How Stigmatizing Language Hinders Treatment

How would you react if one of your coworkers told you that they had a problem with alcohol? What if your neighbor confided they were addicted to a prescription opioid? Would you be angry or ashamed if your spouse revealed they’d become addicted to Xanax? You probably hope you’d react to this kind of news with compassion and support, but when confronted with it, you might be surprised to find the stigma of addiction affects you more than you realize.

Americans are aware there is an opioid epidemic raging across the country but a recent study showed 44% of Americans believe opioid addiction indicates a lack of willpower, and a third regard it as a character defect or the result of bad parenting. Despite this view, another recent poll found that a majority of Americans believe that those addicted to substances have an illness (53%), and that those who have substance use disorder should receive treatment (65%) rather than be incarcerated (28%)

The stigma of drug use keeps people from seeking treatment. Words like “junkie,” “addict,” and “druggie” can hurt, damaging self-image and standing in the way of recovery. Addiction is not a choice. It’s a chronic disease similar to diabetes or HIV. Science has proven that substance use disorder is a chronic brain disease that can be managed with medical treatment. It is NOT a moral failing or a character flaw. But still, only 1 in 10 Americans with a substance use disorder receive treatment.

Addiction is highly stigmatized, and that stigma is fueling the opioid health crisis. Many other diseases have been harmfully burdened by stigma at some point. HIV is a notable example. In the 1980s, when little was known about how HIV is spread, the public developed irrational fears and prejudices about individuals living with the virus. Stigma was the #1 reason people were reluctant or afraid to get tested for HIV, to disclose their HIV positive status, or to get treatment for their illness. But as scientific developments illuminated the realities of HIV, the stigma began to shrink, and care improved. By taking steps like including HIV testing in routine doctor visits, the stigma and fear began to subside. And with that, prevention efforts became more effective. People were able to receive treatment earlier, increasing their chances of survival. When stigma is reduced, lives are saved. And the same can be true of addiction. Substance use disorders are associated with discrimination and social disapproval—more so than any other medical condition. People with substance use disorders are so often isolated, outcast or imprisoned. The stigma of addiction takes hundreds of lives, every day. So, when we talk about the harmful effects of stigma, and stigmatizing language, it’s not about being sensitive, or politically correct. It’s about treatment, care, and saving lives.

Why does this matter? We are all affected by the current epidemic of opioid addiction. Many people know someone who struggles with addiction, or who is in treatment or recovery. For people with OUD, stigma

disproportionately influences health outcomes and mental well-being. Fear of being judged and/or discriminated against can prevent people from getting the help they need. Stigmas can also create physical and mental barriers for people with addiction to seeking treatment. It can also prevent caregivers and medical professional from providing needed services and care.

Stigmas aimed at people with substance use disorders come from many sources.

Personal: Self-disgust, shame and self-hate at one’s own appearance, behavior, lifestyle and/or physical condition, as well as feelings of being unworthy of help or recovery.

Social: Negative perceptions, labels and actions from friends or family; feeling isolated or rejected

Institutional: Negative treatment and attitudes experienced from healthcare providers, the media, law enforcement, places of work or government agencies.

Repeated opioid use causes rapid, observable changes in the brain – A person who uses opioids repeatedly will need to take these drugs just to feel normal. Without opioids, the brain’s new balance is disrupted, and the agonizing symptoms of withdrawal and craving set in. Acknowledging even this basic biological underpinning goes a long way toward helping the public understand why addiction to any opioids is a disease, and not a character flaw.

The goal of addiction treatment is to restore a person’s ability to lead a meaningful life, function productively, and stay alive – This might seem obvious but society tends to focus on “getting clean,” meaning abstinence from any drug use. Equating recovery and abstinence is counterproductive and dangerous because medication assisted treatment for OUD is similar to treatment for other chronic illnesses, for example insulin maintenance for diabetes. However, there is a myth that a person who receives MAT is not actually battling their addiction. People think they are simply trading one drug for another but the stably of regularly taking medication can help a person improve functioning and better prevent relapse and the negative consequences associated with it, including death. Any treatment which allows a person to work, raise a family, fulfill social roles without impairment, and of course stay alive, should be welcomed and applauded.

Changing the stigma of substance use disorder will benefit everyone. It will allow people to regain their self-esteem, allow lawmakers to appropriate funding, allow doctors to treat without disapproval of their peers, allow insurers to cover treatment, and help the public understand this is a medical condition as real as any other. Changing attitudes will take time, but we can change our vocabulary today. Through awareness, education, and conversation, we can bring addiction into the light and choosing words more carefully is one way we can make a difference and end stigma.

Paying attention to how language can worsen stigma is important work but individual habits are hard to break. Changing how we communicate to support the use of respectful and inclusive language can be challenging but having an increased awareness of the relationship between language and stigma is key to breaking this cycle.

With careful attention to language, we can reduce the burden of stigma surrounding substance use disorders, improve access to health care for people with substance use disorders, and save lives. What we say, and how we say it, matters.

Using first-person language is proven to reduce stigma because it’s not about being sensitive, or polite, or politically correct. It’s about access to quality treatment and care. Person-first language doesn’t define a person based on any medical disorder she may have. It’s nonjudgmental, it’s neutral, and the diagnosis is purely clinical.

· We can all be part of the solution.

· We can commit to not using hurtful or damaging words about those who face addiction

· We can take a stand against stigma

· We can support medically assisted treatment

· We can support harm-reduction

· We can encourage people in recovery

· Most importantly, we can talk about addiction amongst our friends and family members to address misperceptions about addiction, treatment options and long-term recovery

To learn more about stigmatizing language and better word choices, please review the following links: Words Matter – Terms to Use and Avoid When Talking About Addiction

National Institute of Drug Abuse, 2020

Words Matter: How Language Choice Can Reduce Stigma SAMHSA, 2018

Words Matter: Starting Conversations Without Stigma

Shatterproof, 2017

Changing the Language of Addiction

Memo from the Office of National Drug Control Policy, 2017