By Pat Matuszak
Name-calling is a bullying tactic and often the first step involved in marginalizing a person or group of people. Because verbal attacks are usually viewed as a lesser assault than physical violence, we have been taught to ignore or overcome the hurt feelings it causes. From Shakespeare’s “What’s in a name? That which we call a rose by any other name would smell as sweet,” to the playground rhyme “Sticks and stone may break my bones, but words can never hurt me,” we learn to minimize the damage done by hurtful names thrown at us by the ignorant or the outright hostile.1
But what if the negative naming is being done by healthcare providers or counselors? Could their attempts to help a specific group of patients actually be hurting them? In the case of individuals who are recovering from substance abuse, the names traditionally used to explain their condition can hold them back or even push them into isolation. Obvious slurs such as “junkie” or “drunk” are easy to spot, but even professionals sometimes use names that imply the person with a physical dependency on opioids or alcohol is in a moral crisis rather than a medical one. While some 12-Step programs insist the person in treatment must admit to being an “alcoholic” or “addict,” many are beginning to believe those names label their patients in a negative way that can hinder recovery and stigmatize them. It can also hurt their chances of getting help from government agencies, insurance companies and legislation.
“The American public is more likely to think of addiction as a moral failing than a medical condition,” according to Colleen L. Barry, PhD, MPP, an associate professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. “With addiction, the feeling is that the addict is a bad or weak person, especially because much drug use is illegal.”
In a 2013 study, Barry reported that respondents surveyed were likely to hold negative opinions about people with substance addiction, oppose legislation to help them, prefer not to hire or work with them and believe a relapse is a lack of willpower rather than “grappling with a chronic health condition that is hard to bring under control.”2
These negative attitudes are spread by the wording used in the media as well. In 2017, the Associated Press put out new directives in their stylebook for journalists that could change the way people in recovery are written about in newspapers, magazines and speeches. The Associated Press Stylebook explains that writers should use “person first” descriptions, just as they do for those suffering from other diseases. So instead of characterizing someone as an “addict,” writers should “choose phrasing like he was addicted, people with heroin addiction or he used drugs.” 3
NPR journalist Maia Szalavist applauded the change in an opinion article, “Why We Should Say Someone is a ‘Person with an Addiction,’ Not an Addict.” Szalavist said, “Unlike many matters of style, these changes aren’t mere semantics or political correctness. Widespread media misunderstanding of the fundamental nature of addiction has led to some deadly misconceptions about how it should be managed. The AP provides news to around 15,000 media organizations and businesses, and its stylebook is highly influential in setting standards for usage. If AP’s more accurate terms are adopted and understood by institutions like The New York Times and CBS News, it could genuinely help improve drug treatment and policy by reducing stigma against lifesaving forms of treatment — amid an overdose crisis that shows no signs of slowing.” 4
Other terms that affect the way patients are treated include “abuse” and “abuser.” Clinicians surveyed in a Harvard study were more likely to recommend punitive measures to treat patients described as “substance abusers” than if they were told the patient “had a substance use disorder.” Using terms of judgment can affect the way professionals treat a person when the individual is introduced with the label of having a moral problem instead of being seen as a patient needing medical treatment.5
Calling a substance use disorder a “habit” or “problem” also suggests that the patient just needs more willpower instead of medical treatment for a disease. Instead, use “substance misuse disorder,” “alcohol and drug disorder,” or “alcohol and drug diseases.”3 Framing the disease of addiction as separated from the person who is suffering from the disease (in the same manner as we would any disease) not only helps the community relate to the patient, but also helps patients relate to themselves. Their goal is to be healed and make the transition from suffering from a disease to being well and leaving it behind. If they haven’t labeled themselves as an “addict” in their own minds, it does not become an embedded part of their identity.
When in doubt, remember the goal of describing patients in a “person first” way to separate the person from the substance or disease. When talking about a patient with an addiction, use person first description, such as “Mary is addicted to alcohol” instead of attaching the negative label, “Mary is an alcoholic.” The thought is that Mary is a person, not an addiction, and the hope is that Mary will be healed from the disease and become “Mary who recovered from alcohol addiction.”
1 NoBullying.com, “About Bullying Names and Name Calling.” July 18,2014.
2 Barry, Colleen L. PhD, MPP “Stigma, Discrimination, Treatment Effectiveness, and Policy: Public Views About Drug Addiction and Mental Illness.” Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, October 1, 2014.
3 Associated Press Stylebook, ref. Addiction 5-4, Alcoholic 12, Associated Press, NY, 2017.
4 Szalavist, Maia, “Why We Should Say Someone is a ‘Person with an Addiction,’ Not an Addict.” NPR.org, June 11, 2017.
5 Kelly, JF, Westerhoff, CM, “Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms.” Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA , May 21, 2010.