Addiction, as described by the National Institute on Drug Abuse (NIDA), is a “chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.” It’s a definition that manages to encompass a complex psychological condition. But for many in the media, medical profession and other related fields, the term “addict” has come under fire for potentially negative and even harmful impact on those struggling with addiction. In 2017, the Associated Press issued new guidelines on terminology related to drugs and addiction, which included substituting “substance abuse disorder (SUD)” for addiction and “in recovery” for sober.
A public radio interview with Michael Botticelli, director of the Office of National Drug Control Policy under former President Obama also urged replacing “addict” or more derogatory terms like “junkie” for their potential to “pigeonhole someone’s entire being to that one single characteristic,” as Botticelli noted. He also cited a study by Dr. John Kelly of the Harvard-MGH Recovery Research Institute, in which trained clinicians were given scenarios about an individual struggling with addiction. The information was identical save for one detail: one report referred to the individual as a “person with a substance abuse disorder,” while the other used the term “substance abuser.” As Botticelli explained, “What [Kelly] found is when you called someone a substance abuser, it elicited, even from trained clinicians, a much more punitive responsive.”
For advocates of using terms other than addict, stigmatization is among the primary reasons for employing newer, less judgmental terms. Labeling an individual with an addiction as an “addict” can reduce the individual to a single term; the NZ Drug Foundation cites a hypothetical scenario about a father of two, employed at a factory, who also happens to have an addiction to drugs. Labeling him as an “addict” obfuscates his occupation and his family. He is simply an addict and nothing more.
“I find that when people identify themselves as the condition they have, it complicates things significantly,” says Elissa Zelman, Psy.D. CEDS. “The main task of recovery is no longer about helping the person understand and manage their symptoms. Rather, it becomes about a deeper, more entrenched view that the person has about him or herself. I encourage people to say, ‘I have…’ rather than, ‘I am…’ if it feels intuitively right to them, to try to disentangle identity issues.”
More significantly, the term “addict” can further stigmatize by serving as a constant focus on his or her weaknesses. Reframing the term could provide support to an individual already feeling marginalized by their perception of societal attitudes towards their condition. It may also open the door for those who are hesitant to enter treatment, specifically because of those societal stigmas.
“I absolutely believe that we lose a large number of potential ‘abusers’ by labeling them as addicts,” says Loree Cohen, M.S., L.C.S.W. and Clinical Director of Inner Actions. “We have two substance users, those that have developed a dependency and those that abuse. Either way, they need help. Those that are dependent may need detox prior to treatment and this is one of the most important reasons to identify them as dependent. Since we are looking at a chronic problem on many levels, micro and macro, we need to address this in a way that more people will ask for the help they need. So, yes, I do believe there is a stigma associated with the term ‘addict’ and that it would be more beneficial to reference to [addiction] as dependence.”
But the push to use terms other than “addict” is often countered by individuals – both in treatment/recovery and addiction/mental health – who view the term as a honest label for their struggle. Substance abuse is a life-threatening, potentially fatal disease. Calling it “like it is” – to describe one’s self or a person in the grip of substance abuse as an addict removes any filter from their conflict. Accepting the realities of addiction – that it is a disease that requires constant, life-long work – can put a person closer to the idea that they can survive and thrive by it.
“I would NOT” substitute the world ‘dependent’ for addict,” says Marc Lewis, Ph.D. “‘Dependent can mean all sorts of things, and is therefore too fuzzy to be meaningful. Addiction is a real condition. While it can be difficult to model or define with precision, almost everybody recognizes it when they see it. Sometimes it’s most efficient and even helpful (e.g., let’s call a spade a spade).”
Lewis agrees that the word can be fraught with negative connotations depending on the context of its use. If the user needs to employ another word, Lewis suggests a parenthetical qualifier – “no disdain or judgment implied in any way.” Another option is to clarify the human component of the condition. “If the recipient/audience is thought to be extremely sensitive, I’d replace it with ‘a person with an addiction,’ or ‘people in addiction.'”
While the debate over the word “addict” – as stigma or no-punches-pulled depiction – remains a divisive one, it does underscore the need for understanding, compassion and rigorous honesty for both sides in the substance abuse scenario.
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