Words Matter: Substance Use Disorder and Preferred Terminology
Rita Agarwal, MD, FAAP, FASA
We know that language matters: how we present diagnoses and treatments to families and patients can have an impact on their decision to consent to a treatment plan. For example, which approach is most likely to lead to family consenting to a recommended block?
· “well, you know you could get this nerve block to help with post-operative pain, if you want, but there are risks…..”
· “we routinely perform a popliteal nerve block for pain management after this surgery. It is safe and effective, and while there are risks …..”.
We are taught to reframe our words around potentially painful experiences because they can contribute to negative pain memories,1,2 and yet the problematic language used for individuals affected by mental health and substance use disorder (SUD) persists. Mental health crises had been increasing prior to Covid and appear to have increased even faster as a result of Covid. Drug overdose deaths which were starting to decline prior to the pandemic increased significantly from 2020 to 2021 and show no signs of slowing down.3
The language we use to describe patients with mental health disorders, in particular patients with substance use disorder is often very stigmatizing. The terms addict, drug addict, drug abuser, drunk, alcoholic, junkie, stoner, or even substance abuser assumes moralistic and judgmental connotation.2 There is blame, shame and stereotyping, even though increased medical and scientific evidence reveals that addiction is a chronic disease with remission, recurrence and relapse. This stigmatization can lead to treatment avoidance, poorer psychological outcomes and social functioning. Some investigators have documented the impact of such language on both individuals with SUD and caregivers and their decisions regarding treatment.4 Stigmatizing language can negatively influence health care workers, including physicians when caring for these patients, and these attitudes as well as those held by the patients themselves can dissuade individuals from seeking help.5,6
We will and do see patients with SUD in the operating room, acute and chronic pain practices, and in the intensive care units, and these numbers will potentially keep increasing. Avoiding the use of problematic language and learning preferred terminology can make a real difference in patients’ and families experience. The American Academy of Pediatrics and the Committee of Substance Use Prevention (COSUP) recently released an article on the recommended terminology for substance use disorder in the care of children and adolescents.
Original article
Rachel H. Alinsky, MD, MPH, FAAP; Scott E. Hadland, MD, MPH, MS, FAAP; Joanna Quigley, MD, FAAP; Stephen W. Patrick, MD, MPH, MS, FAAP; COMMITTEE ON SUBSTANCE USE AND PREVENTION. Recommended Terminology for Substance Use Disorders in the Care of Children, Adolescents, Young Adults, and Families Pediatrics (2022) 149 (6): e2022057529. https://doi.org/10.1542/peds.2022-057529
The article reviews the importance of trying to use less stigmatizing language, much of which is rooted in racial, legal and socioeconomic biases. The article is short and easy to read, with a table highlighting the language we should use, the language we should avoid and reasoning behind it. For example instead of using “prescription opioid abuse” we should say “non-medical opioid use”; and use substance use disorder instead of drug addict or drug abuser. There is also an emphasis on “person-first” language which is consistent with a move throughout medicine to acknowledge the innate personhood of individuals rather than defining them by their disease. For example, a diabetic child becomes a patient or child with diabetes; an intravenous drug abuser becomes a person who injects intravenous drugs. There is a special emphasis on babies who are born after being exposed to substances in utero. These babies have for years been referred to in the lay press inaccurately as addicted babies, crack babies etc. Obviously, neonates cannot meet the criteria for addiction, and these terms can be very distressing for families. The more medically appropriate term is “neonate with substance withdrawal” or” neonate born substance exposed”. Yes, at first it all feels more awkward, but once you start using this terminology it does roll off the tongue much more easily.
As the concerned loved one of a person with substance use disorder I assure you it makes a difference.
References
1. Noel M: Even the way you talk about pain matters, One Thing, 2021
2. Science NIoDAAA: Words Matter - Terms to Use and Avoid When Talking About Addiction, 2021
3. Center. AMAAR: Issue brief: Nation’s drug-related overdose and death epidemic continues to worsen, 2022
4. Kelly JF, Westerhoff CM: Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms. Int J Drug Policy 2010; 21: 202-7
5. Yang LH, Wong LY, Grivel MM, Hasin DS: Stigma and substance use disorders: an international phenomenon. Curr Opin Psychiatry 2017; 30: 378-388
6. Botticelli MP, Koh HK. Changing the Language of Addiction. JAMA. 2016 Oct 4;316(13):1361-1362 PMID: 27701667