The matter of language is often a contentious one. For as long as humans have transcribed their thoughts, word choice has played an important part in the transmission of knowledge from one person to the next. Language isn’t static either; it morphs and changes along with the current zeitgeist and can even be manipulated to fit the need of the author. As important as language is, it should come as no surprise that it is rarely innocuous in any form. When it comes to the way it is used in substance use and recovery, it can be particularly harmful.
Since the late 1800’s, language has been used in popular messaging to push forth an agenda on those individuals who use substances, at least in the United States. The temperance movement used public campaigns in the Women’s Magazine and Sears Roebuck Catalogs to alert the general public to “vagabonds”, “deviants”, “violent offenders”, and “hopeless souls”. By the 1900’s, the messaging came to include the notion of “inebriates” and “the first drink leading to ruin” – all in a push to pass prohibition. The early messaging not only paved the way for prohibition of alcohol in the United States (which failed shortly after passing), but more importantly, for the way that individuals who used alcohol would be treated for decades to come (i.e. the secret, inebriate asylums).
Over the next 100 years, popular media has continued to drive the way the public views severe substance use disorders (addiction in common parlance). One only need to look to covering headlines of the Times to the Washington Post over this time period to see that it should be no surprise that the general American public has such a degenerative view of substance use and substance use disorders.
It should also come as no surprise that there has been a conjoined effect of codified language related to racism and substance use. For years, racism has been underscored and demarked by the language used in the United States – often in hidden ways. “Crime and punishment approaches” are often code for “targeting the black community”. The war on drugs, a failed policy hallmark of the Nixon and Regan administrations, was not just a war on “vagabonds, inebriates, and deviants” but an all-out war on communities of color. This was never specifically stated, hidden behind carefully crafted language that seemed to attack illicit drugs – but ultimately otherized people who use substances and continued to stigmatize and discriminate against them.
After millennia of being subjugated to this type of subliminal messaging – really subliminal and overt discrimination if we are being honest – then why do we continue to allow this type of language to continue in public spaces? Research has continued to show us that the language we now use in the place of “inebriates” – “addict”, “junkie”, “alcoholic”, “substance abuser” – is no better in empowering public support, improving medical care, or decreasing explicit discrimination. In fact, we know the opposite to be true. Even efforts from national journalist trade associations, such as the Associated Press, have released guidelines to improve the language used to described people who use drugs and those with a severe substance use disorder – yet the language continues. Every day a news story is released with a headline describing the “addicts” of the opioid crisis; every day the number of missed opportunities to change the way we perceive addiction grows.
There have been positive highlights over the last few years, however. Groups like Solutions Journalism, started by Jillian Bauer at Temple University, have made a point to embrace the AP’s style guidelines and have written about substance use and recovery in a way that embraces humanity. Many more national organizations have released language guidelines detailing the way research in the field is written, the way their professional members should describe substance use and recovery, and the impact negative language can have if used with clients and patients. Even further, some national organizations – like CASA Columbia – have changed their names to be in line with what is acceptable.
And that is what this discussion ultimately comes down to – what is acceptable. All of the research in the world will not force people to change their habits and language preferences. To be honest, the negative words we use today are easier to remember and even easier to write given their short length. But ease of use does not equate to carte blanche. For those of us in recovery and actively using substances, we do have the freedom, even the right, to describe our pasts, our identities, and our experiences in any way that we want. The language we use to identify and relate are ours and ours alone to be used, however. For many in recovery, identifying as an “addict” or “alcoholic” is not only a rite of passage, but a reminder of where we have been and where we want to continue going in our current lives. For these fellows of mine, I respect that right to use any terms that they so desire.
Personally, I have stopped using these seemingly pejorative labels and language. The negative impact on those still yet to find a pathway to recovery or who don’t want one is too great of a price for me. But that is my choice to make. For those that have not been directly impacted by substance use, you have no such right. For those in the general public – especially medical professionals, policy makers, and journalists – the only choice for you is to use the language that is acceptable: the people you treat, legislate to, and write about are just that – people. We are not “addicts”, “alcoholics”, or “junkies”; only our fellows can call us that.