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Don’t Call Jessica Lareau an Alcoholic. To Her, Words Matter

SSW grad student in long-term recovery from addiction takes on stigmatizing language

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Jessica Lareau used to drink too much. She tried to stop many times, but was unable to on her own. Finally, she sought help. And she has not had a drink in four years. But do not call her an alcoholic. “I’m a person in long-term recovery,” says Lareau, a 28-year-old graduate student in the School of Social Work.

That distinction is significant to her.

She doesn’t believe anyone should be labeled as an alcoholic—or a drug abuser or an addict, for that matter. “That’s stigmatizing language,” says Lareau, who is studying to be a licensed clinical social worker (LICSW) and a licensed alcohol and drug counselor (LADC), “and it reinforces the view that it’s a moral failing and not a disease for which people need treatment.”

People being the crucial word. Label Jessica Lareau an alcoholic and you erase all the other things that define her as a young woman—a BU straight A student from Connecticut, a violinist, a swing dancer, a backpacker, a fly fisherwoman, and a former Peace Corps volunteer in Ethiopia.

Now, Lareau is on a new mission. This semester she launched a campaign—Support Recovery Initiative—to get SSW faculty, staff, and students to replace that stigmatizing language, in teaching, in conversations, in course curricula, and in field placements, with terms that put the person first, not the illness—as in person in recovery or person with a substance use disorder.

The reception has been overwhelmingly positive. “Language is a social construct,” says Jorge Delva, dean of SSW. “As the context changes, new words come in or old words become obsolete and some words become inappropriate. We’re taking Jessica’s work around substance use disorder as an opportunity to make nonstigmatizing language in all areas a more salient conversation at the school.”

Lareau would like to make it a University-wide conversation. She’s met with addiction expert Richard Saitz (CAS’87, MED’87), a School of Public Health professor of community health sciences and a School of Medicine professor of medicine, to enlist his help. Saitz has spoken publicly about the importance of using nonstigmatizing language.

Lareau is bringing to SSW a movement that has been gaining momentum among health policy experts, addiction researchers, and healthcare professionals who work with people with substance use disorders. Not referring to a person as an alcoholic or a drug abuser is not about political correctness, they say, but about being scientifically accurate and describing substance use disorder as a disease of the brain—and as in any physical illness, without judgment.

More important, say experts at Boston Medical Center (BMC) and its Grayken Center for Addiction, which have been leaders in this movement, the use of nonstigmatizing language may significantly encourage more people to seek treatment. Studies show that healthcare professionals and the treatment decisions they make are influenced by how addiction is talked about.

Even journalists who chronicle the nation’s opioid epidemic are making efforts to change their language. In 2017, the influential Associated Press Stylebook declared that journalists should no longer use the word addict as a noun. Instead, they should “choose phrasing like he was addicted, or people with heroin addiction,” the revised stylebook says.

The New York Times is also grappling with the issue, but has not yet made similar institutional changes. “We’re aware of the movement among many experts and others to avoid the word addict as stigmatizing,” Philip Corbett, the paper’s associate managing editor for standards, wrote in an email. But he also said that since the word is so commonly used and familiar and the alternatives can be awkward, any change is complicated.

Times journalists are already using a range of descriptions,” Corbett wrote, and many avoid “addict” when possible.

For Laureau, that shift can’t come soon enough.

On a frigid morning in February, she stood in front of her teacher, Ashley Davis, an SSW clinical associate professor, and classmates in the course Social Work Research 1. “I’m a person in long-term recovery,” she began. “I spent a really long time calling myself an alcoholic because that’s what AA taught me to do.”

It’s okay for people in AA to use that term, she said, and she herself didn’t give it much thought until last semester, when she enrolled in a class on addictions taught by substance use disorder treatment expert Eric Devine, a School of Medicine assistant professor of psychiatry. Devine talked about the harm inflicted by stigmatizing language around addiction. He directed students to research indicating that doctorate-level mental health and substance use disorder clinicians were significantly more likely to assign blame when a person was described as a substance abuser rather than a person with a substance use disorder.

Devine told the class about the Words Matter pledge, which has been a core part of the mission of BMC and the Grayken Center for Addiction since 2017, when Michael Botticelli, who is in long-term recovery from a substance use disorder, became Grayken’s executive director. The pledge is modeled after guidelines Botticelli helped introduce for federal agencies when he led the Office of National Drug Control Policy under President Obama. The pledge asks all hospital personnel 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.”

