Language Can Help Reduce Stigma of Substance Use Disorders
Physician and School of Public Health professor calls for scientifically accurate, non-punitive terms
Changing the language around drug use can help to reduce the stigma for the 23 million Americans who meet criteria for a substance use disorder, according to a Boston University School of Public Health (SPH) researcher, writing in the American Journal of Medicine with two colleagues from Massachusetts General Hospital.
“Every day in our work, we see and hear individuals described as ‘alcohol/substance abusers,’ and urine toxicology screens coming back ‘dirty’ with drugs,” says Dr. Richard Saitz, chair of community health sciences at SPH, and co-authors, in the editorial. “Clinicians may even praise a patient for staying ‘clean’ instead of for having ‘a negative test result.’
“We argue such language is neither professional nor culturally competent and serves only to perpetuate stigma,” they continue. “Use of such terms may evoke implicit punitive biases and decrease patients’ own sense of hope and self-efficacy for change.”
Saitz and co-authors Dr. Sarah E. Wakeman and John F. Kelly say that referring to substance users as “abusers” creates an “implicit cognitive bias that results in punitive judgments that may perpetuate stigmatizing attitudes.” They note that stigma decreases when people perceive that an individual is not responsible for causing his or her problems, and they cited research indicating that half of the risk for addiction is conferred by genetics.
In addition, they say, the chronic effects of substances on the central nervous system produce “profound changes in brain structure and function that radically impair efforts to control use, despite harmful consequences.”
The researchers argue that use of language can go far in helping to reduce stigma, especially in a medical setting.
“Use of the more medically and scientifically accurate ‘substance use disorder’ terminology is linked to a public health approach that captures the medical malfunction inherent in addiction,” they say. “Use of this term may decrease stigma and increase help-seeking.
“In contrast, tough, punitive language, including the word ‘war,’ in ‘war on drugs,’ is intended to send an uncompromising message, ‘You use, you lose,’ in the hopes of deterring drug involvement. Accompanying this aggressive rhetoric are terms such as drug ‘abuse’ and drug ‘abusers,’ implying willful misconduct…This language increases stigma and reduces help-seeking.”