Reducing Stigma through Language

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We are presently in the best position we have ever been in to deal with the terrorism of addiction because we know more about this disease than ever. We have 23 million people in recovery in the US, a large number of whom are young people who are leading the way by setting up resources in colleges, fighting to protect vulnerable persons suffering with this illness, and calling out such heinous acts as patient brokering and human trafficking.

We have had rallies and marches, and we have rappelled down buildings.  We have used social media to raise awareness and forge connections, and we have created resources such as in the rooms and the Addiction Recovery eBulletin. Our journalists have given names and faces to lost loved ones, exposed unethical providers and practices, and highlighted the quality work our legislators are doing.

Together, by speaking out and raising awareness, we are re-examining our ideologies around addiction and determining how we can most effectively break the shame and stigma surrounding this disease that have made it so hard historically for many to get the help they need.

Alice Miller once said, “What is addiction, really? It’s a sign, a signal, a symptom of distress. It’s a language that tells us about a plight that must be understood.” The problem is that, in spite of the work we are doing to reduce the stigma, the language and the plight Alice Miller talks about is too often misunderstood and misrepresented with derogatory words and phraseology. The actual words many often still use when talking about addiction and mental health issues can exacerbate the stigma attached to these conditions.

Despite the hard work done by so many to reduce stigma, there is no doubt that substance use disorder (SUD) and mental health conditions are looked upon negatively by many people. People who are experiencing these conditions frequently have their symptomatic behaviors blamed on them, as if they have a faulty moral compass. In actuality, SUD and mental health conditions are medically recognized disorders that warrant compassionate care and connection rather than judgment and isolation.

This article will explore how derogatory language used to describe these conditions can perpetuate this stigma and how we can mitigate this through modifying our language choice.

Researchers have found that stigma consists of two components – a label and a stereotype[1]. The label (e.g., addict) connects the person to characteristics that are deemed undesirable (e.g., dishonest). When people connect these stereotypes to a person, they are more inclined to discriminate against them. Research has shown that words such as “substance abuser,” “addict,” and “alcoholic” are perceived negatively by the general public[2], so it logically follows that this will be reflected in how people with these conditions are treated.

This has wider implications beyond the individual level. Research has shown that those with stigmatized conditions receive less public funding for their treatment[3]. Given that substance use disorder and mental health conditions are leading causes of death in the United States, it is clear that the language we choose surrounding these conditions matters.

SUD has been stigmatized since the 1800s, when religious groups decided that opium use was “sinful” and led campaigns to ban it[4]. Since then, the introduction of the 1914 Harrison Anti-Narcotic Act criminalized both those who use substances and the physicians who prescribe them[5]. The War on Drugs that came later ensured that many people with SUD were given lengthy jail sentences and made felons for the rest of their lives. The language used to describe these people reflected the societal view, that words such as “addict” and “alcoholic” have been long associated with immorality.

Mental health has historically been equally stigmatized. For centuries, people with mental health conditions were treated as second class citizens. People were put in sanitariums, isolated from communities, and even lobotomized[6]. People still use words like “schizo,” “crazy,” and “mental” to describe behavior that they object to that has nothing to do with mental health conditions.

Medical science has progressed a great deal in the past 50 years. Substance Use Disorder and various mental health conditions are now listed in the DSM-V[7] alongside other diseases such as pneumonia or cancer. Most people would be shocked if anyone used language that denigrated people who were experiencing these more acceptable conditions. However, much of the loaded language around mental health and substance use remains in common parlance.

Whether it is conscious or subconscious, this language serves to further stigmatize those who are actively using substances, experiencing mental health problems, and seeking recovery.

It is not just external stigma that can affect people who use substances or have mental health conditions. Self-stigma is defined by prominent mental health researchers Corrigan and Rao as what happens when “people internalize public attitudes and suffer numerous negative consequences as a result” [8]. Some of these repercussions include not wanting to seek help for their condition, seeing their condition as their fault, and feeling alienated from society[9]. Research by the National Alliance on Mental Illness[10] showed that only 40% of adults with mental health conditions got help in the past year.

