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Language and Stigma: Let’s Do Better


Language matters when we talk about addiction and mental illness.  In a recent interview, a very famous individual responded to a question about “being in and out of rehab seven or eight times” with “Say it nicer to me – I sought treatment repeatedly for issues, substance abuse issues.”

A World Health Organization (WHO) study ranked drug addiction as the most stigmatized health and social problem in society.  Think about that – drug addiction is more stigmatized than often-related social problems like poverty, incarceration, and homelessness.

So what exactly is stigma?  One definition is that stigma is any “attribute, behavior or condition this is socially discrediting.”  Here’s another – stigma is nothing more than discrimination, which is nothing more than fear, which is a basic human emotion that can only be eradicated through personal growth. Stigma is harmful.  What can we do?  One thing we can do is change our vocabulary.

Words like addict, junkie, cokehead, lush, crazy, and schizo are demeaning – they make no distinction between the person and the disease, and they imply willful misconduct.  Those seeking treatment are also often stigmatized by health care providers who refer to them as substance abusers and use terms like dirty urines.  We do not use similar negative terms for people experiencing other chronic illnesses.

The National Institute on Drug Abuse recommends using evidence-based, person-first language.  Some examples of better language include “person with a severe thought disorder” (not a crazy person or a schizophrenic), “person in recovery” (not clean and sober), and “newborn exposed to substances” (not addicted baby).  Still, 85 percent of 508 articles tracked from 2015-2019 by the media watchdog group Changing the Narrative used the word “addict” in a stigmatizing way.  An outcome of this new awareness around stigmatizing language is that The Associated Press updated its stylebook to “avoid words like alcoholic, addict, and abuser unless they are in quotes or names of an organization.”

What difference will changing our language make?  It’s important to note that currently, less than 10 percent of those with a serious drug use problem seek treatment.  Stigma plays a big role in that, as people with a substance use disorder frequently report they are ashamed of their behavior and don’t want to be discriminated against by others.  The more we treat substance use and other forms of mental health disorders in clinical terms, and less in stigmatizing terms, the more people will seek treatment and have the opportunity to become persons experiencing recovery from their illnesses.

Content for this blog post came from “Saying it Nicer:  Why Language Matters for People with Addiction, Lipi Roy, MD, MPH, published in Forbes, November 18, 2020