Here are some of the best responses we received -- pro and con (some letters have been edited for length):

Thank you for your stimulating commentary on the words we use to describe the "disease/illness" of addiction.

Several weeks ago I was with some friends in recovery, and I posed the question' "Why is it that when an AA member dies tragically, unable to have achieved sobriety, that we criticize his not practicing his program, working the steps, etc., and have no compassion for him/her? And yet, when someone fails to respond to treatment of cancer, and tragically dies, we are full of sympathy?" One of the group quickly responded, "Because we really don't believe it (alcoholism/addiction) is a disease."

... I can't agree more that our choices of words to describe this disease/illness don't lend themselves or invite one to get help. They just reinforce the denial and stigma. When I begin to train new "substance-abuse ministry" teams, I quickly apologize for the word "abuse", and somehow justify that choice of words based on the DSM-IV usage. You article has challenged me to rethink our ministry's name and how it may actually be counteracting one of our principle goals: to assist people touched by addictive disease receive the help they need, and to enlighten folks that we're talking about a bona-fide disease, NOT a moral problem.

Thank you again for your insight and challenge. My hope and prayer is that we won't keep shooting ourselves in the foot, resulting [in] our mission of hope and healing from being continually undermined.

Erik A. Vagenius. MHS, CAP
Director - Office of Substance Abuse Ministry
Diocese of Palm Beach
Palm Beach Gardens, Fla.

Shame on Join Together, the organization that developed "Demand Treatment." (Doesn't DT have a 'pejorative' implication?)

Curley's article and efforts are at the least censorship and worse, "spin." (Def: The effort to put a better face on reality and thus persuade people to react differently, i.e., in keeping with the agenda of the 'spinners'.) The terms drug use-abuse-addiction have clear meaning according to ASAM and others. Chemical-substance-drug are synonyms.

I attended the tool of the spinmeister, a 'Focus Group' at the first Demand Treatment meeting in San Jose on this very topic of pejorative semantics. I was underwhelmed with the announced mission of the group and had the satisfaction of seeing the group shrug collectively at its conclusion.

Such a 'clean up the language' undertaking, we were told, is patterned after the early 1980s, when HIV and AIDS were terms not yet commonly used. We don't use the terms "Gay Flu" or "Popper Plague" any more, but in my opinion the righteous, the religious and the moral communities have not changed their bias about victims because they have scientific shorthand to use.

... Those of us in this field should not distract people, editors, fund-raisers, acceptors of grants, legislators, and the criminal-justice system by indicating there are more correct and acceptable ways to refer to the plague of addiction ... Join Together has always found itself on the side of those who study and deal with the genes, the vectors, the science of the brain, and the resultant dead and dying. They should not waste time alarming themselves, or warning others, of the dangers of terms like 'drunk', 'addict', 'abuser,' 'substance' etc.

... Don't let Demand Treatment (DT) become DT with Civility Without Arousing Bias or Passion (DTCABP) ...

David L. Breithaupt MD
San Jose, Calif.

Words define our perspectives. Until we professionals stop this division of mood-altering drugs, how can we expect our clients to break through their alcoholism? I wonder if this does not go back to the old deacons of AA, and their need to feel unique and not a drug addict.

A drug is a drug is a ...

Dee White, MS, CSAC
Kihei, Hawaii

Congratulations to Bob Curley on his commentary ... Issues around language and stigma, while not new, are important and deserve our continued attention and discussion.

While this article focuses on addiction, we must not forget an important point regarding "abuse." "Alcohol abuse" is a clearly defined clinical diagnosis. Alcohol problems can accrue to both individuals (e.g., accidents or injuries, health, legal, or financial problems) and society (e.g.,
health care, criminal justice, and economic problems) as a result of drinking by persons with and without clinical diagnoses.

Further, research shows the success of providing intervention and treatment services to individuals diagnosed with alcohol abuse. For example, most brief interventions are designed to help those at risk for developing alcohol dependence to reduce their alcohol consumption.

Given these important differences, we should not abandon discussion of "abuse." Explaining what it is we are discussing is, as always, paramount.

Geoffrey M. Laredo, Director
Office of Policy, Legislation, and Public Liaison
National Institute on Alcohol Abuse and Alcoholism

I commend you on this excellent article that articulates the issue so well. Especially admirable is your willingness to point out the misuse of language by the powers that be -- even in your own house. True advocacy at its best!

Donna Conley
Chief Executive Officer
Ohio Citizen Advocates
Columbus, Ohio

I certainly have some agreements and disagreements with the recent JT article about the linguistics of the "addiction" (alcohol and other drugs) field.

A couple of thoughts:

Emphasizing the "and other drugs" seems very appropriate and on target; however, where do you stop at being specific? For example, do you say, "alcohol, tobacco, caffeine, and other drugs" since the term "drugs" is so often taken to imply illicit drugs, thereby ignoring significant patterns of addiction (or abuse?) with many other drugs.

Let us not forget that every person who has or will abuse alcohol or other drugs is not necessarily an addict. That point is important for two reasons: From a stigmatizing perspective, the term "addict" still often tends to trigger the image of the "junkie, shooting smack" in a decrepit old building, not unlike the image of the "Alky" years ago.

Also, there is a need to clinically differentiate patterns of misuse, abuse, and addiction. Although one may just be an early stage of another or be a "linguistic denial" for many addicts, there is still a viable group of persons who do misuse and/or abuse alcohol and/or other drugs and are in need of further prevention or intervention services which may be (or are) distinctly different from intervention and treatment services for addiction.

There is some parallel in the medical field when you consider cardiac problems from "signs of abuse" such as high cholesterol, blood pressure, etc., to a mild heart attack, to congestive heart failure. Certainly, all the levels may be connected, but not always and different approaches to prevention, treatment, and recovery are essential.

