Thinking harder about the words we use

"Wrong" Words Used to Define, Defame Addiction and Recovery

A recent story about California State University adopting a comprehensive alcohol policy was both unusual and encouraging, but not because of anything educators in the Golden State were up to. "Eight months after a Palo Alto freshman died from overdosing on blackberry brandy at a Chico fraternity, California State Trustees today will consider a blueprint for helping campuses better protect students from alcohol abuse," the July 10 article from the San Jose Mercury News began.

It's exceedingly rare for a newspaper to describe an alcohol-related death as an "overdose," although clearly that's what is going on in cases such as the tragedy in Chico. Of course, we read about overdoses in the papers all the time, but invariably the writer is referring to heroin, or cocaine, not alcohol.

When someone dies from drinking too much, the typical verbiage used by reporters is "alcohol poisoning," which admittedly has some nice connotations about the toxicity of booze. But this divergence points to a larger problem in the use of language to describe things related to addiction -- another word that is neglected by journalists, and even many in the addiction field itself.

Why is it so important for the fatal result of a drinking binge to be called an "overdose"? First, because it's the most accurate way of describing the cause of death. But more importantly, it helps to beat down the artificial distinctions that the alcohol industry (along with many policymakers, and even some people in recovery themselves) would like to maintain between alcohol and other drugs.

It's Easy to Abuse an "Abuser"

Reforming the language we use to describe things related to addiction is not merely an excercise in semantics or political correctness. Words can be an effective tool in helping to destroy the stigma encountered by people with addictions.

Note that last phrase: "people with addictions." It's not one that you'll find in many newspaper articles, or even in literature from otherwise well-meaning government agencies or addiction-treatment programs. More likely, you'll find people with addictions described as "substance abusers," "drug abusers," or the even more pejorative "addicts."

In a field that is locked in mortal combat with stigma, describing people with addictions as "abusers" of alcohol, tobacco or other drugs helps ensure that the onus of addiction remains solely upon the shoulders of the individual, discounting the role that environmental factors, genetics, and drugs themselves play in addiction.

Of the words used to describe addiction and recovery, the "abuse" terms are among the most ill-chosen and pernicious, says William White, author of a respected history of the addiction field and a research consultant at the Lighthouse Institute/Chestnut Health Systems.

"Terms such as alcohol abuse, drug abuse, and substance abuse all spring from religious and moral conceptions of the roots of severe alcohol and other drug problems," writes White in The Language of Recovery Advocacy: An Essay on the Power of Language. "They define the locus of the problem in the willful choices of the individual, denying how that power can be compromised, denying the power of the drug, and denying the culpability of those whose financial interests are served by promoting and increasing the frequency and quantity of drug consumption."

"To refer to people who are addicted as alcohol, drug, or substance abusers misstates the nature of their condition and calls for their social rejection, sequesterization, and punishment," adds White. "There is no other medical condition where the term abuse is applied."

Of course, many people in the field and in recovery use terms like "addicts" or "drunks" in casual conversation to describe themselves and their peers. But these terms are just as damaging in public discourse as a word like "nigger" -- another term used casually within a peer group, but that has properly been deemed unacceptable in any other context. As White notes, the recovery movement "may need to use one language when it turns inward and another language when it turns outward to communicate with the larger society."

Define Yourself, or Others Will Do it for You

Just as the mental-health field has successfully waged a campaign to rid the public airwaves, publications, and water-cooler chats of stigmatizing terms like "psychos" and "lunatics," the addiction field needs to press reporters, governments, and the public at large to stop the offhand stigmatization of people with addictions.

"Words, and the meanings with which they are imbued, can achieve accuracy and relevance, or they can transmit dangerous stereotypes and half-truths," points out White. "For more than two centuries, addicted and recovering people in America have been the object of language created by others. People experiencing severe and persistent alcohol and other drug problems have inherited a language not of their own making that has been ill-suited to accurately portray their experience to others, or to serve as a catalyst for personal change."

Through its Stigma Watch, the National Mental Health Association routinely responds to media articles on mental-health topics, and has slammed the naming of the XFL's Memphis Maniax and the content of movies like Me, Myself and Irene and TV shows like ABC/Disney's short-lived Wonderland (the latter canceled as a result of protests).

As Jeff Blodgett, coordinator of the pro-recovery Alliance Project, points out, changing the language of addiction is not just about erasing stigma; it's also a lever for empowering constituencies. For example, physically and mentally challenged individuals and their families received a huge psychological boost when they started thinking of themselves as "disabled," not "handicapped" or "crippled."

"What you call people often begins to define them, and limits their ability to grow," agrees Stacia Murphy, president of the National Council on Alcoholism and Drug Dependence. "In this field, where you're already starting from a low point in terms of stigma, words become more powerful in how a person feels about himself or herself."

Why are the Feds Calling Us Names?

Need another example of the power that even a single word can wield? Open your local paper and look for a story on tobacco. Despite years of education, you'll still find many articles that talk about tobacco addiction as a "habit."

