“Does the use of words prevent addicted individuals receiving treatment? Does the stigma attached to such labels like abuser and addict actually create obstacles to discourage sufferers from entering treatment?
Is it better to use terms like Substance Use Disorders (SUDs) which have less negative societal connotations and associations?
Does it matter that much? Should we not use the terms that people with addictive behaviours uses themselves? Isn’t it a bit controlling to impose new words or definitions on addicts when they are perfectly content calling themselves addicts or alcoholics?
We like the term alcoholic not because it is nice and squeaky clean and clinical but the opposite. We like that it’s a horrible word which to our minds effectively describes a most horrible and life threatening disorder.
That is, the very name reminds us of where the condition can take us if we do not work a program and where we have been.
The question is whether the word is too concerned with the illness and not the recovery, the dirty pathology rather than the clean and serene recovery?
That is a valid point? Even using the term recovering alcoholic may not be enough to make this turn around. Although equally having a SUD does not really imply much recovery either or possibility of long term recovery. Or recovered for that matter!?
Or do these addicts using these words in a way that simply stigmatizes them and their conditions? Do they reflect their inner shame-based reactions to themselves and the world?
This is not a simple black and white issue we feel. Language rarely is.
Language, however, undoubtedly has power! It shapes how we think about issues.
Although we are not convinced that it is solely words and definitions that prevent people reaching out for treatment.
We believe that doctors and Clinicians especially in countries in Europe, like the UK, need to spend a whole lot more time being educated about addictive behaviours than the few hours they get on liver damage and chronic alcoholism. They need much more education and training in what they can do to help way before it is almost too late!
The general ignorance among GPs in the UK we have found is more of an obstacle to receiving treatment than the words used or not by GPs to describe the nature of the patients suffering. Many GPs do not believe that there are any such things as addictive disorders at all and that it is a moral failing or lifestyle choice. This type of ignorance about this neurobiological pathology is fairly common.
They are as educated as the average Joe about addiction or less so.
Regardless of this, perhaps the new use of words to define these disorders has merit along with the increasing visibility in the US and other countries of people in recovery, attempting to make recovery more prominent in the public’s mind.
We would add that poor research and a clear misunderstanding of addicted individuals in many journals we have read over the years does not help the cause of these individuals either.
How many decades will be wasted looking into aversion therapies and cue reactivity we wonder? These are symptoms of these conditions, often dissipating in recovery, not the underlying conditions.
We need to properly and more accurately define what this condition is before we start using terms like substance use disorders (SUDs) when many of us feel this term in itself is wholly inadequate too.
Should we not worry more about terms and definitions when we have actually obtained a more accurate understanding of what exactly this disorder is?
For example, certain people can drift in and out of the diagnostic criteria for SUDs for periods of time and some never enter this diagnostic range again in their life times, for example, University students.
They do not need to go into recovery either. Are these people really the same as others who have lost everything apart from their very lives to their addictive behaviours? Do they have the same underlying conditions? If not, why have them under one diagnostic category which describes neither accurately?
Do SUDs explain the severity and multi-faceted nature of addiction?
As a 12 step group member may say, there is a lot more to my condition than alcohol or drug or substance. These substances were used to “treat” an underlying condition. Would it thus be much more beneficial to clearly define what exactly these underlying conditions are?
Addicts are not abusing drugs or substances because the substance has simply disordered their behaviour but because their behaviour and psychology is often disordered already prior to chronic use, abuse and endpoint addiction. Substance often exacerbates these underlying conditions, not always creating them.
We believe that drugs do not solely create addiction or Substance Use Disorders.
In order to de-stigmatize addictive behaviours and help with increasing access to treatment perhaps we could all look more closely at how we define ourselves and our fellow sufferers.
We can all contribute to stigmatizing ourselves if we are not careful and abuse ourselves in “treatment” settings too…”
Here is the statement…
“Substance use disorders (SUDs) are among the most highly stigmatized health conditions in the world which can have implications for help-seeking and treatment (see infographic on stigma). TheInternational Society of Addiction Journal Editors (ISAJE) released an addiction terminology statement recommending against the use of terminology that “can stigmatize people who use alcohol, drugs, other addictive substances or who have an addictive behavior.”
ADDICTION TERMINOLOGY STATEMENT
The International Society of Addiction Journal Editors recommends against the use of terminology that can stigmatize people who use alcohol, drugs, other addictive substances or who have an addictive behavior.
Rationale: Terms that stigmatize can affect the perception and behavior of patients/clients, their loved ones, the general public, scientists, and clinicians (Broyles et al., 2014; Kelly, Dow & Westerhoff, 2010; Kelly, Wakeman & Saitz, 2015. For example, Kelly and Westerhoff (2010) found that the terms used to refer to individuals with substance-related conditions affected clinician perceptions. Clinicians who read a clinical vignette about “abuse” and an “abuser” agreed more with notions of personal culpability and an approach that involved punishment than did those who read an identical vignette that replaced “abuse” and “abuser” with “substance use disorder” and “person with a substance use disorder.”
ISAJE is aware that terminology in the addiction field varies across cultures and countries and over time. It is thus not possible to give globally relevant recommendations about the use or non-use of specific terms. “Abuse” and “abuser” or equivalent words in other languages should, however, in general be avoided, unless there is particular scientific justification (an example of scientific justification of the use of “abuse” is when referring to a person who meets criteria for a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, alcohol abuse; that person would be said to have “alcohol abuse”). Another example of stigmatizing language is describing people as “dirty” (or “clean”) because of a urinalysis that finds the presence (or absence) of a drug (Kelly, Wakeman & Saitz, 2015). Instead, the test results and clinical condition should be described.
Broyles, L. M., Binswanger, I. A., Jenkins, J. A., Finnell, D. S., Faseru, B., Cavaiola, A., Pugatch, M., & Gordon, A. J. (2014). Confronting inadvertent stigma and pejorative language in addiction scholarship: A recognition and response. Substance Abuse, 35, 217–221.
Kelly, J. F., Dow, S. J., &Westerhoff, C. (2010). Does our choice of substance-related terms influence perceptions of treatment need? An empirical investigation with two commonly used terms. Journal of Drug Issues, 40, 805–818.
Kelly, J. F., Wakeman, S. E., & Saitz, R. (2015). Stop talking ‘dirty’: Clinicians, language, and quality of care for the leading cause of preventable death in the United States. American Journal of Medicine, 128, 8–9.
Kelly, J. F., & Westerhoff, C. M. (2010). Does it matter how we refer to individuals with substance-related problems? A randomized study with two commonly used terms. International Journal of Drug Policy, 21, 202–207.
Categories: addiction, Comment, de-stigmatizing addiction
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