How To Talk and Write about Substance Use Disorder

News and feature stories about the opioid epidemic appear daily in a variety of media outlets. To draw interest, these outlets often using provocative language to describe substance use disorders and those affected by substance use across the country. The 2017 Associated Press Stylebook, however, now encourages journalists and the media to use person-first language such as person who injects drugs to describe people with substance use disorders. The style guide directs reporters to avoid certain words such as “addict” or “junkie,” to reduce stigmatization of substance use disorders and improve reporting accuracy. These changes come with growing pains – for example the New York Times recently used several different headlines in its printed and online coverage of a story covering neonatal abstinence syndrome, updating the headline to reflect more clinically appropriate language.

Michael Botticelli, former Drug Czar at the White House Office of National Drug Control Policy, and Dr. Howard Koh at the Harvard T. H. Chan School of Public Health have pointed out how language may be detrimental to those with substance use disorders. In a 2016 viewpoint article in JAMA, they discussed the loaded language of substance use and its social consequences. They emphasize that the stigma created by commonly used phrases such as “substance abusers” may affect patients’ willingness to seek treatment, and the type of treatment prescribed by providers. They instead encourage use of clinically accurate language from the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) that no longer references dependence or addiction.

The American Medical Association, the American Society of Addiction Medicine and other professional organizations have called on providers, researchers and governmental agencies to use non-stigmatizing language in order to address access and barriers to care. In January 2017, Mr. Botticelli issued a memorandum to federal executive departments and agencies with a report on Changing the Language of Addiction. The report reviews study findings that show that language regarding substance use affects attitudes of providers and the public and may negatively impact quality and access to substance use treatment. Most importantly, the report emphasizes the need for person-centered language with regard to substance use by replacing substance user or addict with person with a substance use disorder. This distinguishes the person from his or her disease and creates space and hope for treatment among people with this chronic disorder.

More guidance for researchers comes from several recent editorials and blog posts in peer-reviewed journals calling for person-centered language in publications and grants. A recent blogpost published in the British Medical Journal argues that many commonly used terms and words to describe substance use disorders are not only stigmatizing, they are imprecise and do not appropriately describe the nuances of substance use. The authors also argue that many words imply a value judgement where science should remain objective. Thus, medical journals should “use neutral, respectful and unambiguous language” to describe substance use. Although several medical journals and government agencies continue to have words such as “addiction” and “abuse” in their title, the editorial board of the Journal of Substance Abuse acknowledges this as an artifact of the evolution of language surrounding substance use and hopes to encourage authors, reviewers and readers to engage with this changing language of addiction.

CHERISH recognizes that this is an area where practice continues to evolve, and researchers do not always receive consistent guidance. We have compiled a resource of current recommendations for non-stigmatizing language in substance use disorder research on the CHERISH resources page. Please visit this resource and send us your comments and suggestions for updates.