Just think about what that says for a minute: Smokers aren't addicted to the drug nicotine; they just have a bad habit that they can't --or won't -- break. Is it any wonder that most juries in this country still think that smokers are to blame for their own addiction, and refuse to award monetary damages against tobacco companies despite the decades they spend spreading disinformation on the health risks of smoking?

A campaign against the misuse of addiction-related language could start with the most obvious examples of all: the names of the very federal agencies that represent the interests of people with addictions. The titles of these agencies -- the Substance Abuse and Mental Health Services Administration (SAMHSA), the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, the Center for Substance Abuse Treatment (CSAT), the Center for Substance Abuse Prevention -- are littered with thinly veiled (although presumably unintentional) pejoratives.

The time has come for these agencies to stop referring to "abuse" rather than addiction, and alcohol as somehow being in a different category than "drugs." Public statements from federal agencies routinely use the phrase "alcohol and drugs" rather than "alcohol and other drugs" -- the latter another example where the addition of a single word would make a world of difference in public perception.

Even "National Alcohol and Drug Recovery Month," marked in September and promoted through glossy materials and teleconferences by SAMHSA, gets off on the wrong foot starting with its name. SAMHSA's Recovery Month action kit -- mailed out to advocates for treatment and recovery nationwide -- is a mixed bag of promising use of "addiction-and-recovery" language surrounded by embarrassingly frequent references to "alcohol and drug addiction," and even the occasional "drug and alcohol abusers" thrown in.

The official penchant to throw up linguistic walls between "alcohol" and "other drugs" is especially galling when you consider the very-real political history behind it: When the Office of Substance Abuse Prevention (OSAP -- the predecessor to today's Center for Substance Abuse Prevention) -- tried to unify its programs around an "alcohol and other drug" approach in the mid-1990s, the alcohol industry sicced its friends in Congress on the agency.

The resulting bloodbath nearly saw OSAP killed off and led to the resignation of then-OSAP director Elaine Johnson, Ph.D.; the "alcohol and drug" phrase has been carefully preserved in SAMHSA's vernacular ever since. So remember: every time you read the phrase "alcohol and drug" in a federal document, or hear it coming out of the mouth of a federal official, is an example of the alcoholic-beverage industry shaping national policy on alcohol and other drugs to its own ends.

The feds are hardly alone in this misuse of the language of addiction, however. In fact, you may have noticed that Join Together, where this commentary originates, commonly refers to "substance abuse," including in the names of its website and its popular email discussion group, dubbed "Subabuse." Perhaps most distressingly, a look at the mission statement for Join Together's new "Demand Treatment" initiative yields the following description: "A new nationwide initiative to increase the number of people who get alcohol and drug [emphasis added] brief interventions and quality treatment in American communities."

Yes: we, too, ought to know better.

What are the "Right" Words? Let's Talk

A major self-assessment is in order. How much better a face would a federal "Addiction and Mental Health Services Administration" put on this field, for one example? (Advocates like White would also insert the word "Recovery," to emphasize the focus on the positive outcomes of treatment and other paths to sobriety).

Has your organization ever done a review of its own publications to ensure that you're not unconsciously stigmatizing your own clients and constituents? The process doesn't have to take place in a vacuum. The Alliance Project has conducted focus groups to test the public response to certain messages concerning addiction and recovery. And as part of its National Treatment Plan process, CSAT conducted its own "language audit," which will be available to the public shortly.

Will there be disagreements? Sure. Even within the recovery community, there is strong debate over whether "disease" language helps the field achieve its policy goals. White, for his part, takes issue with the use of terms like "self-help" and "consumers" to describe the relationship between people with addictions and their means of recovery; others in the field would say these are critically important parts of the lexicon.

Such discussions, in part, spring from a desire among some advocates to take the focus off treatment and emphasize the power of recovery in messages to the wider world. "Focusing on treatment and clinical terminology like the "disease model" doesn't help to mobilize people," says the Alliance Project's Blodgett. "We need to provide proof that recovery happens, to demonstrate the economic, social and family power of recovery. I don't think it should replace the public-health discussions, but it needs to be part of the mix."

Also, while diehard AA people steadfastly maintain that recovery lasts a lifetime, White says there may be a point at which an individual should be considered "recovered" from their addiction -- perhaps five years after their last relapse. He writes,

"While 'recovering' conveys the dynamic, developmental process of addiction recovery, 'recovered' provides a means of designating those who have achieved stable sobriety and better conveys the real hope for a permanent resolution of addiction" -- the latter a policy message that the entire addiction field agrees must be emphasized.

Valid opinions exist on all sides of these discussions. But they should be part of a larger debate over what people with addictions call themselves, and how they want to be perceived by the rest of the world. The important thing is to get the field talking, so we can start using the power of language to support the goals of fighting stigma, encouraging recovery, and empowering those who struggle with alcohol and other drug addiction.


By Bob Curley, a journalist who has covered addiction issues for JTO and other publications since 1991. He spends a lot of time each day editing terms like "addicts" and "substance abusers" out of the news summaries posted on Join Together Online and the JTO Direct news service.




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