Self-stigma is also a factor that can prevent those with an SUD from seeking help. Research has found that 22.7% of people with an active SUD felt that stigma kept them from seeking treatment; 11.6% were worried about the impact on their employment; and 11.1% were worried about the negative opinions of their neighbors or community[11].

More progressive substance use and mental health treatment centers have changed the language they use to refer to these conditions in an attempt to reduce the shame surrounding these conditions and empower those who are experiencing them. Some examples include:

  • Addict = substance user
  • Addiction = substance use disorder
  • Alcoholic = alcohol user
  • Mental illness = mental health condition
  • Trauma victim = trauma survivor
  • Substance abuser = substance user
  • Clean = abstinent
  • Dirty drug test = positive drug test
  • Mental disorder = mental health condition

Language constantly evolves to reflect and shape the views of society. If more progressive language around substance use and mental health is used, more people can enhance their understanding of and compassion for those who suffer from these conditions. It will also help people re-frame their experiences and understand their own conditions, which will remove barriers to treatment and finding recovery.

For more information on treatment, contact Heather R. Hayes & Associates – call 800-335-0316 or email info@heatherhayes.com today.

Sources

[1] Link, Bruce G., and Jo C. Phelan. “Conceptualizing Stigma”. Annual Review Of Sociology, vol 27, no. 1, 2001, pp. 363-385. Annual Reviews, doi:10.1146/annurev.soc.27.1.363. Accessed 1 Dec 2020.

[2] Ashford, Robert D et al. “Substance use, recovery, and linguistics: The impact of word choice on explicit and implicit bias.” Drug and alcohol dependence vol. 189 (2018): 131-138. doi:10.1016/j.drugalcdep.2018.05.005

[3] John F. Kelly, Richard Saitz & Sarah Wakeman (2016) Language, Substance Use Disorders, and Policy: The Need to Reach Consensus on an “Addiction-ary”, Alcoholism Treatment Quarterly, 34:1, 116-123, DOI: 10.1080/07347324.2016.1113103

[4] Harding, Geoffrey. “Constructing Addiction As A Moral Failing.”. Sociology Of Health And Illness, vol 8, no. 1, 1986, pp. 75-85. Wiley, doi:10.1111/1467-9566.ep11346491.

[5] Terry, C E. “THE HARRISON ANTI-NARCOTIC ACT.” American journal of public health (New York, N.Y. : 1912) vol. 5,6 (1915): 518. doi:10.2105/ajph.5.6.518

[6] Freeman, W., Watts, J. W., & Hunt, T. (Collaborator). (1942). Psychosurgery: Intelligence, emotion, and social behavior following prefrontal lobotomy for mental disorders. Baillière, Tindall & Cox. https://doi.org/10.1037/11151-000

[7] Hasin, Deborah S et al. “DSM-5 criteria for substance use disorders: recommendations and rationale.” The American journal of psychiatry vol. 170,8 (2013): 834-51. doi:10.1176/appi.ajp.2013.12060782

[8] Corrigan, Patrick W, and Deepa Rao. “On the self-stigma of mental illness: stages, disclosure, and strategies for change.” Canadian journal of psychiatry. Revue canadienne de psychiatrie vol. 57,8 (2012): 464-9. doi:10.1177/070674371205700804

[9] Clement, S et al. “What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies.” Psychological medicine vol. 45,1 (2015): 11-27. doi:10.1017/S0033291714000129

[10] “NAMI”. Nami.Org, 2019, https://www.nami.org/NAMI/media/NAMI-Media/Infographics/GeneralMHFacts.pdf.

[11] Ashford, Robert D et al. “”Abusing Addiction”: Our Language Still Isn’t Good Enough.” Alcoholism treatment quarterly vol. 37,2 (2019): 257-272. doi:10.1080/07347324.2018.1513777

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