Why Words Matter in the Substance Use Conversation

Carefully chosen language can help reduce stigma

Why Words Matter in the Substance Use Conversation
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In any public health or policy issue, it is important to consider the language used to discuss the people affected. The nation’s prolonged opioid crisis continues to touch many communities and families, and the way in which experts and others talk about substance use disorders, their causes, and the solutions is evolving. Today, opioid use disorder (OUD) is largely understood to be a chronic illness that changes the chemistry of the brain and often requires continued, evidence-based treatment for those affected. Opioid misuse is a public health problem—not a moral failing.

To reflect that, medical practitioners, academics, and journalists have started using more sensitive, less stigmatizing language to discuss OUD. At the same time, the gap in access to treatment remains far too wide for a variety of reasons: Only 26% of people with OUD received any kind of treatment for the disorder in 2018.

Contributing factors include provider shortages and cost of treatment, as well as the stigma that remains among policymakers, providers, and even patients themselves about people who misuse drugs and the medications that treat OUD. In addition to policy approaches, a shift in language could reduce stigma and encourage more individuals with OUD to seek medical attention, as they would for other ailments.

The guidance here, based on education campaigns such as Changing the Narrative, expert consensus, and the AP Stylebook, offers three principles on what terminology to adopt and what to avoid when talking about the opioid crisis:

  1. Use person-first language. Labels such as “addicts,” “drug users,” or “junkies” are inappropriate and diminish the humanity of people who misuse drugs. Instead, referring to “people with OUD” acknowledges that they are complete people experiencing a disorder—and are not defined by their opioid use.
  2. Drop negative connotations. Individuals who have stopped using drugs are sometimes said to have gotten “clean.” This implies that misusing drugs causes one to be “dirty.” Such language again contributes to unhelpful stigma and shame that can keep people from seeking the treatment they need. A person no longer misusing drugs would be described as “in recovery.”
  3. Treat OUD like any other medical condition. Like many other chronic illnesses, OUD can be managed with evidence-based, ongoing treatment that allows individuals to live productive lives. The Food and Drug Administration has approved three medications to treat the disorder: buprenorphine, methadone, and naltrexone. Medication has proved to be the most effective treatment available without requiring any other interventions, even behavioral counseling—though access to both is beneficial, given the mental health challenges that can accompany OUD.

At the same time, referring to this gold standard of care as “medication-assisted treatment,” or MAT, suggests that the medicines are not integral to the therapy. Just as insulin would not be called medication-assisted treatment for diabetes, these medicines should not be called such for OUD. The Pew Charitable Trusts has made this change to its lexicon to properly discuss medication use to manage OUD and no longer uses this wording.

Language surrounding OUD, the people affected, and its treatment will probably keep evolving as the opioid crisis continues to unfold. Changing the Narrative—launched by reporters, researchers, academics, and advocates out of Northeastern University in Boston—is a critical resource for learning how to talk about this epidemic in a respectful and constructive way. Humanizing the conversation around OUD can help reduce stigma as a barrier to much-needed health care.

Beth Connolly directs The Pew Charitable Trusts’ substance use prevention and treatment initiative.

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