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At ARCNH we specialize in providing resources that support long term recovery from Substance Use Disorder (SUD). We’ve talked in previous blog posts about what some of those resources are. We went into detail about Recovery Coaching (embed link here) and we discussed our referral services (embed link here) but we have yet to cover exactly what Substance Use Disorder is. So let’s dive into it. 

 

Defining Substance Use Disorder

SAMSHA, or the Substance Abuse and Mental Health Services Administration, defines Substance Use Disorder as ;

 

when the recurrent use of alcohol and/or drugs causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home.”

 

The American Society of Addiction Medicine, or ASAM, defines addiction as;

“a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences. 

Prevention efforts and treatment approaches for addiction are generally as successful as      those for other chronic diseases.”

 

Understanding the Definitions

The term SUD covers many conditions which include Alcohol Use Disorder, Opioid Use Disorder, or non-medical use of any substance including; nicotine, prescription medications, stimulants, hallucinogens, or cannabis. While the above definitions of SUDs seem pretty cut and dry the reality of what SUDs is is much more complicated. The National Institute of Mental Health (NIMH) reports that about 50% of individuals with SUDs have co-occurring mental health conditions like anxiety, depression, bipolar disorder, ADHD or PTSD. SUD does not occur in a bubble likewise, it isn’t a condition with a singular or simple cause. 

 

Like all medical conditions everyone has varying risks for acquiring a SUD. Among the risks that can lead to SUDs are genetics, personal stress, personal trauma, pre-existing mental health conditions, or a family history of trauma or extreme stress which (studies show) can cause genetic changes that predispose individuals to be at higher risk of developing a SUD. Once an individual finds themselves struggling with a Substance Use Disorder, the nature of the disorder makes it increasingly more difficult to achieve recovery. According to NIMH; “ brain changes in people with mental disorders may enhance the rewarding effects of substances, making it more likely they will continue to use the substance” and “substance use may trigger changes in brain structure and function that make a person more likely to develop a mental disorder.” As we can see, SUDs are not as simple as the media sometimes makes them out to be. What is actually true about people with Substance Use Disorders is that they are people struggling with a complex and difficult condition. Like all of us they deserve kindness and compassion. Unfortunately, that is not always what is received.

 

The Stigma Barrier

The language that surrounds Substance Use Disorder in media, in society and even in medicine is often highly stigmatized and can be derogatory. This is problematic not just because it is hurtful but because the stigma of SUD is also a huge barrier to recovery for many. According to ASAM in a study performed in 2017, “28% of individuals in need of substance use treatment reported not obtaining help due to stigma”. Changing the language we use when discussing SUDs or people with SUDs is a simple way to start shifting the perception of society, reducing the stigma of SUDs, and reducing barriers to recovery services. 

 

Turning the Terminology

We have created a chart discussing some common terms used when discussing SUDs that are actually stigmatizing or hurtful and providing alternatives that reduce stigma. If you’re worried about remembering all this terminology try to just remember this good rule of thumb; use people-first language like “a person struggling with a Substance use Disorder” or “a person in Recovery”. This language communicates that the person is your primary concern and that there is more to them than the condition they are struggling with. 

 

