass over those with obvious drug problems when making difficult decisions about where to direct lifesaving personnel and resources.”⁴

Dr. Nora Volkow

How the words we use promote stigma.

Remember the saying “sticks and stones may break my bones, but words can never hurt me”? Whoever coined this phrase did not consider the effects of stigmatizing language.

Research has shown that the language we use to refer to people who use or have difficulties with substance use can impact how we treat them. One example of this is a study by Goodyear, Haass-Koffler, and Chavanne (2018) where participants read descriptions of people referred to as a “drug addict” versus official terms like “opioid use disorder.”⁵  They found that there were more stigmatizing attitudes towards individuals labeled as a “drug addict” than those labeled as having an “opioid use disorder.”  

It is not hard to imagine how stigmatizing language can play out in a number of real-world settings to make a major impact.

Tips: Use words that describe – not stigmatize.

At this point, you may be wondering, what words could I use to describe these experiences? There are many helpful online resources that describe terms to avoid versus terms to use, and why, such as the primer on Overcoming Stigma through Language.⁶  Here is a summary of some of the important takeaways:

1. Use “person-first” language: Put the words that refer to the individual before the words that describe their behaviours or conditions. For instance, instead of using terms like “alcoholic” or “addict”, a person would be described as “person with an alcohol use disorder.”
2. Use official terms the reflect the condition: Using the medical language can help frame addiction as a health issue and a disease. Therefore, it is best to use official diagnostic language like “substance use disorder” instead of use words like “drug abuse” or “junkie.”
3. Avoid slang and idiomatic expressions: Using slang to describe an individuals’ involvement with substance use often means that pejorative or biased language is being used (“pot head”, “strung out”, “getting clean”, as examples). Instead, it is best to describe behaviours and experiences with literal terms, like “someone who uses cannabis”, “someone who is intoxicated”, or “someone who is in treatment for their substance use.

This is just the start of the conversation.

Now that you know about the power of words and how to talk about substance use is a less stigmatizing way, it is time to put this knowledge into action! Together, we can make a real impact to reduce stigmatizing language by correctly the words that we use and educating the people around us to use less stigmatizing language.  

---

Sources

---

1.  Substance Abuse and Mental Health Services Administration. (2020). Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health (HHS Publication No. PEP20-07-01-001, NSDUH Series H-55). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved Sept 28, 2020, from https://www.samhsa.gov/data/
2.  Crapanzano, K. A., Hammarlund, R., Ahmad, B., Hunsinger, N., & Kullar, R. (2018). The association between perceived stigma and substance use disorder treatment outcomes: A review. Substance Abuse and Rehabilitation, 10, 1–12. https://doi.org/10.2147/SAR.S183252
3. Knaak, S., Mantler, E., & Szeto, A. (2017). Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions. Healthcare Management Forum, 30(2), 111-116. https://doi.org/10.1177/0840470416679413
4. Volkow, N. (2020, April 22). Addressing the stigma that surrounds addiction. Nora’s Blog. https://www.drugabuse.gov/about-nida/noras-blog/2020/04/addressing-stigma-surrounds-addiction
5. Goodyear, K., Haass-Koffler, C. L., & Chavanne, D. (2018). Opioid use and stigma: The role of gender, language and precipitating events. Drug and Alcohol Dependence, 185, 339-346. https://doi.org/10.1016/j.drugalcdep.2017.12.037
6. Canadian Centre on Substance Use and Addiction. (2019). Overcoming stigma through language: A primer. (Guide.) Ottawa, Ontario. Retrieved Sept 28, 2020, from https://www.ccsa.ca/overcoming-stigma-through-language-primer