Terminology and Stigma: How Should We Talk about Substance Use?

In the field of substance use prevention and treatment choosing the correct terminology can be tricky, especially if we want to avoid contributing to stigmatised perceptions of people battling with substance use disorders.

‘Abuse’, ‘abuser’, ‘addict’… these words all have negative connotations.

Indeed, a recent article by Sarah Wakeman published in the official journal for the American Society of Addiction Medicine suggests that the first two “imply a wilful misconduct and have been shown to increase stigma and reduce quality of care”.

Wakeman also argues that it is important to distinguish between ‘dependency’ and ‘addiction’: two terms that are often erroneously used interchangeably.

Those who use opioids to treat chronic pain, and who will thus experience withdrawal symptoms if the medication is stopped, can be described as ‘dependent’. In contrast, ‘addiction’ is a medical disorder whereby “you are compulsively using more and more of a drug that can cause bad things to happen in your life”, Wakeman explains.

Moreover, it is important that we use terminology when discussing substance use that reflects the fact that it is a medical condition.

John Kelly of the Harvard Medical School notes: “If we want addiction destigmatised, we need a language that’s unified and really accurately portrays the true nature of what we’ve learned about these conditions over the last 25 years.”

Notably, Kelly’s work on the stigma attached to substance use has informed a recent consensus document on addiction terminology put together by the International Society of Addiction Journal Editors, which can be accessed by clicking here.