May 25, 2019  

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Language and Addiction

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Most of use likely know someone who has or is struggling with a substance use problem or an addiction. Addictions, specifically related to substances, is one of the most stigmatized public health problems worldwide. A major contributing factor to this stigma is the belief held by many about what an addiction is, how it began, and how it is maintained.

For example, many undergraduate students who take my alcohol and drug class will say when beginning the class that addiction to substances is caused by a lack of morality or will power. These comments are often guided by the belief that the addiction that developed was based on a choice to use the substance in the first place. There is no arguing that for most, the initiation of substance use was a behavioral choice; however, there is increasing evidence showing that addiction is a disease. The Merriam-Webster’s dictionary defines disease as “a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms.”

With the advances in science, especially genetics and neuroscience, we have come to learn that the repeated and persistent use of substances changes the functioning in the brain and that the person cannot “simply stop.” These facts bring us back to the stigma associated with addictions, and more specifically how this stigma is maintained. One major factor maintaining this stigma is the associated language we use when describing someone who may have an addiction. Although the movement to destigmatize addictions dates back decades, research is helping us understand how the language we use communicates our judgments and biases ultimately strengthens the stigma.

Harvard Psychologist, John Kelly, has demonstrated through research that among the public describing someone as a “substance abuser” was more likely to elicit judgements of blame and punishment for that person than describing them as “having a substance use disorder.” Interestingly, these findings were very similar when the same research was conducted with doctoral-level mental health and addiction clinicians. Additionally, researchers at the University of Pennsylvania showed that terms labeling people as “addict,” “alcoholic,” and “substance abuser” elicited very strong and negative biases, and that these biases may not even be in our conscious awareness. Therefore, it appears that language matters in helping us to reduce the stigma associated with addictions.

Because the science exists linking labeling words to negative stigma and blaming, there is an increasing effort to change the language related to addictions from labeling or blaming language to positive and person-first language. Positive and person-first language includes terms such as person who uses substances instead of substance abuser, a person with a substance use disorder instead of addict/alcoholic, and recurrence of use instead of relapse. Changing the language may seem like a small step, and at the same time the research shows us it eventually may change our attitudes.