Words Matter: What We Say Can Determine Who Gets Help

Using clinically-accurate terms to describe substance use disorders (SUD) has far more to do with medical accuracy than it does with political correctness. SUD is a disease of the brain and, like any physical condition, the terms used in describing the disease ought to be based on science, not judgement. But experts remind us there is an even more compelling reason to use non-stigmatizing language for SUD: doing so may lead to significantly more people entering treatment. Boston Medical Center’s Grayken Center for Addiction is among several organizations leading the effort to encourage use of non-stigmatizing language as one means to increase treatment rates.

It is estimated only one in 10 people in need of substance use treatment receive it, because of the stigma associated with the disease—patients fear public acknowledgement of their disease could lead to consequences within their careers and/or communities. To break it down further, a significant driver of stigma, defined as “a mark of disgrace associated with a particular circumstance, quality or person,” is the use of derogatory language. Often, the words used around substance use connotes judgement, personal blame and moral failing. Terms like “addict,” “drug habit” and “abuser,” have historically prompted a punitive response rather than one that involves support and recovery.

In one study, mental health and SUD clinicians were significantly more likely to assign blame when an individual was described as a “substance abuser” rather than “a person with a substance use disorder.” In another study, mental health practitioners attending professional conferences were less likely to believe individuals deserved treatment when they were described as a “substance abuser” rather than “a person with a substance use disorder.”

For health care professionals, using accurate, non-stigmatizing language is especially important.

“The routine vocabulary of health care professionals and researchers frames illnesses and shapes medical judgements, and when used in the public arena, convey social norms and attitudes,” wrote Michael Botticelli, executive director of the Grayken Center for Addiction at Boston Medical Center, in a 2016 JAMA article he co-authored.

The Center hopes to influence how the health care community frames addiction with an eye toward more people seeking treatment. In 2017, BMC launched an on-going campaign called, Words Matter which asks all hospital personnel to sign a pledge to “use clinically- appropriate and medically-accurate terminology that recognizes substance use disorder as a chronic illness from which people can and do recover, not a moral failing.”

The pledge, which is available for any organization to adopt, comes with guidelines for stigmatizing and non-stigmatizing language. Person-centered rather than disease- or condition-centered language has been a successful strategy in other areas such as disabilities and mental illness and applies here as well. The effort builds on Botticelli’s previous work as head of the federal Office of National Drug Control Policy where he introduced correct terms for all federal agencies and departments.

Meanwhile, other prominent organizations have also taken up the call. The American Medical Association has urged physicians to use non-stigmatizing language to enhance treatment access for people with SUDs; the American Society of Addiction Medicine and major addiction journals have done the same and are careful to use clinical, non-stigmatizing language. And the Associated Press, the world’s largest wire service, has updated its style book and advises journalists to avoid words like “alcoholic, addict and abuser.”