2.2 Changing the Language of “Addiction”

Addiction as a diagnosable and treatable illness is recent, though the phenomenon of people misusing substances is not.  For example, in the first four iterations of the Diagnostic and Statistical Manual of Mental Disorders (DSM) used in psychiatry, addiction as a disorder was not included; neither for substances nor behaviour.  The DSM is “the standard classification of mental disorders used for clinical, research, policy, and reimbursement purposes in the United States and elsewhere” ⁽¹⁾ and is a text you will use in your program and in your work.  As our understanding of substance use and behaviour has changed, our ability to diagnose and support has also changed; the most recent version, DSM-V, now includes substance-related and addictive disorders.  There are some behavioural disorders like gambling which continue to use the term addiction.  By changing the language, perhaps we can reduce the stigmatization of the term.

What is stigma?  You may have heard the term stigma to describe poverty, disability, mental illness, and culture. Stigmas are negative attitudes or beliefs about a topic ⁽²⁾, and are prevalent in the field of substance use; some even suggest stigma is an underlying factor in substance use and behaviours as Matthews et. al. (2017) suggest, “stigma figures in the social construction of addiction” ⁽³⁾.  If we can address the stigma of the language, we may begin to tackle the stigma of substance use disorders; “stigma not only impedes access to treatment and care delivery, but it also contributes to the disorder on the individual level” ^(4).  If we change the language of addiction, will it reduce stigma and improve health outcomes for people living with addiction?  Only time will tell, though “both scientists and mental health advocates have long suggested that an increase in the lay public’s understanding of stigma…may reduce discrimination and prejudice” ⁽⁵⁾. Substance use is highly stigmatized.

The next step in our learning journey, as we develop greater understanding of substance use and stigma, is to examine the language we use.  For many people, substance use disorders are seen simply as “addiction“.  Take a moment and reflect on the word addiction.

Let us start with this short primer called Illuminate ⁽⁶⁾:

Illuminate – CCSA/CCDUS – Elaine Hyshka, PHD, Assistant Professor at the School of Public Health, University of Alberta, and Barry Andres, Executive Director of Addiction and Mental Health, Alberta Health Services, discuss the importance of humanizing addictions treatment and recovery.

What is your responsibility as a Social Worker for helping to reduce the stigma of substance use disorders (SUD)?   Reflect on the video, it is focusing on taking substance use out of the shadows.  One way we can do this is to explore the word addiction itself, to understand its meaning and it’s history.  The term has evolved and only came to use in the 17th century relating to substance use, with the medical conception of addiction beginning around the 19th century ⁽⁷⁾.  The word addiction has it roots in Latin and was used in the Early Roman Republic as “being bound to” ⁽⁸⁾.  In the case of the Roman Republic, it was bound to a creditor, to someone you owed something.  In today’s world should we view a substance use disorder as still being bound to?  Does this impact our ability to support individuals with substance use disorders?  If we examine the concept of having no will when it comes to substance use, this may contribute to the stigma associated with substance use disorders.

For many, addiction suggests an inability to manage consumption of licit and illicit substances or an inability to manage an activity like gambling.  For others, the word addiction relates to an activity they love to do; addiction has been used to describe activities people are passionate about.  This confusion between the terms adds to the stigma; the “contemporary usage of addiction is contradictory and confusing; the term is highly stigmatizing but popularly used to describe almost any strong desire, passion or pursuit” ⁽⁹⁾.  Let us think for a moment how you use the word addiction?  Is this a word you have used before? Has it related to substance use?  Perhaps you have used this word to describe your relationship with a particular snack food, “I am addicted to chocolate,” or maybe a technology “I am addicted to this new app.”

 

Addiction, consequently, is a term we not only use to describe substance use disorders, but we use it to describe our relationship with the world around us and we use it interchangeably in both positive and negative ways.  If you look up addiction on the internet, you will find the term addiction being used by companies marketing products, celebrity blogs, individual podcasts, and more.  The stigma of the word addiction, however, seems to relate only to substances and behaviours that society deems inappropriate, dangerous, or unhealthy.  Addiction as a term and a concept is so polarizing that in fact “there was an attempt to avoid it entirely by writing it out of the diagnostic manuals and substituting other terms like abuse and dependence” ⁽¹⁰⁾. Addiction as a concept relating to substances has been difficult to define and is slowly being replaced by phrases such as substance use, misuse, or substance use disorder.  Even the term substance abuse has been highlighted as a negative term due to the negative connotation associated with punishment ⁽¹¹⁾.  Addiction, therefore, as a concept relating to substances and activities is often associated with negative behaviours.  This association has led to the stigmatization of the term addiction.

Stigma impacts the way we treat people, it impacts the way people who use substances see themselves and access support.  Please watch the following video Stop Stigma ⁽¹²⁾ by people with substance use disorders who talk about how stigma has impacted their lives.

Stop Stigma.  Save Lives Project:  Experiences of stigma. Northern Health BC. (looking at the many levels of stigma towards those who use substances such as: discrimination, health, etc)

How do we reduce the stigma associated with the words we use when it comes to substance use disorders?

As noted above, stigma impacts individuals who use substances.  According to Volkow, “people with addiction continue to be blamed for their disease” ⁽¹³⁾. This stigma can prevent individuals from accessing support due to self-stigmatization (lack of self-worth, low self-esteem) as well as previous poor experiences with healthcare or other services.  As Social workers, we can seek to stop stigma by helping individuals, family, friends, and communities use language that reduces stigma.

Let’s listen to Dr. Kenneth Tupper discuss ways we can address stigma and discrimination in substance use disorders in the video Stigma and Discrimination in the Language of Addiction ⁽¹⁴⁾.

Dr. Kenneth Tupper, Director, Implementation and Partnerships, British Columbia Centre for Substance Use, discusses the stigmatizing terminology of addiction.  CCSA / CCDUS

Some researchers have suggested we can reduce stigma of many illnesses, including substance use disorders, by using person-first language.  For example, rather than saying an “addicted person,” or an “addict,” we say “a person with a substance use disorder.”  Person-first language has also been championed by people living with mental illnesses and other disabilities.  This puts a person before a diagnosis, making the person the focus, rather than the illness.  When reflecting on the social determinants of health and intersectionality we are looking beyond one factor to the whole individual and multiple connections between these factors, their life, and their experiences.  When we choose person first language, we choose to see all the parts of the individual.  Rather than focusing on the substance use, we see a whole person and work with the unique aspects that make a person who they are.  This allows both a Social Service worker and the agency supporting the individual to provide a more comprehensive service.

We are all affected by addiction whether directly or indirectly, and to improve health outcomes of all Canadians the stigma associated with both the term and the activity must be addressed.  Greater understanding of the terms we use interchangeably for “addiction,” unpacking the stigma associated with the term, and choosing language that highlights the individual rather than the behaviour, we can change how we see and work with people living with a substance use disorder.  This can lead to a change in how others view and treat people with substance use disorders in Canada.