“I thought that was really inspiring, and why couldn’t we do something like that at BU,” Lareau told her classmates that February morning. She has begun a similar conversation at McLean Hospital’s adult drug and alcohol treatment program, where she is a graduate intern.

There are nearly 21 million people in the United States with a substance use disorder and only about 10 percent of them get treatment. People cite stigma as the number one reason why more don’t seek help. Lareau said that it’s why she delayed getting help from Alcoholics Anonymous.

“I didn’t want to be an alcoholic,” she said. “I said to myself, ‘I drink a lot, but I know people who drink more than me so I can’t be an alcoholic, especially if they aren’t.’ It’s a spectrum, and people need to see it that way. That’s probably the reason why so few college kids get help, despite so many drinking at unhealthy rates. They have an idea of what an alcoholic is, and it is not a 23-year-old college student with high grades, great relationships, great work ethic, and a promising future.”

After she finished speaking, she passed around the Words Matter pledge and a separate Support Recovery Initiative pledge, which asks students to commit to changing their own language. Davis, and her fellow students, gave her a round of applause.

Two students raised their hands to thank her and volunteer that they, too, were in recovery and had internalized the stigma brought on, at least in part, by language.

Davis described Lareau’s efforts as a “great example of social action.”

Davis sits on the SSW curriculum committee, which heard Lareau’s pitch last month asking the department to change its language. “There was unanimous support among the faculty,” Davis says. “There was no pushback. If anything, it was, look at what our students are doing—we need to catch up.”

The BU Collegiate Recovery Program connects students in recovery from substance use and provides a support network for wellness and long-term recovery. BU students in recovery can email recovery@bu.edu to learn more. If you are a BU student questioning your substance use, Behavioral Medicine offers free, confidential counseling and is available 24/7 for emergencies. Call 617-353-3569 for a fast and free appointment.

 

25 Comments
Sara Rimer, Senior Writer and Director, Research Communications at Boston University
Sara Rimer

Sara Rimer can be reached at srimer@bu.edu.

25 Comments on Don’t Call Jessica Lareau an Alcoholic. To Her, Words Matter

  • Phyllis McGinnis on 04.02.2019 at 6:15 am

    Jess,great work that will make positive change within our community as we embrace Words Do Matter!

  • Nancy Connor on 04.02.2019 at 10:22 am

    What if you have a person in your family or close friend who is actively over drinking or using drugs and not in recovery? is there non stigmatizing language someone can use when describing for them?

    • Emily Oot on 04.02.2019 at 10:28 am

      “person with a substance use disorder”

  • Bill W on 04.02.2019 at 11:39 am

    AA members say “sober alcoholic” or “alcoholic in recovery” to emphasize awareness of the danger of relapse. Makes sense to me. Relapse is a lot more dangerous than whatever stigmatization still exists. But AA doesn’t have any rules for how you identify yourself. Whatever works for you is fine.

    • Jessica Lareau on 04.04.2019 at 11:08 am

      Hi Bill, I completely agree that people should self-label in whatever way that “keeps them sober.” I responded to a similar comment below if you want to see a more clarified explanation of the target audience for these changes or some research behind the terms. Thanks!

      • Bill W on 04.08.2019 at 10:58 am

        Jessica, I assume you know that AA and NA members identify themselves in diverse ways already. Off the top of my head “I don’t want to drink today”, “I’m a drunk” (remembering when he asked a bouncer throwing him out of a bar “Don’t you know who I am” and the reply was “I know. You’re a drunk”), “I’m addicted to more” and one you might like “Champion human being”. There are many more!

        In my opinion it makes sense to identify as an alcoholic or addict since complacency can set in with long term recovery and I think even little reminders can influence behavior.

    • Cindy L on 04.22.2019 at 10:45 am

      Bill – extremely important points. the word alcoholic carries a very heavy weight but that’s crucial.

  • Stephanie Donvan on 04.03.2019 at 9:28 am

    Wow! Jess, this is fabulous work you are doing! Excellent article…keep up the good work.

