Addiction and Substance Use Disorders: Tips for Communicating without Stigma

Originally published on the NIH Science, Health, and Public Trust website

By Tara Garwood

Social Media Strategist, NIH’s National Institute on Drug Abuse (NIDA)

A very smart man I know once said to me, “When there’s an underclass, there is always language holding them down.” We can see examples of stigma’s effects everywhere—in racist, sexist, and ableist language, even in the visual language of the images we use to depict people.

In the addiction field, we have found that stigma can affect the treatment people with substance use disorders receive and even discourage them from seeking treatment to begin with. But stigmatizing language isn’t always easy to spot. How do you figure out the appropriate, non-stigmatizing way to speak to the communities you serve? I’ll share with you the strategies we use at the National Institute on Drug Abuse (NIDA).

Deciding on Language

We listen to voices in our community. Social media comes in very handy with this. We review all of our comments, and occasionally someone will mention a term that they are uncomfortable with. When that happens, we examine whether or not we should change it and respond to the person who made the comment. If we made a mistake, we own it. It’s as important for people to feel heard as it is to hear them.

We pay attention to changes, not only around possibly stigmatizing language, but also to the scientific understanding of the topic of addiction. We find that naming things in a clear, scientific manner helps to minimize stigma. It’s not always about replacing specific words, though. How we describe things also affects the way people view them. For example, we define addiction as a chronic brain disorder, which encourages a public health approach to preventing and treating it as the medical condition it is and helps dispel the myth that addiction is a moral failing.

We also look to leaders in other communities for examples to follow. When NIDA began working to combat the stigma surrounding substance use disorders, the development of non-stigmatizing, people-centric HIV/AIDS language served as an example for us of “doing it right.”

Stigmatizing Terms

Abuse: Rather than “abuse,” which has a negative, stigmatizing connation, say “use/misuse” or “unhealthy/harmful use” to describe problematic substance use.

User/Abuser/Addict: Instead of these terms, consider “person with a substance use disorder,” “person who uses…,” “person addicted to…,” or similar person-centric language that acknowledges that people with substance use disorders are not defined by that label.

Dirty/Clean: Referring to people who have discontinued harmful drug use as “clean” implies that people who currently use drugs are “dirty.” Try “sober” or simply “not using drugs” instead. “In recovery” may also be appropriate. Calling a drug test “dirty” or “clean” can extend to the person taking the test. Instead, say “tested positive/negative.”

At NIDA, we keep an internal style guide of non-stigmatizing terms. Here are a few examples:

Substance use disorder (SUD): A disorder characterized by problematic use of alcohol and/or drugs despite negative consequences, such as health problems, disability, and failure to meet responsibilities at work, school, or home. A substance use disorder can range from mild to severe. Addiction is often used to refer to the severest form of substance use disorder.

Dependence: Occurs with long-term usage of many drugs, including medications that are used as prescribed. Dependence can accompany addiction but is not always a problem. Many chronic pain patients are dependent on their medications, but that alone does not mean that they are addicted.

Neonatal Abstinence Syndrome (NAS): This is the preferred term for a baby born in withdrawal. Babies are not “born addicted” as that diagnosis requires drug-seeking behavior which a newborn is unable to exhibit. “Born in withdrawal” and “experiencing withdrawal symptoms” are also acceptable.

The Language of Imagery

Imagery is also an important tool for dispelling stigma. Try not to stereotype by showing people of the same race, gender, or sexual orientation whenever you discuss a specific drug or issue related to substance use disorders. Being inclusive of race, gender, disability, family make-up, etc. shows the community that you understand that this can happen to anyone.

Because language and culture are ever-moving targets, we all make mistakes sometimes. That’s okay. As long as you’re trying and treating people with respect and dignity, most people will appreciate it and will generally forgive any missteps, especially if you’re honest about them. It takes some effort to ensure that the words you use are not stigmatizing, and it can be challenging. But it is well worth the effort.

Our Director, Dr. Nora Volkow, speaks on the stigma of addiction often and has written about how scientific language can help counter it on her blog, here and here. She has also discussed how health communicators and journalists can help. NIDA periodically addresses the topic on our teen site, most recently in this guest blog.

About the Author:

Tara Garwood is the Social Media Strategist at the National Institute on Drug Abuse (NIDA). She previously worked in video production at the Food and Drug Administration and the U.S. Secret Service, where she developed and implemented their captioning process. Special interests include eliminating stigma, promoting diversity, and making video accessible. When she’s not planning, creating, or posting NIDA’s social media, (sometimes simultaneously!), you can find Tara shooting her own videos, knitting poorly, or reading on the couch with her two snuggly Boston Terriers.

Tara Garwood
Tara Garwood, Author