Stigmatized Language

The Harm

Language to Use Instead

Substance Abuse The word ‘abuse’ can create stigma as it communicates a negative judgement of the individual.  Substance use, Substance misuse, non-medical medication use, person suffering from SUDs
Abuser Research has shown this term increases stigma thus decreasing quality of care and deterring an individual from seeking treatment as they may feel shame for being labelled an Abuser.  Person suffering from SUDs
Addict Research has shown this term increases stigma thus decreasing quality of care and deterring an individual from seeking treatment as they may feel shame for being labelled an Addict.  Person suffering from SUDs, person who uses substances non-medically
Alcoholic Implies a nonexistent simplicity of the condition of Substance Use Disorder and communicates a negative perception. Person suffering from SUDs, person who uses alcohol, person with Alcohol Use Disorder
Dirty The words Clean and Dirty imply a moral goodness or badness and that a person labelled dirty is of lesser value.  Tested positive, person suffering from SUDs, used (in the case of needles)
Clean The words Clean and Dirty imply a moral goodness or badness and that a person labelled dirty is of lesser value.  In remission, in recovery, tested negative, not used (in the case of needles)
Codependency Labelling someone as codependent can make them feel ashamed of a relationship that is supporting them. Or reduce their likelihood of seeking treatment. Try to avoid this language at all if you can’t try: Emotional or psychological reliance
Dope Sick This slang term minimizes the experience of someone suffering from opioid withdrawals Suffering from withdrawal
Drug This word creates ambiguity which can lead to stigma as drug could mean a medically or non-medically prescribed substance. non-medically used psychoactive substances or medication
Drug Abuse Confers stigma from non-medically used substances onto medically used substances due to the ambiguity of the “drug” creating an additional barrier to treatment suffering from SUDs
Dry Drunk This term minimizes the achievements an individual has made towards their recovery by implying that despite sobriety this individual is still a “drunk” Person in recovery struggling with their mental health
Enabling Places blame and judgement on individuals who may be a vital part of the person with SUDs network Try to avoid this type of language at all if you can’t try: emotional or physical dependence
Lapse, Relapse, Slip Implies a moral failing is associated with a return to use.  Resumed use, experienced a recurrence, return to use
Opioid replacement Therapy Implies that Medication Assisted Recovery from Opioids is just a transition of the Use Disorder from one Substance to another.  Medications for addiction treatment, Medication Assisted Recovery
Prescription drug misuse For some the term misuse is seen as stigmatizing as it implies a negative judgement. Non medical use of a psychoactive substance
Junkie, dopefiend, meth head, stoner Any slang term applied to a human for any reason is hurtful. Minimizing an individual to a label communicates that they are seen as no more than a Substance User. Using person-first language is an important tool in ensuring people understand that they are important and seen as more than the Substance they use.  Person suffering from SUDs
Dope, smack, etc.  Street terms for substances communicate a casual attitude towards a difficult condition.  Opioid, substance, non-medically used drug

 

Harmful in and out of Context

Much like saying “I’m so OCD” just because you like your desk organized, using SUDS specific stigmatizing language out of context is harmful. For instance, saying “this chocolate is like crack” when really you have a healthy relationship chocolate is harmful. Casually throwing around language that is related to  something serious for others minimizes the experience they are having. Much like suggesting OCD is as simple as enjoying organization, suggesting that a Hershey’s bar is similar to cocaine is dismissive of the severity and difficulty of an actual substance use disorder. 

 

What To Do When You Catch Yourself Using The Wrong Language

Everyone makes mistakes and that’s ok. The important thing is that you are trying. If you catch yourself using a word that is harmful simply correct it and move on. So if you say “He’s an addict” and quickly realize your mistake just say “excuse me, He’s a person with a substance use disorder” and then move on. You don’t need to make a big deal of it, just simply and quickly correct your language. 

 

Side note. This is also the advice if you slip up on someone’s pronouns, racial identity, etc. etc. 

 

The Impact You Make

Reducing stigma and changing the way society views people with substance use disorders is a huge task. It will take time and it will take effort but we know it’s possible. Look at the way society’s views have shifted on racial and gender equality, LGBTQ+ rights, and HIV/AIDS. By reading this article and becoming more cognizant of your language you are taking a very important step in reducing the stigma of Substance Use Disorder. By reducing stigma we reduce the barrier to treatment it creates and hopefully help more people find recovery. So thank you for taking the time to broaden your perspective, please feel free to share this blog post and to reach out to us if you have any questions. 

 

Contact us at (603)554-8142 or recover@arcnh.org

 

For More Information

If you are interested in learning more about stigma around SUDs, compassionate terminology or recovery here are some interesting sources we found:

 

Recovery Research Institute – Addictionary

 ASAM Public Policy Statement: Definition of Addiction

Rural Health Information Hub – Defining Substance Abuse and Substance Use Disorders

The Menninger Clinic – The Semantics: Examining the language of addiction recovery and treatment

National Institutes of Mental Health – Substance Use Disorder and Co-Occurring Mental Disorders

Recovery Research Institute – The Real Stigma of Substance Use Disorders

The American Journal of Medicine – Stop ‘Talking Dirty’: Clinicians, Language, and Quality of Care for the Leading Cause of Preventable Death in the United States

 

Get Help Now

If you or a loved one is struggling with Substance Use Disorder and you are ready to learn about recovery or just need to chat, reach out to us at (603)554-8142 or at recover@arcnh.org.

 

 

 

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