  • Jim Jackson, MSW on 04.03.2019 at 4:34 pm

    As a someone who is relatively obsessive about words, I think “Words do Matter”. However, in my opinion this approach sounds like a hedge so many in need of sobriety do not need. As a clinical social work and recovering alcoholic, I do not find the term alcoholic stigmatizing. One who is secure in their sobriety need not be concerned. Labeling oneself, if you will, an ‘alcoholic’ is simply a way to take full responsibility for recovery and ‘fess up to the devastation one may have caused in the lives of other people, and the need to fully embrace the challenging road to sobriety. Maybe I’m unique, but I don’t think I’ve ever considered alcoholism or ‘alcoholic’ a moral failing. Polite or clinical terms such as “person in recovery” or “person with a substance abuse disorder”, from my perspective, invite minimizing and rationalization of the terrible consequences of addiction. Alcoholic and addict are powerful words that remind me (and others) of where I’ve come from and a need for vigilance. Recovery is the polite and neutral moniker that glosses over the nature of the beast. Perhaps our colleagues are overthinking the issue.

    • Jessica Lareau on 04.04.2019 at 10:19 am

      Hi Jim, thanks for your perspective, I completely understand what’re your saying. One of the stipulations is that everyone should self-identify however they wish, I’m a total proponent of “whatever keeps you sober.” This new language is simply another option for those in recovery and it can also be used to teach family, friends, and society about stigma & why someone might choose to identify this way. In reference to clinicians or universities, they should only be using these terms because they are the most clinically accurate, “substance use disorder” is the correct DSM diagnosis, and these newer terms are proven not to cause implicit bias. This movement is based on research proving that clinicians & people in society are unconsciously biased when they read/use the older terms. It has been proven that they view people with a more negative, punitive outlook & lean more towards punishment over treatment when they read, hear or use these terms. Basically saying that, although you do not see the term “alcoholic” as a stigmatizing term, research shows that people outside of AA unconsciously see it as negative or attribute it more to a choice or moral failing rather than to a disease. Lastly, if someone in society says “addict,” that carries a different meaning for that person than the one you were discussing. People in recovery can still identify in any way they like, these terms are meant for everyone else, in order to get rid of judgment, stereotypes & negative connotations that are inevitably attached to the “older terms.”

  • Elizabeth Rouillard on 04.03.2019 at 8:44 pm

    Thank You Laura! I too am a graduate student at BU in the MSW off campus program working to obtain my LICSW. I have been sober from heroin 7 years this August. Words Do Matter! Education and Prevention Matters. We Matter! Great Work!

  • Sarah O on 04.05.2019 at 11:38 am

    This was an interesting read. I’d like to add another perspective here. It seems to me the new language is missing the point that often times the choices and especially untruths that “people with a substance abuse disorder” have made or perpetuated have resulted in hurt not only to themselves but also others. Unconscious bias has a basis in reality – the focus perhaps should be on addressing the source(s) of unconscious bias. Accepting and owning what the illness is (alcohol, drugs etc.) rather than trying to wrap it up with a vague generic clinical description seems to me to be more honest. Unless an individual has been on the receiving end of interactions with a person with a substance abuse disorder, people in recovery are not best suited to understand the “judgment, stereotypes and negative connotations” that come from the experience of others. People can self-identify any way they want, just don’t impose your language on others. If new terms are needed, let’s find some that are inclusive of everyone’s experience and rather than those that appear to be designed make one group of people feel better about themselves.

    • Jessica Lareau on 04.07.2019 at 1:15 am

      Sarah, I’m so sorry, it sounds like your experiences, as a person close to someone with an addiction, have been difficult to deal with and painful to bear. They say that “addiction is a family disease” and I completely agree when you say that this disease hurts other people besides just the person with a Substance Use Disorder (SUD). Understandably, you sound very hurt and angered at the illogical actions of people with SUDs and I hope you know that people with SUDs also feel horrible about the devastation caused by this disease. I can tell you first-hand that the amounts of shame and guilt are overwhelming in people with SUDs, no matter how they self-identify. However, we have seen through history and research that shaming, punishment, and guilt do not motivate people to seek treatment, remain sober or stop using drugs & alcohol, as was evident in the “War on Drugs.” I agree that people should self-identify in whatever way they want, we do not “impose our language on others,” we simply provide another option and discuss why one might choose to identify this way. I understand why you don’t feel people with SUDs can understand the negative experiences of their family or others also affected by addiction. You are right, one won’t ever understand the hurt family members felt as a result of one’s SUD, however, many people with a SUD have also had relatives with addiction and have had to go through the same hurt, scientists have even found 11 genes that can prove addiction is hereditary. For example, I experienced the pain and destruction of a family member with a SUD long before I developed an addiction myself. Both positions are difficult to be in, but just because a person with a SUD wants to be seen as normal, like anyone else with an illness, does not mean that they don’t accept the gravity and the seriousness of the illness. So I ask you- have any stereotypes served any positive purpose throughout history? I rally against the belief that people with SUDs deserve to be viewed negatively for the rest of their lives. Since 1956, SUD has remained scientifically proven as a disease like any other and not a choice. Lastly, there are specific clinical terms like “Alcohol Use Disorder, Opioid Use Disorder,” etc. if one wants to be more accurate by naming the substance. These terms are not attempting to be vague, dishonest or delicate when it comes to the devastating nature of this disease, we are simply suggesting to follow the medical diagnoses already established by experts in the DSM-V and not require that a person’s disease become their identity and sole descriptor.

