Last week, an article was published in the Jewish Link about our organization, Communities Confronting Substance Abuse, and, during the interview, I mentioned that Elana, our daughter who suffered from addiction during her college years and is now 25 years old, has been “clean and sober” for the last two years. After the interview, I began to wonder if “clean and sober” is even the appropriate terminology. After all, as we think about the messaging that CCSA brings to audiences (students, parents, faculty, community) about addiction education and awareness, we realize that we have to use thoughtful language as stigmatizing words can truly hurt people by reinforcing misconceptions of already misunderstood medical conditions like addiction.
Addiction is a disease and it is important that we use language that describes it as such. We have to demonstrate the same awareness and sensitivity as we would with any other illness, and this is something we at CCSA must remind ourselves as spokespeople and as family members directly impacted by this disease.
In a study conducted in 2010, even medical professionals, who are presumably educated about brain chemistry and addiction, were inclined to treat people with substance use disorders differently if they were described as “abusers.” In the study, clinicians at mental health conferences were presented with a scenario: someone suffering from addiction who had relapsed. In the scenario where the person was described as a “substance abuser” the clinicians agreed more with the idea that there was personal culpability and that punitive measures, such as jail, should be taken rather than providing treatment.
The study participants believed that patients described as “substance abusers” were less likely to benefit from treatment, more likely to be socially threatening, and more to blame for their substance related difficulties, than the exact same individuals described as having a “substance use disorder.” Imagine how laypeople, like us, may perceive the person struggling with addiction depending on the verbiage!
Some of the language around addiction implies that it is a character flaw or a willful act. While it is true that people sometimes do choose initially to try a substance (although, in the case of medically prescribed opioids, that “choice” is medically mandated), nobody chooses to become addicted. The medical reality of addiction is complex. Use of substances releases dopamine in the brain, affecting the brain’s pleasure and reward centers. In the brains of people susceptible to addiction to alcohol or other drugs, the need to drink or use drugs supersedes other priorities and compromises self-control and the ability to resist drugs or alcohol. The brain changes that occur in those genetically wired to be vulnerable to this illness result in people often using substances against their will and despite the terrible consequences and personal suffering that result from misuse.
In thinking about other diseases, no person should ever be defined by his/her illness. We say the words, “someone with cancer” and would not use one word that defines someone fighting cancer, yet we use the word “addict” to describe a person with addiction. Addict is a word that perpetuates negative stigma around substance use and labels people with addiction in a shameful and harmful way. It is a label that reduces the person to their struggle with substances and does not show compassion, respect or understanding that this is a medical condition and should be treated as such. Instead we say “a person with addiction” “in active addiction” “with an addictive disorder” or someone “with the disease of addiction.”
Much like “addict,” it is common to hear the words “drug abuse/abuser,” but “abuse” is a word linked with violence or lack of control and blames the person with an addiction instead of framing it as a health issue. It suggests that the person is voluntarily misusing substances rather than struggling with a disease that involves their brain chemistry. Similarly, “drug habit” implies something that can be easily broken through willpower or persistence, that it is somehow a character flaw that one cannot break the “habit” of substance use, but calling addiction a “habit” denies the complicated and medical nature of the disease and its required treatment as well and the incredibly difficult fight a person must go through to overcome addiction.
To answer my own initial question about using the word “clean,” this associates the symptoms of the illness with being inherently “dirty” or somehow socially unacceptable. “In recovery” or “remission” “maintaining wellness” or “addiction-free” are all more positive ways to refer to someone who has battled addiction and is now substance-free.
We ourselves have had to work to reframe and reshape the language we use when talking about our daughter and our family’s struggles. It does not necessarily come naturally, but it is important to be careful to eliminate stigmatizing or inaccurate words and reshape how we refer to people struggling with this disease. Negative labels and stigma isolate people and discourage them from coming forward for help and treatment. Using language that moves away from blame or stigmatization, and that represents the condition accurately, will move us toward collective compassion and engagement.
So, let me reframe and say that we are incredibly proud of our daughter, Elana, who celebrated her second anniversary of being in recovery just last week.
By Lianne Forman