"Addiction" is certainly being utilized to describe a much broader pattern of compulsive behaviors ... eating, sex, shopping, Internet, etc., so will such a term become overused or begin to reflect a general image of compulsive behaviors rather than the addictive process relevant to alcohol and other drugs? Thus, is there a need for another term rather than trying to redirect what has been around for years being overused, misused, and/or misunderstood?

Tom Reynolds
counselor ... no,
therapist ... no,
employee assistance professional ...?
... well, that's a discussion for another time!

It is a long article that describes the problem and provides no answers. The description of the problem is right on. We need to use terms that are not pejorative and that are accurate. For now, I always use the term "alcohol and other drugs" no matter what the alcohol-beverage industry thinks. For lack of better terms, I always use the term alcohol and drug dependency rather than addiction ... and for those that have not developed a dependency, they do abuse alcohol and other drugs.

I am still not convinced that people who develop a dependency are able to become recovered and use again. Haven't seen any good studies on that.

Good article, but would have been better with specific answers to the problem.

Jeff Kushner
Drug Court Administrator
President, Alcohol and Drug Problems Association of North America
St. Louis, Mo.

This is an important discussion for our field, especially at this time when growing numbers of people in recovery and family members join efforts to advocate for stronger public support for the solutions to addiction.

In a field as diverse as ours, it may be hard to find universal agreement on the whole range of language issues. So let's start small -- let's all agree to simply stop using the phrase "substance abuse" when referring to alcohol and other drug addiction.

Jeff Blodgett
Coordinator
The Alliance Project
St. Paul, Minn.

Words do form thinking. Since 1984, in our curricula and related trainings, we have used phrases like "people who develop alcoholism," or "people with alcoholism," rather than "alcoholics," and have found it to be very helpful in guiding thinking.

People notice the difference and discuss it. It not only moves the focus to the addiction rather than the person, it also helps people think of alcoholism more like other health problems, since it is like the language used for other health problems (people refer to developing cancer not becoming cancerics!). We also find it more helpful in establishing alcoholism as a health problem than the common "disease of alcoholism" phrase which can sound odd (people don't say "the disease of cancer," simply "cancer").

However, we would like to suggest caution on further emphasizing the fact that alcohol is a drug ... We realize that the intent of the "alcohol is a drug" message is that by getting the public to think of alcohol as a drug, they may take alcohol more seriously. But if we ignore the power of social context as we struggle to make a pharmacological point, we may jeopardize the impact of our message.

For example ... one state put out a poster showing wine coolers with a phrase pointing out that "these are drugs." ... Maybe some teens saw the poster and thought, "Wow, I never thought of that, I guess I'll never drink a wine cooler. I don't want to use drugs." Maybe. But maybe they looked at it and thought, "Wow, wine coolers are drugs? Wine coolers are good and most of my friends drink them. Maybe drugs are not so bad!" ... Is it possible that our well-intended message about alcohol being a drug, may back-fire because of the powerful social context of alcohol? Of course it is a drug, but we may win the pharmacological battle on this and lose the social war.

Consider another example: As the war on drugs ramped up and the "alcohol is drug" message took hold in schools, we found more and more parents who drank minimally coming to our classes and saying things like, "My fourth grader started crying at dinner the other night when I had a glass of wine. She begged me to stop using drugs." ... Many others have reported milder reactions, but ones that caused difficulty for them as parents ... This is not isolated ...

[H]ow likely are parents to become involved in prevention when doing so requires them to embrace a message that will label them as drug users for having a glass of wine with dinner? Should we be surprised that so few parents become involved with prevention? No matter how we try to dress it up, the fourth-graders in question took the only logical message that could result from the alcohol is a drug message ... Wouldn't it be more productive to emphasize that drug use is not normative behavior?

The more we emphasize that is a drug, the more we alienate those who use drink and the more normative we make drug use ...

[A]s children grow up, they distance themselves from any position that they held as children that they feel will not be consistent with their aspired-to adult status. By middle school the ones who challenged their parents "drug use" when drinking one glass of wine, may look back and think, "Wow, was that a stupid little-kid thing for me to do." And what is the best way the child can think of to distance him/herself from that fourth-grade position? Perhaps it is to drink!

... Those of use concerned with prevention must face the reality that ... teens are rejecting our message as they enter the time in life when alcohol use is highest ... The "alcohol is a drug" message may resonate just fine with those who are more inclined to not drinking than drinking. But if we want to really make an impact our message must penetrate those most inclined to drink -- and they must take the message with them as they grow up ...

Words do form thinking both for us and for the people we serve. One of the issues we face is deciding when our choice of words serves our own ideological needs, and when it serves the needs of the public.

Ray Daugherty
Prevention Research Institute
Lexington, Ky.

I have worked as a consultant in the field of addictions for many years outside of the U.S. The terms used in Europe particularly in the U.K. for abuse and addicted is "Misuse" The person misuses alcohol or drugs/is a misuser.

... One cannot abuse a drug nor alcohol as in "to treat wrongly," but they certainly can misuse it. The action word "abuse" denotes to do someone or something harm. Abusing alcohol? Should be the other way round.

Anne Vance
La Jolla, Calif.

Good article. Words have power. One thing I noted was the article used the term "disabled" rather than handicapped or crippled, implying it was less judgmental. This is still seeing the person as his illness. It might be advantageous to focus on the person rather than the disability, i.e., "person with a disability."

Becky Guilfoyle
Wichita, KS

Your further comments on this and other issues are always welcome: Please e-mail us at editor@jointogether.org.