How the words we use shape our experience and understanding of substance use
Reprinted from the Blips and Dips in the Recovery Journey issue of Visions Journal, 2019, 15 (2), pp. 8-10
The language we use to talk about substance use and addiction is important. Words are powerful: they can include or exclude. Unfortunately, our language around addiction is often negative and impacts the way society perceives substance use and people who use substances. The language we use also frames what the public thinks about recovery, potentially discouraging people from seeking treatment and leading to labels that can affect whether or not they can access life needs, including employment, health care and housing.
Addiction language through history
The history of our language around addiction is complex. Prior to the late 19th century, "addiction" was rarely associated with drugs; it meant being "given over to" or devoted to something. However, in the late 1800s, the word came to be linked to addiction to drugs, vice, withdrawal symptoms and dependence.1 There was also a moral component to the language around addiction: people who used substances were often thought of as sinners.
By the 1930s, "addiction" was used mostly in relation to illegal substances, regardless of whether or not the people who used drugs experienced harmful effects. As medicine became increasingly influenced by science, the language around addiction shifted. People who used certain substances were regarded as having a "disease" that could be treated rather than being regarded as people who lacked self-control or were unwilling to change.
Nowadays, our use of language around addiction tends to blend the constructs of sin and sickness. These two ideas have very different implications. In the first construct, we tend to focus on addiction as the result of individual choice, and often adopt moralistic or judgemental language. In the second construct, we see people as subject to forces outside of themselves; we tend to regard them as needing our help—and in the process, we often deny them agency.2 The two constructs don’t work very well together: on the one hand, we blame people for making poor choices; on the other hand, we deny that they are capable of making their own choices.
Today, language around substance use often implies that using drugs is a bad thing. For example, we use the phrase "getting clean" when referring to someone who stops using drugs, which implies that those who use drugs are "dirty." Unfortunately, such language stigmatizes drug use and drug users, which can have devastating consequences. It can prevent people from seeking treatment by increasing stigma and shame, making people fearful of seeking support. Using words such as "substance abuse" is also problematic. We do not call people with diabetes "sugar abusers," for example, so why do we use the terms "substance abuse" and "substance abuser" to talk about substance use and substances users? There are other ways to talk about drug use and its potential benefits and harms—ways that don't label people as bad, wrong or different in a negative sense.
Challenging our black-and-white thinking while we move towards wellness
When we talk about addiction, our language tends to lack nuance and precision. For example, "recovery" is often framed as complete abstinence from substance use, and "relapse" as the use of any substances at all. However, the recovery path for one person can look very different from the recovery path for another. For many people, recovery does not necessarily mean abstinence, or only abstinence—or even abstinence at all. The concept of recovery goes beyond abstinence to include an ongoing process of growth, self-change or simply making the choices that work best for the individual in the circumstances at the time. Defining recovery as a "lack of use" is narrow and stigmatizing, as it frames people who might occasionally use substances as “relapsing” and, once again, unable to control themselves.
Such black-and-white thinking also leads us to see certain drug use as acceptable—often drugs that are legal, such as alcohol and prescription drugs. Other drug use—often the use of illicit drugs such as methamphetamine or cocaine—is framed as bad, unacceptable or even "evil." In addition, when people think of "using drugs," the practice is almost always seen as negative. However, many drugs have greatly benefited humanity. In fact, most drugs are useful in some way. Unfortunately, we rarely discuss how "illicit" drugs may actually help people. For example, some drugs can be used as part of traditional or religious rituals, or can help people who are homeless cope with the trauma they experience from the conditions they live in.
Our language also tends to blend people's drug use with their personhood. Words like "addict" and "druggie" are dehumanizing. People are more than the drugs they might be using, so it is important to use language that reflects that: "people who use substances" is always preferable to stigmatizing, reductive labels.
Changing our language frameworks to support wellness
For some people, achieving wellness or well-being might include managing drug use in a way that helps them thrive. It might mean finding ways of increasing their social supports so that drug use complements their life instead of filling a void or serving as a means to avoid painful situations or feelings. Often, the language we use around recovery is not only stigmatizing but also implies that any drug use means the person has failed.
Phrases like "falling off the wagon" can imply that the person is a failure by not remaining alcohol-free. This understanding overlooks the many routes that someone's path to wellness may take and what "recovery" might look like to different people. Even the term "recovery" is problematic as it implies that substance use is something that requires healing or a cure, or that a person who uses substances is somehow "sick." Within this framework, people who don't choose to "recover" do not meet a social standard and are judged negatively.
The concept of harm reduction is often brought up as a response to substance use. But while harm reduction is an important tool, it is often framed by law makers in a way that implies drug use always leads to serious harm. For example, harm reduction policies tend to focus on the implementation of safe consumption sites, access to clean needles and the availability of naloxone kits. Part of the problem might be related to language, as the words "harm reduction" imply that substance use necessarily leads to harm. But harm reduction as a model is much more than a tool to minimize injury and death. Harm reduction also focuses on wellness and recovery by providing for social and emotional supports and by making referrals to health and treatment services.
It is important to recognize that our words matter, and that the language we use to frame the discussion of substance use and wellness has real repercussions in terms of our policy decisions, our health care systems and our communities. We must move towards reframing our language to be more inclusive and less judgemental of others. We should strive to use language that doesn’t portray all drug use as bad or that assumes the complete absence of drug use is the only path to wellness. By thinking critically about the language we use around addiction—by asking ourselves, "What are the assumptions implicit in the words I am using?"—we can ensure a more open, varied and inclusive dialogue about substance use, addiction, recovery and wellness.
About the author
Gaëlle is a research associate for the Canadian Institute for Substance Use Research at the University of Victoria. Gaëlle’s work focuses on developing resources that engage communities in dialogue about drugs and gambling. Her interests include health promotion, dialogue and social justice
Footnotes:
- Alexander, B.K. & Schweighofer, A.R. (1988). Defining addiction. Canadian Psychology/Psychologie Canadienne, 29(2), 151.
- Franzwa, G. (1998). Degrees of culpability: Aristotle and the language of addiction. Humanitas, 11(1), 91-102 (p. 91).
