Words Matter: The Language of Addiction

Thursday, July 6, 2017
Michael Rass

Media outlets frequently cover the many aspects of the addiction crisis in America. As the overdose death toll continues to rise, they typically paint a pessimistic portrait of addiction, often using language that should be considered problematic. Articles regularly use terms like “abuse” or “abuser” or refer to individuals as “addicts.” The term “clean,” too, is loaded when referring to sobriety, since it implies that a person in active addiction is somehow “dirty.”

A lot of the coverage focuses on the aberrant behavior of people misusing substances or it describes an ominous, unpredictable crisis that requires a firm response from the criminal justice system. Focus and language matter very much because they either help people understand that addiction is a chronic brain disease or they reinforce the notion that substance users are morally depraved individuals who simply refuse to do the right thing.

In 2013, the American Psychiatric Association strengthened the classification of addiction as a disease when it dropped all “abuse” terminology from the latest edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which serves as a universal authority for psychiatric diagnoses in the United States. The term “addiction” was mostly replaced with the more neutral “substance use disorder” (SUD).

In June, the Associated Press took an important step in the same direction. The new edition of its widely used AP Stylebook declares that "addict" should no longer be used as a noun. "Instead," it says, "choose phrasing like he was addicted, people with heroin addiction or he used drugs." That means separating the person from the disease and is in line with other medical usage. For instance, many professionals avoid speaking of “autists” now, using “person with autism” instead.

In his comprehensive report on addiction last November, the former Surgeon General, Dr. Vivek Murthy, primarily used the term “substance misuse” but continued to speak of “addiction” which he equated with the severe form of substance use disorder in DSM-5.

Dr. Murthy also criticizes the persisting stigma of addiction despite the prevalence of the problem. “Most Americans know someone with a substance use disorder, and many know someone who has lost or nearly lost a family member as a consequence of substance misuse. Yet, at the same time, few other medical conditions are surrounded by as much shame and misunderstanding as substance use disorders.”

It is a real problem because stigma prevents people with SUD from seeking treatment and prejudices medical professionals as well as law enforcement officers. Before handing over to the Trump administration in January, the outgoing director of the Office of National Drug Control Policy (ONDCP), Michael Botticelli—who is in recovery himself—issued a memorandum entitled “Changing the Language of Addiction.”

“Research has shown that people with substance use disorders are viewed more negatively than people with physical or psychiatric disabilities,” Botticelli wrote. “Researchers found that even highly trained substance use disorder and mental health clinicians were significantly more likely to assign blame and believe that an individual should be subjected to more punitive (e.g., jail sentence) rather than therapeutic measures, when the subject of a case vignette was referred to as a “substance abuser” rather than as a “person with a substance use disorder.”

Addiction is a complicated bio-psycho-social-spiritual disorder that now affects millions of Americans and imposes enormous costs on our society. It affects all age brackets, ethnic groups and social strata across the nation.

Although more than 20 million Americans met the diagnostic criteria for substance use disorder in 2015, only 2.2 million individuals (10.4 percent) received any kind of treatment. This discrepancy can only be improved when we start viewing people with addiction as persons suffering from a serious disease who need help rather than as flawed individuals “abusing” drugs and alcohol to get high.