This article is the second in a 12-part series about the U.S. addiction crisis. In the interest of compassionate conversation and eliminating stigma, we’ve chosen language that’s cultivated by the Research Recovery Institute and hope it inspires you to as well. The U.S. drug crisis is impacting everyone, from young children to first responders to librarians. In grappling with this overwhelming life-or-death problem, we may have overlooked one group – drug users – and the way our language generates stigma that only fuels the epidemic. In his report on Alcohol, Drugs, and Health, former Surgeon General Vivek Murthy argues for a "cultural shift" in how we approach addiction. "For far too long," Murthy writes, "too many in our country have viewed addiction as a moral failing." The consequence of this definition is an "added burden of shame that has made people with substance use disorders less likely to come forward and seek help." The way in which addiction is framed has enormous consequences, not just for how our health care system treats addiction, but how our entire culture views addictive behavior.
"Choice" has consequences
When addiction is framed as a choice, drug treatment is not a medical necessity, but an elective procedure. Historically, that has meant that drug treatment and recovery programs were prohibitively expensive for many people. Prior to 2014, only one in 10 addicts sought treatment. That low treatment rate was certainly related to limited access to care. It was also related to the stigma that those in the healthcare profession held toward addicts. One study found that healthcare workers have lower regard for their addicted patients than patients with other conditions. The choice model doesn't only impact treatment options for addiction. The phrase "war on drugs" suggests that drug abusers are bad guys who have taken the wrong side. Sentencing laws group drug users alongside others deemed to have moral failings sufficiently poisonous to require removal from society. "Choice" makes it simple to deny treatment to or promote the incarceration of people who elect to become addicted. The choice metaphor has also allowed anyone who hasn't made the same choice to ignore the problem. Choice implies blame, and this blame has helped us avoid taking any societal responsibility for the drug crisis.
Parent Co. partnered with Aspenti because they know that carrying the weight of the addiction crisis is everyone’s responsibility.
How the disease model reduces stigma
The disease model of addiction shifts our national focus from blame to recovery. Under a disease model, addicts are not immoral. They are ill. Under the Affordable Care Act, addiction treatment became an "essential benefit," meaning that 2.8 million people suffering from addiction now have coverage. That coverage – especially in states that accepted Medicare expansions – is almost certainly saving lives, as it now covers not only inpatient detox, but also counseling and medication. Under a disease model, addicts are not criminals. They're citizens in need of assistance. Portugal, faced with similar drug problems as the U.S., redefined addiction as a disease both medically and legally, expanding medical treatment and decriminalizing drug use. Rather than jailing drug users, Portugal brings them to hearings with social workers. When drug users are not afraid of arrest, they are also more likely to seek treatment. Now, the rate of drug-related death in Portugal is six per million. In the United States, it's 312 per million.
The language of addiction
Efforts to replace the language of choice with the language of disease are already improving access to treatment. But this is not the only language that needs to change. We don't talk about heart transplant patients as being "dirty," but we do talk about drug addicts that way. We don't talk about cancer patients "relapsing" when their cancers return, but addicts relapse all the time. We don't demand that people suffering from cancer apologize for their cancers or that people who have had a heart transplant apologize for their diseased organs, even if these people exhibited many dangerous behaviors that contributed to their health problems. The very word "addict" is a problem. We don't describe people with cancer as "cancers," or people who have had heart transplants as "heart transplants." When we use the word "addict," we reduce a person to an illness. That term creates stigma despite efforts to view addiction as a medical problem. Look back to the preceding paragraphs and notice the use of "addict," and "drug abuser." Although those paragraphs argue for a compassionate response to addiction, they unintentionally heap blame and shame on people suffering from it. The Recovery Research Institute's Addiction-ary promotes more specific and compassionate addiction vocabulary. Taking its cue from mental health advocates who have shifted the national conversation from "the disabled" to "people with disabilities," the RRI advocates "person-first" language. Terms like "abuser" and "addict" define a person in terms of addiction. This definition generates stigma that leads to lower quality care and even discourages people from seeking treatment. Changing our vocabulary to person-first language can help reduce stigma by textually reminding ourselves that people suffering from substance use disorders are just that: people. Not "junkies" or "abusers" or "addicts." People. The RRI also advocates avoiding language that implies blame. Instead of "lapse" or "slip," the RRI recommends more medically-appropriate terms like "resumed" or "recurred." Using person-first, blame-neutral language is a good start. Yet one of the greatest challenges comes from a word we probably don't even think about: "drug." The word "drug" is stunningly unspecific. Culturally, it carries many negative connotations, whether the subject is "illicit drugs" or "drug companies." The word is so stigmatized that many will often reject drugs even when they would be medically beneficial. Part of better addiction treatment and recovery is greater specificity. Instead of "drug," the Addiction-ary suggests "medication" when referring to a properly used drug, and "non-medically used psychoactive substance" when referring to illicit or improperly used drugs.Treating substance use disorder as a moral issue
Addiction is a moral issue, but not for people with substance use disorders. When our society views substance use disorder as a sign of a flawed moral code, we absolve ourselves of any societal obligation to help. Murthy describes addiction as a "moral test," not for people with substance use disorders, but for all Americans: "Are we as a nation willing to take on an epidemic that is causing great human suffering and economic loss? Are we able to live up to that most fundamental obligation we have as human beings: to care for one another?" Person-first. Blame-neutral. Drug-free. Choosing our words more carefully and demanding that media, healthcare, and research organizations do the same will help decrease the stigma of substance use disorders and pave the way to recovery.
Parent Co. partnered with Aspenti because they know that carrying the weight of the addiction crisis is everyone’s responsibility.
