Language in addiction recovery

Mental health and substance use disorder treatment is often fraught with stigma, both from the general public as well as those who are seeking help. Even in the medical and clinical community, stigma can still exist and prevent many from fully accessing the care that they need. Recently, many organizations such as The American Society of Addiction Medicine and The Office of National Drug Control Policy have examined how person-first language and the language of addiction and recovery as a whole can have a major impact on reducing stigma and improving care. Up to a quarter of those who need treatment for substance use disorders don’t seek it due to fear of being stigmatized by others. With the rate of substance use ever growing, it is important that we take every step we can to reduce barriers for as many individuals seeking help as possible.

Just as those with chronic medical diseases such as diabetes and cancer are not shamed for their conditions, so too should those with mental health and/or substance use disorders be free of shame and stigma.

Stigma promotes feelings of isolation, guilt, and shame – all of which can already be major contributors to a variety mental health and substance use disorders, as well as prevent many from initiating help. Changing the language, we use can help remove the blame, shame, and guilt that underlies many of these disorders. Even for those who are in long-term recovery, the words we use can have a powerful effect on how one views oneself and others.

For those engaged in their own personal recovery from substance use disorder and attending recovery support groups, we often call ourselves and others addicts, alcoholic, or other terms that can be seen as pejorative by others. For many, it feels different to call oneself an “addict” or an “alcoholic” than to hear someone else call them that term, especially if that person is not in recovery themselves. While terms such as “addict” and “alcoholic” can help foster a shared sense of background and community, these terms should not be the first option for healthcare providers. The use of such terms is a personal choice for those with intimate working knowledge of substance use and recovery, but we should avoid using them in a professional setting or applying them to individuals that may have a negative experience of such terms. The transition away from certain terms takes time, and parts of the recovery community may be slow to change or continue using certain terms due to the culture that has existed for decades within them. We do not see this as a bad thing for those that are comfortable with their own definitions of such words, but we refrain from using them as professionals, and advise others to avoid them in an effort to help reduce stigma and continue to evolve treatment into an accepted and accessible option for individuals well before it becomes a last resort.

Person-First Language

Person-first language in addiction recovery is used in many medical and clinical settings. It is all about approaching individuals from a nonjudgmental and compassionate place – truly seeing people as people, and not as diseases.

Below, you can see some recommendations on how to make better word choices when talking about addiction.

Terms to avoid	Terms to use
Addiction	Substance use disorder
Drug problem or ha bit	Substance use disorder
Drug abuse	Drug misuse
Drug abuser or addict	Person with substance use disorder / person diagnosed with substance use disorder
Alcoholic	Person with alcohol use disorder / person diagnosed with alcohol use disorder
Substance abuse	Substance use disorder
Substance dependence	Substance use disorder
Former alcoholic/addiction	Person in recovery
Clean	Substance-free
Replacement or substitution therapy	Treatment, medication-assisted treatment

At our drug rehab center in Virginia, Encore Outpatient understands the importance of the language our staff, clients, and community use, and how language can play a pivotal role in the treatment of substance use disorders and trauma. Our trauma-informed approach takes into consideration what may initially appear to be subtle differences in language, but what can actually have a major impact on a client’s care.

SAMHSA outlines guidelines on effective trauma-informed care, and an important piece of these principles involves the words we use. Appropriate language promotes rapport and trust in the therapeutic setting, which is integral to providing the best client care.