On January 9th, 2017, the White House released a “Memorandum to Heads of Executive Departments and Agencies”. The subject of the memorandum was “Changing Federal Terminology Regarding Substance Use and Substance Use Disorders”. Enclosed was a document entitled Changing the Language of Addiction. The memorandum was designed to guide federal agencies in the proper terminology to use in reference to substance use disorder in government literature and/or communications.
Why is the highest office in the land an advocate for changing the language of addiction? Furthermore, why might these changes be more prevalent in clinical settings rather than society at large or even the recovery community itself? Our goal is to not only help people understand why experts propose changing the language of addiction, but also to inspire the community to adopt, embrace, and encourage a progressive attitude toward an updated vocabulary.
Why Are Experts Changing the Language of Addiction?
Since Alcoholics Anonymous was founded in 1935 – and Narcotics Anonymous in 1953 – the terms “alcoholic,” “addict,” “addiction,” “substance abuse,” and “clean” have been prevalent in recovery circles. In society at large, terminology has been even more jarring, with labels like “junkie” or “drunk” tossed around with little regard to the cruelty. While it’s easy to understand why the use of these words is incredibly stigmatizing, what about terms like “addict” et al.? In a nutshell, these words minimize the fact that substance use is a disorder rather than an identity or a reflection of moral character. The White House memo provides a succinct and scientific explanation:
“[Sometimes] the terminology used in the discussion of substance use can suggest that problematic use of substances and substance use disorders are the result of a personal failing…However, research shows addictive substances can lead to dramatic changes in brain function and reduce a person’s ability to control his or her substance use, and that repeated use of these substances powerfully alters brain chemistry and the function of brain circuitry to create a neurobiological disorder.
Research also has shown that people with substance use disorders are viewed more negatively than people with physical or psychiatric disabilities…Negative attitudes among health professionals have been found to adversely affect quality of care and subsequent treatment outcomes. Shame and concerns about social, economic, and legal consequences of disclosing a substance use disorder may deter helpseeking among those with substance use disorders and their families”.
The Process Recovery Center’s clinical director, Traci Weaver, MS, MBA, MLADC, LCMHC, points to generational factors when explaining why some treatment professionals support changing the language of addiction. In the age of social media, young people are wired for instant gratification. The window to connect with them is, therefore, intrinsically narrow. The use of negative or shaming language can slam the window shut. Traci asserts that treatment providers and recovery programs need to be sensitive to the needs of young people, and to shape interventions accordingly. Changing the language of addiction is one way to start. A failure to do so could, arguably, lead to a paucity in effectiveness and program relevance. Traci also uses a bus analogy to describe a holistic approach to the individual. If the bus represents a person’s overall identity, substance use disorder only represents one passenger. Identifying solely as an “addict” can not only feel unwelcoming or negative, but it is also dismissive of all the other passengers on board the metaphorical bus.
Resistance to Changing the Language of Addiction
Those who don’t have a thorough understanding of substance use as a neurobiological disorder will be most resistant to changing the language of addiction. Unfortunately, some individuals cling to the idea that substance use disorder is a “lack of willpower,” despite concrete, irrefutable science proving otherwise. However, another variety of resistance may come from the recovery community itself, particularly 12 Step programs which have been utilizing terms such as “addict” and “alcoholic” since their inception. In programs like A.A., many members introduce themselves by saying: “Hi, my name is ____________, and I’m an alcoholic”. Advocates of this practice argue that it helps newcomers not only bust through denial, but also combat shame around having a substance use disorder. Since most members identify this way, it can help a beginner feel less alone.
However, this practice can have the opposite effect. As the Process’ clinical director points out, substance use disorder is only one small element of an individual’s overall makeup. Feeling pressure to assume an all-encompassing label with widespread negative connotations can drive some seeking help out the door. While 12 Step programs are effective – and have been saving lives for decades – science has progressed and alternative interventions are available. This lends credence to the idea that the recovery community as a whole is more sustainable if programs maintain an open mind. The availability of a wide variety of recovery programming entails a greater number of lives saved – which gives programs the impetus to evaluate their practices and strive to be as welcoming and progressive as possible.
What Words Should I Use?
According to the White House memo, research demonstrates “that use of the terms “abuse” and “abuser” negatively affect perceptions and judgments about people with substance use disorders, including whether they should receive punishment rather than medical care for their disease. Terms such as “addict” and “alcoholic” can have similar effects”. To counteract unsympathetic and punitive attitudes, the Office of National Drug Control Policy recommends person-first language. “[Expressions] such as “person with a mental health condition” or “person with a disability” carry neutral rather than pejorative connotations, and distinguish the person from his/her diagnosis”. An example of a person-first statement would be “person with a substance use disorder” versus “an addict”.
The Office of National Drug Control Policy further recommends avoiding terms like “clean” or “dirty”, which suggest a flaw in a person’s moral character. It is more appropriate to describe someone as a “person in recovery”. If a drug test reveals substance use, it is appropriate to describe the results as “positive,” and the individual as a “person who is currently using substances”.
If you or a loved one need assistance with a substance use problem, please call (888) 649-1149 or contact us here.
Autumn Khavari is the Process Recovery Center’s in-house writer. She received an education in Substance Use Counseling from Beal College in Bangor, Maine.
Memo – Changing Federal Terminology Regarding Substance Use and Substance Use Disorders. (2017). Retrieved from https://www.whitehouse.gov/sites/whitehouse.gov/files/images/Memo%20-%20Changing%20Federal%20Terminology%20Regrading%20Substance%20Use%20and%20Substance%20Use%20Disorders.pdf