  • MM on 04.05.2019 at 1:49 pm

    I’d like to also add that stigma and discrimination against individuals with serious mental illness continues to be a problem and they too, need to be included in this conversation. I still see/hear people casually use the word “(that person is a) schizophrenic” to describe someone with schizophrenia and who is in recovery. The field of psychiatric rehabilitation (https://www.psychrehabassociation.org/about/core-principles-and-values) have considered this stigmatizing language and have advocated for change for years.

  • PJY on 04.09.2019 at 6:57 am

    Great article! There is a strong movement in the Peer Community teaching how to use human experience language, not only using the DSM V diagnosis for example a person with substance use disorder, but moving away from delusions/hallucinations with people who have fixed beliefs or a person who hears voices. Just using more everyday language to describe the situation.

  • Faigy on 04.09.2019 at 10:20 am

    Jessica, I really appreciate what you are trying to do! Continue the great work! As a student of Social Work myself, I have to admit to using works such as ‘alcoholic’ and ‘addict.’I have never looked at it with the perspective that you have presented. Now that I have read your article, I hope to use those stigmatizing words less often and work together towards helping people get the help they need without feeling stigmatized.

  • S on 04.09.2019 at 10:22 am

    As a sober alcoholic, MSW student myself I detract. We can’t say “addict” anymore? That’s fragility gone too far. Yes, “people with SUDs” of course have a long history of stigma (to say the least) and language matters. But let’s get some perspective. Throw out things like “junkie”, but “addict”, really? There’s something about that language that helps keep people, like myself, ‘honest’ if you will. And as someone else pointed out, some consider those terms helpful, self-identifying language. In this instance, it’s not right to constrict how some speak because a select few are offended. At a certain point, you have to have enough ego strength to not let what society thinks affect you. Lastly, long-term recovery is traditionally considered 5 years.

    • Jessica Lareau on 04.09.2019 at 2:03 pm

      As stated in the article, these terms are simply a new option developed by researchers on stigma to further align with person-centered care practices and assure that a person’s diagnosis does not consume their identity. They are a person living with challenges, not just a label. These terms are also empirically-proven through research, debated by top addiction professionals and refined, no single person decided upon these terms. Additionally, these language changes are important because they are proven to cause implicit bias with clinicians, more punitive care practices and more negative treatment outcomes for patients. Lastly, people in recovery can refer to themselves in whatever way “keeps them sober.” No one is being forced to change their language, clinicians are being asked to use clinically-precise language within education and the medical field. Also, there are different connotations between a person self-identifying because it keeps them “honest” and society using the term as a stereotype or label with implications of negative connotations. I did not know there was a definitive time frame for someone being able to refer to themselves as being in “long-term” recovery, thank you for letting me know. From now on, I will refer to myself as a “person in recovery.” We all learn something new every day.

      Examples of research on this topic:
      https://www.tandfonline.com/doi/abs/10.1080/10410236.2018.1481709
      https://www.recoveryanswers.org/research-post/how-we-describe-individuals-substance-problems-affects-perceptions/

      • S on 04.09.2019 at 4:29 pm

        I applaud you getting a conversation going and taking action in something you believe it and can see your perspective.

        But, I couldn’t disagree more.

        My fear is not saying addict ‘will not keep others honest’ either. I see the information you reference suggesting harm, however, I feel people not identifying thusly will do more harm than good. Simply see the points and responses here.

        Really, anytime I’ve seen addicts over identifying with a brain disease concept it’s when they are skirting responsibility. (But yes, of course biology comes into play. And no, I’m not in AA).

