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The Power of Words: Shifting the Language of Substance Use to Reduce Stigma


"Be mindful when it comes to your words. A string of some that don't mean much to you, may stick with someone else for a lifetime." -Rachel Wolchin

In our ever-evolving society, the discourse surrounding substance use is undergoing a necessary transformation. Through this article, we'll explore the profound implications of language, the weight of stigma, and the journey toward a more compassionate narrative.

People use substances for a wide array of reasons. Some turn to them as a refuge from the weight of traumatic experiences, or as a means to cope with the pervasive challenges of racism, oppression, and discrimination. Many seek relief from physical or emotional pain, while others are drawn to the allure of euphoria, relaxation, or the promise of enhanced performance in academics, work, or sports. Some explore substances to delve into deeper insights, unlock hidden realms of the mind, or alleviate mental health issues like depression and anxiety. Moreover, for some communities, some substances hold profound cultural and ceremonial significance.

Substance use is not uncommon. To illustrate, according to the National Survey on Drug Use and Health 2021 Highlights, of the U.S. population aged 12 and older:

  • 58% (161.8 million people) had used tobacco, alcohol, or an illicit drug in the past month.
  • Of these, 47% (133.1 million) consumed alcohol, 19% (54.7 million) used a tobacco product, and 14% (40 million) used an illicit drug.
  • 18.7% ( 52.5 million people) used cannabis in the past year
  • 3.3% (9.2 million) misuse opioids in the past year

Stigma, at its core, is a societal mark of disgrace, often borne by individuals who deviate from what is conventionally accepted. When it comes to substance use, stigma manifests in multiple forms, each feeding into negative perceptions, stereotypes, shame, and fear. There's structural stigma, embedded in institutional policies and societal structures that unintentionally or deliberately limit the opportunities of those with addiction. Public stigma refers to the collective adverse reactions and stereotypes the general public harbors against these individuals. Most insidious, perhaps, is self-stigma, where individuals internalize these negative beliefs, amplifying feelings of shame and worthlessness. The consequences of these stigmas are profound, erecting barriers to recovery, limiting access to treatment, and often compounding the isolation and despair felt by those with addiction.

Language is a dynamic tool in our quest to diminish stigma. Words wield immense power, particularly in conversations surrounding substance use and mental health. As our society grows and evolves, so does our language. Fortunately, with increased awareness and advocacy, we've seen a shift towards more inclusive and less stigmatizing terminology concerning substance use. Terms like "drug abuser" and "addict," which once dominated discourse, have given way to more empathetic phrases like "people who use or misuse substances". Labeling someone with the term "abuse" conveys notions of violence, anger, and loss of control, invariably leading to punitive and judgmental perspectives. Labels such as "user," "addict," or "junkie" unfairly saddle individuals with blame and shame. Embracing a person-first approach in language emphasizes the humanity of the individual, separating them from the substance. The crucial distinction being, that a person may be having a problem, versus that they are the problem.

While "misuse" is often touted as a more compassionate term, it inherently carries judgment and suggests a definitive right or wrong approach to substance use. But can we always dictate a universally right way to use a substance? Merriam-Webster defines "misuse" as "to use incorrectly" or "to mistreat." By extension, labeling someone's consumption as "substance misuse" conjures up notions of deliberate recklessness and harmful intent. This suggests an individual is purposefully going against recommended or intended use - possibly even hinting at an uncontrollable addiction. In contrast, the term "substance use" offers a neutral perspective, free from these negative undertones. It encompasses all reasons someone might engage with a substance, be it medicinal, recreational, or otherwise. By adopting "substance use," we sidestep the trap of assigning blame or judgment, focusing instead on the act, not the assumed intent. In contexts like prescription medications, distinctions such as "used other than prescribed" can be appropriate to convey specific deviations from medical guidance.

To the Prevention Field: The journey towards compassionate, non-stigmatizing language is continuous and requires our collective introspection. The transition from "Substance Abuse Prevention" to "Substance Misuse Prevention" was a significant stride towards embracing a more empathetic lexicon. It's a testament to the field's commitment to evolving with a greater understanding of the complexities of substance use. However, as we delve deeper into the intricacies of language and its profound impact, it's vital to remain open to further refinement. The term "misuse," though well-intentioned, still carries with it undertones of judgment. As pioneers in shaping societal perspectives on substance use, it's crucial that we continuously reevaluate our terminology. We must ensure it's not only accurate but also devoid of negative connotations. By spurring this ongoing dialogue, the prevention field can set the gold standard for inclusive, non-judgmental communication.

As our understanding deepens, our language must adapt. It's essential for us to challenge, refine, and perfect our discourse, ensuring it's both accurate and compassionate. By doing so, we not only reflect the evolution of our societal understanding, but actively participate in shaping a more inclusive and empathetic future.