Health Canada recently launched an initiative aimed at reducing the negative impact of stigma by changing the language we use to talk about substance abuse disorder.1 These changes align with a White House initiative, promulgated in a January 2017 memorandum, to update federal terminology regarding substance use and substance use disorders.2
In this blog, we share the specific directives of both the US and Canadian authorities that aim to reduce stigma as well as create a societal discourse that is respectful, inclusive, and compassionate. Here we share why it is important to use neutral, medically-accurate terminology when describing substance abuse disorder.
Health Canada: Changing How We Talk About Substance Use
Health Canada recommends that health care providers and researchers use “people-first language,”3 which focuses on the individual, not on the action (e.g. “people who use drugs” instead of “addicts”). In a publicly-available table, Health Canada provides the following:
|Addicts||People who use drugs|
|Junkies||People with substance use disorder|
|Users||People with lived/living experience|
|Drug abusers||People with lived/living experience|
|Recreational drug users||People who occasionally use drugs|
|Former drug addicts||People who have used drugs|
|Referring to a person as being "clean"||People in recovery|
|Substance/drug misuse||Substance use disorder
Opioid use disorder
Problematic (drug) use
US Office of National Drug Control Policy: Changing the Language of Addiction
Similarly, the United States Office of National Drug Control Policy (ONDCP) in Changing the Language of Addiction promotes the use of “person-first language” adopted by professional associations and scientific journals as a replacement for outdated, stigmatizing language for substance use.4 Taking as its cue expressions such as “person with a mental health condition” or “person with a disability,” Changing the Language of Addiction makes clear the importance of carrying neutral rather than pejorative connotations, as well as distinguishing a person from a diagnosis or perceived membership in a group.5
The current Diagnostic and Statistical Manual of Mental Disorders (DSM V) replaced older categories of substance “abuse and dependence” with a single classification of “substance use disorder.”6 According to the ONDCP, terms such as “drug habit” inaccurately imply that an affected person can choose to stop using drugs.7 Substance use disorder more accurately describes the constellation of impairments caused by a repeated use of a substance.8
The Consequences of Stigma for Persons with a Substance Use Disorder
Both countries embrace person-first language as the accepted standard for discussing people with disabilities and/or chronic medical conditions. Research shows that the use of terms “abuse” and “abuser” or “addict” and “alcoholic” carry stigma, which can negatively affect perceptions and judgments about people with substance use disorder, including whether they should receive punishment rather than medical care for their disease.9
A growing body of evidence suggests that substance use disorder is among the most stigmatized conditions in the US and Canada.10 Many believe that people with a substance use disorder can or should be denied housing, employment social services, and health care.11 Health care providers frequently have lower expectations for health outcomes for patients with substance use disorder. Additionally, people who experience stigma are less likely to seek out treatment or access those services. When they do, people who experience stigma are more likely to drop out of care earlier.12
Checking Ourselves: Does Research Language Perpetuate Substance Use Disorder Stigma?
Changes in the language that the health care research community uses to describe substance use disorder can shape public perception. Unintentionally stigmatizing language that may appear in our work can perpetuate negative stereotypes about the types of people who are affected by substance use disorder, and ultimately decrease public support for research related to prevention and treatment.
In the context of the growing opioid crisis in both the US and Canada, the language we use becomes especially important as we find ourselves in partnership with research volunteers who experience substance use disorder and who confront directly the myriad societal stigmas associated with substance abuse disorder. The guidelines of Health Canada and the US Office of National Drug Policy provide useful standards against which we can gauge the language we use in research-related materials and ensure we avoid continuing that stigma.
At Quorum Review we are driven by our missional commitment to “build a community dedicated to the well-being of all people, and to drive research forward together.” We are guided by the core value of treating all people with respect, which carries with it an obligation to employ language around substance use disorder that is not only medically accurate, but also compassionate.
6. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, D.C. 16
9. Kelly, J.F., Westerhoff, C.M. (2010). Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms. International Journal of Drug Policy. 21(3):202-7. 6
10. Barry, C.L., McGinty, E.E., Pescosolido, B.A. & Goldman, H.H. (2014). Stigma, discrimination, treatment effectiveness, and policy: public views about drug addiction and mental illness. Psychiatric Services 65(10), 1269-1272.
11. Committee on the Science of Changing Behavioral Health Social Norms; Board on Behavioral, Cognitive, and Sensory Sciences; Division of Behavioral and Social Sciences and Education; National Academies of Sciences, Engineering, and Medicine. Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence of Stigma Change. Washington (DC): National Academies Press (US); 2016 Aug 3,2, Understanding Stigma of Mental and Substance Use Disorders. Available from: https://www.ncbi.nlm.nih.gov/books/NBK384923/
12. Wagner, K.D., Davidson, P.J., Iverson, E., Washburn, R., Burke, E., Kral, A.H.,…&Lankaneau, S.E. (2014). “I felt like a superhero”: The experience of responding to drug overdose among individuals trained in overdose prevention. International Journal of Drug Policy, 25(1), 157-165.