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Abuse Terminology
reinforces Stigma
Commentary by Bob Curley, Join Together
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 suport the goals of fighting stigma, encouraging recovery, and
empowering those who struggle with alcohol and other drug addiction.
Bob Curley is 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.
- Comments about this feature? Email them to editor@jointogether.org.
We'll publish the best of the bunch. Please include your name, city
& state. Published comments may be edited for length.
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Discuss the language of addiction and many other topics with your
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