It’s long been common practice to describe a person who regularly uses drugs or alcohol as a substance abuser and to label that person an addict or alcoholic. However, all three words—abuser, addict, and alcoholic—can be negative and stigmatizing.
The word “abuse” carries a negative connotation, especially as it’s commonly connected to harm inflicted on another, as in child, domestic or sexual abuse.
It should be noted that within the privacy of Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) group meetings, terms like alcoholic or addict are still used but are an accepted part of the program. Both AA and NA are based on a person admitting they are an addict or alcoholic as their first step to recovery.
What is Substance Use Disorder?
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the American Psychiatric Association’s publication of criteria to be used by doctors to diagnose specific mental health disorders, including those involving alcohol or drugs.
The fifth edition (DSM-5) was published in 2013 and changed the terminology from substance abuse, addiction or alcoholism to Substance Use Disorder (SUD), which encompasses both drugs and alcohol, or Alcohol Use Disorder (AUD) focused solely on alcohol.
According to the DSM-5, a “substance use disorder describes a problematic pattern of using alcohol or another substance that results in impairment in daily life or noticeable distress.” Patterns of substance use may cause problems with health, personal relationships, work, or school. Substance use disorders often lead to risky behavior, legal problems, physical harm, or even death.
The DSM-5 also updated the criteria used for diagnosis of a SUD, as well as guidelines to determine whether the disorder is at a mild, moderate, or severe level. Guidelines used to diagnose the severity of a SUD are based on “evidence of impaired control, social impairment, risky use, and pharmacological criteria.”
Research supports derogatory labels are harmful
Fortunately, decades of research have given us a deeper understanding of what drives an individual’s compulsion to continue using drugs or alcohol despite negative consequences. This deeper understanding has also shone a light on the harm caused by negative labels.
Surprisingly, research has shown that even some medical professionals judge a person differently depending on whether they’ve been labeled as a substance abuser or as suffering from a substance use disorder.
In a 2016 paper he co-wrote for the Journal of the American Medical Association (JAMA) entitled ‘Changing the Language of Addiction,’ Michael P. Botticelli states, “Stigma isolates people, discourages people from coming forward for treatment and leads some clinicians, knowingly or unknowingly, to resist delivering evidence-based treatment services.”
An article in U.S. News & World Report by Ruben Castaneda quotes Dr. John F. Kelly, director of the Recovery Research Institute at Massachusetts General Hospital in Boston and Associate Professor at Harvard Medical School as stating that avoiding stigmatizing labels “can save lives.” Kelly cautions that calling someone a substance abuser unfairly labels them as deliberately choosing to continue misusing a substance, “which some people believe should be punished, not treated.”
A research paper published in the International Journal of Drug Policy supports Dr. Kelly’s conclusion. Over 500 mental health practitioners attending a conference completed a survey asking for their treatment recommendations for two individuals who had relapsed. The patients were identical except one was described as a substance abuser and the other as having a SUD. The clinicians who evaluated the “substance abuser” recommended a “more punitive” approach, including jail or community service rather than continued treatment.
Mental health professionals have long argued that labeling someone as a substance abuser is defining the entire person by their disease. However, when a person is said to have a substance use disorder, it is understood they have a medical problem that does not define their entire person. Just like a person with cancer or heart disease is far more than their diagnosis, a person with an alcohol or drug use problem has an entire identity apart from their illness, no matter what their label.
As Botticelli writes in ‘Changing the Language of Addiction,’ “This is not just about being politically correct. There’s scientific evidence to show that language matters. We know stigma plays a huge role in why some people with substance use disorders avoid or delay seeking treatment.”
The 2015 National Survey on Drug Use and Health (NSDUH) data found that of the 21.7 million people aged 12 or older who identified as needing substance use treatment in the past year, only about 2.3 million people received treatment. The majority of those not receiving treatment said they didn’t feel they needed it. The survey identified some reasons for not seeking treatment as including the fear that others would view them negatively and that the perceived “stigma” could interfere with job or personal opportunities.
The Mayo Clinic warns that “stigma can lead to discrimination.” According to their website, the harmful effects of stigma may include:
- Reluctance to seek help or treatment
- Lack of understanding by family, friends, co-workers, or others
- Fewer opportunities for work, school or social activities or trouble finding housing
- Bullying, physical violence, or harassment
- Health insurance that doesn’t adequately cover your mental illness treatment
- The belief that you’ll never succeed at certain challenges or that you can’t improve your situation
It’s clear there’s a great need for raising awareness on the harm caused by negative labels and that stigmatizing those suffering from a substance use disorder, or any disorder, is unfair, traumatic and may threaten their decision to seek help.
Turning Point of Tampa’s goal is to always provide a safe environment and a solid foundation in 12-Step recovery, in tandem with quality individual therapy and groups. We have been offering Licensed Residential Treatment for Addiction, Eating Disorders and Dual Diagnosis in Tampa since 1987.
