Safer Solutions: Language Choices and Substance Use
Substance use is common in the United States, with 56 percent of people aged 12 and older reporting nicotine, alcohol, or drug use in the past month. Despite this, substance use is often stigmatized, while perceptions of people who use substances differ by substance type and extent of use. This is evident in the variety of ways people refer to substance use and people who use substances. In today’s edition of Safer Solutions, we discuss how substance use terminology has evolved, what challenges different terminology can present, and how we choose the words we use here at R Street.
Changing the Substance-Use Lexicon
The common terms for substances and the people who use them have started to change in recent decades. Although there are many reasons for this, two are particularly significant.
First, our understanding of the biological mechanisms that lead to substance use disorder (SUD), commonly referred to as “addiction”—an example of technical versus colloquial word choice—has evolved. Classifying “alcoholism” as a disease dates back to the late 1700s, but it wasn’t until the late 1990s that science and medicine started to view SUD as a brain disease. Acceptance of the brain disease model marked a turning point in how we think and talk about SUD. Although many people still view substance use as a moral or personal failing, the shift to talking about it as a brain disease started to chip away at this characterization. While the brain disease model is sometimes criticized for being disempowering and de-emphasizing socioeconomic contributors to SUD, the shift has undeniably affected the way we see and talk about substance use.
The second reason for recent changes in language around SUD is stigma and its effects on individuals’ well-being and healthcare engagement. People who use substances encounter stigma in their daily lives as well as in the healthcare system, which can discourage them from seeking all types of healthcare, including treatment. Experiencing stigma can also lead to internalized or self-stigma, where a person begins accepting the negative beliefs they encounter as true. Not only can this further discourage care-seeking, it can also lead to increased or riskier substance use (e.g., using alone). Although changing societal attitudes about substance use is not as simple as changing the language around it, careful consideration of the terminology we use can help decrease stigma and minimize its ill effects.
Putting the Person First
People are dynamic and multifaceted, and few of us want to be defined by just one aspect of our lives. Person-first language is a way to talk about a person’s illness, disability, or identity without defining them by that characteristic. Saying “a person who uses drugs” instead of “drug user” or “drug abuser” emphasizes the person’s humanity instead of defining them solely by their drug use. Person-first language also avoids contributing to the stigma, blame, and judgement that make people less likely to seek care. Although people who use or have used drugs might choose to refer to themselves as “addicts” or otherwise, people without lived experience should not default to stigmatizing language.
While there has been a distinct shift toward person-first language when referring to people who use drugs, the same can’t be said for people who smoke. It’s still common to refer to people who smoke as “smokers,” although they face stigma just like people who use drugs. Even we at R Street have been slower to shift to person-first language for smoking.
A Double-Edged Sword
While these changes are supported by theory, non-stigmatizing language can sometimes make communication clunky. Person-first phrasing often adds extra words to sentences, which can negatively affect comprehension. This language can also feel forced, and some audiences might assume—rightly or not—that they will be judged harshly if they don’t change their own phrasing. Combined with terms that may be unfamiliar, these dynamics can decrease understanding and increase resistance to the content, thereby shutting down productive dialogue.
Our Word Choice Decisions
R Street’s Healthier Communities team frequently wrestles with language choices. While our focus is on evidence-based communications, we think carefully about our audience and goals. Depending on who we’re talking to, our terminology might be more technical or more straightforward. We default to non-stigmatizing, person-first language because we don’t want to contribute to stereotypes or negative characterizations of people who use substances. We frequently encounter misinformation about substance use, and correcting this misinformation is important. Using stigmatizing language would only reinforce the misperceptions we’re trying to correct.
We also default to using the most medically or scientifically accurate terms. For example, “substance use disorder” replaced “substance abuse/dependence” as the medically accurate choice in the 2013 revision of the Diagnostic and Statistical Manual of Mental Disorders. We adjust our language for different audiences as well, as long as those adjustments are true to the evidence and to the goal of promoting non-stigmatizing language. For instance, because the Safer Solutions newsletter was created to make complex topics accessible to a broad audience, we might use the more colloquial term “opioid addiction” rather than “opioid use disorder.”
Like most cultural changes, not everyone adopts language changes at the same time. At R Street, we consider it extremely important not to participate in perpetuating harmful, counterproductive stereotypes about substance use and other health issues, even though using non-stigmatizing language might ruffle some feathers in the short term. Our goal is to foster productive dialogue and build consensus around policy supported by evidence, which is why we’ll continue to use accessible, accurate language wherever possible.