SAY THIS. NOT THAT.
Person in active addiction
Person with a substance misuse disorder
Person experiencing an alcohol/drug problem
Why it works: these modifiers give identity to individuals as people, rather than labeling them by their illness.
Substance misuse disorder
Alcohol and drug disorder (or disease)
Why it works: TBy incorporating disorder or disease, these terms reinforce the medical nature of the condition
Person who misuses alcohol/ drugs
Has a mental health condition (or diagnosis)
Why it works: conveys the message that an individual's total identity is not his or her illness label, rather, he or she is a full person that happens to have the experience of mental illness.
Why it works: Indicates the patient is free from the dangerous compulsive behaviors of addiction. Less stigmatizing than “clean” or “sober” yet shows the person is no longer in active addiction.
Why Language Matters
The language we use when referring to people speaks volumes about how we think about them. And how we think about things impacts our attitudes and approaches to addressing them. Calling someone an “addict” or “crazy” not only reduces them to just that, it also increases negative perceptions that influence the value of our social and public health policies.
Person-first language puts a person before a diagnosis, describing what a person “has” rather than asserting what a person “is.”
Person-first language is humanizing. When we use terminology like “addict” or “crazy,” we may unknowingly begin to objectify the person and strip away their individuality. This often reduces the person into a predetermined box that discriminates.
By placing the person first, the person is what is important. Addiction or mental illness is no longer the primary, defining characteristic of an individual, but one of several aspects of the whole person. We must speak, write and think in a way that acknowledges the human being first, rather than their condition or disease.
Health Care Professionals
The treatment and recovery communities can help recovering people grow by recognizing that they have a disease but are not defined by that disease. Recovery is about becoming a caring husband or wife, a loving father or mother, or perhaps a better son or daughter. Helping people achieve healthy biopsychosocial and spiritual lives and helping them to recognize that they have the capacity to do so is the greatest tool we have to prevent and reduce stigma.
—Richard Landis, Senior Vice President of Operations, Danya International, Silver Spring, Maryland
When a patient comes in for the first visit, focus on three things to minimize stigma and promote an effective dialogue:
- Let the patient tell their story. Start out broadly, asking open-ended questions to get the patient talking about their story—not their substance use disorder story, but rather their personal story. People really want to tell their story, but they often feel constrained in a medical environment. But if you allow them to [tell their story,] it can be the most efficient thing of all…. People want to be heard. You can get a lot of relevant information right up front. Certainly, by the time [a patient] is open to treatment, they’re not having a good time. They’ve really exported to a phase of substance use disorder that’s miserable in trying to avoid withdrawal and struggling with something that feels like it’s got a stranglehold on them.
- Get to the heart of the matter. Understanding the reason for a patient’s substance use is key to finding the treatment option most suitable for that patient. “They’re usually really hurting, and almost always they have some story of trauma that underlies it.
- Convey respect. Stigma is a big issue in these conversations, and respect is a key ingredient to avoiding it. “People with substance use disorders, because of the stigma, are used to being treated badly,” Dr. Komaromy said. “It’s so important to convey respect. The message—on a really gut level—is that I’m just another human being like you, and I want to figure out how I can help.”
Pay attention to the following:
- Never conduct the interview while standing. Try to sit at the same level as the patient.
- Make eye contact.
- Say things that are encouraging, empathetic and simple during their story such as, ‘That sounds really difficult.’
Impact of Person First Language in Addiction Treatment
Using appropriate language in a rehab treatment setting can positively affect the ways individuals view themselves and their ability to make lifestyle changes. Inappropriate language can have the opposite effect by stigmatizing certain groups and depersonalizing someone who is attempting to withdraw substance use from their individual identity.
Stigmatizing words can discourage, isolate, shame and embarrass someone with a substance abuse disorder. Entire groups of people become devalued and excluded from society when identity first language is used to describe socially unacceptable health conditions. People may decide not to seek the treatment they need because of the stigma and social or economic consequences resulting from the way they’ve been defined.
Stakeholders, Law Enforcement, First Responders, Non-Profits
Change the Dialogue
Words can heal. Words can hurt. Words can poison. Labels can lead to stigma. And stigma leads to discrimination.
Addicted people are not all the same. They are as varied as the general population. There is no “addictive personality” common to addicted people. There is as much biological, psychological, and sociological variety among addicted people as there is among the general population. Don’t generalize.
Speaking out is central to the prevention and reduction of stigma. On the most basic level, stigma prevention involves people in recovery, treatment providers and advocates, and people concerned about stigma speaking out. There is power in people telling their stories. Perceptions can change. Attitudes can shift. Behaviors can be modified. Knowledge can be increased. But none of these will happen unless people speak out. When people speak out, the power of stigma is diminished. When people tell their stories, others struggling with recovery receive encouragement, recognize that someone else has taken this journey, and perceive that they too can stay on the journey to recovery. It gives people in recovery hope.
Referring to someone as an “alcoholic”, an “addict”, a “user”, “abuser” or “crazy” is labeling a person with an illness. This tends to wipe out, in words at least, any individual differences that exist. These terms tend to presume similar experiences, character qualities and motivations that depersonalize the people they describe.
It is more respectful of a person’s dignity and worth to identify them as:
- a person with an opioid use disorder
- an adolescent with an addiction
- people engaged in risky use of substances
- a person struggling with an alcohol addiction
Friends and Family
Friends and family can make all the difference in a person's recovery process.
Talking to friends and family about SUD, OUD, MI or HIV/Viral Hepatitis problems can be an opportunity to provide information, support, and guidance. Learning about these struggles can lead to:
- Improved recognition of early signs of mental health problems
- Earlier treatment
- Greater understanding and compassion
How to Talk About It
Do you need help starting the conversation? Try leading with these questions and make sure to actively listen to your friend or family member's response.
- I've been worried about you. Can we talk about what you are experiencing? If not, who are you comfortable talking to?
- What can I do to help you to talk about issues with your parents or someone else who is responsible and cares about you?
- What else can I help you with?
- I am someone who cares and wants to listen. What do you want me to know about how you are feeling?
- Who or what has helped you deal with similar issues in the past?
- It seems like you are going through a difficult time. How can I help you to find help?
- How can I help you find more information about mental health problems?
When talking about these struggles:
- Know how to connect people to help.
- Communicate in a straightforward manner.
- Discuss the topic when and where the person feels safe and comfortable.
- Watch for reactions during the discussion and slow down or back up if the person becomes confused or looks upset.
How to Make a Difference
Whether there’s someone in your life who suffers from a substance use disorder or mental illness or whether you just want to help make a difference in the ways we, as a society, treat people with certain conditions, there are some things you can do to make a positive impact.
Take a good, long internal look at your personal feelings, words or behaviors that might be negative and/or biased in nature. Do you use or automatically think of any of the slang words listed here in relation to someone facing an alcohol and/or drug disease? Remember to put your focus on the person and not the disorder.
Try not to use addiction terms as metaphors, such as stating you are “addicted” to chocolate or saying someone has an “addictive personality.”
When you notice something inaccurate or a stereotype being used in the media, call attention to the situation. Educate other people by providing them with factual information. Actually speak to someone with an addiction if you haven’t done so already and use person first language.
If you or someone you love has an addiction issue, tell your story to others. You can also encourage and give power to people with addiction conditions in small ways, sometimes simply by using person first language.