        On the topic of labels, I find ‘disordered language’ far more harmful in that it is often self-limiting (the way you feel about “alcoholic”; all encompassing, internalized stigma) and again, detracting from personal responsibility. You said it yourself, we don’t want a person’s diagnosis to consume their identity. “Alcoholic” isn’t a diagnosis but “substance use disorder” is.

        So, where does that leave us?

        How about “person who is an alcoholic”?

        • Jessica Lareau on 04.09.2019 at 10:13 pm

          Hi S, thanks for sharing your thoughts. Just to clarify, people can identify in whatever way they choose so it’s not for me to debate how people should identify, that is up to them and these terms are merely presented as an option. The intention is not for people to blame the illness as a reason to not pursue treatment or recovery, however, SUD is a disease. Clinicians are asked to use medical terminology as it is defined in the DSM-V, which is the point of this initiative. As clinicians, we should also be using “person-first” language. Therefore, to say “person with a substance use disorder” is accurate and person-first language, to say “person who is an alcoholic” would be labeling & defining who the person is other than what challenges they struggle with. If a person in recovery or clinician wants to be specific, they can choose to say “person with an alcohol use disorder” or another diagnosis that is substance-specific. I would love to meet with you and continue this conversation to learn more about your perspective and share some of the research that went into the development of this initiative. If you are interested, please e-mail me at jlareau1@bu.edu

          • S on 04.12.2019 at 10:17 am

            Well, I think every copy of the DSM should go up in flames so it will be a long discussion :)

            Let’s try to make something happen.

            I get your position and the research you are citing.

  • Jacqueline Solano on 04.10.2019 at 9:10 am

    Hi Jessica,
    I found your article very interesting and an eye opener. Having close relatives who are currently abusing alcohol/ drugs and also in recovery the term that is used “I’m a person in long- term recovery” really stuck out because individuals who are on the road to recovery often times describe themselves as an ex alcoholic or ex substance abusers. Which as you said is stigmatizing language and takes away all other things that makes them a person so in essence, all people see is an alcoholic or drug addict. Thank you Jessica for this article and your honesty.

  • Bill W on 04.10.2019 at 12:33 pm

    I’m repeating myself, but I feel strongly. There is a matter of priorities here. My absolute #1 priority is avoiding complacency and relapse. I’ve heard too many tragic stories. If I think identifying myself as alcoholic/addict provides some defense against forgetting the nightmare and going out for some more research, I’m going to do it, and not worry about anything else.

  • Mark Nierman on 04.12.2019 at 3:15 pm

    I’ve read some comments of people that were sounding as if it all is just a matter of self-perception, and whether you are an alcoholic or a person with substance use disorder, you should own up to whatever disasters in life you’ve caused, so if you’re, as an “alcoholic”, ashamed with the way society looks at you, then it’s too bad. Deal with it or die. Well… As far as I’m concerned, personally, I am recovering addict, and I’m actually proud to be called one. However, I personally know some good, and strong in their recovery people, who prefer to keep the information about their addiction to themselves. Some of them told me that they, “Can’t afford it to go public”. I wonder, how some practicing MD or attorney, or politician, or just a son who doesn’t want to disappoint his parents, would feel about their issue to be exposed. Fifth Tradition of Alcoholics Anonymous says, “Each group has but one primary purpose–to carry its message to the alcoholic who still suffering”. In NA, for that Tradition we use the word “addict” just to include as well the individuals addicted to drugs other that alcohol… Also, in 12-step fellowship we always say, that a newcomer is the most important person in the room. We share our “experience, strength, and hope” in our groups, we allocate our personal time to go to hospitals and institutions to “carry the message”, and we pray for those who are “still suffering”. Today luckiest of us are privileged to be able, instead of running around looking for the “next one” or puking our brains out due to a hangover, to go online and theorize how we’d like to be called… Don’t get me wrong, I do like this option so much better, but let’s not forget that we are just a few of so many. If we, together, manage to make that change, which will allow for addicted individuals to start considering themselves as people with any other diseases do – in need of help, and actually start addressing their problem, then it is nothing short of a greatest revolution in modern history. Thank you, Jessica, and keep up your G”D’s work!

  • Nathan on 04.22.2019 at 11:59 pm

    Jessica I am very interested in this topic and would love to hear your story. Also I’d like to follow yoo and your work to see how this and other topics develop. The feedback forum for this article really made me think, especially a few of your thoughtful replies. How can I follow your work? Do you have a website or Facebook page? I’ll be sharing this in the recovery groups I run.

    Thank you,

    Nathan C
    Everett, WA.

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