Words Matter: Terminology & Addiction, and Why What We Say Makes a Difference

This article provides background information and suggestions for providers utilizing person-first language, as well as phrases to avoid when discussing addiction to enhance addiction recovery and eliminate stigma and negative bias.

Although stigmatizing language is often employed among social communities of people who suffer from substance use disorder (SUD), physicians can lead the way in destigmatizing the condition of addiction through language. NIDA’s Words Matter: Preferred Language for Talking About Addiction provides comparable information for sober living patients.

Visit NIDAMED Your Words Matter – Language Showing Compassion and Care for Women, Infants, Families, and Communities Impacted by Substance Use Disorder for additional information on the specific impact of stigma on pregnant women and moms in addiction recovery.

CME/CE credit can be obtained in the following ways:

1. 1. Step 1: Read the entire article.
  2. Step 2: To acquire your CE certificate, go to the Words Matter CME/CE Activity page and follow the directions under Method of Participation and Request for Credit.

Addiction & Stigma

Stigma: what exactly is it and how does it influence people?

Discrimination against a certain group of people, a location, or a country is referred to as stigma. People with SUD may be stigmatized for a variety of reasons, including false or unjustified beliefs that they are dangerous, incapable of handling treatment and recovery, or responsible for their illness.

What is the source of substance use disorder stigmatisation?

Stigmatization of people with SUDs may come from outdated and incorrect notions that addiction is a moral failing, rather than what we now know it to be: a chronic, treatable disease from which patients can recover and live healthy lives.

What is the impact of stigma on persons who suffer from SUBSTANCE USE DISORDER?

- - - Individuals with SUD may be less likely to seek treatment if they are stigmatized.
    - Stereotyping of people with SUD is frequent, and it can make others feel pity, fear, resentment, and a desire for social distance from them.
    - Health care providers’ impressions of persons with SUD might be influenced by stigmatizing language, which can affect the care they give.

How may stigmatizing conduct be changed?

- - Use non-stigmatizing language that represents an accurate, science-based understanding of SUD and is compatible with your professional role when speaking with persons who have SUD, their loved ones, and your colleagues.
  - Clinicians should “take all means necessary to reduce the possibility for stigma and unfavorable bias” because they are often the initial points of contact for people with SUD. Learn which terms to avoid and which to use as a starting step.
  - Allow people to select how they are described by using person-first language. By eliminating terminology that relates persons to their conditions or has negative implications, person-first language preserves individuals’ integrity as full human beings. For example, the phrase “person with a substance use disorder” has a neutral tone and separates the person from his or her illness or condition.

Is there anything else I should consider?

It is advised that doctors use the term “substance use” to cover all substances, including alcohol and other drugs, and that severity specifiers (e.g., mild, moderate, severe) be used to reflect the severity of the SUD. This language also facilitates accurate clinical evaluation documentation and the establishment of effective treatment regimens.
Use evidence-based language instead of referring to treatment as an intervention when discussing treatment plans with people who have SUD and their loved ones.

For more information, contact the Vanderburgh Communities to get more guidance on Sober houses and sober living as a whole

What terms should you avoid, what terms should you use, and why

When discussing addiction, consider using these terminology to help decrease stigma and unfavorable prejudice.

Instead of…	Use…	Because…
Addict	Person with substance use disorder	Person-first language. The change shows that a person “has” a problem, rather than “is” the problem.7 The terms avoid eliciting negative associations, punitive attitudes, and individual blame.
User	Person with OUD or person with opioid addiction (when substance in use is opioids)
Substance or drug abuser	Patient
Junkie	Person in active use; use the person’s name, and then say “is in active use.”
Alcoholic	Person with alcohol use disorder
Drunk	Person who misuses alcohol/engages in unhealthy/hazardous alcohol use
Former addict	Person in recovery or long-term recovery
Reformed addict	Person who previously used drugs

Instead of…	Use…	Because…
Habit	Substance use disorder Drug addiction	Inaccurately implies that a person is choosing to use substances or can choose to stop. “Habit” may undermine the seriousness of the disease.
Abuse	For illicit drugs: Use For prescription medications: Misuse Used other than prescribed	The term “abuse” was found to have a high association with negative judgments and punishment. Legitimate use of prescription medications is limited to their use as prescribed by the person to whom they are prescribed. Consumption outside these parameters is misuse.
Opioid substitution replacement therapy Medication-assisted treatment (MAT)	Opioid agonist therapy Pharmacotherapy Addiction medication Medication for a substance use disorder Medication for opioid use disorder (MOUD)	It is a misconception that medications merely “substitute” one drug or “one addiction” for another. The term MAT implies that medication should have a supplemental or temporary role in treatment. Using “MOUD” aligns with the way other psychiatric medications are understood (e.g., antidepressants, antipsychotics), as critical tools that are central to a patient’s treatment plan.
Clean	For toxicology screen results: Testing negative For non-toxicology purposes: Being in remission or recovery Abstinent from drugs Not drinking or taking drugs Not currently or actively using drugs	Use clinically accurate, non-stigmatizing terminology the same way it would be used for other medical conditions. Set an example with your own language when treating patients who might use stigmatizing slang. Use of such terms may evoke negative and punitive implicit cognitions.
Dirty	For toxicology screen results: Testing positive For non-toxicology purposes: Person who uses drugs	Use clinically accurate, non-stigmatizing terminology the same way it would be used for other medical conditions. May decrease patients’ sense of hope and self-efficacy for change.
Addicted baby	Baby born to mother who used drugs while pregnant Baby with signs of withdrawal from prenatal drug exposure Baby with neonatal opioid withdrawal/neonatal abstinence syndrome Newborn exposed to substances	Babies cannot be born with addiction because addiction is a behavioral disorder—they are simply born manifesting a withdrawal syndrome. Use clinically accurate, non-stigmatizing terminology the same way it would be used for other medical conditions. Using person-first language can reduce stigma.

Our sober house directory is a great place to start looking for a place to live, but ultimately it is up to you to locate the right place for you. While accreditation and a professional appearance are excellent starting points, you should conduct additional research before making a choice. Do not be hesitant to inquire! While many homes provide wonderful sober living, we have a soft spot for Vanderburgh House, which we credit to the fact that they helped create this directory.

If you’ve ever wondered what it’s like to run a sober house, we recommend contacting Vanderburgh Communities, the first organization in the United States to grant sober living charters. Maintain a positive attitude and take things one day at a time.

References

NIDAMED. (2021, July 21). National Institute on Drug Abuse. Retrieved 27, 2021, from Words Matter – Terms to Use and Avoid When Talking About Addiction

Stigma associated with medication treatment for young adults with opioid use disorder: a case series

Stigma and substance use disorders: an international phenomenon

https://www.tandfonline.com/doi/abs/10.1080/10826084.2019.1581221?journalCode=isum20(link is external)

In their own words: language preferences of individuals who use heroin

https://apastyle.apa.org/6th-edition-resources/nonhandicapping-language(link is external)

https://obamawhitehouse.archives.gov/sites/whitehouse.gov/files/images/Memo%20-%20Changing%20Federal%20Terminology%20Regrading%20Substance%20Use%20and%20Substance%20Use%20Disorders.pdf

https://www.thenationalcouncil.org/wp-content/uploads/2016/10/Substance-Use-Teminology.pdf(link is external)

https://psycnet.apa.org/record/2018-44736-001(link is external)

https://www.sciencedirect.com/science/article/abs/pii/S0955395909001546?via%3Dihu(link is external)

Confronting the Stigma of Opioid Use Disorder—and Its Treatment | Clinical Pharmacy and Pharmacology | JAMA