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Word Choices Affect Attitudes Toward Addiction Recovery
January 15, 2010

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Research Summary

A survey of health professionals found that referring to people with addictions as "substance abusers" was more likely to evoke punitive responses to drug use than those who referred to individuals with "substance-use disorders," according to researchers at Massachusetts General Hospital (MGH).

John F. Kelly, Ph.D., associate director of MGH's Center for Addiction Medicine noted that the World Health Organization declared the term "abuser" as stigmatizing three decades ago, but the term is still commonly used to describe people with addictions to illicit drugs. Referring to recovery, Kelly said, "There's an old proverb that states, if you want something to survive and flourish, call it a flower; if you want to kill it, call it a weed."

Kelly and colleagues surveyed more than 700 mental-health professionals attending a conference on addiction and mental illness. Half received a survey that referred to a hypothetical patient as a "substance abuser," while the rest got a survey referring to the patient as having a "substance use disorder." The surveys were otherwise identical.

Respondents who received the "substance abuser" version were more likely to say that the patient should be punished for failing to follow a treatment plan and to agree that the patient shouldered blame for having trouble complying with court-ordered treatment requirements.

"Our results imply that these punitive attitudes may be evoked by use of the 'abuser' term, whether individuals are conscious of it or not, and suggest that this term perpetuates that kind of thinking," Kelly said. "From the perspective of the individual sufferers, who often feel intense self-loathing and self-blame, such terminology may add to the feelings that prevent them from seeking help."

The study was published in the International Journal of Drug Policy.

This article summarizes an external report or press release on research published in a scientific journal. When available, links to the sources are provided above.

COMMENTS ON THIS ARTICLE:

Posted by Alexb on 19 Jan 10 12:35 PM EST
So glad this issue is up and in the news again. The perjorative phrase SA has seemingly taken over the field (SAMHSA / CSAT could definitely take some leadership here!) The phrase is not only stigmatizing, but grammatically illogical. An alcoholic friend once told me that an example of alcohol abuse would be mixing good bourbon with kool aid.

Posted by Dr. Henry Steinberger on 19 Jan 10 12:49 PM EST
It is for this reason that we, at SMART Recovery, have discouraged labels and why I have advocated for "People First" language. E.g. 'I am a person who used to smoke weed, but quit years ago and no longer have any desire to use" rather than: "My name is Henry and I'm a pothead with 20 years clean". Or "I'm a person who over-drinks and I'm here to learn how to quit entirely." rather than "I'm an alcoholic". This is what I and my colleagues at SMART Recovery have been saying for years. And this is old news. Our colleagues at SMART-UK sent us just such a finding in an article published years ago.

Posted by frjimt on 19 Jan 10 12:52 PM EST
funny, isn't it? weeds have deeper roots than flowers........ in the rooms of recovery, thank God, things aren't painted all "flowery"... in order to get to the depth of the weeds, we've got to do deep..... call it what you like in medicine, drug abuse is abuse: for the heroin addict and the pill popping grandma. still, whatever it takes to get people help.....

Posted by Frank S Dorsey on 19 Jan 10 03:27 PM EST
I'm a full supporter of the new termnolgy, just the same as I support calling Mental Illness (MI)a Chemical Imbalance (CI) the old terms have to much negitive with them and stigma that in our society its hard just to be accepted for who you are when there is so many people that judge you after leaving treatment including ones self.

Posted by Rokki on 19 Jan 10 03:50 PM EST
I started doing this presentation almost 10 years ago at various forms of Harm Reduction Conferences to help end Stigma surrounding Medication Assisted Treatment. It has taken awhile but folks are finally getting it. Not to say my work is any where close to done. Many Harm Reductionists feed stigma and don't even realize it,as do patients of MAT and ex-patients. So listen to your National Alliance for Medication Assisted Recovery Certified Advocate. They know what they are talking about! Rokki

Posted by Jim Joyner on 19 Jan 10 05:35 PM EST
I stopped using "substance abuse" years ago. let’s not stop here however. Do you think we can get the same people and organizations to stop treating alcohol as something other than a drug? It is not "alcohol and drugs" it's "alcohol and other drugs!" We do our patients and clients a disservice by suggesting that alcohol is something other then what it is. It's long past the time for SAMHSA, CSAT, NIAAA, NIDA, etc. to understand that also. It's "ALCOHOL AND OTHER DRUGS!!"

Posted by pixxie on 19 Jan 10 07:38 PM EST
Let me play the devil's advocate...if you try to find milder terms for substance abuse, you could be letting people delude themselves into thinking that ruining their lives with drugs or alcohol isn't such a serious problem. I don't see the point in sugar-coating these disorders just to try to avoid bruising people's tender feelings. I had a serious addiction to alcohol,i'm not proud about it but i've been sober for 10 years...i call myself a reformed drunk and that works for me.

Posted by John B.Mays on 21 Jan 10 11:15 AM EST
Agreed, we need to get more people help.However, abuse is abuse whether it be alcohol, food or other substances. I certainly don't want to offend anyone so just use what ever is appropriate at the time. At one time persons receiving treatment were called patients, then clients, then consumers. Sounds like health, law and grocery shopping. What will be the next " chosen word or title"? They all are just people in need. What ever works---works. Proverb,converb or middle of the road verb.

Posted by Jill Kerr on 21 Jan 10 01:40 PM EST
The term "substance abuse" does not fully describe the disorder, and is misleading. It is only ONE diagnosis. The term substance use disorder describe any of the disorers listed in the DSM-IV TR. It's the term I teach my staff and students because it is the most accurate.

Posted by maxwood on 22 Jan 10 04:22 PM EST
The "A" in some of the acronyms Jim Joyner cited is of course "Abuse", and these same organizations then proceed to deliver web sermons on cannabis (connect the dots). The reason such terminology is still used today, as Dr. Kelly cited, is that certain "industries" (such as arresting officers, prison guards) have a vested interest in punishing strategies.

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